Friday, September 28, 2012

Partnering with Consumers

One of the workshops I attended at the Australasian Conference onSafety and Quality in Health Care in Cairns earlier this month focussed on how to help health services to take up the challenge of partnering with consumers to ensure they comply with the ‘Partnering with Consumers’ Standard within the National Safety and Quality Health Service Standards (NSQHSS).

‘Partnering with Consumers’ is Standard 2 of the 10 NSQHSS.  It is a particularly important Standard because it provides the framework for active partnership with consumers by health service organisations. It is also one of the most challenging for many health service providers, because it is overarching and applies in conjunction with Standard 1, ‘Governance for Safety and Quality in Health Service Organisations’, in the implementation of all other Standards.
Consumer-centred Care is also the first of three core principles for safe and high-quality care as stated in The Australian Safety and Quality Framework for Health Care. This means providing care that is easy for patients to get when they need it; making sure that health care staff respect and respond to patient choices, needs and values; and forming partnerships between patients, their family, carers and healthcare providers.

The workshop was led by Karen Luxford, Director of Patient Based Care at the Clinical Excellence Commission (CEC) in Sydney, and Nicola Dunbar, Program Manager at the Australian Commission on Safety and Quality in HealthCare with responsibility for a range of program areas, including the deteriorating patient, primary health care, and patient-centred care.

In 2012, the CEC adopted an organisation-wide policy to proactively include principles of patient-centred care within the CEC, to ensure a consistent approach to consumer engagement.

Consumer Advisors were recruited in September 2010 and matched by interest and relevant experience to CEC programs and projects.

Evaluation was through a case-controlled qualitative survey in November 2011.  105 participants were divided into four groups – CEC employees, CEC consumer advisors, CEC working group members and CEC event attendees.  Participants completed a questionnaire anonymously online.

Interestingly, the top three potential barriers identified by participants were as consumer advisors being ‘disregarded as not a health professional’, ‘having an axe to grind’ and ‘lack of clinical knowledge’.

The following headings cover some of the challenges reported by both patients and clinicians.

Communication

Good communication was often found to be lacking. Patients reported not having access to medical staff when things were going wrong; and when the patients knew something was wrong – they were simply not listened to and, if they were in pain, they were just given pain killers to mask the symptoms.

This comment from a consumer, who was told by a nurse that she understood exactly what he was going through after hitting his finger with a hammer, illustrates the point:

‘You can watch someone hit their finger with a hammer a hundred times but until you experience what it’s like yourself you really don’t know what it’s like to hit your finger with a hammer.’

Concept of Consumer

Many clinicians have difficulty with the concept and do not like the term. Some feel there needs to be a focus on the patient and a differentiation of their needs in comparison to family and carer’s needs.  They feel the use of the word ‘consumer’ distorts this.

Concept of Partnership

The concept of partnership refers to a two way relationship characterised by trust and respect and open communication and varies depending on the context. Karen Luxford and Nicola Dunbar acknowledge that this raises the power differentiation between clinicians and patients. The term partnership, as used in a legal concept, refers to sharing responsibility which is not the case with health. The responsibility lies firmly in the hands of the clinicians.

Evidence of the benefits of adopting Patient-Centred Care

In recent years, a number of studies show distinct improvements in hospitals’ uptake of a patient-centred care approach. In one study a comparison was done between two hospital outpatient units - one adopted a patient centred care approach and the other did not; results showed the first had shorter stays and therefore lower costs. Additional positive findings from these studies included significant operational benefits, more satisfied staff, higher staff retention rates, decreased costs, fewer medication errors and adverse events, and improved patient compliance.

Engagement in Governance

It is important to involve consumers who have had direct experience with the health service.  Consumer representatives must be comfortable and briefed so they can speak up at committees. Consumer representatives play a vital role in contributing to quality improvement processes and it is important that they are respected and valued in committee work, otherwise the engagement is tokenistic.

As the only consumers attending the workshop, we drew attention to the role of consumer peak organisations, explaining their important role in support and training.

Unexpected benefits of consumer involvement in governance are that consumers can see the problems more simply and are often solution focused. Standard 2  has been found to be the least met standard because it is seen as being a bit ‘out of the box’. Australia could do well to follow one of the policies in United States health system, where health service providers lose 2% of their Medicare reimbursement if they fail to publish their consumer data.

The Australian health system needs to shift its focus from accreditation to adopting an ongoing process of quality improvement that is responsive to patient needs. Clinical handover, the deteriorating patient, infection control are all part of this process.

How do we measure how we are making a difference

Audit tools currently focus on quantitative data; it is important to think about ways to gather qualitative data.

Conclusion

The need for ‘partnership with consumers’ in governance and care is growing and the role of patients and carers in safety, models of care, program design and review of the organisations performance is key to the establishment of effective partnerships with health service managers and the clinical workforce.

Karen Jameson
HCCA Policy Officer

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