Compassionate Care Bundle

Initiative Type
Service Improvement
Status
Deliver
Added
27 August 2019
Last updated
05 September 2019

Summary

Compassionate care is central to person centred care. Along with the safety and costs reductions associated with person centred care, placing the person at the centre of their care and keeping them informed is the right thing to do.

The Beryl Institute defines the patient experience as the sum of interactions (Wolf, Niederhauser, Marshburn & La Vela, 2014) and this is precisely what the Compassionate Care Bundle aims to achieve; a Compassionate Care experience based on the sum of the interactions during the care episode(s). Nursing and healthcare staff are in the business of caring, and this philosophy reconnects staff with their caring purpose and places the focus on the person and their health journey. Our goal is to ensure the persons journey is framed within the Compassionate Care Bundle, across all settings and includes all staff.

The project has successfully navigated healthcare system challenges to deliver change, improvement and innovation in their own health service and was presented at the Clinical Excellence Queensland Showcase 2019.

Key dates
Aug 2018
Apr 2019
Partnerships
Approximately 160 community members helped design the processes, survey and interview questions and trial of Patient shadowing and willingness to engage with Compassionate care initiatives.

Aim

To improve the levels of engagement with our patients, decrease complaints, improve inclusion and engagement of patients and families in decision making and improve satisfaction. The initiative also provides an improved capture of patient feedback, improving service design based around what patients needed and how to improve access and usability.

Benefits

  • The use of My Boards to keep patients informed has increased from 60 per cent to 89 per cent.
  • Patient reported scores for AIDET have shown an increase from 40 per cent to 96 per cent over all net recommender rates have improved to 98 per cent.
  • Patient reported knowledge of their condition and preparation for discharge has grown consistently to over 96 per cent across all categories.
  • Self reported compassion has improved across all facilities.

Background

The concept of ‘Care Bundles’ evolved from taking a number of small evidenced-based interventions and using them together to deliver a set target for a client. The concept of ‘bundles’ was developed to help care providers deliver the best, most reliable care possible (Institute for Health Improvement, 2016). Typically, care bundles have been used in a specific clinical context, an example being clients with diabetic foot ulcers or Chronic Obstructive Pulmonary Disease (COPD)
(Green, Bell & Mays, 2017). Care bundles however, can be applied to many different contexts.

Solutions Implemented

A recent study for cancer care clients defined the patient experience through five key elements; environment experience, emotive experience, behavioral experience, comfort experience and social experience. The elements of the SWHHS Compassionate Care Bundles fall within these elements of patient experience.

Environment experience

  • My board
  • Person centred care posters and badges

Emotive experience

  • Compassionate care
  • Personalised health care and plans

Behavioural experience

  • Health literacy
  • Collaboration in health teams
  • Senior leader rounding

Comfort experience

  • Environment
  • Pain
  • Rounding
  • Responsive care that can change with the needs of the person

Social experience (Deshwal and Bhuyan, 2018)

  • Holistic care
  • Staff are friendly, open and honest

Evaluation and Results

Patient rounding, patient experience surveys and Patient Shadowing are techniques that have been used to evaluate implementation, patient satisfaction of their experience with the service and compassion.

Lessons Learnt

Changing staff perceptions about how they interact with patients has been difficult as they believe that they introduce and include patients in their care. It is not until you use patient feedback and focus groups that this information helps in changing the staff perceptions. Engaging patients in Human based Co-design processes is challenging as they are at times worried to provide feedback especially in small communities, this takes significant engagement to be able to get patients to be open and honest with feedback especially at point of care. The #Hello my Name Is .. was surprising as the staff really engaged with the concept and patients found it extremely useful as they knew who staff were and staff introduced themselves. Patients have been very complementary of the initiative.

Another lesson learnt was that being too prescriptive about the how and when can at times stifle innovation and implementation as each hospital in the group like to put their own style on the program of initiatives.
Monitoring implementation and hardwiring is beneficial through observational auditing, patient rounding and interviewing of observations and experience and Leader Rounding is powerful process for gathering experiential data from patients to drive staff hardwiring of improvement bundles.

