Saturday, November 6, 2010

Conference Workshop 26 October 2010

On Tuesday 26 October 2010 ACT Health staff and consumer representatives from HCCA facilitated  workshop at the National Forum on Quality and Safety in Canberra.

The workshop was run in world cafe style and considered the challenges of collaborative health care for service providers and consumers.   Challenges and successes in four areas were discussed:
  • clinical review
  • consumer feedback
  • policy development and 
  • accreditation of health services 
A summary of the issues participants identified is included in this post.

Clinical Review: The role for consumers

Discussion re consumer representative selection, orientation and training 
Ongoing support for the representative
Discussion re involving consumer reps in clinical review and the Root Cause Analysis process. General discussion points:
o May need to clarify terms, technical aspects
o Adds value - the why and what if person
o Organisation has to be ready for consumer involvement
o Need good consumer rep preparation
o Need good understanding of system issues
o Able to relate the Health Care rights
o Time consumer and reimbursement considerations
o Depends on the type of review
o May not be appropriate for more technical reviews
o Questionable benefit in surgical mortality reviews
o Involve in the team but maybe not interviewing the clinicians involved in the incident
o Some medical staff are not comfortable with consumer representation
o Unclear about the benefit of consumer representation 
o Reminds clinicians of the consumer/human/person aspect of harm
o Transparency
o Ask the questions that may be overlooked by clinicians
Comments regarding the benefits of including the consumer/family/carer side of their experience as part of the review – talking with them.

Policy: How to make collaborative care work for both parties

Consensus: Depends on a variety of factors, including:
Consumer background and role:
Training of consumer reps-  formal vs informal support
need a variety of roles and experience of the consumer
challenge of being on committees –not for all consumers other avenues for input like focus groups or commenting on policies can be used
Issue of renumeration and how this affects the type of input provided eg the difference between type of feedback you get from advocacy organisations and individual consumers  

How the consumers are engaged and the culture of the organisation:
The right questions need to be asked of consumers;  
General agreement that proactive and innovative approaches required to engage with potentially marginalised groups ie holding meetings in their community spaces in partnership with local groups eg social clubs
Victorian document and framework for engagement Doing It With Us, Not For Us talked about as a good approach to consumer participation
Aspects of consumer engagement like consumer advisory committees is mandated in some health services and this was seen as effective
consumer-led consultation being achieved in some areas; 
Resources – clinical staff not necessarily resourced to do consultation and consumer engagement as well as clinical loads, this is a challenge for staff. Use of advocacy and interest groups was suggested as means of addressing this, as they can facilitate feedback
health services do consumer engagement in policy best when they foster a culture of debate and learning where they are open to feedback and different perspectives
Highlight the importance of creating a safe space for consumer feedback, and the role that advocacy organisations play in creating that for consumers ie a place where they can give their raw feedback and the organisation can help to work out the key issues and provide those to health service organisations

What setting and type of policy:
Stages of policy – depends on whether new or re-evaluating as to when to get consumer involved
Use of an evidence based approach can assist when policies are across different areas
In larger geographical areas/ different settings there is a need to simplify frameworks and define where different health services cross over – need to seek out existing policies to avoid duplication and use “reactionary” policies (ie, from incidents, sentinel events) to identify gaps
There needs to be flexibility in systems to allow for things to changes following evaluation and monitoring 
Standardising policies and reducing the number of policy documents wherever possible was seen as a good approach to simplify things for staff and consumers
Importance of good governance structures to support consumer engagement and provide transparent policy decision making 

Consumer Engagement: Summary of key points raised in discussions:
Clear message was the fear of retribution, with immediate consequences, hinders consumers providing feedback, particularly complaints.  How can we give consumers confidence that their complaints will not affect the care they receive?  Is this through training, education, or a middle person?  Participants noted Helen Fernando's session where she explained her activities over a number of years - she's a consumer who talks to people waiting for care and treatment in the paediatrics unit - their concerns are taken to staff and clinical leader immediately so that can be addressed then and there.  This information is then collated, fed back to the clinical director, and also to the consumer association.
The importance of feeding back or marketing the changes that result from consumer feedback was also mentioned - in this way it's possible to let the public know that things are and can be done as a result of them providing feedback, and that it's not "pointless".  
Communication skills and training for staff to actively encourage consumers to provide feedback, softening the terminology from "complaints" in that situation, with a view to making service improvements.  Complaints are focussed
Ideas for getting creative about seeking feedback.  eg. focus groups, conversations with the community, using anecdotal/3rd party information. point of time feedback.
Responding to the demographics make-up of the community - providing feedback forms in other languages, involving community groups to support or interpret for people from other cultures.
Do we acquaint people with their legal rights?
Consumer feedback and engagement to influence the clinical governance framework.
Consumer satisfaction surveys - need to ensure that we're asking the right questions, to get the right information, to fix what we do wrong.

Accreditation: The role of consumers

Consumers have a pivotal role: whether consumers are supportive of providers work is integral to the process.  Consumer reps are important for strategic participation planning/operational planning and implementation:

o Rep on Divisional Quality committees
o Rep on awards – internal – state/territory
o Consumer on accreditation steering group
o Consumer surveyor (ACHS) and helping prepare organisations for survey
o Consumer planning and policy
o Consumer feedback

Developing standards 
o Not needed for compliance standards. 
Monitoring standards 
o Mandated for Mental Health surveyors to have consumer involvement – in depth review 
o Regarding service involvement in survey team – looking at processes, making linkages between services
o Issue 1 – what  type of consumer – educated as individual or group (self serving?), health background? – representing culturally safe practices.
Consumer feedback 
o Continuous improvement – must not be threatening.
o Can use consumer as conduit to listen to feedback then reflect back to management?
o Broad representation
o Define Terms of Reference for consumers – orientation important.
Consumer perspective
o Issue 2 - Confidentiality - Should not be a barrier
o Consumers as advocates for consumers and for organisation eg at survey.

Representative on clinical Board 
o the patient journey/experience provides a  different perspective/ contribution to quality improvement
Quality Forums – education of consumers about activities being undertaken
Focus Groups – useful conversations 

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