Creating value though ‘Always Events’®: what matters to you?

Neil Churchill – Director Patient Experience NHS EnglandPat Rutherford – Vice President IHIDee Roach – Director of Nursing & Quality Lancashire Care NHS FTHelen Lee – Head of Quality Improvement & Experience Lancashire Care NHS FT

Introduction

• Why we developed the always events programme• What NHS England and partners are doing• Ongoing work and continued plans

Always Events®

Chief Nursing Officerfor England’s SUMMIT 2015

Patient Experience Defined

The Need and Opportunity

Nurses, doctors, health care staff, and community health providers seek to understand the comprehensive needs and goals of the patients they serve. Yet, in the busy world of clinical care, there are innumerable situations where what really matters to patients and their family members is not understood or addressed.

What Matters to You?

n engl j med 366;9 nejm.org march 1, 2012

Enhancing conversations between patients and clinicians from -- “What’s the matter?” to also including “What matters to you?”

Helen

#hellomynameis campaign

“….I firmly believe it is not just about knowing someone's name, but it runs much deeper. It is about making a human connection, beginning a therapeutic relationship and building trust. In my mind it is the first rung on the ladder to providing compassionate care.”

Kate Granger, MD

What if….

every clinician and staff member and routinely asked -- “what matters to you?” – and listened attentively at every encounter with patients and their family members?

What would we learn? How would this understanding enhance our ability to develop genuine partnerships with patients, carers and family members?

Themes from Storytelling about Patient Experiences when Vulnerable

Ask – Don’t Assume

From God to Guide

https://www.youtube.com/watch?v=LnDWt10Maf8

Example of a Bedside White Board

Any concerns or worries about going home (or to next care setting)?

Diabetes Visit Cards• The patient sorts the cards to select issues that form the agenda for the visit• Satisfaction is improved and patients report more control of their disease

Developed in England by the Design Council to improve the effectiveness of chronic care visits at physicians’ offices

LAST FIVE MINUTES

• Review the goal of the visit.• Develop a personal connection.• Is there anything else you’d like to

discuss?

• Uncover any unresolved issues.• Let parent know who to contact.• Confirm next appointment.

“What matters to you today?”

(1st and last 5 Minutes)

A Soul Doctor and a Jazz Singer

“What would be a good day for you?”

https://www.youtube.com/watch?v=QzdIdb2s144

Always Events®

Always Events® are defined as “those aspects of the patient [individual] and family experience that should always occur when patients [individuals] interact with healthcare professionals and the delivery system.”

Always Events®

Always Events is a clear, action-oriented, and pervasive practice or set of behaviors that:

• Provides a foundation for partnering with patients and their families;• Ensures optimal patient experience and improved outcomes; and• Serves as a unifying force for all that demonstrates an ongoing commitment

to person- and family-centered care

Criteria for Always Events® 1. Important – Patients and family members have identified the

event as fundamental to improving their experience of care, and they predict that the event will have a meaningful impact when successfully implemented.

2. Evidence-based – The event is known to contribute to the optimal care of and respect for patients and family members (either through research or quality improvement measurement over time)

Criteria for Always Events® 3. Measurable – The event is specific enough that it is possible to determine

whether or not the process or behaviors occur reliably. This requirement is necessary to ensure that Always Events are not merely aspirational, but also quantifiable.

4. Affordable and Sustainable --The event should be achievable and sustainable without substantial renovations, capital expenditures, or the purchase of new equipment or technology. This specification encourages organizations to focus on leveraging opportunities to improve the care experience through improvements in relationship-based care and in care processes.

