2. Partnering with Consumers

Sharing decisions and planning care

Action 2.6

The health service organisation has processes for clinicians to partner with patients and/or their substitute decision maker to plan, communicate, set goals and make decisions about their current and future care

Intent

Patients receive safe and high-quality care by being involved in decisions and planning about current and future care.

Reflective questions

What systems and processes are available for clinicians to partner with patients or their substitute decision-maker to plan, communicate, set goals, and make decisions about current and future care?

How does the health service organisation review the use and outcomes of systems and processes for partnering with patients or their substitute decision-maker?

Key tasks

  • Develop policies and processes (or review existing policies and processes) to involve patients or their substitute decision-maker in planning, communication, goal-setting and decision-making for their current and future care, and review workforce compliance with these policies and processes

  • Set up mechanisms to support communication between clinicians and patients or their substitute decision-maker

  • Periodically review the systems for partnering with patients or their substitute decision-maker in their own care.

Strategies for improvement

Hospitals

Partnering with patients in their own care is integral to the delivery of safe and high-quality person-centred health care. Ensure that effective processes are in place to support clinicians to partner with patients or their substitute decision-maker in the planning, communication, goal-setting and decision-making relating to their current and future care.

Review current systems for supporting clinicians and patients to be partners in care

If systems are already in place to support clinician and patient partnerships, review the strategies outlined below and consider any additions or updates.

If the organisation does not have systems in place to support partnerships between clinicians and patients, use the strategies outlined below to develop or adapt policies and processes for partnering with patients in their care.

Create a supportive organisational culture

Supportive organisational climates are vital for achieving person-centred care, in which partnerships between clinicians and patients become the established norm. Strategies may include:

  • Engaging leadership and governing bodies to act as champions for partnerships between clinicians and patients
  • Incorporating the importance of clinician and consumer partnerships into the organisation’s strategic planning, vision and goals
  • Engaging consumers in organisational governance and strategic planning to support organisational redesign (see Action 2.1 for guidance)
  • Providing enough resources to support clinicians to partner with patients in their care
  • Providing education and training to equip clinicians to partner with patients in their care; further information on education and training for clinicians is provided in Action 2.7.1

Enable communication and knowledge exchange between clinicians and patients

Patients can be partners in their own care in many ways, including shared decision making, self-management of their condition and personalised care planning. For these partnerships to be meaningful, both the clinician and the patient must feel trusted and respected. Good communication is vital to foster this trust and respect, and drive clinician and patient partnerships.1

Use the following strategies to encourage communication and knowledge exchange between clinicians and patients:

  • Review the current admissions process to see what information is provided to patients and how that information is given; identify any communication barriers and areas for improvement, and implement solutions to overcome these; consider engaging consumers in this review process by holding informal discussions with patients in waiting rooms, or discussing the admission process during a consumer advisory group or focus group
  • Provide consumers with access to information and resources in a format that meets their needs; this may include
    • general information about their health, condition and healthcare arrangements
    • information and tools about how they can be involved in their own care
    • information that has been developed specifically for them
  • Provide patients with timely and open access to their healthcare record, test results and other clinical information relevant to their care
  • Encourage clinicians to create an environment in which patients feel confident asking questions, and in which clinicians respond positively to patient needs; this may involve speaking with patients in a neutral environment, away from the clinical setting
  • Use technology such as telehealth, and mobile and tablet apps to interact and share information with patients before, during and after their care, especially as a strategy for facilitating clinician and patient partnerships across long distances; ensure that any healthcare records transmitted electronically are encrypted or aligned with privacy regulations
  • Develop a policy and procedure to support active engagement of patients during bedside rounding and clinical handovers
  • Support patients to take part in shared decision making with decision support tools, such as information sheets, pamphlets and videos that provide structured information about their health options
  • Implement self-management of certain aspects of care, such as medicine use, to encourage engagement.2-5

The Agency for Healthcare Research and Quality6 provides practical advice for improving clinician and patient communication, including tools to educate consumers on how to be involved in their own care.

The SA Health Guide for Engaging with Consumers and the Community7 provides a tool to help clinicians encourage questions from their patients.

The Commission and Healthdirect Australia developed Question Builder8, a free web-based tool to help consumers prepare for a visit to the doctor. In addition, the Commission’s Top Tips for Safe Health Care9 can help consumers, families, carers and other support people get the most out of their health care.

