Transforming health care organisations through quality improvement work is gaining considerable attention in the UK NHS and in other countries (Eccles et al., 2009; Glasgow et al., 2012). A wide range of tools and tech- niques have emerged to support quality improvement activities (Greenhalgh et al., 2004; Nilsen, 2015). In particular, there is a growing emphasis on patient ex- perience as a means to build capacity and support im- provement (Bate and Robert, 2006; Callard and Rose, 2012; Rose, 2014). In 2015 the Point of Care Foundation 1 received funding from the UK Health Foundation Spreading Improvement programme, and set up a programme titled: ‘Living well to the Very End’. In this programme the Point of Care Foundation used an evidence-based approach called Patient and Family Centred Care (PFCC) to support improvement. PFCC was originally developed by the Innovation Centre at the University of Pittsburgh Medical Centre . It has subsequently been adapted and refined by the Point of Care Foundation team through its applica- tion in previous improvement programmes. The programme has six core elements 2 designed to estab- lish infrastructure for improvement, understand the current and ideal state of the service and work to de- liver improvements. This article will focus on one of these core elements; patient shadowing. As detailed in the original PFCC literature from Pittsburgh by DiGioia and colleagues , shadowing is designed to be a transformative experience for health care service staff, where practitioners see the service from the per- spective of patients (and their families) and in the process not only see the problems with their service but are also able to empathise from the perspective of the patient and possibly pre-empt their reactions to receiving care and build service capacity in response. The programme originators describe the importance of shadowing as follows:
The aim of this study was to identify and explore organisational barriers to, and enablers of, patient and family centred care within an Australian acute care hospital from the perspective of that hospital’s management staff. A qualitative study, incorporating purposive sampling and semi-structured interviews was undertaken in a 215-bed metropolitan acute care public hospital in Sydney, Australia. Fifteen health managers from a broad range of professional groups, including Medicine, Nursing, Allied Health and non-clinical services were interviewed. Interview data were recorded, transcribed, and analysed for key themes using the Framework Approach. The key barriers to patient and family centred care were: i) staffing constraints and reduced levels of staff experience, ii) high staff workloads and time pressures, iii) physical resource and environment constraints and iv) unsupportive staff attitudes. The key enablers of patient and family centred care were: i) leadership focus on patient and family centred care, ii) staff satisfaction and positive staff relations, iii) formal structures and processes to support patient and family centred care, iv) staff cultural diversity and v) health professional values and role expectations. This study provides an understanding of the factors that restrict and enhance patient and family centred care specific to an Australian acute care hospital setting. Implementation of strategies targeted at these factors may help the study site, and potentially other hospitals in similar settings, to improve patient and family centred care. In turn, this may lead to improved outcomes for patients, families, staff and healthcare organisations.
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The aim was to evaluate the current state of knowledge pertaining to patient safety and its link to person-centred care. The international relevance of pa- tient safety has expanded, as have the models of person-centred care. Inspired by this new trend, we collated and summarized the literature for evidence of the two topics. The study was guided by Russell, Whittemore and Knafl’s in- tegrative review framework. An electronic database search was conducted for relevant articles from 2005 to 2016. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The structure and process of the evaluation of the evidence are de- scribed and the findings interpreted by means of a thematic synthesis. One theme emerged: trustful , safe communication in the relationship between the patient , family members and healthcare professionals and two domains; safety culture and multidisciplinary capacity building . The dominant dimension in the safety culture domain is respectful communication, which implies sharing experiences that lead to a sense of control during labour and birth and is re- lated to the women’s feeling of personal capacity. The dominant dimensions in the multidisciplinary capacity building domain are collaborative teamwork, coordination and risk management, knowledge sharing and patient-centred communication. In conclusion, to enhance patient safety, it is necessary to de- velop patient-focused, evidence-based skills and guidelines as well as a suppor- tive organization. Due to their interaction with patients, midwives’ communi- cation competence on the part of midwives is essential for supporting the birth How to cite this paper: Severinsson, E.,
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evaluated an intervention at a residential substance abuse treatment centre that helps women to develop healthy relationships with family and friends, called for further research about how improved relationships affect long- term outcomes. Although most RCC research focuses on the practitioner–patient relationship, new areas of study are emerging, for example, how information technology affects the practitioner–patient relationship, as well as health care in general. 75 Williams et al. 76 suggested research
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As healthcare systems seek to provide patient-centred care, questions about how to measure this aspect of qua- lity have become more important since previously develo- ped QIs rarely incorporated patient perspectives [19,27]. A qualitative study done in preparation for this research demonstrated patients of differing age, sex and health sta- tus have consistently indicated that patient participation is important so that quality improvement efforts can reflect patient preferences, something that cannot be determined by health providers [28,29]. Patient-centred measures have been successfully developed in select domains of health care. For example, the Consumer Assessment of Health Providers and Systems Survey (CAHPS) has been used to evaluate patient experiences with primary care, and has identified shortfalls in care delivery and support qual- ity improvement [30-32]. A hospital version of CAHPS (HCAHPS) has been developed to measure medical, surgi- cal and obstetrical inpatient experiences with care, is pub- licly reported in the United States  and the results appear to correlate with processes of care for acute myo- cardial infarction, congestive heart failure, pneumonia and prevention of complications from surgery . No such patient-centred QIs currently exist to evaluate the quality of injury care.