Always Events are… Always Events are not…

Reliable processes or behaviors that ensure optimal patient and family member experiences of care

Evidence-based practices (e.g. hand-washing) or professional standards of practice (e.g. patients are treated with dignity and respect) that should “always” occur to ensure safe, high-quality care

Co-designed with patients and family members (done “with”)

Improvement in processes that are done “for” patients and family members

Integrated into overall person- and family-centered care strategies

An isolated organizational QI initiative or local improvement

Understand “What Matters to Patients?” in Pilot Unit or

Program

Co-Design an Always Event®

Create an Aim Statement and Begin to Co-Design an

Always Event®

Specify Details of Successful Changes for the Always Event®

Reliably Implement Standard Work Over Time

Communicate New Specified/Standard

Work Processesto Clinicians and Staff

PLAN

DO

Observe, Reflect & Redesign Standard Work as Needed to

Increase Reliability

STUDY/ACT

Test Specific Change Ideas for the

Always Event®

Even

t AlwaysTeach, Coach and Support

Implementation

Doing To Doing For Doing With

“Where are you in your journey?”

Always Events

Leader’s Role in Patient Experience….“the drivers of exceptional patient experience are founded on a commitment to patient and family-centered care -- care that is constantly viewed through the patient’s eyes … Critical to the entire hospital’s success is senior leaders’ ability to continually clarify, articulate and model the organization’s goals for patient and family experience and why they matter.”

….“any time leaders chase the numbers, they miss an opportunity to really innovate in their systems.” Innovating in terms of patient centeredness is “really about the patient and family at the center as partners in everything we do.” Barbara Balik, RN, EdD, a senior IHI faculty member and a senior IHI faculty member and principal with Aefina Partners, authored “The

Leader’s Role in Patient Experience” in the Healthcare Executive (July/August 2011) ncipal with Aefina Partners, authored “The Leader’s Role in Patient Experience” in the He

What Matters to Nurses, Clinicians and Staff?

• Leaders make it a priority to fix inefficient processes and the need for workarounds • QI initiative overload and never-ending changes >>> need for sense-making re: strategic

priorities• Clinicians and staff have a key role in redesigning care processes (engage them early in the

process)• System supports for the emotional toll at the front-lines of care• A respectful work environment that support their professional practice• Spending more time with patients

Co-Designing an Always Event

• Understand what matters to patients in the pilot unit or program Engage patients/individuals and family members and a clinical team >> convene a launch

meeting • Decide upon a specific focus for improvement (partnership between the clinical team and

patients and family members) If successful, what will have a big impact on patient experiences of care? Create an aim statement (how good, by when?)

• Generate change ideas for an Always Event• Test specific change ideas – adopt, adapt, abandon• Specify details of successful changes for the Always Event

Sequential Testing, Implementation and Spread

Sustaining the improvement and spreading the change to other locations

Developing changes

Implementing changes

Testing changesTheory and Prediction

Test under a variety of conditions

Make part of routine operations

Study

Act

Do

Act Plan

DoStudy

Evaluating Outcomes and Spreading

Time Order (Monthly Data)

OutcomeData

Design Target

Pilot Unit #1Pilot Unit #2

All Units

Change 1

Change 2

Change 3

Change 2

Change 1

Change 1

Always Events®: National Programme

Pilot Sites in NHS England Always Events® Programme

Pilot Sites and Area of Focus for the Always Events

Blackpool Teaching Hospitals NHS FT (phase 1) Stroke Ward: “Patients always know what to do when they get home or, if not, they know who to contact”.

Lancashire Care NHS Trust (phase 1) Learning Disability Services: “We will always support you in moving on in care.”

Aintree University Hospital NHS FT Medicine Ward and Major Trauma Ward: Open visitation for family members

Ashford and St Peters NHS FT Dementia-Friendly Medical Ward: What matters to you and your carer?

Calderdale and Huddersfield NHS FT Outpatient Vascular Clinic or Orthopaedic Clinic: Patients understand clinical condition and treatment plans; Clinical team understands “what matters to patients”

East Kent Community Trust Neurology Rehabilitation Unit in a Community Hospital: Co-design of personalized care plans

The Royal Marsden NHS FT Haematology Clinic: Patients get the right information at the right timeSouthampton NHS FT Medical Ward: Involvement of patients and family members in planning for discharge

Taunton and Somerset NHS FT Pre-natal Care by Community Midwives: Create and implement individualized care plans based on what matters to mothers, fathers and family members

University Hospitals Morecambe Bay NHS FT Post-partum Ward: Customize immediate post-natal care for the entire family and prepare for discharge