21.03.14
Our patient journey becomes a reality
Source: National Health Executive Mar/Apr 2014
Helen Sanderson and Tracey Bush discuss patient-centred care Spiral Health CIC in Blackpool, the first NHS foundation trust hospital to become a social enterprise.
Jeremy Hunt said recently that it was essential every patient was treated as a person – a person with a name and a person with a family, not a diagnostic puzzle or a four-hour target.
A year ago, and with the country still reeling in the wake of the Mid Staffs crisis, we began working on a new approach to patient care. The central tenet – which echoed Hunt’s views precisely – was that every patient should be treated as an individual.
We worked with a nurse-led hospital unit in Blackpool which helps rehabilitate mainly older patients after illness or surgery, run by social enterprise Spiral Health. Although it is commissioned by the NHS, Spiral Health’s community interest company status gives it the freedom to be pioneering.
The patient journey we envisaged uses person-centred practices to enhance care at every stage of the inpatient stay. The journey begins with the creation of a one-page profile of each patient. This covers what is important to a patient and how they’d like to be supported whilst in hospital. Profiles are displayed above beds (nothing confidential is included) where staff can view them and quickly learn about a new patient.
There are many other elements and we’ve introduced them gradually. Staff routinely ask patients ‘What would make today a good day for you?’ and work hard to ensure their small requests (a walk around the unit, an extra cup of tea or perhaps a bubble bath) happen. We hold all multi-disciplinary planning meetings at bedsides rather than behind closed doors and involve family members in those meetings. We personalise visiting hours and exercise regimes and follow up at home with patients after they leave the unit. Midway through the stay, we ask patients what is working and not working. We feed this information through a process called ‘Working Together for Change’ where a team of patients, staff and managers review the feedback and agree priorities for change.
Introducing one-page profiles was a challenge because they take nursing staff around 20 minutes per patient to complete. We found it was possible to embed this routine into the referral and admissions process – it was just a question of coaching staff to ask a few different questions. These days we have many examples of one-page profiles giving patients the opportunity to open up to staff. When asked what was important to her, our patient Jenny told us that her beloved dog had died and it was important to her that she get well enough to return home and to get another dog. Amanda, her nurse, is a dog owner and she arranged for her own dog to be brought into the hospital. Jenny was delighted.
Another challenge was the implementation of the bedside discharge planning meetings. We were determined to push these through as they embody our ‘nothing about you without you’ philosophy. Some of the team were concerned that these meetings would take too long to complete. Our lead nurse, Jan, found the opposite. She said, “When we were behind closed doors, there was too much distraction. Now we are doing it at the bedside we are fully concentrating on the patient.”
As staff have become more familiar with the processes, we have given them the freedom to make adaptations. One of our nurses, Zandra, was tasked with making follow-up calls to patients a week after they had returned home but she now calls after three or four weeks, when problems are more likely to have arisen. This personal touch allows Zandra to offer moral support, practical advice and a link between healthcare and social care teams.
Patient feedback so far has been overwhelmingly positive. Over five months in late 2013, an average of 98.2% of patients said they would recommend our service to their friends or family, and 100% felt they were treated as an individual during their stay. By the end of their stays, four-fifths of patients feel confident about returning home after discharge.
Our work has been shortlisted for three major healthcare awards and word has spread fast. Helen Bevan, who was chief executive of the NHS Institute for Innovation, now chief transformation officer with the NHS Horizons Group at NHS Improving Quality, is an ardent supporter of one-page profiles. Hilary Garratt, director of nursing, nurse commissioning and health improvement at NHS England, has described this work as ‘good practice’. Other hospitals and healthcare providers are now at the beginning of their own patient-centred journeys, including a major NHS hospital in the Midlands – and we believe this approach could work well in any rehabilitation setting or care of the elderly ward .
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 hospital to become a social enterprise.