UNDERSTANDING PATIENT, STAFF AND
FAMILY EXPERIENCE AND TRANSFORMING
CARE THROUGH DESIGN
HQSC, Partners in Care, Show & Tell Symposium, June 2014
Lynne Maher and Hilary Boyd
1
PLAN FOR TODAY
At the end of the workshop participants will:
•
Understand how to work closely with patients and staff to co-design health services
•
Be introduced to a range of tools and methods to support co-design in practice
•
Recognise the value patients bring to improving quality, safety and experience of
care
•
2
Know where to go to find out more information
I. ABOUT CODESIGN
3
THE CO-DESIGN APPROACH
IS...
•
…about
using experience to gain insights from which you can identify
opportunities for improvement
•
4
…about experiences not attitudes or opinions
EXPERIENCE BASED DESIGN IS ABOUT
DESIGNING BETTER EXPERIENCES
5
HEALTH SERVICE CO-DESIGN:
FRAMEWORK
www.healthcodesign.org.nz/about.html
6
HEALTH SERVICE CO-DESIGN
PHASES
01 Engage: Establish and maintain meaningful relationships.
02 Plan: Work with patients and staff to establish project goals and how to achieve them.
03 Explore: Capture and understand patient experiences of services and identify ideas for
change.
04 Develop: Work with patients to turn ideas into possible improvements.
05 Decide: Decide which improvements to make and how to make them.
06 Change: Implement the changes.
www.healthcodesign.org.nz/about.html
7
TERMINOLOGY
8
•
Feeling informed and being given options
•
Patient experience
•
Patient engagement
•
Patient involvement?
•
Patient satisfaction?
•
Patient- and family-centred care?
•
PFCC?
•
Person-centred care?
•
Co-design?
BUT WHY?
“We need to move from a service that does
things to and for its patients to one where the
service works with patients and whaanau to
supports them with their health needs.”
9
When you start to work closely with patients to understand their
needs and support them to achieve their health goals you cannot
go back to your old way of working.
10
“Stories from patients are inspiring, insightful, humbling, uplifting,
reassuring and above all remind us of why we are here.”
[Liz Goldie, Partners in Care Programme, 2014]
11
“Those that believe patient experience is simply about making
people happy have simply missed the point.”
[James Merlino, Chief Experience Officer, Cleveland Clinic]
12
POSITIVE PATIENT EXPERIENCE IS
ASSOCIATED WITH HIGHER QUALITY CARE
Hospitals with high levels of ‘ patient care experience ’ reported by
patients provide clinical care that is higher in quality across a range of
conditions.
[Jha A et al (2008) N Engl J Med 2008; 359:1921-1931]
13
Improved patient experience is
positively associated with…
•
Objectively measured health outcomes
•
Adherence to medications and treatments
•
Health resource usage
•
Technical quality of care & adverse events
[Doyle C et al BMJ Open Jan 20, 2013]
14
WE NEED TO MOVE AWAY FROM THIS...
15
WE AS CLINICIANS AND MANAGERS WORRY
ABOUT THIS...
16
WE THINK PATIENTS WANT THIS...
17
WHAT MATTERS TO PATIENTS
(ENGLAND, 2011)
•
Feeling informed and being given options
•
Staff who listen and spend time with me/patients
•
Being treated as a person, not a number
•
Being involved in care and being able to ask questions
•
The value of support services, for example patient and carer support groups
•
Efficient processes
[Robert, Cornwall, Brearley et al., 2011]
18
A QUICK SURVEY
What did you think of your journey this morning?
A
Very Good
19
B
C
D
E
Very Poor
A QUICK SURVEY
20
•
Work in two’s or ‘threes’
•
One person tell their story of their journey here today- take 5
minutes
•
The ‘listeners’ do just that; and particularly ‘tune in’ to any
words that could depict emotion.
FEEDBACK - TABLES
Discuss what was the difference between doing a survey and
telling your story.
