Our healthcare: what patients want from patient centred standards

1
Our healthcare what patients want from patient
centred standards

• Patricia Wilkie
• Chairman Lay Committee
• Academy Medical Royal Colleges

2
General Medical CouncilGood Medical Practice
2006

• 79 principles and values on which good practice
  is based
• Guidance, not a statutory code
• Must is an overriding principle
• Should used to describe how the overriding duty
  will be met
• Serious or persistent failure to follow he
  guidance will put registration at risk

3
Patient standards. 1

• Discussion about treatment and options (7)
• Explanation about what is happening (AE)
• Reason for investigations
• Explanation of test results
• Information about medicines and their side
  effects (3)
• Accurate information about how one feels post
  operatively (After Bruster et al 1994)

4
Patient standards.2

• Competent diagnostician (3)
• Competent surgeon (3)
• Treating patient as a whole
• Continuity of care (general practice)
• Knows limits of expertise (3)
• Knows how to guide patients to information

5
Two definitions of a good physician

• The most important difference between a good and
  indifferent clinician lies in the amount of
  attention paid to the story of the patient Sir
  Farquahar Buzzard (1871-1945)
• A great physician understands diagnosis and is
  not he who has a remedy for all symptoms Dr
  Jacob Bigelow (1787-1879)

6
Patient centred care.1

• Should provide patient access to protocols and
  guidelines
• Should give patient choice in treatments provided
• Should use patient information in service design
• Should place premium on patient views
• Should challenge vested interests by asking who
  is the customer

7
Patient centred care.2

• Should share information with patients
• Should share information with public
• Should ensure collaborative planning involving
  patients and professionals
• Should develop advocacy for those least able to
  speak out
• Should publish audit results

8
Problem for organisation how patients are
described

• Demand, costs, benefits, input and output
• Voters, clients or consumers of services
• Bearers of rights or pursuers of litigation
• The leg ulcer in bed 14
• Frozen sperm in the deep freeze
• Points in a graph
• Numbers crunched in a soft ware programme (after
  Roy Porter,1997)

9
Organisation patient standards and patient
centred care. 1

• Services to focus directly on patient
• Patient surveys in clinical and non clinical
  departments
• Focus on high quality patient outcomes
• Partnership between patient and clinical team
• Use of reliable instruments for measuring and
  monitoring patient care

10
Organisation patient standards and patient
centred care. 2

• Publish results of surveys
• Use results of surveys to improve service
• Understand how management affects the provision
  of patient centred care mixed sex wards
• Involve and work with patients, voluntary
  organisations and the public

11
Organisational readiness

• Must have an attitude that accepts patient
  standards and patient centred approach
• Must have commitment to make the changes to
  produce a patient centred environment
• Needs sufficient enthusiasm to maintain changes
• Patient centred approach requires reinforcement
  and reward

12
Patient standards in education

• Patients as teachers
• Patient involvement in research
• Patient involvement in curriculum development
• Town and Gown partnerships
• Improving health care

13
Patients as teachers. 1

• Patients playing patient role for training and
  examination
• Patients involved in creating roles
• Patients involved in assessment
• Patients involved in giving both formative and
  summative feedback about interpersonal,
  communication and physical examination skills
• Implications for GMC, Colleges and PMETB

14
Patients as teachers. 2

• Patients involved in developing and enhancing
  the quality of teaching
• Patient narratives to capture the patient
  experience
• Patient involvement in curricula development in
  undergraduate and post graduate education and
  training

15
Patients involved in research

• Not just as a participant
• Patients involved in defining questions
• Patients choosing research topics
• Patients involved in research design
• Patient testing of information leaflet
• Disseminating of research information
• Research results into practice
• Cochrane Collaboration and Involve

16
Town and Gown the community

• DOCC- parents of children with chronic illness as
  teachers in the community of trainee physicians
  (USA)
• Community Involvement Team work with mental
  health users (University of Central Lancashire)
• Queens Anniversary Prize for higher and further
  education

17
Improving health services

• UK Expert Patient Programme
• Maternity services
• Care of children in hospital
• Potential for fewer complaints
• Potential for more satisfied patients
• Pilot studies and evaluation needed

18
Changing heart and minds

• Persuading guardians of curriculum
• GMC
• Post graduate deans
• PMETB
• Colleges and Faculties

19
Patient and public awareness of GMP standards

• Patients expect high quality care given by
  competent doctors
• Unlikely that most patients know the standards
  they should expect
• Public and patients unaware of role of GMC
• GMP not widely available distribute and show
  widely

20
Patient feedback

• Patient surveys but not instant
• Use of Blogs
• Patient opinion websites, government and problem
  specific
• Comments books widely available
• Use of complaints to organisations, NCAS and to
  GMC
• Surveys must reflect patient standards

21
Who to consult, listen to and appoint?

• Individual patients who have direct experience
• Patient members of voluntary organisations who
  have group knowledge
• Patient advocates who have wide general knowledge
  of the patient perspective (After Charlotte
  Williamson 2007)

22
Who to appoint or consult?

• Organisations need to find the right people
• Non-executive directors need to have an
  understanding and knowledge of the patient
  standards and patient centred care
• Applies to GMC Council, proposed GMC lay
  associates, PMETB Board and DH working groups and
  committees and commissioners

23
A conversation

• First doctor. It seems to me that you are
  locating them wrongly. The heart is on the left
  and the liver is on the right.
• Second doctor. Yes in the old days that was so,
  but we have changed all that and now practice
  medicine by a completely new method. Molière Le
  Médecin Malgré Lui 1666

24
Overweight patients wanting treatment

• Advice from Dr John Abernethy (1764 -1831)
  Madam, buy a skipping rope