Develop policies and procedures to guide care planning in partnership with patients

Involve patients in the development of any current and future care planning, such as:

  • Inpatient treatment and recovery planning
  • Treatment and preventive health strategies for ongoing care outside the health service organisation
  • Advance care planning (see Action 5.9).

Strategies for involving patients in care planning may include systematically discussing patient preferences for care during admission consultations, and at regular times during their care. This may be facilitated by including patients in bedside rounding and clinical handovers.5

Develop meaningful measures to monitor success

Monitoring and measuring the success of clinician and patient care partnerships is important for ensuring that systems are relevant and useful to consumers and the organisation.1, 5

Strategies for monitoring and measuring the success of the systems may include:

  • Collecting informal feedback from patients in waiting rooms and during rounds
  • Collecting formal feedback from consumers through submissions and events, such as focus groups or community meetings
  • Surveying patients to self-report on their experience and satisfaction with the level of engagement they had in their care.

Use the outcomes of these evaluations to set realistic goals for improving partnerships between clinicians and patients.

Several established measures and tools can be used to capture patient-reported outcomes, including:

For guidance on undertaking consultations and surveys, see the Scottish Health Council’s Participation Toolkit.10

Tools and resources to help guide the integration of clinician and patient care partnerships include:

  • The NSW Clinical Excellence Commission’s Partnering with Patients11 program, which supports health service organisations to transform services by partnering with consumers, carers and family as members of the health team
  • The NSW Agency for Clinical Innovation’s Designing Change Projects12 model, which provides a simple methodology and tools to support health service organisations through the change process
  • Planetree’s improvement guide and accreditation scheme that demonstrates whether a health service organisation has fulfilled its goals for person-centred care13
  • The Institute for Patient- and Family-Centered Care’s getting started guide for advancing the practice of patient- and family-centred care in hospitals.14
Day Procedure Services

Partnering with patients in their own care is integral to the delivery of safe and high-quality person-centred health care. Day procedure services will generally engage with patients for a short time, and patients may have discussed their procedure with the referring clinician before admission. The service should still have systems in place to support clinicians to partner with patients in any planning, communication, goal-setting and decision-making related to the care they receive.

Review current systems for supporting clinicians and patients to be partners in care

If systems are already in place to support partnerships between clinicians and patients, review the strategies outlined below, and consider any additions or updates.

If the organisation does not have systems in place to support partnerships between clinicians and patients, use the strategies outlined below to develop or adapt policies and processes for partnering with patients while they receive care at the day procedure service.

Create a supportive organisational culture

Supportive organisational climates are vital for achieving person-centred care, in which partnerships between clinicians and patients become the established norm. Strategies may include:

  • Engaging leadership and the governing body to act as champions for partnerships between clinicians and patients
  • Providing enough resources to support clinicians to partner with patients in their care
  • Providing education and training to equip clinicians to partner with patients in their care; further information on education and training for clinicians is provided in Action 2.7.1

Encourage communication and knowledge exchange between clinicians and patients

Patients can be partners in their own care in many ways, including shared decision making and self-management of their condition. For these partnerships to be meaningful, both the clinician and the patient must feel trusted and respected. Good communication is vital to foster this trust and respect, and drive clinician and patient partnerships.1

Use the following strategies to encourage communication and knowledge exchange between clinicians and patients2-5:

  • Review the current admissions process to see what information is provided to patients and how that information is given; identify any communication barriers and areas for improvement, and implement solutions to overcome these; consider engaging consumers in this review process by holding informal discussions with patients in waiting rooms.
  • Provide consumers with access to information and resources in a format that meets their needs; this may include
    • general information about their health, condition and procedure
    • information and tools about how they can be involved in their own care
    • information that has been developed specifically for them.
  • Encourage clinicians to create an environment in which patients feel confident asking questions, and in which clinicians respond positively to patient needs; this may involve speaking with patients in a neutral environment, away from the clinical setting.
  • Use technology such as telehealth, and mobile and tablet apps to interact and share information with patients before, during and after their care, especially as a strategy for facilitating clinician and patient partnerships across long distances; ensure that any healthcare records transmitted electronically are encrypted or aligned with privacy regulations.
  • Support patients to take part in shared decision making with decision support tools, such as information sheets, pamphlets and videos that provide structured information about their health options.

