Partners in Care:Working with families/whaanau to encourage participation

Background:A proposed change to our admission documentation, included questions about which people are key to the patients well being and who is to be involved in decision making.

Aims:•Define partners in care•Identify barriers to working in partnership with patients, family/whaanau members•Develop strategy to address key barriers•Contribute to the continued review of the current documentation•Identify training and/or information requirements to support patients, families/whaanau and staff to work as ‘partners in care’

Method:•Focused on two surgical wards at Middlemore Hospital.•Surveyed surgical inpatients & family/whaanau members and staff over 1 week•Conducted interviews with staff who had been patients or family/whaanau of patients over 4 weeks•Reviewed surgical patient satisfaction survey narrative responses for last quarter•Recruited patients and family/whaanau members for attendance at workshop event

Partners in Care Forum:Full day event attended by•Patients•Family/whaanau members •Ward Nurses•Health Care Assistants•Ward Clerk•Physiotherapist•ICU Consultant

Survey Feedback:Patients are asked who are key family./whaanau members:•60% Staff say – always/mostly•33% Patients/family/whaanau say they were askedFamily/whaanau members are encouraged to be at doctors rounds•76% Staff say – always/mostly•28% Patients/family/whaanau say they were encouragedOpinions of family/whaanau members are listened to and respected•84% Staff say – always/mostly•85% Patients/family/whaanau say they were satisfied

Patients & family/whaanau say: Staff say:

Staff would be taught how to use the document, but how do we prepare patients, family/whaanau and staff for working in partnership?

Partners in Care Definition:‘anyone named by the patient that they want to work with them (the patient) and the healthcare team to help make decisions and be involved in care’Key concepts: partners are patient defined; members of healthcare team can support the patient to find a partner (Whaanau Support Workers, for instance)

Initial area of focus: •Who is involved in my care? •What facilities are available?•What are the routines and general processes?*The charge nurse had already extended the times the ward was ‘unlocked’ from 2pm-8pm to 8am–8pm

What we tried:1. Patient (family/whaanau) will know the name of the nurse looking after them. nurse name displayed on bedside information board•Tested in 4 bed spaces•Difficult to find a good place to hang the board so it could be seen•Nurses sometimes forgot to update (only few boards on ward)•Patients, family/whaanau really liked the board and could say who was looking after them2. Bed space telephone number included on information board so family/whaanau could call patient direct•Soon identified that only 46% of bed spaces had a telephone at the bedside•Phones purchased to ensure all patients had access to phone3. Develop process to update board at start of shift•Boards to be placed at each bedside• updating process to be standardised4. Patients will be aware of facilities and ward routines•Work continues to evolve pictorial information sheet for the bedside

Next Steps:Develop training resources that ‘script’ key conversations and demonstrate these in action (via video scenarios, for example) to address the staff support/guidance needs as identified in the staff survey. Work to be adopted by the newly formed Patient & Whaanau Centered Care Programme

Lessons:•Forum was a big commitment from patients & family/whaanau members•Partnership working is about changing attitudes – requires leadership•Stories are a powerful means to engage staff

Partners in Care Workgroup: Denise Kivell; David Hughes; Joye Rowlands; Lynne Kane; Melanie Olliff; Ian Kaihe-Wetting; Adrienne Batterton; Maika Veikune; Soli Henare; Sue Cotton; Maggie Spencer

Partners in Care:Working with families/whaanau to encourage participation

What is the problem?• Families and Whaanau are not consistently

part of the ‘care team’• Some specialty areas work in partnership –

Mental Health; Womens & Childrens, etc• 2010 Survey showed 79% patient/whaanau

respondents wanted family presence; 70% staff had concerns about ‘open access’

Driver for change…..

• November 2011, Multidisciplinary Collaborative Care Plan, to be piloted

• Patient to be asked:– Who are the key people, family or whaanau you

wish to be involved in care and treatment decisions?

– Who would you like to be present at the ward round?

• ‘Partners-in-care’ concept introduced

Aims:• To define ‘Partners-in-care’ • Identify barriers to working in partnership with

patients, family/whaanau members• Develop strategy to address key barriers• Contribute to the continued review of the current

documentation• Identify training and/or information requirements to

support patients, families/whaanau and staff to work as ‘partners in care’

Method• Focused on two surgical wards • Surveyed surgical inpatients & family/whaanau

members and staff over 1 week• Conducted interviews with staff who had been

patients or family/whaanau of patients over 4 weeks• Reviewed surgical patient satisfaction survey

narrative responses for last quarter• Recruited patients and family/whaanau members for

attendance at Forum

Key survey findings….

• 20 patients; 25 staff – 2 surgical wards• Staff made patient/family/whaanau feel

‘welcome’• 60% staff ask who are key family/whaanau to

be involved in care; 67% patients say they weren’t asked

• 76% staff encourage key family/whaanau to be at doctors rounds; 28% patients informed they were ‘welcome’ at ward rounds

Key survey findings….What could we improve?• Enable my family/whaanau

to be with me (44%)• Explain my options (35%)

Staff support/guidance?• Support families is stressful

situations (55%)• Involve pts/whaanau in

care/treatment decisions (55%)

• Strategies for working with large families (41%)

• 12% staff confident working with patients and family/whaanau

Partners in Care ForumPartners in care definition:• ‘anyone named by the

patient that they want to work with them (the patient) and the healthcare team to help make decisions and be involved in care’

• Key concepts: partners are patient defined; members of healthcare team can support the patient to find a partner (Whaanau Support Workers, for instance)

Initial area of focus:

• Who is involved in my care? • What facilities are available?• What are the routines and general processes?

The charge nurse extended the times the ward was ‘unlocked’ from 2pm-8pm to 8am–8pm

Tests…• Patient information boards– 4 bed spaces initially– Process for updating– Patients/families liked them

• Bedside phones– All bed spaces have phones

• Information boards being rolled out to all bed spaces

• Pictorial bedside information sheet

Lessons.….• Dealing with attitudes– Leadership is key– Anxiety - apparent conflicts between what is law;

policy & right thing to do• Forum as a means of engagement– Huge commitment – Other ways to engage to be explored – eg. EBD

• Staff as patients/whaanau – how do they provide feedback?

Next stage…..

• Key message: family/whaanau not visitors – Newly formed Patient & Whaanau Centered Care

Board

• Development of support guidance– Adopted as work stream– Offers of help to establish