COMMENT
6
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ot so long ago I was assistant director of nursing for patient experience at an acute trust.Trying to improve patient care was sometimes very difficult and I often just saw complaints. In November 2010 I took a strategic decision to move to a smaller unit where I could personally make a difference to patients. I’m now clinical director at Spiral Health, a North West social enterprise that runs nurseled rehabilitation units. We’ve adopted a pioneering approach to patient care that has helped us translate the 6Cs into real, meaningful action. The challenge with the 6Cs is how to make them manifest. Concepts such as care, compassion, courage and commitment are worthy goals, but can remain nebulous unless healthcare staff are given the right tools. To understand what these tools should be, we went back to the drawing board and established a working partnership with Helen Sanderson, one of the UK’s leading experts in personalisation. Our goal was to find a way to treat each individual patient as a real person and not just a medical condition to be resolved. By treating the whole person, you can mend someone both physically and emotionally. This is vital in our units, where many of our patients are older and have long-term conditions. We developed an approach known as the patientcentred journey. This ensures that at every phase of their hospital experience—referral, admission, ongoing care and discharge—patients’ individual needs are put at the very centre of decision-making. At referral stage, our nurse assessor will visit a potential patient on the acute ward at our local hospital or at home and, alongside a medical assessment, will begin to compile a one-page personal profile of them. These profiles will help our staff understand what makes a patient tick. What is important to them? How do they wish to be supported? On admission new patients are greeted by name and quickly introduced to their nursing teams. Information about patients is collected efficiently so that they only have to tell their story once. With permission from the patients, their one-page personal profiles are posted above their beds, to help staff get to know them. During patients’ stays, all discharge planning meetings are held at bedsides and family members and friends are encouraged to attend, if the patient wishes. Involving family members has dramatically improved communications and helped many patients transition home more smoothly. We also work hard to personalise visiting hours to suit the patient and personalise their exercise routines and classes. Every day, we ask patients what would make this a good day for them and staff work hard to fulfil this. Mid-stay, all patients are asked, in relaxed bedside
interviews, what is working and not working— and for their suggestions for future changes. This information is collated and fed through our Working Together for Change (WTFC) planning process, which we run through quarterly and which allows us to improve and learn continuously. All hospital stakeholders—patients, staff and managers—take part in assessing the information gathered from patients and deciding action points. We believe this is the most thorough approach to patient feedback ever undertaken in a hospital setting. When it comes to discharge, patients are able choose their own departure times. A nurse then telephones a week after they’ve returned home to check on progress and ensure that the handover to community teams has gone smoothly. A lack of joined-up care at this point can cause problems with physical rehabilitation but can also undermine an older patient’s confidence significantly. We know from gathering patient feedback through WTFC that we are exceeding the expectations of the majority of our patients. One hundred percent of patients would recommend our services to their family and friends, and report that they are treated as an individual during their stay. We have also been monitoring patients’ ratings of how confident they would be to live at home after discharge. Average confidence ratings on admission are 1.5/5. Average ratings on discharge are 4.5. Perhaps the most telling statistics are these: the average length of stay in intermediate care is 35 days, but our patients stay for 17 days and 94% of them return to their own homes. Implementing this patient-centred journey has required a significant culture change among our staff, with leadership coming from the top and senior staff being approachable and person-centred. Staff have also been empowered to take decisions about the unit, with special staff-led working parties set up to decide on key aspects of change. In this atmosphere of transparency, staff have been willing to take on change. For example, initially, some nursing staff were reluctant to hold planning meetings at bedsides. It wasn’t until this was tried by one team, with huge success, that others started to come on board. Our patient-centred journey could work exceptionally well in any rehabilitation setting or care of the elderly ward. We feel evangelical about what we’ve achieved and take delight in the many positive reviews we receive from our patients. All it has taken BJN is commitment. Cheryl Swan
