By Cheryl Swan
Our patient-centred journey has brought the 6Cs to life
Not so long ago I was assistant director of nursing for patient experience at an acute trust. Trying to improve patient care was sometimes very difficult and I often just saw complaints. In November 2010 I took a strategic decision to move to a smaller unit where I could personally make a difference to patients. I’m now clinical director at Spiral Health, a North West social enterprise which runs nurse-led rehabilitation units. We’ve adopted a pioneering approach to patient care which has helped us translate the 6Cs into real, meaningful action.
The challenge with the 6Cs is how to make them manifest. Concepts such as care, compassion, courage and commitment are worthy goals, but can remain nebulous unless healthcare staff are given the right tools. To understand what these tools should be, we went back to the drawing board and established a working partnership with Helen Sanderson, one of the UK’s leading experts in personalisation.
Our number one goal was to find a way to treat each individual patient as a real person and not just medical condition to be resolved. By treating the whole person, you can mend someone both physically and emotionally. This is vital in our units, where many of our patients are older and have long-term conditions.
We developed an approach known as the patient-centred journey. This ensures that at every phase of their hospital experience – referral, admission, ongoing care and discharge – patients’ individual needs are put at the very centre of decision-making.
At referral stage, our nurse assessor will visit a potential patient on the acute ward at our local hospital or at home and, alongside a medical assessment, will begin to compile a one-page personal profile of them. These profiles will help our staff understand what makes a patient tick. What is important to them? How do they wish to be supported?
On admission, we ensure that new patients are greeted by name and quickly introduced to their nursing teams. We ensure that information about patients is collected efficiently so that they only have to tell their story once. These small gestures reassure patients, many of whom are anxious about what lies ahead. With permission from the patients, their one-page personal profiles are posted above their beds, to help staff get to know them. Patients will also spot that we’ve posted personal profiles of all our staff on notice boards around the unit. As staff, we all share information about our hobbies and interests with patients – it helps us all get to know each other.
During patients’ stays, all discharge planning meetings are held at bedsides and family members and friends are encouraged to attend, if the patient wishes. Involving family members in open, honest bedside meetings has dramatically improved communications and helped many patients transition home more smoothly. We also work hard to personalise visiting hours to suit the patient and personalise their exercise routines and classes.
Every day, we ask patients what would make this a good day for them and staff work hard to fulfill this. Mid stay, all patients are asked, in relaxed bedside interviews, what is working and not working during their stay – and for their suggestions for future changes. This information is collated and fed through our Working Together for Change (WTFC) planning process, which we run through quarterly and which allows us to continuously improve and learn. All hospital stakeholders – patients, staff and managers – take part in assessing the information gathered from patients and deciding action points.
When it comes to discharge, patients are able choose their own departure times. Then a nurse telephones them a week after they’ve returned home to check on progress and ensure that the handover to community teams has gone without a hitch. A lack in joined-up care at this point can cause problems with physical rehabilitation but can also undermine an older patient’s confidence significantly.
One hundred per cent of patients would recommend our services to their family and friends and 100 per cent report that they are treated as an individual during their stay. Average confidence ratings on admission are 1.5/5. Average ratings on discharge are 4.5. Perhaps the most telling statistics are these: the average length of stay in intermediate care is 35 days, but our patients stay for 17 days and 93 per cent of them return to their own homes.
Our patient-centred journey could work exceptionally well in any rehabilitation setting or care of the elderly ward. We feel evangelical about what we’ve achieved and take delight in the many positive reviews we receive from our patients. All it has taken is commitment.
This article first appeared in the British Journal of Nursing, 9 January 2014. Cheryl Swan is Clinical Director at Spiral Health CIC.