21
UNDERSTANDING THE NEEDS OF PEOPLE
LIVING WITH MULTIPLE SCLEROSIS
22
CONVERSATIONS
THAT COUNT
How can we encourage conversations about
planning for death and dying amongst and in
communities so that people can get the care they
want at the end of their lives?
[Auckland District Health Board]
23
WHAT WE DID
•
Held several consumer workshops to understand their experiences of advance care planning
and find out what they would like done differently.
•
Received HQSC funding to implement the peer-education idea.
•
Recruited consumer representatives.
•
Held four practical co-design workshops to understand how to structure a peer education
programme and how the resources would look.
24
•
Produced a 52-page modular-based toolkit and a 2-day training package.
•
Trained 27 volunteers who held 19 community sessions with 172 people.
“I found our sessions very enlightening! I was amazed at the
many topics we discussed, they truly opened my eyes as to what
is available to people facing end-of-life. Not knowing what is
available can lead to fear and isolation. It would be wonderful to
get this information out to the community so people could make
decisions for themselves, how to best look after themselves and
face this phase of their life positively without fear.”
[Community session participant]
25
II. CO-DESIGN
IN PRACTICE
26
If I had an hour to save the
world, I would spend 59 minutes
defining the problem and one
minute finding solutions.”
[Albert Einstein]
27
HOW CAN YOU DO THIS?
28
•
As a regular way to understand patient and staff experiences
•
In an area where you have challenges- perhaps where you know you have a
number of complaints
•
As part of an improvement project
•
All of the time
•
Looking at services, product design, the technology design, facility design and
tackling big issues
PUBLIC SPACES PROJECT
How can we understand people’s experience of public spaces at Auckland City
Hospital?
•How
staff, patients and visitors use the space
•What
•How
people access care, services and information
•What
•How
people use the space for…existing entry points, foyers and retail spaces
kinds of services we provide
the entry points, foyers and public spaces work and the qualities they portray
[Auckland District Health Board]
29
PUBLIC SPACES
DISCOVERY WEEK
•
A week of discovering what people thought
•
Developed three new tools for intercept
interviews: journey, services and qualities
•
Over one weekend and three weekdays had
teams doing interviews
•
Two co-design workshops: staff and
community
•
Online staff survey
•
Daily debriefing sessions to compile results
[Auckland District Health Board]
30
HOW CAN WORKING WITH VERY HIGH
INTENSITY USERS HELP US SOLVE THE
READMISSION PROBLEM?
Agnes became unwell and
went to the ER.
She was admitted to
hospital and responded
well to treatment.
Agnes was discharged
home with medications
and information.
Agnes became unwell and
went to the ER.
She was admitted to
hospital and responded
well to treatment.
Agnes was discharged
home with medications
and information.
Non-compliant patient?
31
Agnes became unwell and
went to the ER.
She was admitted to
hospital and responded
well to treatment.
Agnes was discharged
home with medications
and information.
Insanity: Doing the same thing
over and over again and
expecting different results.”
[Albert Einstein]
32
AGNES AND TWO BLUE PILLS
33
"There comes a point you have
to stop pulling people out of the
river, get upstream and find out
why they're falling in."
[Desmond Tutu]
34
III. CAPTURE
AND ENGAGE
35
ENGAGING PATIENTS AND
WHAANAU
36
•
You do not need high numbers of patients
•
Develop information about what you are planning to do and the role patients can
play
•
Use methods of engagement that are relevant to the patient group.
•
Talk to patients / whaanau and ask if they would like to be involved
•
Identify patients /whaanau who have recently had cause to complain
•
Clinical staff might identify patients/whaanau
WAYS OF GATHERING
EXPERIENCES
Collect stories and thoughts from both patients and staff
•
•
37
•
Structured conversations
•
Shadowing
•
Still photography and film provides compelling illustration
•
Creation of story boards
•
Diaries
•
Intercept interviews
Observe patients and staff delivering and receiving the service
OBSERVATION
•
People do not always do what they say they do
•
People do not always do what they think they do
•
People do not always do what you think they do
•
People cannot always tell you what they need
•
Observation lets you find out what people really do and need
[IDEO, 2006]
38
THE STORY OF THE TOILET
ROLL HOLDER
39
INTERCEPT INTERVIEWS
One-one-one, short interviews ‘on location’. Useful for gathering
immediate impressions of a large number of people. Can be
used in conjunction with visual aids.
