Mitchell, Imogen — Through the Patient’s Eyes

Through the Patient’s Eyes

@IA_Mitchell2013/14 Harkness Fellow, Johns Hopkins Bloomberg School of Public Health

Cutting for Stone: Abraham Verghese

Dr Stone, Professor Of Surgery:

“My son’s terrible death is not something I will ever get over, but perhaps in time it will be less painful. But I cannot get

over one image, a last image that could have been different. Before I was asked to leave the room in a very rough

manner, I must tell you that I saw my son was terrified and there was no one who addressed his fear. The only person

who tried was a nurse. She held my son’s hand and said, ‘Don’t worry, it will be all right.’ Everyone else ignored him.

Sure, the doctors were busy with his body. It would have been merciful if he had been unconscious. They had important

things to do. They cared only about his chest and belly. Not about the little boy who was in fear….I saw no sign of the

slightest bit of human kindness. My son and I were irritants. Your team would have preferred for me to be gone and for

him to be quiet. Eventually they got their wish. Dr. Stone, as head of surgery, perhaps as a parent yourself, do you not

feel some obligation to have your staff comfort the patient? Would the patient not be better off with less anxiety, less

fright? My son’s last conscious memory will be of people ignoring him. My last memory of him will be of my little boy,

watching in terror as his mother is escorted out of the room. It is the graven image I will carry to my own deathbed. The

fact that people were attentive to his body does not compensate for their ignoring his being”

Cutting for Stone: Abraham Verghese

“What treatment in an emergency is administered by ear?”

“Words of comfort”

Modern Medicine

• Large leaps in medicine

penicillin, CT scan, cancer treatments, HIV treatment, intensive care

• Life expectancy (years)

1964 2014

Female 74 84.1

Male 67.79 79.7

Patient Experience: GP/Regular Doctor

Why?

Patient becoming invisible?

Patient is unseen and unheard?

Collision of Events

2009

Alice’ Mother

“I still believe that either someone or something failed my daughter on that

weekend.

……..a seemingly total lack of clinical assessment and decision making

affording early intervention in order that her deterioration was halted

From the Other Side

• Lack of ControlThe sense of helplessness

• FixateFocus on small things

• Emotional Roller CoasterTerrified

Leigh and Lisa

• Stepped into their ShoesA young man, with a wife, a 2 year old and one on the way who I thought would die if he did not receive

ECMO

• Closed the loopHe and his wife came back to our ICU to say “thank you”

• HumbledFundraising for ICF in rural NSW, in one night raised $30 000

My Mother

• Effects of StressSensible people can be too traumatized to think clearly in times of desperation

• Effects of SeparationWhy do we need to keep locking families out?

• Extraordinary Trust Need to always remember how much trust patients and their families put in us

“We are but a guest in patients’ lives”

Alice’s Mother

• Loss of ControlAlice’s mother allowed me to step into her shoes and feel the emotion of watching someone struggle for

life and seemingly nothing happening

• Fill the white spaceCommunication, communication, communication

Patient Centred Care

Patient Centred Care

providing the best quality care,

which includes the best possible experience for the patient

partnerships based on dignity and respect, information sharing, participation and collaboration to

the extent that people choose

improving the health service by using the knowledge, skills and experience of people who are

using, have used or may use the health service

Policy Framework: Patient Centred Care

Australian Safety and Quality Framework for Health Care, 2011:

describes a vision for safe and high quality care for all Australians

safe and high quality care is:

consumer centred | driven by information | organised for safety

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Patient-centred care and outcomesEvidence that patient-centred care is associated with improved safety and quality,

lower costs, improved patient and provider satisfaction

Emerging evidence of benefits including:

decreased mortality

improved care

lower length of stay

fewer medication errors

lower infection rates

fewer diagnostic tests and unnecessary referrals

reduced costs

Vidant Health, Greenville, North Carolina

• 2011: Partnerships with patients and families

• 2012: Home Care Patient Experience surveys

Improved from 50th to 85th Centile

• Changes related to introductions and the wearing of uniforms

• Appointing patient and family advisors

• 50% reduction in hospital acquired infections in 2 years

• 73% reduction in serious safety events since 2007.

• RN turnover decreased from 15.26% in 2008 to 5.18% in 2011

How can we improve the patient and family experience?

3 Simple Things

1st Thing:

Make the Small Things Count

1st Thing: Make the Small Things Count

“Want Drs to sit down, tell them their name and smile!”

“Lisa did not want to leave and was sitting next to my bed trying to share my pillow. One of the

nurses offered to get her a pillow and they closed the curtains and dimmed the lights to allow Lisa

to sleep for a while”

“Wardsman… Not once in my complete state of vulnerability was I self conscious with these guys.

My impression was that they brought a quiet but strong calming presence whenever they were

around which in turn had a calming influence on me”

“They just appeared to care about what they were doing and that I and my family were important to

them at that time. They were human, and were affected and that was reassuring also”

1st Thing: Make the Small Things Count

“he sat down on my daughter’s bed, started to explain the procedure she was about to undergo

but at the same time expected me to read the consent form and sign it…at no stage did he

introduce himself. I assumed he was the orthopaedic registrar”

1st Thing: Make the Small Things Count

Kate Granger: 32 Aged care trainee

July 2011 diagnosed pelvic sarcoma

Chemo

@kategranger 20K followers

http://drkategranger.wordpress.com

1st Thing: Make the Small Things Count

• Admission to hospital via ED

• Noticed multiple doctors, nurses or support staff did not introduced themselves

• When they did it made such a different to the person who was there

• #hellomynameis

• Went viral

• Adopted by a number of NHS hospitals

2nd Thing:

Turn tradition around

2nd Thing: Turn tradition around

• IHI, CEO Maureen Bisognano

“What matters to you?”

• What are your patient’s goals”

mowing the lawn

gardening and being able to kneel

Jennifer Rodgers RN

York Hill Hospital

Glasgow, Scotland

“What matters to me”

3rd Thing:

Make time to Listen

3rd Thing: Make time to Listen

• Know your patient

Develop a relationship/connect

Build trust

Acknowledge your own vulnerability

• Understand their story

Make an accurate diagnosis and manage appropriately

• Welcome concerns and complaints

Opportunity to review, reflect and acknowledge that you may have got it wrong

“Pretty simple but I felt that she [the ICU nurse] treated me 'normally' and it was like her job

came second to connecting with me. The simple act of speaking to me regardless of whether

she knew i could hear her or not showed she saw me as doing worth her time”

And so

• Make the Small Things Count

introduce yourself

• What Matters to the Patient?

what are your patient’s goals?

• Make the time to Listen

know your patient

Change the paradigm of the socialisation in medicine

Patients are people