01.04.13
Using person-centred practices to improve hospital care
Source: National Health Executive Mar/Apr 2013
Helen Sanderson and Tracey Bush explain the new patient-centred approach to care that’s proving successful at a Blackpool hospital unit.
Person-centred approaches focus on understanding what matters to individuals and how they want to be supported and cared for. We believe these approaches can help to deliver a better quality of patient care and we’ve been working together at Bispham hospital in Blackpool to bring this idea to life.
Bispham is run by Spiral Health CIC, a social enterprise. It’s a 40-bed rehabilitation unit where patients stay for an average of 16 days. In implementing our patient-centred journey, there are two key challenges. The fi rst is to understand that patients and healthcare staff are stakeholders in this process. If we don’t treat nurses and support staff in a personcentred way, we can’t ask them to do the same with patients. The second is to ensure that we are not adding to the staff’s workload.
The tools we use must facilitate a change of mindset, not add an extra layer of bureaucracy.
We are still at the implementation phase of the work, but we’re going to share here our entire vision. With every element of this we are looking to treat patients as real people who matter – not just patients with medical conditions.
A patient booked into Bispham for rehabilitation such as physiotherapy would first receive a visit from the unit’s assessor, Zandra.
Zandra would meet the patient in hospital and start to develop a patient-centred profile about what is important to the patient and how to support her. The patient’s profile would include information about how she usually sleeps, her hobbies, interests and family.
Zandra would then check the information that she was happy to have shared on the patient profile which would be posted above her bed, for staff to read. Nothing medical or confi dential would be included in this profile.
When the patient arrived, the receptionist would know she was due and would have read her profile. She would welcome her by name and, as she was taken to her bed, the patient would see a display of the staff team, each with a photo and details of their role, as well as a little bit of personal information that staff were happy to share about their hobbies and interests.
These short profiles help patients get to know the nurses and support staff, but also help staff get to know each other – and this is an important part of the cultural change.
Very quickly, the patient’s named nurse would have met her and completed her admission. The nurse would build on information already collected by Zandra so that the patient didn’t have to answer the same questions again and again.
The patient’s named nurse would introduce her to her ‘team’ by showing her the mini-profiles of the physiotherapist who would be working with her and any other professionals. The nurse and patient would then decide the best visiting times, personalising them depending upon energy levels and what was possible for her family and friends.
Each day, the nurse responsible for her care that day would ask her what a good day would look like for her. She might say, it would be walking an extra three steps unaided, or writing a letter, or having a good game of Scrabble.
The nurse would write this on her notice-board and at the end of the day the night nurse would ask how the day had gone.
After five days, the nurse manager or a volunteer would talk to the patient privately and ask her about two things that were going well, two things that could be better and two things that she would like to see in the hospital in the future. This information would be used to improve her stay immediately and to give feedback directly to staff. Information collected from patients would be collated and used to inform business planning. The patient’s progress would be discussed with her and the therapists involved in her care around her bed, rather than separately in multidisciplinary meetings, reflecting the ‘nothing about me without me’ philosophy of the unit.
Thinking about departure would actually start on the day of admission, with tentative dates discussed. When it came to planning that departure, the patient would be asked how and when she wanted to leave. Her updated profile would be sent to the health professionals who would be involved with her after she left hospital. A week later, she would get a call from the hospital to check how she was doing at home.
Our approach is achieving early success. Profiles of the nurses and health professionals are up on the walls at Bispham and patient profiles are posted above beds. Different conversations are happening. Nurses and patients are finding interests in common; managers and nurses are learning more about each other. The mindset is changing at Bispham – and now other hospitals are starting to follow our progress.
About the authors
Helen Sanderson leads HSA, an international development team (www. helensandersonassociates.co.uk) and is Director Emeritus of the International Learning Community for Person-Centred Practices. Tracey Bush is managing director of Spiral Health CIC, the first NHS Foundation Trust bed-based service to become a social enterprise.
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