Over one half of all patients admitted to the Rehabilitation service at the Royal Melbourne Hospital reported that they would like greater involvement in the decision-making process regarding their care (The Royal Melbourne Hospital Post Discharge Patient Experience Survey, n=32, July 2013 – June 2014).

This was surprising given the treating medical and allied health teams within the Rehabilitation Unit conducted biweekly ward rounds, case conferences, communication chart rounds and family meetings (where required) for all patients admitted to the service.

Evidence suggests that greater patient (and family) engagement and involvement in discharge planning and care, improves the overall hospital experience and related outcomes.

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Strategy for change

Patient and Family Shadowing is an effective way of allowing staff to view the process through the patient’s eyes. It “…involves having a committed and empathic observer follow a patient and family throughout a selected ‘care experience’ to view and capture details of the entire care experience from the point of view of the patient and family” (DiGioa, 2011).

The Patient Experience Team and the treating medical team in the Rehabilitation Unit developed the following:

• The Patient and Family Shadowing proposal • A summary of existing literature • A step-by-step action plan and person allocated for actions • Tools including:

• A tip sheet for new ‘shadower’• Patient shadowing protocol and template for data collection• Patient information sheet and consent form

• Quality Assurance checklist

Fifteen patient and family shadowing ‘care experiences’ were observed in August / September 2014. A number of shadowers completed more than one.

By using grounded theory, the qualitative data was independently analysed by two separate analysts and data validated with the wider medical group.

To undertake Patient and Family Shadowing in order to improve the Post Discharge Patient Survey score on question 11 “Did you feel as involved as you wanted to be about decisions about your care?”. The ‘medical ward rounds’ were selected given the ability of the medical team to influence patient involvement in the relevant ‘care experience’.

Introduction

Aim

Methods

Results (continued)

Acknowledgements

Hanna, Georgina¹; Doan, Katie¹; Ng, Louisa²; Khan, Fary²

¹ The Royal Melbourne Hospital (RMH), Transformation and Quality Unit – Patient Experience Team, Melbourne, Victoria, AUSTRALIA

² The Royal Melbourne Hospital (RMH), Royal Park Campus – Rehabilitation Unit, Melbourne, Victoria, AUSTRALIA

The power of empathy: Greater involvement of patients in decisions

in their care through Patient and Family Shadowing

Results

Measurement of improvement

Emerging themes: •Arrival of ward rounds, introductions and overall impressions•Provision of explanations and addressing concerns •Ward round members being present and the patient/family members•“The (Discharge) Plan” for the patient / family •Comfort and privacy

This data was discussed amongst Senior medical staff at their monthly meetings, each discussion occurring a month or two apart, with input from the Patient Experience Team.

The survey data post-intervention (Oct-Dec 2014) showed a statistically significant improvement in Question 11, “Did you feel as involved as you wanted to be in decisions about your care?”.

Q 6. When you had important questions to ask

a doctor, did you get answers that you could understand? This data relates to responses of

“yes always” July 2013-June 2014 = 50% (n=32) and Oct-Dec 2014 = 75%

(n=18), was not statistically significant

result but certainly clinically relevant.

50%

75%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

More patients got answers they could understand, when they had important

questions to ask a doctor

Pre-intervention (July 2013-June2014) n=32 Post-intervention (Oct-Dec 2014) n=18

84%

94%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

More Rehabilitation patients would recommend RMH to a relative or friend

Pre-intervention (July 2013-June2014) n=32 Post-intervention (Oct-Dec 2014) n=18

Q 21. Would you recommend the Royal Melbourne Hospital to a relative or friend? This data relates to responses “yes”, rating it either “8, 9 or 10” out of a possible 10.July 2013-June 2014 = 84% (n=32) and Oct-Dec 2014 =94% (n=18), was not statistically significant result but certainly clinically relevant.

Discussion

Effects of changes

“Doctors are all engaged, this is an issue that’s important to them”

-Medical Head of Rehabilitation Unit

“Themes from the shadowing highlighted areas we were aware of but didn’t realise their impact (on patients) and (discovered) new ways to do things better”

-Medical Head of Rehabilitation Unit

“I can see that doctors are paying more attention to the data and changing practice “

-Nurse Unit Manager

The Medical Head of the Rehabilitation Unit subtly changed her language to encourage more patient ownership of their own journey “How long do you think you’ll need to be in Rehab for?”

Lessons learnt

Careful consideration was given to how best engage the doctors. Striking a balance between formal presentation of data versus giving ‘time and space’ to reflect, was key for success.

Strong medical leadership and commitment with a clear directive from the hospital Executive to improve kick started the process, and kept the momentum going.

Based on their shadowing experiences, the doctors reflected on and changed their practice without need for formal rules or prescribed and/or audited processes.

It is possible that the improved results may be attributable to an increase in the response rates to the survey, potentially providing more representative results.

Conclusion

Message for others

Engage the interest and vision of the medical leaders in the area and align their vision and priorities with those of the organisation.

Find the correct balance between use of data to stimulate and inspire versus allowing space and time for the doctors to reflect and generate their own solutions.

Invite doctors to collect the data themselves, rather than management “forcing” data upon them. This strategy ensured that treating medical clinicians were fully engaged and facilitated a rich empathic experience that resulted in a positive change in practice.

It is not about ‘adding more time’ - but doing things ‘differently’ for improved person-centred outcomes.

Amy Levinson, Dr Aladdin Elmalik, Dr Lucy Selleck, Julie Louie, Dr Brent Doolan, Dr Bronwyn O’Gorman, Dr Astrid Richards and Dr Krystal Song.

The survey data post-intervention (Oct-Dec 2014) showed a clinically relevant improvement in Question 6 “When you had an important question to ask a doctor, did you get answers that you could understand?” and in Question 21 “Would you recommend The Royal Melbourne Hospital to a relative or friend?”