Action 5.06

Use the Partnering with Consumers Standard to guide the development of processes for comprehensive care.

Collaborate with patients, carers and families

Collaborating with patients, carers and family members can ensure that essential baseline information about a patient’s condition is established so that deterioration, improvement and strategies for ongoing care can be identified. For example, the carer of a person with advanced dementia is likely to be the most accurate source of information about that patient’s usual capabilities, behaviours, preferences and medical history.¹

As well as being experts in care needs, information providers and part of shared decision making, carers and other family members may also choose to be actively involved in a person’s care.² Health service organisations can support carers in this role through policies and programs that enable practical strategies such as providing beds or chairs for overnight stays, refreshments, discounted parking and flexible visiting hours. An example is the 40 unique carer zones [video] that were commissioned in single rooms across the new clinical services building at Blacktown Hospital, Sydney. Formal, agreed procedures governing the program were created in partnership with consumers.

Implement shared decision making

Shared decision making is a critical strategy for effectively collaborating with patients, carers and families. Shared decision making is a process of incorporating the best available clinical evidence into a discussion about a patient’s values and preferences to make decisions about care.³ Shared decision making offers a framework for working jointly with patients (and carers and families, if the patient chooses to have them involved) to make decisions about the comprehensive care plan that are based on a shared understanding of the patient’s goals of care, and the risks and benefits of clinically appropriate options for diagnostic tests, treatments, interventions and care.⁴

One model for shared decision making describes five questions that clinicians can use to guide the process^4,5:

1. What will happen if the patient waits and watches?
2. What are the test or treatment options?
3. What are the benefits and harms of each option?
4. How do the benefits and harms weigh up for the patient?
5. Does the patient have enough information to make a choice?

Another model, framed from the patient perspective, is Ask Share Know, which encourages patients to ask three questions about their care.

The Commission has also developed a Question Builder tool to help patients, carers and families consider questions to ask their doctor and prepare for a clinical consultation.

Use decision support tools

Decision aids are a type of decision support tool that clinicians, patients, carers and families can work through together. Specific decision aids have been developed for some health topics, and an online inventory of existing tools is available.

A generic decision aid tool has also been developed to help clinicians, patients, carers and families work together to make decisions if no specific decision aid is available.

Strengthen teamwork processes

No single clinician can deliver all aspects of the care that a patient needs.⁶ Different clinician groups bring specific expertise and need to work together to provide the complete health care that a patient requires. Effective teamwork and collaboration rely on establishing and communicating clear and shared goals. These goals should have meaning for each team member who contributes to the effort to achieve them.⁷

Use processes for clinical handover, communicating critical information and documenting information (described in the Communicating for Safety Standard) to ensure that clinicians collaborate effectively to plan and deliver comprehensive care.

Interventions to improve teamwork vary, but broadly include⁸:

• Training to increase individual competence of team members and offer the opportunity to practise skills (for example, in simulation or role play)
• Structured communication protocols to increase reliability of communication
• Clear articulation of the roles, responsibilities and accountabilities of different team members
• Work and process redesign to provide structured opportunities for effective team communication.

The professional cultures associated with different disciplines and specialty groups can strongly influence the way that clinicians approach goal-setting and decision-making.⁷ These cultures contribute to differing degrees of engagement in working collaboratively with other disciplines and professions.^7,9 Set up processes to support clinicians to understand their own accountabilities in relation to planning and delivering comprehensive care, and those of other members of the team.¹⁰ Strategies may include:

• Using structured handover and communication tools¹¹
• Using checklists to prompt discussion of patient, family and clinical concerns during bedside rounds¹²
• Using tools to prompt participation from different professional groups at critical moments – for example
  • the surgical safety checklist
  • the central line insertion checklist
• Identifying roles and responsibilities relating to comprehensive care in position descriptions and scope of clinical practice documentation
• Identifying accountabilities relating to collaboration, teamwork, shared decision making and other key skills, attitudes and behaviours required for comprehensive care in performance review processes
• Identifying clinical and executive leaders to lead collaborative practice and act as role models
• Developing processes to manage issues and feedback relating to multidisciplinary collaboration.

Work with clinical leaders to directly and specifically deal with the expectations for clinicians’ participation in teamwork for comprehensive care. Suboptimal collaboration and communication can be especially apparent in the relationships between clinicians, and between clinicians and other professional groups.^13-16 Such problems have been attributed to issues arising from traditional professional hierarchies and cultures, and the relative seniority of the clinicians involved.⁷ Improving the organisation of care delivery routines (such as structured multidisciplinary bedside rounds) within the workflow can help provide opportunities for more effective communication and collaboration between clinicians and other professional groups.^17-19

Monitor, analyse and report on system effectiveness

Develop systems consistent with the requirements of the Clinical Governance Standard for reporting and analysing adverse events relating to failures of teamwork and communication, and for ensuring that clinicians are professionally accountable for working collaboratively with patients, carers, families and each other in the planning and delivery of comprehensive care.