The Agency for Healthcare Research and Quality6 provides practical advice for improving clinician and patient communication, including tools to educate consumers on how to be involved in their care.

The SA Health Guide for Engaging with Consumers and the Community7 provides a tool to help clinicians encourage questions from their patients.

The Commission and Healthdirect Australia developed Question Builder8, a free web-based tool to help consumers prepare for a visit to the doctor. In addition, the Commission’s Top Tips for Safe Health Care9 can help consumers, carers, families and other support people get the most out of their health care.

Develop meaningful measures to monitor success

Monitoring and measuring the success of clinician and patient care partnerships is important for ensuring that systems are relevant and useful to consumers and the organisation.1, 5

Strategies for monitoring and measuring the success of the systems may include:

  • Collecting feedback from patients in waiting rooms and during rounds
  • Surveying patients to self-report on their experience and satisfaction with the level of engagement they had in their care.

Use the outcomes of these evaluations to set realistic goals for improving partnerships between clinicians and patients.

For guidance on undertaking consultations and surveys, see the Victorian Government’s Engagement Toolkit15 or the Scottish Health Council’s Participation Toolkit.10

The Point of Care Foundation’s Patient and Family-Centred Care toolkit16 also provides guidance and tools to measure consumer partnerships.

Examples of evidence

Select only examples currently in use:

  • Policy documents for partnering with consumers in their care, including communication and interpersonal skills, shared decision making, and planning current and future care
  • Training documents about communication and interpersonal skills, partnering with consumers and shared decision making
  • Tools to support shared decision making, care planning and development of goals of care
  • Audit results of healthcare records to see whether
    • information was provided to patients and carers about care options
    • patients and carers were involved in preoperative assessment, including information about the impact that surgery or the intervention will have on them post-discharge (for example, when they can fly, drive, return to work or sport)
    • a plan for care was developed with patients and clinicians, and provided to patients to review, sign and receive as a copy relating to their treatment
    • patients and carers were involved in decision-making (for example, case conference records)
    • patients and carers could choose the dates for surgery, if possible
    • patients could choose their own music, reading material, comforters and so on
    • carers were able to stay with patients throughout their treatment, if they chose to
    • patients and carers were involved in discharge planning
    • patients were engaged in developing goals of care (for example, in an advance care plan)
  • Patient information packages or resources about care options that are available for patients in different languages and formats, consistent with the patient profile
  • Results of patient and carer experience surveys, and actions taken to deal with issues identified regarding participation in making decisions about their care
  • Observation of patients and carers taking part in making decisions about their care
  • Feedback from patients and carers about their experiences in shared decision making and care planning.
MPS & Small Hospitals

Partnering with patients in their own care is integral to the delivery of safe and high-quality person-centred health care. To ensure that effective systems are in place:

  • Develop policies and processes (or review existing policies and processes) to involve patients or their substitute decision-maker in planning, communication, goal-setting and decision-making for their current and future care, and review workforce compliance with these policies and processes
  • Set up mechanisms to support communication between clinicians and patients or their substitute decision-maker
  • Periodically review the systems for partnering with patients or their substitute decision-maker in their own care.

Create a supportive organisational culture

Supportive organisational climates are vital for achieving person-centred care, in which partnerships between clinicians and patients become the established norm. Strategies may include:

  • Engaging leadership and the governing body to act as champions for partnerships between clinicians and patients
  • Providing enough resources to support clinicians to partner with patients in their care
  • Providing education and training to equip clinicians to partner with patients in their care; further information on education and training for clinicians is provided in Action 2.7.1

Encourage communication and knowledge exchange between clinicians and patients

Patients can be partners in their own care in many ways, including shared decision making, self-management of their condition and personalised care planning. For these partnerships to be meaningful, both the clinician and the patient must feel trusted and respected. Good communication is vital to foster this trust and respect, and drive clinician and patient partnerships.1

Review the current admissions process to see what information is provided to patients and how that information is given. Identify any communication barriers and areas for improvement, and implement solutions to overcome these. Consider engaging consumers in this review process by holding informal discussions with patients in waiting rooms, or discussing the admission process during a consumer advisory group or focus group.

