November 2014 rounds - RGPEO 2014...

Hearing the Voice of Older People in a Hospital that is Friendly to them

Regional Geriatric Rounds Ottawa General Hospital

November 14 2014

Presented by

Sholom Glouberman

An introduction: What do patients want?

Agenda

1. A healthcare experience 2. A step back – healthcare in Canada 3. Changes in patient needs 4. Patients Canada is making a Difference

Oct 1, 20132


Agenda

1. A healthcare experience 2. A step back – healthcare in Canada 3. Changes in patient needs 4. Patients Canada is making a difference

Oct 1, 20133


Type 2 Diabetic

• Grandfather of 5, looks pasty and tired Wife checks blood sugar .. 16 (too high) • Calls family doctor – cannot get through Leaves note at Dr’s office -‐ no response • Two days later Wife checks blood sugar .. 23( way too high) • Calls family doctor’s office; Dr says call ambulance • Is left on a Gurney for 14 hours before being admitted • He is stabilized, but remains in hospital for 4 weeks • He is ashamed to be seen in a hospital gown and rarely leaves his bed • His wife brings him no food • Visits him morning afternoon and evening and must pay for parking • Return trip by car instead of private ambulance ($500) • Frequent hospital visits as home invalid for 18 months • Short stay in Nursing home (wheelchair) and death • Many similar stories

Oct 1, 2013 4


Agenda

1. A healthcare experience 2. A step back – healthcare Canada 3. Changes in patient needs 4. Patients Canada is making a difference

Oct 1, 20135


A brief history of our health system

Before 1850 • Longevity = 35-‐40 years

• Leading causes of death – infectious diseases

• Cholera, tuberculosis, small pox, typhoid fever, etc.

Major Innovations 1850-‐1880 • 1850 – Use of Ether as Anaesthetic

• 1867 – Joseph Lister & carbolic acid

• 1880-‐81 Robert Koch and Louis Pasteur discover cause and vaccine for anthrax and other infectious diseases

Oct 1, 2013 6


Our health care system begins

Rapid decline of % of death by acute infectious diseases – success!

• Hospitals grow

• Doctors professionalize and specialize

• Laboratory success including the discovery of insulin

• Penicillin begins to save lives in WWII (1940-‐45)

• New surgeries are performed

• Medical science promises silver bullets

• Cures all around!

Oct 1, 2013 7


20th century medicine

Does amazing things to patients

Does wonderful things for patients

Does very little with patients

. . . to say nothing about their family caregivers

Oct 1, 2013 8


Canadian medicare

• 1918 First World War • Soldiers have treatable diseases

• Saskatchewan • 1947 Saskatchewan Hospital Insurance Program

• 1962 Saskatchewan Hospital & Doctor care

• Canada • 1957 A national hospital insurance program

• 1966 Medicare: hospital & doctor care • Future coverage is meant to gradually increase

• 1984 Canada Health Act: Medically necessary • Covers hospital care and Doctors fees

• Does not cover drugs

• Does not cover much community based and non-‐medical treatment

• Intention of framers that this was to be the beginning – more to come (When?)

Oct 1, 2013 9


Agenda

1. A healthcare experience 2. A step back – healthcare in Canada 3. Changes in patient needs 4. Patients Canada is making a difference

Oct 1, 201310


Disease shifts: acute > chronic

Canada today • 89% of deaths due to chronic diseases (WHO Atlas) • Cancer, heart disease, lung disease, diabetes

• <3% deaths due to acute infectious diseases (WHO Atlas)

• 36% of the population take two or more drugs per day (Health Council)

• 57% of Canadians have at least one chronic condition (Health Council)

• 31% of Canadians have two or more chronic conditions (Health Council)

• Canada has second highest per capita expenditure on prescription drugs in the world (over $900 per capita) (CIHI)

