Promoting patient-centred healthcare around the world Patient Empowerment Designing a Better Healthcare Estate EuHPN Workshop 16 November 2015
Promoting patient-centred healthcare around the world
Patient Empowerment
Designing a Better Healthcare Estate
EuHPN Workshop 16 November 2015
Promoting patient-centred healthcare around the world
Advocacy
Capacity Building
Partnerships
Vision: patients at the centre of healthcare around the world .
Mission: build patient-centred healthcare worldwide.
– Set-up 15 years ago. Size,
diversity and experience our
strength
– We are a unique global alliance of
over 250 national, regional and
international groups representing
patients in over 60 countries
– Our diverse cross-disease
member organisations cover over
50 main WHO ICD 10 disease
classifications
– We are the global voice for
patient-centred healthcare:
representing an estimated 365
million patients
Promoting patient-centred healthcare around the world
IAPO’s Global Membership
Promoting patient-centred healthcare around the world
OUTCOMES DESIRED
Patients ask for health infrastructure and facilities that are: Available: sufficient quantity of functioning LOCAL health care facilities-no overcrowding or long travelling Accessible: physically accessible, economically accessible (affordability), information accessibility (signage etc) and non-discriminatory(gender, age, race etc) Acceptable: respectful of medical ethics and comfort. Designed ergonomically in a culturally sensitive way (age and gender).cooling, heating and lighting to improve patient experience. Quality: appropriate medically and by construction codes (fabric, ventilation, heating, sanitation). Safe: From accidents (trips, falls and electrocutions!) and clinically safe nosocomial infections
Promoting patient-centred healthcare around the world
Whole-of-System & Life-Course approach
• IAPO wants a whole-of-system & integrated Estate. Clinical care (operating theatres etc) should link with ‘hoteling’ ( wards, beds, catering, stores etc.). Primary, acute and social care should be seamless as: • Our patients have chronic conditions. The use both primary and acute care
facilities. They use acute care on an out/in patient basis.
• We want a Life-Course Approach: Facility design to
reflect changing needs:
• Compared to other patients, who use facilities for a single issue on a one-off treatment, our patients have to access these facilities for multiple comorbidities over a LIFE-COURSE.
• Needs of patients with chronic conditions change with time. Health infrastructure needs to change to meet these changing needs
• Digital infrastructure also needs to match pace of change. Free broadband access helps communication and patient experience
Promoting patient-centred healthcare around the world
Age, gender and culturally sensitive hospitals
People-centred and integrated health care (WHO)
Promoting patient-centred healthcare around the world
• WHO- transfer decision-making to local level. Encourage local responsiveness and economies of scale in redesigning health infrastructure
• WHO- health infrastructure best managed and maintained by local community and patients. Redistribute resources to respond to this new integrated models of care.
• Patient groups bring about people-centred local health care facilities. They can be better custodians (they use the facilities regularly). Self-help can mean user maintained facilities.
Installation of water tank for a maternity care unit-Serengeti Plains
Engage patients at the outset in feasibility, design and procurement stages*
Promoting patient-centred healthcare around the world
*Royal Institute of British Architects: Good Design: it adds up Healthcare buildings: a suitable case for treatment
e-buildings* + telehealth**=joinedup care
Promoting patient-centred healthcare around the world
• Patients lead ‘connected lives’. Health estates now connected buildings. ‘Intelligent Buildings’ linked with telehealth.
• Geospatial revolution and automated responses. (Case Study) • Patients walk into building. Building picks up phone signal.
• Patient recognised and then tracked in building • App logs them into clinic and guides them to the right clinic
• App alerts health care team, waiting-time status SMS sent • App launches health records retrieval. Records ready.
• App keeps patients informed on waiting-time • Patient leaves with an e-prescription voucher that redeemed by
pharmacists. Maybe uploads health plan. • Maybe pays by M-Pesa mobile credit!
• Home monitoring. Telehealth equipment and devices connected to primary and acute care facilities via local intranet. Early discharge no bed blocking!
* Connected Buildings Make Technology A Path To Peak Performance : Johnson controls ** Telecare Services Association
Promoting patient-centred healthcare around the world
PROBLEM
• Poor illumination leads to accidents
• Inadequate power supply. Sockets overloaded
• Water and electrical systems a nosocomial infection reservoir
• Post-surgery wash-down and sluicing arrangement not adequate
WHO Safe Surgery: Operating Theatres
SOLUTION:
Atul Gwande’s ‘Checklist Manifesto’:
Give the checklist to the patient groups! They will make sure every faulty device and electrical system is mapped and repaired!
Promoting patient-centred healthcare around the world
PATIENTS & VALUE ENGINEERING*
• Value engineering is used in public procurement of health infrastructure. Used to identify and eliminate unwanted costs, while improving function and quality.
• Used at a very early stage before a line is drawn on plan, and then continues at each design stage and construction stage.
• Do we need this facility? Are the materials and construction methods optimum for this location? Have we addressed transportation issues, site limitations or budgets?
• Benefits delivered include an estate that fits with local patients’ needs and also reduces life cycle costs, improves quality, reduces environmental impact
* 1) The good and the bad of value engineering HEALTH CARE DESIGN June 2005 2) Incorporating Patient Handling Ergonomics into the Design of Healthcare Facilities: Patient and Caregiver Benefits 3) eBook: Empowering the Patient and Hospital Staff: Evidence Based Designs Practices that Promote Healing in a Healthcare Environment
Value engineering (VE) examples
• World Bank Budget: US $7 million for maternal hospital. Site chosen a forested grove. Mothers in VE identified centrally located disused railway warehouses. Budget reduced to $ 2.5 million. Savings ploughed back into health professional training.
• NHS East London wanted to set-up a new women's’ health and well being services for Bangladeshi women. £4 million budgeted to turn old wards into clinics etc. Women identified local East London Mosque and its Friday female services. Mosque refitted its women’s wing into a clinic and other health services. Saving £3 million.
Promoting patient-centred healthcare around the world
Patients and life-cycle of buildings
• Where Private Finance Initiative (PFI) used as procurement method for facilities, patients to be involved in all stages of finance, construction and operating decisions. *
• Transparent, accountable and participatory procurement and investment decision-making
• Patients involved in all subsequent change-of-use and refurbishment considerations
• Patients involved in regular condition of estate and maintenance inspections
• Recovered MRSA and other nosocomial patients to be part of the environmental inspection and control regimes!
Promoting patient-centred healthcare around the world
Private finance initiative: A catalyst for better healthcare design? HEALTH CARE DESIGN
IAPO & WHO Patients for Patient Safety collaboration
Promoting patient-centred healthcare around the world
One in 10 patients may be harmed while in hospital
Hospital infections affect 14 out of every 100 patients admitted
Many patients lack access to properly wired and connected medical devices
Patient and community engagement and empowerment are key
Hospital partnerships can play a critical role
A poor safety record for health care
THANK YOU!
Promoting patient-centred healthcare around the world
International Alliance of Patients' Organizations CAN Mezzanine 49-51 East Road London N1 6AH United Kingdom Email: [email protected] Join our social networks Facebook Twitter YouTube