Action 6.03

The Partnering with Consumers Standard has specific actions (Action 2.03, 2.04, 2.05, 2.06, 2.07, 2.08, 2.09 and 2.10) relating to health service organisations’ processes for involving patients in their own care, shared-decision making, informed consent and effective communication.

Effective clinical communication requires the active participation of patients, carers and families.

Health service organisations should use established processes from the Partnering with Consumers Standard when:

• Conducting patient identification and procedure matching

• Performing clinical handover

• Communicating critical information.

Ensure that communication with, and information provided to, patients, carers and families about procedures, treatments and care (including follow-up care after discharge) reflect health literacy principles, and are delivered in a way that supports effective partnerships (see Actions 2.08, 2.09 and 2.10).

Ensure that the organisation has support systems for patients who need assistance to communicate. This could include ensuring that interpreters are available, and putting in place processes to support patients with hearing or vision problems.

Support patients, carers and families to effectively use clinical communication processes and tools to actively take part in communications.

Implement processes to review internally developed patient information relating to clinical communications by conducting regular patient feedback or experience surveys (see Action 2.09).

Case study 2 demonstrates a number of strategies to engage patients, carers and families in communications about their care.

Case study 2

This case study shows the links between the Communicating for Safety Standard and the Partnering with Consumers Standard, and demonstrates how organisations may implement a range of strategies, processes and tools that support effective patient–clinician communication, person-centred care and safe transfer of care.

This case study is an example of a public health service organisation with a number of statewide specialist services that has implemented a person-centred approach across the organisation. The organisation’s culture and plan are guided by the Australian Charter of Healthcare Rights, with strong leadership and consumer input (as indicated by positions such as Manager for Patient Experience and Consumer Participation, and a broad range of volunteers with diverse responsibilities).

The organisation promotes six ‘good ward management principles’:

• Having all patients reviewed within two hours of admission

• Decision making by senior multidisciplinary team members

• Daily interdisciplinary rounds for all patients

• Allocation of patients to a designated team

• Active management of patients to ensure that they are hospitalised for only as long as clinically necessary

• Appropriate transfer of care on discharge.

The workforce within the organisation manages a multitude of complex patient transitions, from community to hospital, and from emergency department to acute, subacute (with aged care or geriatric streams), internal rehabilitation, residential care, home and community.

An electronic communication system ensures consistency of information and provides the nursing workforce with more time for patient engagement. The type and extent of patient engagement depend on the transitions and the age, status, ability and preferences of the patient.

The first thing is there’s a multitude of complex transitions – from community to hospital, transfer from subacute to acute to transition care to community or residential care. Subacute encompasses a number of streams of care including aged care with geriatric medicine and rehabilitation. It can be quite difficult to engage the patients, in which case you have to work through the family. With a younger cohort of patients it’s more straightforward. Inpatient care transitions are about involving the patient from day one, being open and transparent, setting goals, reality checks about where we’ve got to, and having a key liaison or ‘go to’ person so there’s always someone the patient can interact with in terms of the evolution of their discharge plan. It’s the go-to backwards and forwards. – Gerontologist

The organisation has instituted a range of models of care and tools for service delivery. Bedside handover is used throughout the service, but with wide variability in the processes used in different wards. The Patients Come First strategy encompasses five areas, each with its own specific objectives:

• Australian Charter of Healthcare Rights

• Patient information

• Person-centred care education

• Patient feedback

• Consumer and carer engagement.

A number of other initiatives are aimed at patient engagement. For example, ‘Let me know’ has members of the workforce wear ‘Let me know’ buttons to prompt patients and families for feedback on their care or to encourage them to call back with any postdischarge needs. The message is also visible on rental TV messages, screensavers and other materials.

Tools: ‘Let me know’ buttons worn by the workforce invite patients and families to share their thoughts, ideas and preferences for care.

The service uses tools for consumer feedback where volunteers are trained to gather electronic and paper-based feedback from patients in multiple languages. A Project Manager for Consumer Participation collects patient stories as a ‘powerful teaching tool for change’, celebrating positive experiences and identifying service gaps. A Volunteer Manager audits the input from volunteers twice a year as part of patient feedback, working with the Patient Liaison ‘Go to’ person, who communicates patient and family concerns at weekly team meetings using ‘journey board discussions’ at the ward level. The service also uses a toolkit for person-centred care developed jointly by the state and Australian governments to focus on person-centred care for older people. This toolkit was designed to ‘do things with rather than for people’. There is also a care service for family members to stay overnight, and flexible visiting hours that promote family engagement in care.

Tip: Volunteers can be used to gather authentic patient and family feedback about care, but this feedback requires a subsequent plan to deal with issues that may emerge.

The pre-admission tool is a multidisciplinary assessment that prompts patient inclusion in goal-setting for care, including advance care planning, preferences and values relating to what is to be achieved, ‘tempered with what is possible and realistic’. Members of the workforce engage patients in ‘goal-directed transitions’ where they are included in open and transparent goals, time frames, and realistic achievements for their rehabilitation or discharge.

