Best practice improving the patient experience: An international perspective Amy Maclean, Head of Patient Experience
Bit about me • Lived and worked in USA until 2000 — From Chicago most recently. • Married a Brummie in 1999 — had been working in Chicago in Corporate Change Management. • Own and run a healthcare business since 2003 and trained and worked with as an Antenatal Educator from 2003. • Service user since 2000 at BW and came into post in 2014.
21 USA Site Visits since ‘15 Most recently: • Providence Hospital - Burbank, California • Emory University Healthcare System - Atlanta, Georgia • Keck Medical Center, University of Southern California • Cedars Sinai Hospital - Los Angeles, California • 2015 - 17 other US Hospitals: http://amymaclean.wordpress.com/ Work at Birmingham Women’s and Children’s NHS Foundation Trust and regularly visit other UK hospitals looking through the lens of Patient Experience
Patient Experience Hierarchy: Where to begin? Patients as partners Patient and family centred care WOWs - Harnessing Gratitude Outstanding customer service including service recovery Empathy
Technology driving Patient Experience • Forced changes through legislation • Challenge to creatively mirror expectations of patients with in- house technology. • Insight to improvement needs behind the data • Rapid response ability to real or near time feedback — getting to patients earlier in their journey. • Using technology for appropriate transparency of data and communication. • Using technology for patient partnership throughout the journey.
A few general principles USA UK 326 million people 66 million people 50 governments 1 government There is little to no ‘choice’ (market) in The marketplace dominates, so consumers win. However, once into an healthcare — offering choice quickly health episode, it is difficult to exercise true choice. Reviews of facilities and individual clinicians is readily available, and hospitals are protective becomes a conversation about private of reputational damage. healthcare. • Spirit of people: Government holds solutions • • Fiercely self-reliant: personal freedoms, individual responsibility, More skeptical of change, more likely to resist someone telling them what to do or how to live. resist changes which might infringe on • Rapidly embrace change, seeing progress as a good thing. Easily privacy. • mirror industry and take that as a model to comfortably adapt to. Ultimately do adapt to industry but it takes longer. Voluntarism/Giving/Philanthropy deeply engrained from early on. Present but less developed. Needs a nudge! Obamacare centralised obligation to report on Pt Experience through FFT came about in 2012-13 as first monthly reporting via HCAHPS (Hospital Consumer Assessment of centralised measure for Pt Experience Healthcare Providers & Systems)
How they use data: What matters most
Rising tides: Biggest ‘bang for your buck!’ Statistics gives us insight into the following ‘rising tide’ measures: By improving ‘ nurse/ midwife/ doctor communication’ we see improvement across the domains of: o Safety o Overall experience o Reduced readmission o Reduced pain And two proven ways to improve nurse/ midwife communication: o Purposeful rounds (preferably hourly) o Bedside handover
Tech continues to inform: Closing the feedback loop The use of technology supports patients and families to access information they need and share feedback in ways they are most comfortable with. We have ability to control from a desktop and analyse data for insight.
Tools to drive communication: Next tech solution?
Patient Experience Strategy in Action Develop a culture Develop a culture that supports where families, continuous parents and patients improvement of the are the centre of our patient experience service. Build and refine sustainable feedback Parents/Patients/ to improvement loops Families Build the brand of Prevent poor the Trust: Excellent experiences from Service, Care, occurring or Quality and getting worse. Experience for all our Engage with future parents, patients and service users for families inclusion and planning Listen to feedback, Create proactive identify themes and mechanisms for identifying act issues early in the parent / patient journey • Easy from-App comms • Ward-based PALS • Easy-access to PALS Empower staff through appropriate Make it easy for users with extended hours governance to be part to feedback of the conversation and • After-Thoughts solution creation. Listening Service Full Patient Experience and Engagement Strategy: http://www.bwnft.nhs.uk/wp-content/uploads/2015/03/Patient- Experience-and-Engagement-Strategy-2016-19-FINAL.pdf
A great place to start: Introducing a “ Listening Service ”— bedside and beyond Is there a pattern to your complaints? Go in early!