Clinical Director at Spiral Health CIC. www.spiralhealthcic.co.uk
© 2014 MA Healthcare Ltd
Editorial Board Palo Almond, Academic and Research Consultant, Anglia Ruskin University Irene Anderson, Prinicipal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Residential Nurse Dimitri Beeckman, Lecturer and Researcher, Florence Nightingale School of Nursing & Midwifery, King’s College London Dr Lizzy Bernthal, Research Fellow and lead nursing lecturer, Medical Directorate, Birmingham, Honorary Research Fellow University of Southampton. Martyn Bradbury, Clinical Skills Network Lead, University of Plymouth Alison Coull, Lecturer, Department of Nursing and Midwifery, University of Stirling, Scotland Willie Doherty, CNS Continence Care, Park Drive Health Centre, Baldock, Hertfordshire Jane Fox, Independent Consultant, Derbyshire Alan Glasper, Professor of Child Health Nursing, University of Southampton Angela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, London Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Andrew McVicar, Reader, Dept of Mental Health & Learning Disabilities, Anglia Ruskin University Danny Meetoo, Lecturer in Adult Nursing, University of Salford Mervyn Morris, Director, Centre for Mental Health Policy, Birmingham City University Aru Narayanasamy, Associate Professor, University of Nottingham Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser (U.K) Joy Notter, Professor, Birmingham City University, UK & Saxion University of Applied Science, NL Lynn Parker, Independent Educational Adviser, Infection Control, Sheffield Hilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of Wolverhampton Ian Peate, Head of School, Nursing, Midwifery and Healthcare, Thames Valley University Bernadette Porter, Nurse Consultant, Multiple Sclerosis, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust Jo Sharman, Operational Commissioning Manager, University Hospitals Birmingham NHS Foundation Trust John Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent University Catherine Whitmore, Research Nurse, Diabetes and Endocrinology, University of Liverpool Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Lecturer, Bournemouth University, PhD student at London School of Hygiene and Tropical Medicine Sue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King’s College London
Our patient-centred journey has brought the 6Cs to life
British Journal of Nursing, 2014, Vol 23, No 1
British Journal of Nursing. Downloaded from magonlinelibrary.com by 165.123.034.086 on December 8, 2015. For personal use only. No other uses without permission. . All rights reserved.
6
N
ot so long ago I was assistant director of nursing for patient experience at an acute trust.Trying to improve patient care was sometimes very difficult and I often just saw complaints. In November 2010 I took a strategic decision to move to a smaller unit where I could personally make a difference to patients. I’m now clinical director at Spiral Health, a North West social enterprise that runs nurseled rehabilitation units. We’ve adopted a pioneering approach to patient care that has helped us translate the 6Cs into real, meaningful action. The challenge with the 6Cs is how to make them manifest. Concepts such as care, compassion, courage and commitment are worthy goals, but can remain nebulous unless healthcare staff are given the right tools. To understand what these tools should be, we went back to the drawing board and established a working partnership with Helen Sanderson, one of the UK’s leading experts in personalisation. Our goal was to find a way to treat each individual patient as a real person and not just a medical condition to be resolved. By treating the whole person, you can mend someone both physically and emotionally. This is vital in our units, where many of our patients are older and have long-term conditions. We developed an approach known as the patientcentred journey. This ensures that at every phase of their hospital experience—referral, admission, ongoing care and discharge—patients’ individual needs are put at the very centre of decision-making. At referral stage, our nurse assessor will visit a potential patient on the acute ward at our local hospital or at home and, alongside a medical assessment, will begin to compile a one-page personal profile of them. These profiles will help our staff understand what makes a patient tick. What is important to them? How do they wish to be supported? On admission new patients are greeted by name and quickly introduced to their nursing teams. Information about patients is collected efficiently so that they only have to tell their story once. With permission from the patients, their one-page personal profiles are posted above their beds, to help staff get to know them. During patients’ stays, all discharge planning meetings are held at bedsides and family members and friends are encouraged to attend, if the patient wishes. Involving family members has dramatically improved communications and helped many patients transition home more smoothly. We also work hard to personalise visiting hours to suit the patient and personalise their exercise routines and classes. Every day, we ask patients what would make this a good day for them and staff work hard to fulfil this. Mid-stay, all patients are asked, in relaxed bedside