40
SERVICE SELECTION
41
EXPERIENCE OF SERVICES
42
IV. EXPLORE,
UNDERSTAND
AND DEVELOP
43
UNDERSTAND THE EXPERIENCE
1. Identify emotions
2. Find the touchpoints
3. Map the emotions
(highs and lows) to the
touchpoints
44
45
IDENTIFYING EMOTIONS
46
•
Watch this film and write down the emotions that the patient talks about.
•
Write positive emotions above the line and negative emotions below the
line.
•
Remember that they may not be ‘pure’ emotion words but that you are
gathering the emotions and memories from the patient story to
understand the experience.
VIDEO SHOWING
EMOTIONS
Movie: Sheila shares her experience (1:30)
47
48
EXPERIENCE QUESTIONNAIRE
This is a tool that can be used on its own or as a starting point
for understanding which part of the pathway you might want to
focus on.
49
USING WORDS
[Developed by the NHS Institute for Innovation and Improvement; adapted by many.]
50
51
USING SMILEY FACES
52
PERSONAS
53
•
A way of describing characteristics of service users through
using composite characters.
•
Personas often developed according to sets of behaviours.
•
Can be developed as part of analysing the results of interviews
or as part of a co-design workshop.
•
Personas can help us better understand who a product or
service may affect.
PERSONA EXAMPLE
http://precisionmedicine.files.wordpress.com
54
IV. DEVELOP, DECIDE,
CHANGE AND IMPROVE
[THE CO-DESIGN PART]
55
IMPROVE THE EXPERIENCE
Experience based co-design positions patients as active partners with
staff in quality improvement.”
[Tsianakas et al 2012]
56
IMPROVE THE EXPERIENCE
57
•
Involve patients/carers and staff
•
Create ‘co-design’ teams
•
Be clear about actions needed and impact desired
•
Use improvement tools and techniques
PLANNING AN EXPERIENCE
EVENT
•
Working in partnerships with patients can create some apprehension, but it has the potential to
transform health services
58
•
Plan the date in advance
•
Make sure everyone can get to the event
•
Use ‘simple English’
•
Staff are often as nervous as patients/family members
•
Staff may try to ‘take control’ facilitation is important
•
Do not leave without next action steps
59
ACTION
PLANNING
A personal responsibility.
60
•
Hugh McGrath, Patient
•
Julie, Clinic receptionist
•
John Pickles, Consultant
PROTOTYPING
IN ACTION
•
New
Zealand ’ s
first
advance
care
planning
Conversations that Counts Day.
•
The 2014 campaign was aimed at active older people.
•
Rough ideas.
•
Workshop at a retirement village.
•
Groups to select a pre-prepared persona and develop a
prototype campaign postcard including the slogan,
images and format.
•
Groups were then asked to pitch their postcard ideas.
[Auckland District Health Board]
61
THE FINAL RESULT
62
V. CHANGE
AND MEASURE
63
THE QUANTITATIVE
PERSPECTIVE
Reduction in Time
•
Reduction in duplication
•
Reduction in steps
Increase in Safety: reduction in error and cost
Improve Patient Experience
•
Reduction in handoffs
•
Reduction in complaints
Increase in Effectiveness
•
64
Adherence to standards/protocols; reduction in variation
MEASURING
What matters more than raw data is our ability to place these facts in
context and deliver them with emotional impact.”