30% greater odds of reporting FCC, suggesting that pro- viders might focus on building relationships with more vulnerable patients. If patients reported ever having been diagnosed with a chronic condition or had been with their practice for 5 or more years, they had nearly 40% greater odds of reporting FCC. These results are not unexpected, as both characteristics indicate greater interaction between patient and provider and FCC is considered a dimension of the patient-provider relation- ship. Furthermore, patients excluded for not completing the FCC questions were less likely to have been diag- nosed with a chronic condition or to have been with their practice this long, which might mean that this is an underestimate of the effect size of these variables. Overall, these findings indicate that demographic fac- tors might be important when assessing patient reports of FCC. In particular, age, sex, number of family mem- bers attending a clinic, presence of a chronic condition, length of time with a practice, and economic factors should be taken into account in any future studies look- ing at patient assessments of FCC.
Our main objectives are to establish the number, type, and effectiveness of PC interventions in ICU, and to as- certain differences between Europe, North America, South America, and Asia. We will attempt to categorise outcomes of PC interventions according to previously established domains (patient- and family- centred care, communication, continuity of care, emotional and prac- tical support of patients and families, symptom manage- ment and comfort care, spiritual support, and emotional and organisational support for ICU clinicians), to cir- cumvent variations in terminology. We will also endeav- our to assess the models for integrating palliative care into the ICU, identify research priorities, and formulate a research agenda to improve palliative care in ICUs.
Program description The Academic Family Medicine Clinic partnered with the South Health Campus Patient and Family Centred Care staff in developing a dedicated family medicine patient and community council. The resulting committee of 6 volunteers and 3 staff members has delivered presentations to incoming family medicine residents and staff on the role of a patient advisory council; advised on methodology to collect and represent broad patient perspectives; provided patient-perspective input to operations management and quality improvement committees; developed a pilot patient satisfaction and experience survey; and brought additional perspective, based on learnings from other industries and professions with experience in “customer service,” on how to enhance the quality of the patient experience.
Implementation of the ICPM began in November 2009 with 2 showcase units. We quickly came to realize that in order to create and sustain a patient- and family-centred approach to care, we needed patients and families to advise us along the way. The KGH Patient and Family Advisory Council (PFAC) was formed in January 2010. This very active engaged council provided direction to the ICPM as it was implemented and continues to provide direction as the model of care is evaluated throughout the hospital. This innovative strategy aims to place patients at the heart of decision-making and puts our patients and their families first. The PFAC is leading the way in ensuring that patients and families are involved in all aspects of care, safety and improvement initiatives. The council is grounded in and guided by the core principles of patient- and family-centred care: dignity and respect, information-sharing, participation and collaboration. The PFAC is comprised of the following: twelve former patients or family members of patients who have received care at KGH, working in partnership with executive leadership and staff. This council is driving the paradigm shift from an organization that does things to and for its patients to one which is patient-led, where a partnership is formed with patients to meet their health needs. The PFAC developed the following formal definition for patient- and family-centred care: “Patient- and Family- Centred care at Kingston General Hospital is healthcare based on a partnership among practitioners, patients and families. Its goal is to ensure decisions respect patient’s needs, values and preferences. Its outcome provides patients with information, knowledge and support to participate in their care as they choose.” A shorter version is “Respect me, Hear me, Work with me” crafted to create expectations for all parties in the partnership – patients, families, providers and staff alike.
