Transcript patient centered care buzzword or reality

PATIENT CENTERED CAREBUZZWORD OR REALITY?
BY Dr Simbo Davidson
WHAT IS PATIENT-CENTERED CARE?
AND HOW MAY WE ACHIEVE IT?
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What participants will learn
Core elements of patient centered care
Facilitators and Barriers to patient centered care
Organizational cultural competency
assessments
Doctor-Patient relationship models that impact
patient experience
World Health measures for responsiveness to
patients
Case examples with study questions
PROCEED WITH THE CASE STUDYBARRIERS TO PATIENT CENTERED CARE
(WORK IN PAIRS)- 20 mins
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STUDY QUESTIONS
How could Walter’s family physician have
behaved differently to change his poor outcome?
Are there interventions that could have helped
Walter avoid his use of the ER?
What could have been done to ensure that
Walter’s referral for diagnostics wasn’t lost?
How can care be shaped to help Walter help
himself in achieving his health goals?
What can be done to improve cultural sensitivity
for Metis and First Nation’s patients?
IMPROVE QUALITY, ACCESS TO CARE AND
AFFORDABILITY (COST)
CORE ELEMENTS OF PATIENT
CENTERED CARE
• Respect for patient’s values, needs
convenience, culture, and preferences
• Providing adequate information during visits,
while on admission, on patients’ diagnosis,
treatments and lifestyle requirements
• Team collaboration in providing services so that
patients are not referred randomly and tossed to
and fro between specialists
• Ensuring that patients understand information
provided eg teachback systems
• Removing barriers such as language barriers,
staffing shortages, out of stock etc
WATCH THIS VIDEOFACILITATORS OF PATIENT
CENTERED CARE
• IN GENERAL ,WHAT MADE Dr ISMAIL
UNIQUE?
• WHAT WERE THE BEHAVIORS SPECIFICALLY
IN THIS VIDEO THAT MADE HIM HIGHLY
APPRECIATED BY HIS PATIENTS?
• WHAT MAJOR LESSON CAN WE LEARN
ABOUT DR ISMAIL’S PATIENT CENTERED
CARE STRATEGY?
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CULTURAL COMPETENCY- ARE YOU CULTURALLY
COMPETENT?- CHECK YOUR SCORE
CHECKLIST
CULTURAL COMPETENCY IMPROVES THE
PATIENT’S EXPERIENCE
1. ARE YOU CONSIDERATE OF OTHER
PERSON’S RELIGIOUS BELIEFS WHEN
PROVIDING CARE?
2. IS THERE ANYTHING WRONG WITH THE
USE OF LOCAL LANGUAGES IN HEALTH
SETTINGS?
3. WOULD YOU EMPLOY SOMEONE WHO
OBSERVES RELIGIOUS DRESSING ?
4. HAVE YOU EVER EXCLUDED PERSONS
FROM OTHER ETHNIC GROUPS WHEN
RECRUITING?
5. DO YOU PROVIDE PATIENT
INFORMATION IN MANY LOCAL
LANGUAGES?
RELIGIOUS
DIVERSITY
PATIENT EXPERIENCE- HOW DO
WE MEASURE THIS?
WORLD HEALTH MEASURES
OF PATIENT EXPERIENCE
• RESPONSIVENESS IS
MORE THAN PATIENT
SATISFACTION
• RESPONSIVENESS
MEASURES THE
PATIENT’S
EXPERIENCE
WORLD HEALTH MEASURESRESPONSIVENESS
RESPONSIVENESS
MEASUREMENT
• Percentage of persons who could not get an
appointment in any week or month
• Percentage of patients who could not collect
medications due to affordability or availability
• Patients rating of explanations offered by
physician about diagnosis or treatment
• Patient’s rating of time spent with physician
during consultation
• Patient’s rating for ease at which he could ask
the doctor questions about his/her care
• Rating of extent to which patient was involved in
the clinic decision making process
TYPES OF DOCTOR:
PATIENT RELATIONSHIPS that
impact EXPERIENCE
• MEDICAL PATERNALISM- The doctor determines what is best for
the patient and takes a one sided decision. No options are offered to
the patient and Doctor does not entertain questions
• INFORMATIVE MODEL- The Doctor informs the patient about the
benefits, risks, prognosis, alternatives to treatment and allows the
patient to choose. No recommendations are given
• INTERPRETIVE MODEL- The Doctor helps the patient to examine
his/her preferences, beliefs and values and to make a rational
decision- Recommends but does not persuade
• DELIBERATIVE MODEL- The doctor presents call relevant
information and persuades the patient to take the most rationale
option
SCORE WALTER’S EXPERIENCE
IF YOU WERE WALTER…..
• How would you rate the wait
times for consultations out of
10
• How would you rate the
physicians’ communication
about diagnosis or treatment?
Out of 10
• How would you rate the time
spent with the doctor out of 10
• How would you rate ability to
ask questions and receive
answers? Out of 10
• How would you rate your
involvement in the clinic
decision making process?
RATING EXPERIENCE
EXAMPLE OF PROM QUESTIONS- Hip & knee
replacements, Varicose veins, hernia repair
Are you able to
Dress yourself in the morning, including
underwear?
Stand up from an armless chair?
Get in and out of bed without help?
Lift a full glass of water to your mouth
Walk to your nearest bus-stop on flat
ground
Without any
difficulty
With a little
difficulty
With some
difficulty
With much
difficulty
Unable to d
it
WHAT DO WE NEED TO DO
BETTER?
• Implement patient surveys to check patient experience in
all aspects of care
• Ensure that employees are reporting high levels of job
satisfaction
• Improve team work between departments
• Improve communication between Providers & Patients
• Establish cultural competency interventions
• Carry out a root cause analysis
• Implement a QUALITY IMPROVEMENT SYSTEMLEAN MANAGEMENT/ CQI (continuous quality
improvement)
• IMPLEMENT IMPROVEMENTS THAT CAN CHANGE
PATIENT EXPERIENCE for the better
THANK YOU !!!