Use the Partnering with Consumers Standard to guide the development of processes for comprehensive care.

Collaborate with patients, carers and families

Pre-admission screening and assessment processes require collaboration with patients, carers and family members to ensure that essential baseline information about a patient’s condition is established. This is so that deterioration, improvement and strategies for comprehensive care can be identified. For example, the carer of a person with advanced dementia is likely to be the most accurate source of information about that patient’s usual capabilities, behaviours, preferences and medical history.¹

Carers may be able to assist in providing strategies for managing a patient’s care during a procedure, and may wish to be actively involved in the provision of care.

Implement shared decision making

Shared decision making is a critical strategy for effectively collaborating with patients, carers and families during pre-admission assessment and comprehensive care planning. Shared decision making may occur between the referring clinician and the patient before admission to the day procedure service. However, do not assume that this has happened: include requirements relating to shared decision making in by-laws and screening processes, and provide information about shared decision making to all clinicians, including referring clinicians.

Shared decision making is a process of incorporating the best available clinical evidence into a discussion about a patient’s values and preferences to make decisions about care.³ Shared decision making offers a framework for working jointly with patients (and carers and families, if the patient chooses to have them involved) to make decisions about the comprehensive care plan that are based on a shared understanding of the patient’s goals of care, and the risks and benefits of clinically appropriate options for diagnostic tests, treatments, procedures and care.⁴

One model for shared decision making describes five questions that clinicians can use to guide the process^4,5:

1. What will happen if the patient waits and watches?
2. What are the test or treatment options?
3. What are the benefits and harms of each option?
4. How do the benefits and harms weigh up for the patient?
5. Does the patient have enough information to make a choice?

Another model, framed from the patient perspective, is Ask Share Know, which encourages patients to ask three questions about their care.

Use decision support tools

Decision aids are a type of decision support tool that clinicians, patients, carers and families can work through together. Specific decision aids have been developed for some health topics, and an online inventory of existing tools is available.

A generic decision aid tool has also been developed to help clinicians, patients, carers and families work together to make decisions if no specific decision aid is available.

Strengthen teamwork processes

No single clinician can deliver all aspects of the care that a patient needs.⁶ Different clinician groups bring specific expertise and need to work together to provide the complete health care that a patient requires. Effective teamwork and collaboration rely on establishing and communicating clear and shared goals. These goals should have meaning for each team member who contributes to the effort to achieve them.⁷

Use processes for clinical handover, communicating critical information and documenting information (described in the Communicating for Safety Standard) to ensure that clinicians collaborate effectively to plan and deliver comprehensive care.

The professional cultures associated with different disciplines and specialty groups can strongly influence the way that clinicians approach goal-setting and decision-making.⁷ These cultures contribute to differing degrees of engagement in working collaboratively with other disciplines and professions.^7,9 Set up processes to support clinicians (including credentialed medical and other practitioners) to understand their own accountabilities in relation to planning and delivering comprehensive care, and those of other members of the team.¹⁰

By-laws should address the expectations for clinicians’ participation in teamwork for comprehensive care. Suboptimal collaboration and communication can be particularly apparent in the relationships between clinicians, and between clinicians and other professional groups.^13-15 Such problems have been attributed to issues arising from traditional professional hierarchies and cultures, and the relative seniority of the clinicians involved.⁷ Improving the organisation of care delivery routines (such as structured multidisciplinary bedside rounds) within the workflow can help provide opportunities for more effective communication and collaboration between clinicians and other professional groups.^17-19

Monitor, analyse and report on system effectiveness

Develop systems consistent with the requirements of the Clinical Governance Standard for reporting and analysing adverse events relating to failures of teamwork and communication, and for ensuring that clinicians are professionally accountable for working collaboratively with patients, carers, families and each other in the planning and delivery of comprehensive care.

Examples of evidence

Select only examples currently in use:

• Resources and tools, including decision aids or pathways, that outline accountabilities of clinicians and promote collaborative practice (for example, whiteboards, electronic journey boards)
• Examples of activities that have been implemented and evaluated to improve organisation of care delivery routines and workflow
• Observation of collaborative work to plan and deliver care
• Feedback from consumers about how clinicians worked together to deliver care
• Data from patient and carer experience surveys about collaboration and teamwork among clinicians.