Use technology such as telehealth, and mobile and tablet apps to interact and share information with patients before, during and after their care. This can be an important strategy for facilitating clinician and patient partnerships across long distances. Develop a policy and procedure to support active engagement of patients during bedside rounding and clinical handovers.

Other strategies to encourage communication and knowledge exchange between clinicians and patients include the following:

  • Provide consumers with access to information and resources in a format that meets their needs; this may include
    • general information about their health, condition and healthcare arrangements
    • information and tools about how they can be involved in their own care
    • information that has been developed specifically for them
  • Provide patients with timely and open access to their healthcare record, test results and other clinical information relevant to their care
  • Encourage clinicians to create an environment in which patients feel confident asking questions, and in which clinicians respond positively to patient needs; this may involve speaking with patients in a neutral environment, away from the clinical setting
  • Support patients to take part in shared decision making with decision support tools, such as information sheets, pamphlets and videos that provide structured information about their health options
  • Implement self-management of certain aspects of care, such as medicine use, to encourage engagement.2-5

The Agency for Healthcare Research and Quality6 provides practical advice for improving clinician and patient communication, including tools to educate consumers on how to be involved in their care.

The SA Health Guide for Engaging with Consumers and the Community7 provides a tool to help clinicians encourage questions from their patients.

The Commission and Healthdirect Australia developed Question Builder8, a free web-based tool to help consumers prepare for a visit to the doctor. In addition, the Commission’s Top Tips for Safe Health Care9 can help consumers, families, carers and other support people get the most out of their health care.

Develop policies and procedures to guide care planning in partnership with patients

Involve patients in the development of any current and future care planning, such as:

  • Inpatient treatment and recovery planning
  • Treatment and preventive health strategies for ongoing care outside the health service organisation
  • Advance care planning (see Action 5.9).

Strategies for involving patients in care planning may include systematically discussing patient preferences for care during admission consultations, and at regular times during their care. This may be facilitated by including patients in bedside rounding and clinical handovers.5

Develop meaningful measures to monitor success

Monitoring and measuring the success of clinician and patient care partnerships is important for ensuring that systems are relevant and useful to consumers and the organisation.1, 5

Strategies for monitoring and measuring the success of the systems may include:

  • Collecting informal feedback from patients in waiting rooms and during rounds
  • Surveying patients to self-report on their experience and satisfaction with the level of engagement they had in their care.

Use the outcomes of these evaluations to set realistic goals for improving partnerships between clinicians and patients.

Tools and resources are listed in the Resources section of this standard.

Action 2.7

The health service organisation supports the workforce to form partnerships with patients and carers so that patients can be actively involved in their own care

Intent

Clinicians work with patients to enable them to be partners in their own care.

Reflective questions

How is the workforce supported to form partnerships with patients so that they can be actively involved in their own care?

How is workforce participation in education and training to support patient partnerships monitored and evaluated?

Key task

  • Implement an education and training program to develop the skills of the health workforce to partner with patients in their care.

Strategies for improvement

Hospitals

Do not assume that clinicians have all the interpersonal or communication skills required to effectively partner with patients in their care. It is important to develop clinicians’ skills so that they feel confident about approaching consumer partnerships.

Education and training may include:

  • Communication and interpersonal skills
  • Techniques for shared decision making
  • Awareness of individual health literacy and the health literacy environment.

Education and training can be developed by the organisation, in partnership with consumers (see Action 2.14). Alternatively, several established clinician education and training programs support engagement with consumers, including:

  • The Health Issues Centre and other state-based health consumer organisations that provide consumer engagement training for clinicians17
  • The NSW Clinical Excellence Commission Partnering with Patients program Patient Based Care Challenge, which can be adopted as a training tool11
  • The Point of Care Foundation’s Patient and Family-Centred Care toolkit, which provides a step-by-step method to help clinicians understand the importance of partnering with consumers16
  • The Agency for Healthcare Research and Quality Communicating to Improve Quality Strategy, which provides a PowerPoint presentation and handout on communication competencies for clinicians6
  • The Australian Institute for Patient and Family Centred Care clinical education play Hear Me.
Day Procedure Services

Do not assume that clinicians have all the interpersonal or communication skills required to effectively partner with patients in their care. It is important to develop clinicians’ skills so that they feel confident about approaching consumer partnerships.