References

Australian Commission on Safety and Quality in health care. (2012). National Safety and Quality Health Service Standards. Sydney
Barber, S. (2018). Patient care in decline: AIDET as a tool for improvement. Radiological Technology. 89(4). Pp. 419-421
Deshwal, P., Bhuyan, P. (2018). Cancer patient service experience and satisfaction. International Journal of healthcare Management. 11(2). Pp. 88-95
Harrison, P., Hara, P., Pope, J., Young, M., Rula, E. (2011). The impact of post discharge telephonic follow-up on hospital readmission. Population health Management. 14. Pp. 27-32
Institute of health Improvement. (2016). Evidence-Based Care Bundles: What is a Bundle? Viewed 9th April 2018 from http://www.ihi.org/resources/Pages/ImprovementStories/WhatIsaBundle.aspx
Malott, D., Ayala, L. (2008). The Root of All Satisfaction, Patients Want Caregivers Who Provide Information and Compassion. Press Ganey Australia, Satisfaction Snapshot.
Naffe, A. (2012). Post discharge follow-up phone call. Heart & Lung: The journal of acute and critical care. 41(1). Pp. 102
Paterson, L. (2012). Managing touch point value: 10 steps to improve customer engagement.
Rondinelli, J., Ecker, M., Crawford, C., Seelinger, C & Omery, A. (2012) Hourly rounding implementation: a multisite description of structures, processes and outcomes. Journal of Nursing Administration. 42(6). Pp. 326-332
Sandlin, D., Tranter, L., Atkinson, N., Grothaus, C., Tracy, K., Burtschy, T., Lawson, V., Stephens, K., Welch, N., Dietz, E., Schletker, J., Sanborn, J., Goins, P., Edwards, K., Garrett, S., Klaine, L., Thomas, D., Klein, C., Crone, M., Herthel, C., Smith, S., Adkins, D., Cummins, A., Bruggemann, J., Osborn, R. (2017). Partner in care: Improving the patient experience through AIDET. Journal of Paranesthesia Nursing. 29(5). Pp. 10-11- 18 -
Sawyer, T, McBroom, K, Granger, B., Bride, W., Harper, M. (2011). Making a difference: a shared position to address patients understanding of discharge instruction and post discharge adherence. Heart Lung.40. pp. 386
Skaggs, M.K., Daniels, J.F., Hodge, A.J., DeCamp, V.L. (2018). Using evidence-based practice service nursing bundle to increase patient satisfaction. Journal of Emergency Nursing. 44(1). Pp. 37-45
Tan, M., Evans, K.H., Braddock, C.H., Shieh, L. (2013). Patient whiteboards to improve patient-centred care in the hospital. Postgraduate Medical Journal. 89. Pp. 604-609
Torpie, K. (2014) Customer service Vs. Patient care. Patient experience journal. 1(2). Pp. 6-8
Van Vliet, L.M., Epstein, A.S. (2014). Current state of the art science of patient-clinician communication in progressive disease: patient’s need to know and need to feel known. Journal of Clinical Oncology. 32(31). Pp. 3474-3478
Whitty, J.A., Spinks, J., Bucknall, T., Tobiano, G., Chaboyer, W. (2016). Patient and nurse preference for implementation of bedside handover: Do they agree? Findings from a discrete choice experiment. Health Expectations. 20. Pp. 742-750
World Health Organisation. (2016). Action on Patient Safety- High 5s. Viewed 9th April 2018 at http://www.who.int/patient safety/implementation/solutions/high5s/en/
Weigand, L. (2013). Customer Service: the Nursing Bundle. Journal of Emergency Nursing. 39(5). Pp. 454-455

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Key contact

Chris Small
Executive Director Srategy Performance and Governance
South West Hospital and Health Service
(07) 4505 1565
Chris.Small@health.qld.gov.au