Oct 1, 2013 11

*Stats from 2012


Acute/chronic comparison

Acute diseases • Simple or complicated • Have clear diagnoses • Many can be “conquered” with vaccines and almost all respond well to

established procedures without much patient participation • Care in Hospital and with specialist

Chronic conditions • Complex • Many causes • Need patient & family participation • Care in the community

Oct 1, 2013 12


The patient challenge defined

With acute disease With chronic condition

Complicated Complex

• Body to be treated • Person with history

• Individual – not linked to others • Person with people close to them

• Focus on disease or organ repair • Partner on the health team

• Try prescribed treatment • Try different approaches or options

• Medicare card name • Person with healthcare experience as patient or caregiver

Oct 1, 2013 13

An Introduction to the Patients’ Association of Canada

Types of problems -‐ examples

13-‐Nov-‐14 14

Simple Complicated ComplexStep by Step Recipe Building a Bridge Raising a Second Child

Steps are critical Formulae are critical Formulae useful but not aloneSteps are tested so they

work each timeBuilding 1 bridge helps make sure the next will

be ok

Raising 1 child is no assurance of success

with the 2nd

No particular expertise needed

Expertise in many fields required + coordination

Expertise helpful but you must follow the Same results every time High certainty of

outcomeOptimism despite uncertain outcome

Keeping Healthy: Next Steps for Cardiac Care

People with chronic conditions are healthy

• 75% of patients with one chronic condition feel healthy • 50% of patients with 2 chronic conditions feel healthy • How do we keep them feeling healthy? • Self reporting is a verifiable indicator of future health

• Specialist care is there to avert acute episodes • Medication, advice about lifestyle

• A hospital that is friendly to older people will provide medical care that maintains and improves health

• Will be “salutogenic” or health making

Oct 26, 2014 15


The provider challenge

Past Situation • Risk averse • Information control • Professional authority • High boundaries

The Coming Changes • Risk accepting • Open information • Patient partnerships • Loosening boundaries

Oct 1, 2013 16


How we have coped in Ontario

• Health Care expenditure in Ontario 2013: $48.9 Billion • 58% of health care budget goes to 5% of the patients almost

all of them chronic with repeated acute care episodes. • If we assume that everyone in Ontario used the system at

least once, 675,000 people cost the system $28.4 Billion • Virtually all of that 5% are patients with multiple chronic

diseases, • It is clear that more services that meet their needs in the

community could avert at least some of that cost and keep them at home longer.

Oct 1, 2013 17

Keeping Healthy: Next Steps for Cardiac Care

Robert Salois Report in QuébecIn 2013

3.4 .Million -‐ total emergency visits

1.1. Million -‐ by ambulance (non-‐ambulatory visits)

18.4 hours -‐average wait for non-‐trauma patients in ER

Some common consequences:

Incontinence – on a gurney without bathroom trips

Confusion-‐ lights on for 18 -‐24 hours

Mobility -‐ poor balance after 8=18 hours on a gurney

Weakness – no regular food service in the emergency room

Bed sores – no regular skin care for patient on gurney

25% who return to ER < 30 days of discharge have a new condition

Oct 26, 2014 18

Patient Engagement Working Group Meeting

Simon Stevens in England (Oct 2014)

Head of NHS proposes a five year plan with five key changes 1. Increase prevention and public health as part of healthcare 2. Give patients and family caregivers far greater control over their

own care including the funding for it 3. Increase NHS support for voluntary sector community based

organizations to support patients and caregivers 4. Take decisive steps to break down the barriers in how care is

provided between family doctors and hospitals, between physical and mental health, between health and social care.

5. More care delivered locally but with some services in specialist centres, organised to support people with multiple health conditions, not just single diseases.