[Daniel Pink, A whole new mind, 2008]
65
USING QUANTITATIVE AND QUALITATIVE
REPORTING TOGETHER
66
NOTHING ABOUT ME WITHOUT ME
67
LEARN MORE
•
Co-design in Healthcare networking website: http://codesign.hiirc.org.nz
•
Design for Health and Wellbeing lab: http://dhwlab.com/
•
Toolkit and website: www.healthcodesign.org.nz
•
Consumer engagement: www.hqsc.govt.nz/our-programmes/consumer-
engagement/
68
LEARNING FROM THE
NEXT GENERATION
Movie: Trevor Torres has Diabetes (4:42))
69
70
PLAN FOR TODAY
At the end of the workshop participants will:
•
Understand how to work closely with patients and staff to co-design health services
•
Be introduced to a range of tools and methods to support co-design in practice
•
Recognise the value patients bring to improving quality, safety and experience of care
•
Know where to go to find out more information
Did we achieve this?
71
SUGGESTED READING
•
Bate P, Robert G (2006) Experience-based design: from redesigning the system around the
patient to co-designing services with the patient. Qual Saf Health Care 15(5):307–310
•
Bessant, J. Maher, L. (2009) Developing radical service innovations in healthcare – the role of
design methods. International Journal of Innovation Management. Vol. 13, No 4.
•
Boyd, H., McKernon, S., Mullin, B., & Old, A. (2012). Improving healthcare through the use of
co-design. Journal of the New Zealand Medical Association,125(1357).
•
Davies E, Cleary D (2005) Hearing the patient’s voice? Factors affecting the use of patient
survey data in quality improvement. Qual Saf Health Care 14:428–432
•
Department of Health (2013) Report of the Mid Staffordshire Public Enquiry www.officialdocuments.gov.uk or www.midstaffspublicinquiry.com
72
73
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Dewar B, Mackay R, Smith S, Pullin S, Tocher R (2010) Use of emotional touchpoints as a
method of tapping into the experience of receiving compassionate care in a hospital setting. J
Res Nurs 15 (1):29–41
•
Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient
experience and clinical safety and effectiveness. BMJ Open 2013;3:e001570.
•
Goodrich J, Cornwell J (2008) Seeing the person in the patient. The King’s Fund, London
•
Iedema R,Merrick E, Piper D, Britton K, Gray J, Verma R,Manning N (2010) Co-design as
discursive practice in emergency health services: the architecture of deliberation. J Appl
Behav Sci 46:73–91
•
Maben J. Adams M. Peccei R. Murrellst. & Robert G. (2012) ‘Poppets and parcels’: the links
between staff experience of work and acutely ill older peoples’ experience of hospital care.
International Journal of Older People. Nursing 7, 83–94
74
•
Maher L. (2013) Smart Guide to Developing Pathways – Using patient and carer experience.
NHS Networks Accessed via . http://www.networks.nhs.uk/nhs-networks/smart-guides
•
Maher, L. (2011) Untapped Resource. Public Servant Journal. September 2011.
•
Reeves et al. Facilitated patient experience feedback can improve nursing care: a pilot study
for a phase III cluster randomised controlled trial. BMC Health Services Research 2013, 13:259.
http://www.biomedcentral.com/1472-6963/13/259
•
Schaeper, J. Maher, L. Baxter, H. (2009) Designing from within- embedding service design into
the UK health system. Touchpoint- The Journal of Service Design. Vol. 1, No 2.
•
Tsianakas, V. Robert, G. Maben, J. Richardson, A. Dale, C . Wiseman, T. ( 2011) Implementing
patient-centred cancer care: using experience-based co-design to improve patient
experience in breast and lung cancer service. Support Care Cancer with open access at
Springerlink.com
TABLE TASK
75
•
In groups, get a piece of A1 paper and draw a vertical line in
the middle of your paper
•
On the left hand side of the line list what tools and techniques
are you using to capture patient experiences
•
For each item on your list, discuss what you have done with
the information you learnt
TABLE TASK
76
•
On the right hand side of the line, list some of the things you
would do differently given what you have learnt today
•
Discuss