Partners in Care: Working with families/whaanau to encourage participation

1. Initial area of focus: • Who is involved in my care? • What facilities are available? • What are the routines and general processes? • *The charge nurse had already extended the times the ward was ‘unlocked’ from 2pm-8pm to 8am–8pm • Survey Feedback: • Patients are asked who are key family./whaanau members: • 60% Staff say – always/mostly • 33% Patients/family/whaanau say they were asked • Family/whaanau members are encouraged to be at doctors rounds • 76% Staff say – always/mostly • 28% Patients/family/whaanau say they were encouraged • Opinions of family/whaanau members are listened to and respected • 84% Staff say – always/mostly • 85% Patients/family/whaanau say they were satisfied • Patients & family/whaanau say: Staff say: • What we tried: • 1. Patient (family/whaanau) will know the name of the nurse looking after them. nurse name displayed on bedside information board • Tested in 4 bed spaces • Difficult to find a good place to hang the board so it could be seen • Nurses sometimes forgot to update (only few boards on ward) • Patients, family/whaanau really liked the board and could say who was looking after them • 2. Bed space telephone number included on information board so family/whaanau could call patient direct • Soon identified that only 46% of bed spaces had a telephone at the bedside • Phones purchased to ensure all patients had access to phone • 3. Develop process to update board at start of shift • Boards to be placed at each bedside • updating process to be standardised • 4. Patients will be aware of facilities and ward routines • Work continues to evolve pictorial information sheet for the bedside Background: A proposed change to our admission documentation, included questions about which people are key to the patients well being and who is to be involved in decision making. Partners in Care:Working with families/whaanau to encourage participation Staff would be taught how to use the document, but how do we prepare patients, family/whaanau and staff for working in partnership? • Aims: • Define partners in care • Identify barriers to working in partnership with patients, family/whaanau members • Develop strategy to address key barriers • Contribute to the continued review of the current documentation • Identify training and/or information requirements to support patients, families/whaanau and staff to work as ‘partners in care’ • Partners in Care Forum: • Full day event attended by • Patients • Family/whaanau members • Ward Nurses • Health Care Assistants • Ward Clerk • Physiotherapist • ICU Consultant • Lessons: • Forum was a big commitment from patients & family/whaanau members • Partnership working is about changing attitudes – requires leadership • Stories are a powerful means to engage staff • Method: • Focused on two surgical wards at Middlemore Hospital. • Surveyed surgical inpatients & family/whaanau members and staff over 1 week • Conducted interviews with staff who had been patients or family/whaanau of patients over 4 weeks • Reviewed surgical patient satisfaction survey narrative responses for last quarter • Recruited patients and family/whaanau members for attendance at workshop event Partners in Care Definition: ‘anyone named by the patient that they want to work with them (the patient) and the healthcare team to help make decisions and be involved in care’ Key concepts: partners are patient defined; members of healthcare team can support the patient to find a partner (Whaanau Support Workers, for instance) Next Steps: Develop training resources that ‘script’ key conversations and demonstrate these in action (via video scenarios, for example) to address the staff support/guidance needs as identified in the staff survey. Work to be adopted by the newly formed Patient & Whaanau Centered Care Programme Partners in Care Workgroup: Denise Kivell; David Hughes; Joye Rowlands; Lynne Kane; Melanie Olliff; Ian Kaihe-Wetting; Adrienne Batterton; Maika Veikune; Soli Henare; Sue Cotton; Maggie Spencer

2. Partners in Care:Working with families/whaanau to encourage participation What is the problem? • Families and Whaanau are not consistently part of the ‘care team’ • Some specialty areas work in partnership – Mental Health; Womens & Childrens, etc • 2010 Survey showed 79% patient/whaanau respondents wanted family presence; 70% staff had concerns about ‘open access’

3. Driver for change….. • November 2011, Multidisciplinary Collaborative Care Plan, to be piloted • Patient to be asked: • Who are the key people, family or whaanau you wish to be involved in care and treatment decisions? • Who would you like to be present at the ward round? • ‘Partners-in-care’ concept introduced

4. Aims: • To define ‘Partners-in-care’ • Identify barriers to working in partnership with patients, family/whaanau members • Develop strategy to address key barriers • Contribute to the continued review of the current documentation • Identify training and/or information requirements to support patients, families/whaanau and staff to work as ‘partners in care’

5. Method • Focused on two surgical wards • Surveyed surgical inpatients & family/whaanau members and staff over 1 week • Conducted interviews with staff who had been patients or family/whaanau of patients over 4 weeks • Reviewed surgical patient satisfaction survey narrative responses for last quarter • Recruited patients and family/whaanau members for attendance at Forum

6. Key survey findings…. • 20 patients; 25 staff – 2 surgical wards • Staff made patient/family/whaanau feel ‘welcome’ • 60% staff ask who are key family/whaanau to be involved in care; 67% patients say they weren’t asked • 76% staff encourage key family/whaanau to be at doctors rounds; 28% patients informed they were ‘welcome’ at ward rounds

7. What could we improve? Enable my family/whaanau to be with me (44%) Explain my options (35%) Staff support/guidance? Support families is stressful situations (55%) Involve pts/whaanau in care/treatment decisions (55%) Strategies for working with large families (41%) 12% staff confident working with patients and family/whaanau Key survey findings….

8. Partners in Care Forum Partners in care definition: • ‘anyone named by the patient that they want to work with them (the patient) and the healthcare team to help make decisions and be involved in care’ • Key concepts: partners are patient defined; members of healthcare team can support the patient to find a partner (Whaanau Support Workers, for instance)

9. Initial area of focus: • Who is involved in my care? • What facilities are available? • What are the routines and general processes? The charge nurse extended the times the ward was ‘unlocked’ from 2pm-8pm to 8am–8pm

10. Tests… • Patient information boards • 4 bed spaces initially • Process for updating • Patients/families liked them • Bedside phones • All bed spaces have phones • Information boards being rolled out to all bed spaces • Pictorial bedside information sheet

11. Lessons.…. • Dealing with attitudes • Leadership is key • Anxiety - apparent conflicts between what is law; policy & right thing to do • Forum as a means of engagement • Huge commitment • Other ways to engage to be explored – eg. EBD • Staff as patients/whaanau • how do they provide feedback?

12. Next stage….. • Key message: family/whaanau not visitors • Newly formed Patient & Whaanau Centered Care Board • Development of support guidance • Adopted as work stream • Offers of help to establish