Collaborate with patients, carers and families

Collaborating with patients, carers and family members can ensure that essential baseline information about a patient’s condition is established so that deterioration, improvement and strategies for ongoing care can be identified. For example, the carer of a person with advanced dementia is likely to be the most accurate source of information about that patient’s usual capabilities, behaviours, preferences and medical history.¹

As well as being experts in care needs, information providers and part of shared decision making, carers and other family members may also choose to be actively involved in a person’s care.² Health service organisations can support carers in this role through policies and programs that enable practical strategies such as providing beds or chairs for overnight stays, refreshments, discounted parking and flexible visiting hours.

Implement shared decision making

Shared decision making is a critical strategy for effectively collaborating with patients, carers and families. Shared decision making is a process of incorporating the best available clinical evidence into a discussion about a patient’s values and preferences to make decisions about care.³ Shared decision making offers a framework for working jointly with patients (and carers and families, if the patient chooses to have them involved) to make decisions about the comprehensive care plan that are based on a shared understanding of the patient’s goals of care, and the risks and benefits of clinically appropriate options for diagnostic tests, treatments, interventions and care.⁴

One model for shared decision making describes five questions that clinicians can use to guide the process^4,5:

1. What will happen if the patient waits and watches?
2. What are the test or treatment options?
3. What are the benefits and harms of each option?
4. How do the benefits and harms weigh up for the patient?
5. Does the patient have enough information to make a choice?

Another model, framed from the patient perspective, is Ask Share Know, which encourages patients to ask three questions about their care.

The Commission has also developed a Question Builder tool to help patients, carers and families consider questions to ask their doctor and prepare for a clinical consultation.

Use decision support tools

Decision aids are a type of decision support tool that clinicians, patients, carers and families can work through together. Specific decision aids have been developed for some health topics, and an online inventory of existing tools is available.

A generic decision aid tool has also been developed to help clinicians, patients, carers and families work together to make decisions if no specific decision aid is available.

Strengthen teamwork processes

No single clinician can deliver all aspects of the care that a patient needs.⁶ Different clinician groups bring specific expertise and need to work together to provide the complete health care that a patient requires. Effective teamwork and collaboration rely on establishing and communicating clear and shared goals. These goals should have meaning for each team member who contributes to the effort to achieve them.⁷

Use processes for clinical handover, communicating critical information and documenting information (described in the Communicating for Safety Standard), to ensure that clinicians collaborate effectively to plan and deliver comprehensive care.

Interventions to improve teamwork vary, but broadly include⁸:

• Training to increase individual competency of team members and offer the opportunity to practise skills (for example, in simulation or role play)
• Structured communication protocols to increase reliability of communication
• Clear articulation of the roles, responsibilities and accountabilities of different team members
• Work and process redesign to provide structured opportunities for effective team communication.

The professional cultures associated with different disciplines and specialty groups can strongly influence the way that clinicians approach goal-setting and decision-making.⁷ These cultures contribute to differing degrees of engagement in working collaboratively with other disciplines and professions.^7,9 Set up processes to support clinicians to understand their own accountabilities in relation to planning and delivering comprehensive care, and those of other members of the team.¹⁰ Strategies may include:

• Using structured handover and communication tools¹¹
• Using checklists to prompt discussion of patient, family and clinical concerns during bedside rounds¹²
• Using tools to prompt participation from different professional groups at critical moments – for example
  • the surgical safety checklist
  • the central line insertion checklist
• Identifying roles and responsibilities relating to comprehensive care in position descriptions and scope of clinical practice documentation
• Identifying accountabilities relating to collaboration, teamwork, shared decision making and other key skills, attitudes and behaviours required for comprehensive care in performance review processes
• Identifying clinical and executive leaders to lead collaborative practice and act as role models
• Developing processes to manage issues and feedback relating to multidisciplinary collaboration.

Work with clinical leaders to directly and specifically deal with the expectations for clinicians’ participation in teamwork for comprehensive care. Suboptimal collaboration and communication can be especially apparent in the relationships between clinicians, and between clinicians and other professional groups.^13-16 Such problems have been attributed to issues arising from traditional professional hierarchies and cultures, and the relative seniority of the clinicians involved.⁸ Improving the organisation of care delivery routines (such as structured multidisciplinary bedside rounds) within the workflow can help provide opportunities for more effective communication and collaboration between clinicians and other professional groups.^17-19

Monitor, analyse and report on system effectiveness

Develop systems consistent with the requirements of the Clinical Governance Standard for reporting and analysing adverse events relating to failures of teamwork and communication, and for ensuring that clinicians are professionally accountable for working collaboratively with patients, carers, families and each other in the planning and delivery of comprehensive care.