Nov 17 2014 19


Agenda

1. A healthcare experience 2. A step back – healthcare in 3 countries 3. Changes in patient needs 4. Patients Canada is making a difference

Oct 1, 201320


We help making the patient experience count

We base all our work on patient and caregiver stories • People send us their experiences for our website • Patients tell us about their wonderful doctors to nominate them for

Patients Choice Awards • We have awarded more than 30 physicians and others across Ontario with Awards since 2010

• People come to our Open Meetings to share their experiences and learn from others • We have held bimonthly open meetings to hear from patients and families since we began

• We actively search for patient experiences from many different sources • We have members who scan the internet for patient experiences and send them to us

• We discuss our own experiences, from the projects we are involved in and the internet

• We begin every board meeting with the presentation and discussion of a patient experience

Oct 1, 2013 21


We develop key performance targets (KPTs)

• We base all our targets on patient and family experience

• KPTs must be concrete and easily measurable • KPTs must not be qualitative • KPTs must have a positive impact on patient and family experience

• KPTs must be readily implementable

Oct 1, 2013 22

The Patients Canada method of KPT development

• Gather patient and family healthcare experiences

• Bring experiences to our Key Performance Target Panel

• Discuss and elaborate narratives

• Identify patient and family care givers expressed needs

• Identify needs that are and are not met

• Identify policies and practices which meet patient needs

• Review by a panel of doctors

• Refine wording of KPTs

• Select publishable KPTs

Pathway from experience to impact

25-‐Sep-‐14 24

Partnering with patients to improve healthcare


Where our KPTs are making a difference

• We sit on the Health Quality Ontario Primary Care Measurement Group and contribute our Indicators

• We sit on the Accreditation Canada Advisory Panel to review patient centred care

• We are working with CIHI on measurement issues

• We are patient advisers to the PATH project to improve transitions of care in Northumberland County

• We are meeting with LHINs and hospitals to support the patient perspective

• We are members of the CIHR SPOR grant to Ontario (OSSU)

Oct 1, 2013 25


Type 2 Diabetic

• Grandfather of 5, looks pasty and tired Wife checks blood sugar .. 16 (too high) • Calls family doctor – cannot get through Leaves note at Dr’s office -‐ no response • Two days later Wife checks blood sugar .. 23( way too high) • Calls family doctor’s office; Dr says call ambulance • Is left on a Gurney for 14 hours before being admitted • He is stabilized, but remains in hospital for 4 weeks • He is ashamed to be seen in a hospital gown and rarely leaves his bed • His wife brings him no food • Visits him morning afternoon and evening and must pay for parking • Return trip by car instead of private ambulance ($500) • Frequent hospital visits as home invalid for 18 months • Short stay in Nursing home (wheelchair) and death • Many similar stories

Oct 1, 2013 26


A better system: some possible KPTs

• Same day responsive in primary care

• Specialist services outside hospital

• Transport from hospital

• More comprehensive home care

• More support for family caregivers

• Modular wheelchair libraries

Oct 1, 2013 27

Six KPTs for hospitals friendly to older people

1. Hospital gowns are not obligatory and do not erode people’s dignity

2. Parking fees are significantly reduced for patients, frequent visitors and family members

3. There is a third chair in the triage position in Emergency

4. There is an open visiting policy that recognizes the important contribution that visitors make to the health of older people

5. A care plan for older people is devised together with them and their family members and is available to them at all times

6. Hospital food policy is known to family members and encourages them to bring in healthy food the patient likes


Partnering with hospitals on the six KPTs

• We have met with CEOs and VPs of Patient Experience

• We partner with hospitals to elucidate and implement these KPTs

• Upon completion they will be certified as Patients Canada Partners in Patient Centred Care

• They can also become Sponsors of the development and implementation of the next set of KPTs

• We have a CIHR SPOR grant to proceed with the evaluation of the impact of these changes on patient experience and will evaluate their impact on our partner hospitals

Oct 1, 2013 29

web patientscanada.ca email communications@patientscanada .ca facebook Patients Canada Twitter @PatientsCanada

Get in Touch! Join us!

We always need more partners!

Thank you!

November 2014 rounds - RGPEO 2014...

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