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Medical professionalism matters

Exploring the real life challenges experienced by today’s medical professionals and providing support that doctors want and need

Moving from ‘what’s the matter?’ to ‘what matters to you?’

Paul Jebb (@pauljebb1) is the Experience of Care Professional Lead at NHS England and a proud nurse. Here, he writes about how Always Events can boost an organisation’s ability to deliver truly person-centred care. 

In order to find out what matters most to those in our care, we need to take a more person-centred approach, which not only includes developing compassionate care across all professional groups within health care, but also how health care staff interact with each other.

The Medical professionalism matters event on ‘the compassionate doctor‘ in Cardiff helped delegates explore this further and to look at why the delivery of care has changed over the years.

Care has changed. We have developed a lot which has been supported by the growth in technology. We have more wide-reaching roles and we have removed barriers to how health care staff work with people to ensure they can meet their health needs across a team, rather than relying on individuals to deliver specific care needs.

Teaching compassion has always been a topic of discussion. My view is that compassion can’t be taught, but it can be nurtured and developed, which is exactly what we need to do to ensure we meet the needs of people who access the services we deliver.

My view is that compassion can’t be taught, but it can be nurtured and developed, which is exactly what we need to do to ensure we meet the needs of people who access the services we deliver.

Developing compassion across professional groups was seen as vital to meet the needs of those who access health care services – plenty of ideas were discussed and debated, including:

  • Visible leadership
  • Rewarding progress rather than just ongoing monitoring of status quo
  • Measuring things that are seen as hard to measure, and not falling into the trap of thinking things like compassionate care can’t be measured
  • Working with patients/families and carers as well as across a broad range of professional groups and support staff was also key to ensuring a culture of compassion was created and sustained.
Artwork summarising the main discussion points from 'the compassionate doctor' event

Summary artwork of the discussion at ‘the compassionate doctor’ event in Cardiff by Cara @GraphicChange

Linked to the Compassion in Practice Strategy (2012), the patient experience team at NHS England has been working with the Institute for Healthcare Improvement (IHI) and Picker (Europe) to look at how NHS organisations in England can develop consistent ways to meet the individual needs of patients to ensure that care is patient-centred and delivered in partnership with them and those close to them.

Always Events®, initially conceived in the United States by the Picker Institute and now led by the Institute for Healthcare Improvement (IHI), laid the foundation for the development of IHI’s trademarked Always Events framework. This framework provides a strategy to help health care providers identify, develop, and achieve reliability in person- and family-centred care delivery processes.

Always Events are aspects of the patient experience that are so important to patients and family members that health care providers must aim to perform them consistently for every individual.

(You can read more information on the IHI work around Always Events and developing patient and family-centred care here.)

An Always Event is a clear, action-oriented, and pervasive practice or set of behaviours that:

  • provides a foundation for partnering with patients and their families
  • ensures optimal patient experience and improved outcomes
  • serves as a unifying force for all that demonstrates an ongoing commitment to person- and family-centred care.

Always Events are aspects of the patient experience that are so important to patients and family members that health care providers must aim to perform them consistently for every individual. These can only be achieved with the patient firmly placed as a partner in the development of the event. The co-production is the key to ensure organisations meet the patients’ needs and what matters to them.

An Always Event must meet four criteria:

  1. Important: Patients and family members have identified the event as fundamental to improving their experience of care, and they predict that the event will have a meaningful impact when successfully implemented.
  2. Evidence-based: The event is known to contribute to the optimal care of and respect for patients and family members (either through research or quality improvement measurement over time).
  3. Measurable: The event is specific enough that it is possible to determine whether or not the process or behaviours occur reliably. This requirement is necessary to ensure that Always Events are not merely aspirational, but also quantifiable.
  4. Affordable and sustainable: The event should be achievable and sustainable without substantial renovations, capital expenditures, or the purchase of new equipment or technology. This specification encourages organisations to focus on leveraging opportunities to enhance the care experience through improvements in relationship-based care and in care processes.

NHS England, IHI and Picker (Europe) have been working with provider organisations in England to test out the Always Events methodology and will soon be enrolling other organisations for phase two of the project that will test a toolkit on how to develop Always Events within the NHS. These trusts have been recognised by IHI as pioneers in this work.

Great work has been done and this has happened as staff members have engaged with patients and carers as partners, not just a token patient in the room. When developing an Always Event, the pioneer Trusts have aimed to have 50% staff and 50% patients/carers in the room to work it through. This has led to so many great ideas that have ensured care is focused on what really matters to the patient.

Great work has been done and this has happened as staff members have engaged with patients and carers as partners, not just a token patient in the room.

Lancashire Care NHS Foundation Trust has developed their first Always Event as:

  • We will always support you in your transitions of care
  • We will always support you in moving on in care

These Always Events were established by asking the service users who accessed the community learning disability team, what was good, what was bad, what needed improving and how they could improve. Some great ideas came from the co-production workshop including the use of photographs on letters so service users could actually see who was sending the letter or who was going to be providing their care next.

Blackpool Teaching Hospitals NHS Foundation Trust is working with patients who have accessed stroke treatment to develop an Always Event to ensure their discharge is safe and, in the words of their patients, “I always know what to do when I get home or, if not, I know who to contact.”

This has included work with all staff groups including pharmacy staff. Medication is a key area to work with patients and their carers to ensure understanding of what is explained or taught on discharge. In this area, quality initiatives around ‘teach back’ have been explored and implemented, not to test patients’ knowledge but to test how well the discharge co-ordinator has explained the medications, when to take them, side effects etc.

Some great ideas came from the co-production workshop including the use of photographs on letters so service users could actually see who was sending the letter or who was going to be providing their care next.

As we move forward with this exciting programme NHS England, IHI and Picker (Europe) will be developing and testing an Always Event toolkit on how the NHS should co-produce Always Events; this will be tested over and over again and will be published in 2016.

For me, the development of Always Events is truly the development of partnership care, changing the culture of organisations to enhance the care they deliver to their patients. This programme can help us make sure what matters to patients is the priority within the relevant systems and process of care delivery.

If you have been involved in Always Events or have other ideas about how to deliver compassionate care, please leave your comments below. 

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Discussion

  1. Caroline Mawer says:

    I really like the ‘Always Event’ concept!
    But as a patient, and as a GP, is the Lancashire example really quantifiable?
    I think my own doctors think they are doing well by me – but personally I am quite sure that dealing with many of them is the very worst part of having a chronic illness.

    • Paul Jebb Paul Jebb says:

      Thanks for your comments Caroline, I have discussed this with the team at Lancashire Care NHS FT. Always events are specific to each organisation and as you are aware always events are based on quality improvement methodologies developed by the Institute of Healthcare improvement (IHI) and a key component of this is measuring the outcome. The difference with always events is that they are co-designed with people who use services, their families and carers and staff. Together the co design team determines what the always event is and what improvement ideas to test, measure and evaluate to ensure they are effective and making a real difference for people who use the individual services, their families and carers and staff.
      Regards Paul

  2. Russell Cartwright says:

    Hi Caroline, thanks for your comments. I have asked for a bit more info about this work.

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