Tip: Engaging patients in plans for their transitions in care requires not only understanding patient preferences, but also providing information on what is realistic to expect.

Patient whiteboards are used to engage patients in two-way communication. A system of scheduled daily multidisciplinary rounds are provided in general medical wards to include patient and family participation, and ensure that information is provided in plain English, demystifying medical jargon. Before the rounds, team members conduct a ‘daily journey board huddle’ to make sure ‘everyone is on the same page’. Discharge planning is variable in different wards, but patients are provided with a 24-hour post-discharge hotline to communicate their concerns back to the hospital. General medical wards also provide videos and USBs with discharge information that patients can take home to check the information provided in hospital and ensure that they understand instructions from doctors, pharmacists or other members of the team.

It takes the team, the nursing team, the allied health team, the medical team and the family and patient. Everybody’s on board. We’re here for the patient.

– Nurse manager

Lessons learned:

• Large public organisations can embed person-centred care with strong leadership and commitment, and by capitalising on multidisciplinary input.

• When carefully managed, the volunteer workforce can provide valuable input into quality care processes and ensure continuity of engagement with patients and families.

• Goal-directed planning can make discharge plans more efficient.

• Person-centred care models that have been found to be effective on some wards need to be carefully evaluated for their applicability to other wards.

Adapted from the Deakin University and Griffith University review Engaging Patients in Communication at Transitions of Care.

The Partnering with Consumers Standard has specific actions (Action 2.03, 2.04, 2.05, 2.06, 2.07, 2.08, 2.09 and 2.10) related to health service organisations’ processes for involving patients in their own care, shared-decision making, informed consent and effective communication.

Effective clinical communication requires the active participation of patients, carers and families.

Ensure that policies and procedures describe patients as key participants in their care, and how patients, families and carers can be involved in clinical communication strategies and associated processes. This involvement could include:

• Consumer membership on relevant committees
• Complaints, compliments and feedback systems
• Administration of regular patient feedback or experience surveys
• Processes to review internally developed patient information (see Action 2.09).

Although contact time with patients in day procedure services is likely to be short, it is still important to consider how systems and processes support effective communication with patients, including listening to them. This is particularly important for situations when a high risk for communication errors exists, such as patient identification, procedure matching, communication at transitions of care (handover), and communication when there is new or emerging critical information on admission or post-discharge.

Support clinicians to communicate with patients, families and carers at the times identified as high risk. Where appropriate, support patients, families and carers to actively participate in communications about care.

Ensure that the organisation has support systems for patients who need assistance to communicate. This could include ensuring that interpreters are available, and putting in place processes to support patients with hearing or vision problems.

Ensure that communication with, and information provided to, patients, carers and families about procedures, treatments and care (including follow-up care after discharge) reflect health literacy principles (see Actions 2.08, 2.09 and 2.10).

Examples of evidence

Select only examples currently in use:

• Training documents about person-centred care, patient partnerships and communication strategies
• Observation of clinicians’ practice that shows use of the health service organisation’s processes for partnering with consumers
• Records of interviews with clinicians that show that they understand the health service organisation’s processes for partnering with consumers
• Policy documents about clinical communications that are based on principles of consumer engagement, health literacy and shared decision making
• Policy documents that describe mechanisms for consumer involvement in organisation-wide clinical communication strategies and associated processes, including
  • membership on relevant committees
  • complaints, compliments and feedback systems
  • administration of regular patient feedback or experience surveys
  • processes to review internally developed patient information
• Terms of reference and membership of the consumer advisory committees responsible for providing input and feedback on the organisation-wide communication strategy and associated processes, including internally developed patient information
• Committee and meeting records in which consumer input or advice on the health service organisation’s clinical communication processes was discussed, including any actions taken as a result of this advice
• Structured communication processes that include an opportunity for patient, carer and family engagement
• Records of the use of interpreters and other support services for consumers who need help to communicate
• Information for patients and carers about their roles in clinical communication processes.

The Partnering with Consumers Standard has specific actions (Action 2.03, 2.04, 2.05, 2.06, 2.07, 2.08, 2.09 and 2.10) relating to health service organisations’ processes for involving patients in their own care, shared-decision making, informed consent and effective communication.

Effective clinical communication requires the active participation of patients, carers and families.

Health service organisations should use established processes from the Partnering with Consumers Standard when:

• Conducting patient identification and procedure matching
• Performing clinical handover
• Communicating critical information.

Ensure that communication with, and information provided to, patients, carers and families about procedures, treatments and care (including follow-up care after discharge) reflect health literacy principles, and are delivered in a way that supports effective partnerships (see Actions 2.08, 2.09 and 2.10).

Ensure that the organisation has support systems for patients who need assistance to communicate. This could include ensuring that interpreters are available, and putting in place processes to support patients with hearing or vision problems.

Support patients, carers and families to effectively use clinical communication processes and tools to actively take part in communications.

Implement processes to review internally developed patient information relating to clinical communication by conducting regular patient feedback or experience surveys (see Action 2.09).