(2003), "Patient centred approach", International Journal of Health Care Quality Assurance, Vol. 16 No. 6. https://doi.org/10.1108/ijhcqa.2003.06216faa.001Download as .RIS
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Patient centred approach
Patient centred approach
Throughout my travels and day-to-day working with health professionals I often hear the phrase "patient centred". One particular time was when I was attending and speaking at a conference focusing on clinical audit. During the conference, two people from a successful clinical audit team provided an interesting presentation regarding their unit's approach and achievements. In essence the team demonstrated that they had a robust system in place whereby the key areas audited mirrored the national, local and professional agendas (i.e. published clinical guidelines and government directives). As part of their closing statement the team mentioned that the next challenges were around ensuring that their approach to clinical audit was patient-centred. Recognising that this was a major shift from their previous approach I asked for more information on what they felt those challenges would be. At that stage they were unable to provide any details relating to the future ways of working of the clinical audit team.
It therefore inspired me to consider the impact of designing a clinical audit system around the patient. Particularly when being patient centred means that a service "must" be shaped on the needs (and insights) of the patient and not the other way round (Department of Health, 2002) and doing this requires a major shift for most organisations (Thompson, 2000). Stone and Young (1992) recognise that putting the customer (patient) at the centre requires an, "outside-in viewpoint" (i.e. one that starts with customer needs as its foundation) rather than the traditional "inside-out model" where organisations determine what the services will look like. Working in this way will obviously give patients (customers) new powers for influencing healthcare services (Department of Health, 2002) and radically change the emphasis of clinical audit. In particular, audit departments will have to undertake some form of market analysis in order to determine the priorities from the patient's point of view. Questions that would need to be asked include:
What do patients want the organisation to audit?
What do patients think about the current audit programme?
What suggestions do the patients have for improving the audit programme?
What are the future needs of patients in relation to audit?
Clearly patients will need to have an understanding of the audit function in order to answer these questions. Another issue that arises from this way of working is in aligning the values of professionals and patients in relation to audit. Particularly, when my experience of speaking with patients has often demonstrated that the areas most important to them is the attitude of the hospital staff, the noise levels in ward areas, the level of catering provided, the cleanliness of the healthcare environment, the parking facilities, the waiting times and the information imparted to them (i.e. lack of, duplication or conflicting). Other areas that cause concern for patients are those reported in the media (i.e. medical errors and stories of abuse) and individualistic worries influenced by their own experiences and those of their friends and relatives.
Therefore to be truly patient-centred clinical audit departments will have to undergo a major shift in their audit schedule because not many patients will mention a need for audit programmes to prioritise clinical outcomes and progress in relation to the national, local and professional agendas. Moreover, the scope of the audit programmes will be much more diverse than they have been in the past, which will impact on demand and resource availability.
Moreover, in order to reflect the necessary changes clinical audit departments may need to rename themselves as healthcare audit departments thereby making the clinical element of their audit remit implicit rather than explicit. Clearly this would have an influence on what the auditors valued in the past and what they need to value in the future. For instance, previous work has concentrated on improving clinical care in order to save lives and/or improve clinical outcomes. So how will it feel to have to consider compromising that agenda for measuring and improving noise levels on wards? Furthermore, how will the audit department balance the requirement to put the patient at the centre in addition to fulfilling the requirements of statutory bodies in relation to auditing healthcare?
One hospital that has managed to find an equilibrium regarding this agenda is the King's College Hospital, London, England. The process they use to put the patient at the centre consists of the following six stages:
Understanding the patients' experience of the existing services by undertaking patient interviews, observation trails, workshops, focus groups and mapping the patient journey.
Demonstrating a need for change by focusing on the areas for change and setting up quality improvement teams.
Analysing the situation through using process maps, and/or cause and effect diagrams.
Designing new processes that centre on the patient.
Testing out new process, and implementing them.
Measuring the impact of the changes implemented.
One area where the hospital attained success was in the area of availability of scan results in outpatient departments. The audit team found that many patients expressed discontent because a high number of scan results were not available in clinics. As a consequence the team utilised the fishbone diagram to determine the cause of the problem. Following on from identifying the key causes of the problem the team facilitated the necessary organisational changes and transformed the availability of scan results in outpatient departments from an average of 68 per cent availability to an average of 87 per cent availability. A further benefit realised from this piece of work included an increase in the level of privacy during the receipt of results from 31 per cent to 57 per cent.
This case in point provides a good example of balancing the two agendas. However, some areas for audit may not be so compatible. Hence, if you have done some good and innovative work in this area, that could help others working in the field, the journal would be very interested to hear from you. After all, it is this sharing of learning that lies at the heart of the journal.
ReferencesDepartment of Health (2002), The NHS Plan. A Plan for Investment. A Plan for Reform, Department of Health, July, London.Stone, M. and Young, L. (1992), Competitive Customer Care: A Guide to Keeping Customers, Croner Publications Ltd, Surrey.Thompson, H. (2000), The Customer-centred Enterprise: How IBM and Other World-class Companies Achieve Extraordinary Results by Putting Customers First, McGraw-Hill, London.