interviews, what is working and not working— and for their suggestions for future changes. This information is collated and fed through our Working Together for Change (WTFC) planning process, which we run through quarterly and which allows us to improve and learn continuously. All hospital stakeholders—patients, staff and managers—take part in assessing the information gathered from patients and deciding action points. We believe this is the most thorough approach to patient feedback ever undertaken in a hospital setting. When it comes to discharge, patients are able choose their own departure times. A nurse then telephones a week after they’ve returned home to check on progress and ensure that the handover to community teams has gone smoothly. A lack of joined-up care at this point can cause problems with physical rehabilitation but can also undermine an older patient’s confidence significantly. We know from gathering patient feedback through WTFC that we are exceeding the expectations of the majority of our patients. One hundred percent of patients would recommend our services to their family and friends, and report that they are treated as an individual during their stay. We have also been monitoring patients’ ratings of how confident they would be to live at home after discharge. Average confidence ratings on admission are 1.5/5. Average ratings on discharge are 4.5. Perhaps the most telling statistics are these: the average length of stay in intermediate care is 35 days, but our patients stay for 17 days and 94% of them return to their own homes. Implementing this patient-centred journey has required a significant culture change among our staff, with leadership coming from the top and senior staff being approachable and person-centred. Staff have also been empowered to take decisions about the unit, with special staff-led working parties set up to decide on key aspects of change. In this atmosphere of transparency, staff have been willing to take on change. For example, initially, some nursing staff were reluctant to hold planning meetings at bedsides. It wasn’t until this was tried by one team, with huge success, that others started to come on board. Our patient-centred journey could work exceptionally well in any rehabilitation setting or care of the elderly ward. We feel evangelical about what we’ve achieved and take delight in the many positive reviews we receive from our patients. All it has taken BJN is commitment. Cheryl Swan
Clinical Director at Spiral Health CIC. www.spiralhealthcic.co.uk
© 2014 MA Healthcare Ltd
Editorial Board Palo Almond, Academic and Research Consultant, Anglia Ruskin University Irene Anderson, Prinicipal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Residential Nurse Dimitri Beeckman, Lecturer and Researcher, Florence Nightingale School of Nursing & Midwifery, King’s College London Dr Lizzy Bernthal, Research Fellow and lead nursing lecturer, Medical Directorate, Birmingham, Honorary Research Fellow University of Southampton. Martyn Bradbury, Clinical Skills Network Lead, University of Plymouth Alison Coull, Lecturer, Department of Nursing and Midwifery, University of Stirling, Scotland Willie Doherty, CNS Continence Care, Park Drive Health Centre, Baldock, Hertfordshire Jane Fox, Independent Consultant, Derbyshire Alan Glasper, Professor of Child Health Nursing, University of Southampton Angela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, London Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Andrew McVicar, Reader, Dept of Mental Health & Learning Disabilities, Anglia Ruskin University Danny Meetoo, Lecturer in Adult Nursing, University of Salford Mervyn Morris, Director, Centre for Mental Health Policy, Birmingham City University Aru Narayanasamy, Associate Professor, University of Nottingham Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser (U.K) Joy Notter, Professor, Birmingham City University, UK & Saxion University of Applied Science, NL Lynn Parker, Independent Educational Adviser, Infection Control, Sheffield Hilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of Wolverhampton Ian Peate, Head of School, Nursing, Midwifery and Healthcare, Thames Valley University Bernadette Porter, Nurse Consultant, Multiple Sclerosis, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust Jo Sharman, Operational Commissioning Manager, University Hospitals Birmingham NHS Foundation Trust John Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent University Catherine Whitmore, Research Nurse, Diabetes and Endocrinology, University of Liverpool Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Lecturer, Bournemouth University, PhD student at London School of Hygiene and Tropical Medicine Sue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King’s College London
Our patient-centred journey has brought the 6Cs to life
British Journal of Nursing, 2014, Vol 23, No 1
British Journal of Nursing. Downloaded from magonlinelibrary.com by 165.123.034.086 on December 8, 2015. For personal use only. No other uses without permission. . All rights reserved.
