Skip to 0 minutes and 9 seconds PROFESSOR KEVIN ROONEY: There’s an old Palestinian proverb which states that cannot fatten a cow alone by weighing it. So improvement is not just about measurement. However, if you can’t measure it, you cannot improve it. So without measurement we would never be able to know if a change actually leads to improvement.
Skip to 0 minutes and 31 seconds This week you have learned about Deming’s system of profound knowledge, and how we can use it as a lens to examine compassionate care. What is it about a system or workplace that sometimes makes it easier to bring compassionate than others? What is it about the human side of change that motivates people to provide compassionate care? And why is it that it’s sometimes easier to provide compassionate care at day times rather than night times or weekends? All of these questions will enable us to draw up a list of barriers, and as a result, a list of solutions that we can hypothesise and test out as part of our theory of knowledge.
Skip to 1 minute and 13 seconds You have learned about the different diagnostic tools, such as the cause-and-effect diagram and process maps. And there’s some other examples of tools that you could use. In your process map, you’ve identified bottlenecks and barriers to providing compassionate care, as well as times it may be easier to do so.
Skip to 1 minute and 34 seconds If we wish to provide compassionate care, we need to be able to define it very well. This is a duck. How do I know it’s a duck? Well, I know it’s a duck because it looks like a duck, it walks like a duck, and it quacks like a duck. If only the operational definition of compassionate care was as easy. Some people feel that compassionate care is purely just patient satisfaction. But I put it to you it is far more than that. It is patient experience, including qualitative, patient-reported outcome measures. A patient may be satisfied with their care. The care they receive may not fulfil the Institute of Medicine’s six domains of quality health care.
Skip to 2 minutes and 21 seconds We also need to strive to maintain the focus on our patients, because we want our care to be as relational as possible, while as well being as transactional as possible, so that fact is efficient and warm. And as a result, everything works as in the top right-hand side of this graph.
Skip to 2 minutes and 45 seconds There are three different types of measures we need to be aware of. The first of all is an outcome measure. Deming described this as the voice of the customer. So an example of that may be a patient satisfaction score. Then we have the voices of the working of the system of the process measures. That may be something like the percentage of patients whose relatives speak to them 24 hours. And last but not least, Deming described the voice of the system, the unintended consequences of balancing measures. So you make an improvement here, just to have a detrimental effect elsewhere.
Skip to 3 minutes and 25 seconds But if we really want to improve compassionate care and measure it, don’t take my word for it. We need to ask our patients. We’d need to ask them who provided them with compassionate care, how did they do it, why did they do it, and under what circumstances, and then we can really learn. I’d like to share some examples you can measure in your workplace of compassionate care. In my board, everyone wears a “Hello, My Name Is” badge as advocated by the late Kate Granger. But it’s not just wearing the badge that’s important. It’s actually saying to the patients who you are, and why you’re here, and what you’re going to do.
Skip to 4 minutes and 6 seconds Instead of asking patients what’s the matter, we need to ask them what matters to them, because we may find out things that worry them and unsettle them, and as a result, we can solve these problems. So the use of what matters to you boards for each patient is very good.
Skip to 4 minutes and 25 seconds Patients dying in their preferred place of death is a very good compassionate care outcome measure. The vast majority of us wish to die at home, surrounded by our friends and families. However, unfortunately, due to the way the system is designed, a lot of them are still dying in hospitals. So again, actually people getting to die in a preferred place of death is another way to measure compassionate care.
Skip to 4 minutes and 53 seconds Here we have from Ardgowan hospice a nice example of a You Said to We Did board. So the patient said that their mattress was uncomfortable. What did Ardgowan do? Well, they changed the mattress and he had a better night’s sleep. And such boards are a nice example of person-centered care.
Skip to 5 minutes and 16 seconds It has long been known that shared decision-making actually includes patient outcome. But this nice scientific paper also shows that shared decision-making, as well as treating patients with dignity and respect, provides even higher satisfaction a and positive outcomes for our patients.
Skip to 5 minutes and 40 seconds Who would have thought that the aviation industry could teach us how to provide compassionate care? But if you think about it, the stewardess, when she goes through the safety brief, advises us to put on our own oxygen mask on ourselves first and then deal with others. So first of all, we need to take care of ourselves, and them of each other, and then other people, patients, and their families. So if we really are serious about providing compassionate care. It’s not only that patients need to ask what matters to them, but their staff. These are some of the nurses from my ICU. And sometimes I make decisions and don’t involve them.
Skip to 6 minutes and 21 seconds And you get results on the right-hand side of the slide. In the workplace, as a result, they are less likely to burn out. Our scores for the patient safety culture would improve, and we’d see greater recruitment and retention of our staff.
Skip to 6 minutes and 41 seconds Christina Gunther-Murphy from IHI shared with me a nice example of a way to daily measure the joy in the workplace. That’s a marble jar reward system. Your staff put marbles in a jar when they leave work. And it means they are either happy or unhappy. And it gives you an immediate temperature of the culture and the staff that day in the workplace.
Skip to 7 minutes and 5 seconds We also need to start focusing on the bright spots, and learning from what works well. Think of all the useful information you can find in letters of praise from patients and their families. In general, if someone takes the time to write, and not just satisfied users, it’s likely the care they have received has moved and touched them. As a result, we can use the bright spots from these letters to test and implement as part of our work for the future.
Skip to 7 minutes and 37 seconds And finally, we need to move away from a culture of looking at adverse events to a culture of looking at always events. We need patient important measures to supplement the patient satisfaction scores. I we are asking patients what matters to them, we should also be asking them whether they felt the doctor or nurse understood what matters to them. I’m going to finish up with a quote from The Little Prince. And he said, “If you want to build a ship do not gather men together and assign tasks. Instead teach them the longing for the wide endless sea.” Doctors, nurses, and health care professionals should all be taught the longing for care and for compassion.
Measuring your progress
At this stage, a key question to ask yourself is Do you have any baseline information you can build from? The above presentation by your week lead, Professor Kevin Rooney, introduced you to the importance of data in improvement projects.
There are three types of measurement to look at when you undertake an improvement project. These are:
An outcome measure is linked to your aim. If your improvement project does not have an outcome measure, it is difficult to justify the time and expense necessary to undertake it. An outcome measure is a way of demonstrating that the aim has been met, and helps to convince others that the project is worthwhile. When looking at compassionate care, you may be interested in how your workplace is performing in terms of communication, for example. To examine this, your outcome measure may be concerned with the percentage of patient satisfaction questionnaires that report a very good or excellent score for communication with next of kin and information on admission.
What is the process telling you? How well it is functioning? These measures are early indicators of improvement and are logically connected to the outcome. For example, this measure might look at the percentage of patients’ next of kin who meet with the admitting doctor within one hour of admission to the ward.
This measure looks at the system from a different perspective. What happened to the system as you improved the outcome and process measures? This looks at the unintended consequences. Sometimes when we optimise one part of the system, we de-optimise the system as a whole by making other things worse. For example, this measure might look at the impact of how long it takes the doctor to clerk in a patient, and the impact of this on the number of operating cases or number of clinic appointments scheduled per day.
Share one outcome measure for your project on the discussion board and comment on at least one other person’s measure.
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