29 Apr 2019 | Patient Deterioration
Patients and whānau often say ‘something just doesn’t feel right’ and they are often correct, recognising subtle signs of patient deterioration in hospital, even when vital signs are normal. Failures to adequately respond to concerns raised by patients and whānau are commonly highlighted in adverse events reported to the Health Quality & Safety Commission.
One US study reviewed patient and family escalation data over a two-year period, concluding that the patient and whānau escalation system saved lives, without an overload of false positive calls.
Dr Alex Psirides, the Commission’s clinical lead on patient deterioration, says it is important that patients and whānau feel comfortable escalating care and have a way to do this that suits their needs.
To achieve this, Dr Psirides says a co-design approach to quality improvement can bring about positive changes in the delivery of health care in particular settings. Co-design is at the heart of the Commission’s patient deterioration programme Kōrero mai | Talk to me.
‘Involving patients in the design of the escalation process is important because they have unique experiences and insights to share alongside the staff delivering care.’
To gain a better understanding of the cultural aspects of whānau escalation, Kōrero mai is supporting a co-design project at the Bay of Plenty District Health Board (DHB) kaupapa Māori ward. Part of this involves patient experience data collection.
Patients and whānau showed high levels of connection to nurses. One patient reported ‘because there is more of a whānau feel in this ward, and the nurses make you feel very comfortable, it is easier to tell them if you have a concern.’
Another patient said ‘I asked the doctor to write down what was my illness and why I am in hospital. The doctor left a hand-written note. This was great, I then felt as if I knew what I needed to know.’
‘These positive relationships with staff appear to encourage patients to use the call button and raise concerns immediately when needed. The data and analysis has shown that tikanga Māori concepts such as whanaungatanga and manaakitanga are critical in delivering safe and effective care for patients and whānau,’ says Dr Psirides.
Whanaungatanga (building a relationship connection with others) can be characterised by staff introducing themselves to patients, explaining why they are there, and treating the patient with familiarity and warmth.
Manaakitanga (care, hospitality) between clinicians and patients is also important. Manaakitanga can be characterised by clinicians taking the time to explain medical matters to patients and whānau, being gentle and caring, not rushing, and ensuring the patient feels safe.
The project also highlighted that consulting doctors and house officers don’t tend to introduce themselves to the patient and their whānau.
‘The simple action of doctors introducing themselves can help to build connection and break down barriers. This helps patients and whānau feel more comfortable about escalating concerns if needed.
‘Another reason that was highlighted for delayed escalation is due to patients not wanting to be hōhā (a nuisance). Identifying this is useful for understanding some of the barriers patients face,’ says Dr Psirides.
Ria Earp, the chair of the Commission’s Te Rōpū Māori (Māori advisory group) says ‘the approach to patient safety used in the kaupapa Māori ward could benefit far more patients, both Māori and non-Māori, if it was introduced into the wards we call ‘mainstream’.
‘When bringing these successful elements into health care it is important to have high-level management support the application of tikanga Māori principles in wards, and staff who are familiar with demonstrating regional tikanga Māori principles,’ she says.