Technology helps us become a true Service Economy: Far more than ‘customer service’ • Look to industry - our patients do! A focus on getting the ‘service right’ and attempting ‘service recovery.’ Intentional interventions: Memorial Sloan Kettering What do we do? Coffee cards! Outstanding customer service including service recovery
Utter compliance with agreed Service Economy behaviours: Keck USC uses the KNOWN K N O W N Kind Notice Needs: Own it: Wow them: Next Steps: Observe Gain insight Engagement Action planning Greeting : Connect with the person • • • • • Enter the What is the Ask clarifying questions: See Define conversati perceived issue? seek to understand involvement solutions • • Open-ended questions — • on: How What is the body Be present together • is your language, tone of How, what Why, Who, When in the Explore • day voice, urgency of Actively listen with moment options and empathy — listen from • going? conversation? Ask for their benefits of • How may What can you THEIR perspective recommende each • • I help learn from Build self-esteem through d solutions End the you? observation or process conversation asking to notice AND with a • their needs? Make it happen commitment • Find solutions moving • Embrace it forward • Don’t pass the buck!
Expected behaviours UCLA: - Connect with Compassion By addressing patients by the name they prefer. Smile and greet at 5/10. - Introduce Yourself with integrity by stating your name and role. #hellomynameis …. - Communicate With teamwork what you are going to do, how long it is going to take and how it will impact the patient - Anticipate needs/Ask with Discovery By anticipating the patient needs, questions or concerns - Respond with Respect To patient questions and requests with immediacy or a sense of urgency - Exit with Excellence By ensuring all the patient needs are met
Many locations have implemented a No Pass Zone • We never pass by a parent/patient/family or visitor in need. • It is everyone’s job to assist our parents, patients, their families, our visitors and each other. • It emphasises that parents, patients, families and visitors are not an interruptions to our work. • They are the reason we are here! • If we are unable to help, we will find someone who can help. • A No Pass Zone applies to EVERY member of staff, EVERY Parent/Patient/Family/Visitor, EVERY time. Watch our training video here: https://youtu.be/LNGSwEsFywk
WOWs: Giving • Art and “Singing Medicine” bedside and in busy clinics National initiative made local: • Compassion Carts ‘Project Linus’ • Pamper Hamper • Pets as Therapy WOWs /Grateful Patients
WOWs/Giving — into Partnership • Partnership begins with family access • Baby Webcams: http://www.latimes.com/socal/burbank-leader/news/tn-blr-me-providence- media-20170603-story.html • Video of lead nurse detailing camera https://youtu.be/sAF-uB6-kwY WOWs/Grateful Patients
WOWs: Voluntarism, Giving and Philanthropy • ‘Grateful Patients’: channeling gratitude - acknowledging the innate human need for reciprocity • Grateful Patient Rounds: giving of time, feedback / stories / money • Planting seeds for philanthropy including patient / family led PE Awards • Highly structured, intentional, normalising the ‘ask’ - making it simple for patients / families / businesses to give WOWs/Grateful WOWs/Grateful Patients WOWs/Grateful Patients Patients
Family and Patient Centered Care • Personalised care: food, discharge, information needs, family involvement • Caregiver involvement: classes, inclusion, rounds, empowerment, facilities • IFPCC toolkit: http://www.ipfcc.org/bestpractices/better-together.html • Planetree Care Partner Programme: http://planetree.org/wp-content/uploads/2017/04/11.-Care-Partners-Primer.pdf • This tool from 2008 is used to move services to being move patient centred: Patient Centered Care Improvement Guide http://patient-centeredcare.org Patient and family centred care
The involvement continuum From “Real Involvement – Working with People to Improve Health Services” Patients as partners
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