Healthcare organizations in Canada and the United States are seeking to enhance their ability to offer patient and family centred care (PFCC). One aspect of PFCC is the participation of Patient and Family Partners (PFPs) in a variety of roles within healthcare organizations. This article describes the creation and evaluation of a hiring process that utilized a PFCC interview tool (PFCCIT) and collaborated with PFPs in interviewing candidates for healthcare positions. An evaluation of the new hiring process was designed, including an on-line survey of candidates and semi-structured interviews with healthcare leaders and PFPs. Survey results indicated candidates felt the new process helped them understand the importance of PFCC at the organization. In interviews with leaders, comments were overwhelmingly positive, with leaders urging the spread of this hiring process throughout the organization. Similarly, the four PFPs who were interviewed felt their participation was valuable, and useful in furthering the organization’s commitment to PFCC. The implementation of a staff hiring process utilizing PFPs and the PFCCIT provides a valuable tool for healthcare organizations working to enhance PFCC to better meet the needs of their patients and families. Further study is required to validate the long-term impact of this initiative and determine whether it improves recruitment and retention of staff sharing the organization’s commitment to PFCC.
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While our study revealed no differences in perceptions of FCRs between fellows and practising cardiologists, our study is the first to note distinctions between less and more experienced practitioners. A greater propor- tion of more experienced practitioners felt that families should be active participants in decision-making and that FCRs ease family anxiety. Although this finding may seem counterintuitive, given that FCRs are a relatively recent phenomenon, perhaps the senior attendings’ greater clinical experience shaped their perceptions about the role of family input. Additionally, senior attendings are more likely to have experienced the patient side of medi- cine, which may have also affected their perspectives of FCRs.
However, whilst the technical aspects of incentive design and implementation are obviously complex, concentration on these can mask the more important question of whether care should be incentivised at all. Whilst full consideration of this is beyond the scope of this paper, evidence suggests that the impact of incentives on clinical care is modest with an associated uncertain but sometimes negative impact upon clinician behaviours and motivation. 29-31 Patients themselves are
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satisfaction [26-29]. According to our study, less edu- cated patients might receive ‘too much’ in the domains of communication, information and shared decision making, and high educated patients ‘too little’ (though with these high experience scores, there is not much room for improvement). Since patient satisfaction is in turn associated with specific health outcomes, such as self-perceived health  and mortality , a discrep- ancy between patient preferences and experiences in health care can negatively affect health. It should be noted though, that it is unclear to what extent the dif- ferences in experiences reported by these patient groups reflect actual differences in the care received. In the patient experience literature, it has often been described that patients with a lower level of education report more positive experiences than patients with a higher level of education [32,33]. This might reflect a systematic reporting bias rather than real differences in patients’ experiences .
Adherence to medication is reported to be <33%. Most people who suffer chronic conditions require pharmacological intervention; they collect prescription repeats every month creating an opportunity for further regular intervention by the community pharmacist. to investigate if pharmacist intervention in Chronic Disease Management in rural Australia could improve patients’ outcomes through better monitoring of disease markers, self- management skills and medication adherence. This project was a pilot before and after, pragmatic study, which was designed as a foundation to support future definitive studies. The data was analysed in ASReml-R™ using linear mixed models or generalised linear mixed models. Using modified Health Education Impact Questionnaires™, there was 29.65% improvement in patients’ total score from pre and post clinical intervention. Patient education and ongoing interaction between patients and pharmacists enforced the importance of monitoring improving patients’ knowledge and self-management commitment. The use of prescription repeat collections as an opportunity to reinforce disease management messages deserves further investigation.