Education and training may include:

  • Communication and interpersonal skills
  • Techniques for shared decision making
  • Awareness of individual health literacy and the health literacy environment.

Day procedure services may not have the capacity to develop an education and training program for clinicians. If the service is part of a larger, networked group, see whether the wider group provides any training opportunities.

Alternatively, day procedure services can source training through established clinician education and training programs that support engagement with consumers, such as:

  • The Health Issues Centre and other state-based health consumer organisations that provide consumer engagement training for clinicians18
  • The NSW Clinical Excellence Commission Partnering with Patients program Patient Based Care Challenge, which can be adopted as a training tool11
  • The Point of Care Foundation’s Patient and Family-Centred Care toolkit, which provides a step-by-step method to help clinicians understand the importance of partnering with consumers16
  • The Agency for Healthcare Research and Quality Communicating to Improve Quality Strategy, which provides a PowerPoint presentation and handout on communication competencies for clinicians19
  • The Australian Institute for Patient & Family Centred Care clinical education play Hear Me.

Clinicians working in day procedure services, such as credentialed medical and other practitioners, may also work for other health service organisations, and may have access to education and training through these organisations. In these circumstances, it may be enough to request evidence of the completion of such training. These clinicians may also feel well equipped to provide peer-to-peer training to other members of the workforce.

Examples of evidence

Select only examples currently in use:

  • Policy documents for partnering with consumers in their care, including policies on communication and interpersonal skills, shared decision making and health literacy
  • Training documents about partnering with consumers in their care and shared decision making
  • Audit results of healthcare records to identify the involvement of clinicians and patients in developing a plan of care, including coordinated care meetings
  • Analysis of feedback data from the workforce about partnering with consumers in their care.
MPS & Small Hospitals

Do not assume that clinicians have all the interpersonal or communication skills required to effectively partner with patients in their care. It is important to develop clinicians’ skills so that they feel confident about approaching consumer partnerships.

Education and training may include:

  • Communication and interpersonal skills
  • Techniques for shared decision making
  • Awareness of individual health literacy and the health literacy environment.

MPSs or small hospitals that are part of a local health network or private hospital group should adopt or adapt and use the established education resources to train the workforce to form partnerships with patients and carers.

Small hospitals that are not part of a network can gain access to training through established clinician education and training programs that support engagement with consumers, including:

Last updated 21st June, 2018 at 11:16pm
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References

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Sarrami-Foroushani P, Travaglia J, Debono D, Braithwaite J. Implementing strategies in consumer and community engagement in healthcare: results of large-scale, scoping meta-review. BMC Health Serv Res 2014;14:402.

Rozenveig A, Kuspinar A, Daskalopoulou SS, Mayo NE. Toward patient-centered care: a systematic review of how to ask questions that matter to patients. Medicine (Baltimore) 2014;93(22):e120.

Prey JE, Woollen J, Wilcox L, Sackeim AD, Hripcsak G, Bakken S, et al. Patient engagement in the inpatient setting: a systematic review. J Am Med Inform Assoc 2014;21(4):742–50.

National Patient Safety Foundation (US). Free from harm: accelerating patient safety improvement fifteen years after To err is human. Boston (MA): NPSF; 2015 (accessed Sep 2017).

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SA Health. Guide for engaging with consumers and the community. Adelaide: SA Health; 2013.

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Scottish Health Council. The participation toolkit. Edinburgh: SHC; 2010.

Clinical Excellence Commission. Partnering with patients. Sydney: CEC; 2016 [cited 2016 Sep 28].

Institute for Patient- and Family-Centered Care (US). Advancing the practice of patient- and family-centered care in hospitals: how to get started. Bethesda (MD): IPFCC; 2015.

Victoria Department of Environment and Primary Industries. The engagement toolkit – version 4. Melbourne: DEPI; 2014.

Point of Care Foundation. Patient and family-centred care toolkit. London: The Point of Care Foundation; 2016 [cited 2016 Apr 10].

Health Issues Centre. Health staff training. Melbourne: Health Issues Centre; 2016 [cited 2016 Mar 20].

Agency for Healthcare Research and Quality (US). Strategy 2: communicating to improve quality. Washington (DC): AHRQ; 2013 (accessed Sep 2017).