In the past three weeks I have had two very uncomfortable meetings with family members of patients who have died in Dumfries and Galloway Royal Infirmary. Both were daughters who had submitted complaints about the ‘lack of care’ delivered to their loved one in the last few weeks of their lives. These meetings were difficult for all involved as both daughters were clearly grieving and emotions ran high. In both cases what lacked were clear and timely communication, empathy and understanding. Regardless of what may have been going on “behind the scenes”, this was what was played out to the family and as a result their memories of the last few days and hours of their loved ones will be tarnished forever.
It was as a result of a similar experience that I was personally involved in some years ago that started me on the journey that would result in ‘Enhanced Patient Experience.’ I was very fortunate to be able to discuss these issues with some close friends and we came up with the idea of running one day work-shops where we raise these issues, discuss possible solutions, use improvement methodology to put them in place and, hopefully, make a difference.
In Dumfries Peter Bryden picked up the baton and organised our first day in November of last year. It was quite a small affair with 37 participants in 7 teams from primary and secondary care but feedback, both verbal and written, was overwhelmingly positive so we planned more events. A second, in March of this year, was cancelled due to heavy snow and the focus shifted to September 2013.
Around this time Jean Robson, Director of Education, saw Professor Jason Leitch deliver a talk on Person Centred Care and was inspired. Jean was keen to invite Jason to D&G to give the same talk and we wondered whether we could tie the two together. It would, however, be a waste to bring someone of Jason’s talents all the way to Dumfries to talk to 37 people so we had to think big. Peters advertising campaign kicked into gear and before we knew it we had 30 teams with over 200 participants and we had shifted to Easterbrook Hall.
On Friday September the 6th we ran our second event which, in Twitter speak, would be known as #DGEPE2. Jason had been joined by Professor Craig White, Assistant Director at NHS Ayrshire and Arran, to deliver a morning of patient experience, person centred care and improvement methodology. The main outcome of the morning session was a driver diagram detailing an improvement plan for each team to take back to their workplace. Each team had a facilitator who would guide them through this process and also follow up their work.
The afternoon saw the return of Ewan Kelly, Programme Director for Healthcare Chaplaincy and Spiritual Care at NHS Education for Scotland, who had spoken at our inaugural event. Ewan was preceded by the powerful clip on youtube from the Cleveland Clinic. If you have yet to see this it can be viewed here. Ewan introduced us to the concept of Values Based Reflective Practice (VBRP). This is a process where a team will discuss a case in a structured and protected fashion. It is important that there is strong facilitation and team members feel ‘safe’. One person relates the story or case and then is asked questions, which are framed “I notice…….and I wonder” to ensure no direct blame is apportioned. VBRP is a very powerful tool and the objective here is to take the concept away and use it as groups in individual departments and also in day to day practice by asking “Whose needs are being met?”
We ended the day with a question and answer session involving all 3 keynote speakers and Jeff Ace, Chief Executive Officer and Andrew Johnston, Chairman of the board. This proved to be a lively and interesting session which, amongst other things, proved that our Board and CEO are very supportive of the Enhanced Patient Experience’ project.
So what did the attendee’s tell us about the event? We have been through the feedback and once again it is overwhelmingly positive and constructive. We are very grateful to all who took the time to complete the feedback which will we will use to plan our future events. The negative aspects mainly reflect that the Hall was too cold and audio-visual left a little to be desired which we have fed back to the venue… nothing has been decided but, in future, we intend to aim towards several smaller sessions 2 or 3 times a year with a large 200+ event every 2 years.
Are we making a difference? This is harder to answer and I suspect it is too early to say. What will tell us we are succeeding? Again hard to answer however, of all the great work undertaken by the Scottish Patient Safety Programme there is one small thing which never fails to impress me. 10 years ago I was not the best hand washer! I was not alone in this in the medical profession. Once or twice a ward round I would stop by a sink and quickly rinse….if you were lucky. Nowadays I am rubbing alcohol gel on constantly – as I enter ward, as I leave it, after every patient encounter and sometimes for no reason at all – I just haven’t done it for a while. Its second nature. And I know if I don’t do it a medical student or healthcare assistant will quite happily say “Dr Donaldson, you haven’t washed your hands.” One day I would like it if kindness, caring and compassion for our patients was equally as second nature. Even during a bad day we were able to reflect on their predicament and suffering and be kind. So if a healthcare assistant turns to me one day and says “Dr Donaldson, I didn’t like the way you spoke to that patient. I think you should go back and apologise” then I’ll know we are getting somewhere.
Enhanced Patient Experience will return……
Ken Donaldson is a Consultant Physician and Peter Bryden is Patient Experience & Safety Facilitator within the Acute Services Directorate, DGRI