include: informing the family in a private location; using the child’s name; informing the family of all medical procedures performed; noting any family efforts to help or comfort the child (such as seeking medical care, giving a good medical history, providing comfort by touching the child); offering information about autopsy and tissue donation; contacting important family supports such as members of the family’s faith community; offering pri- vate or accompanied time with the child’s body; allow- ing for time to make meaningful mementos consonant with religious or cultural precepts; and providing a fol- low-up contact. For most parents, the image of their child’s body lying unattended in a hospital morgue in- flicts additional pain after loss. If a medical examiner’s evaluation is not required, many EDs have found a way to keep an attendant with the child’s body until a des- ignated funeral home can come, in that way reassuring and comforting surviving family members. The death of a child is the beginning of a lifelong condition of be- reavement for parents and siblings, one on which ED health care professionals can have a profound effect. 76
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However, GPs also highlighted that some more complex cases require the input of palliative care specialists. GPs indicated that best practice palliative care should involve a multidisciplinary team of healthcare providers and services, including community services, allied health professionals, and palliative care physicians. Despite this, GPs reported that they had an important role to play in managing multidisciplinary teamwork and coordinating patient care. This was because GPs suggested that, compared to specialists, they were more accessible to patients and that their care usually involved less out-of-pocket costs and shorter waiting times. GPs said that they were often patients’ first point of contact at various stages of the care trajectory, which provided them with a better understanding of the variety and interplay of patients’ symptoms and needs, than a specialist may have:
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Results: A total of 64 elderly patients with type 2 diabetes were previously identi ﬁ ed as possibly over-treated and included; 57.8% male, median age 75 years (IQR=72 – 82), median diabetes duration 12 years (IQR=8 – 18). De-intensi ﬁ cation was implemented in more than half (n=36) of them. Care providers preferred person-centred care above just setting general HbA1c target values, considering patient characteristics (such as comorbidity) and patient ’ s preference. Patients valued glucose levels as most important in determining their treatment. Both patients and care providers felt that de-intensi ﬁ cation should occur gradually. Conclusion: Treatment had been de-intensi ﬁ ed in more than half of the patients (56.3%). Insight in reasons for not de-intensifying elderly patients is important since treatment for them can be “ person-centred care ” . De-intensi ﬁ cation is an iterative and time-intensive process.
responsible for improving a child’s reading ability – as this will also depend on the child, the teachers and parents and it would be impossible to distinguish what else is impacting on the child’s attainment. Similarly hospital librarians may provide information that contributes to a reduced length of stay for a patient or group of patients, but this will also be affected by the patient’s illness, prior health and the work of all the clinical staff and the hospital environment. For the most part, experimental studies, which would be used in other fields to establish cause and effect and actual impacts, are not
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Interviews were undertaken with a cross section of Australian health-care accreditation stakeholders. In late 2011, management teams of accreditation agencies involved in ACCREDIT provided the contact details of representatives from organizations they viewed as key stake- holder groups, such as government quality improvement agencies, accreditation agencies and health-care professional associations. Invita- tions were emailed to the representatives inviting them to participate in the study. A convenience sample of health-care professionals was recruited at accreditation educational workshops held in every Australian state and territory during early 2012. Also arranged at this time was a group interview with consumer representatives from a peak national organization representing the rights, needs and interests of older Australians.
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The leadership from nursing staff needs to be more visible when it comes to the organisation of doctors’ ward rounds. It was observed that many ward rounds currently take place when activity on the ward is excessive and the nurses have other priorities. Birtwistle et al. (2000) noted that whilst doctors see ward rounds as playing a valuable part of good care, nurses did not view them as constructive use of their time. Birtwistle et al. (2000) further speculate that the dissatisfaction of the nursing staff around this issue is detrimental to the professional relationship. Nurses highlighted that the arrival of doctors to perform a ward round at unscheduled times had a negative impact on the nurses’ time and delayed patient care. Nurses need to use their leadership and organisational skills to negotiate the ground rules for doctors’ ward rounds that best suit the doctors, the ward nurses and the patients. In addition, an excessive number of doctors accompanying the ward round were observed on one particular busy ward. Despite none of the patients or nurses raising this as a problem the ward was very overcrowded, indeed unsafe. This again could be reflected upon by the leader of the ward and discussed with the wider multi-disciplinary team.
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