What is important to patients and their families attending inpatient rehabilitation? The consumer s perspective - insights from a qualitative study.

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1 18 20 July 2011

2 What is important to patients and their families attending inpatient rehabilitation? The consumer s perspective - insights from a qualitative study.

3 What does your customer want? You ve got to start with the customer experience and work backwards not the other way around (Steve Jobs, Apple, 1997) Healthcare providers have designed systems and services for the convenience of clinicians and administrators rather than to address patients needs (Garling, report on Acute Care Services in New South Wales Public Hospitals, 2008)

4 Patient-centered care Patient-centered care - providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions (IOM, Crossing the Quality Chasm, 2003)

5 Study objective Objective: To explore the experiences, needs, and preferences of recent inpatients of a rehabilitation centre, and the needs of their families.

6 Geelong Study location Barwon Health

7 Study location Inpatient Rehabilitation Centre

8 Method - recruitment 75 recent patients 5 patients 6 family members

9 Method - focus groups Two groups Patients Family Two researchers present Audio taped 60 minutes

10 Method - data analysis Audio tapes were transcribed verbatim Transcriptions analysed for themes independently Consensus reached

11 Six key themes emerged 1. Staff attitudes and behaviors. 2. Knowing and meeting staff. 3. Quality and timing of communication. 4. Making best use of time in the rehabilitation centre. 5. The impact of the physical environment. 6. Managing patients with complex needs.

12 Staff attitudes and behaviours 1. Staff attitudes and behaviors 1. Busy staff they re all busy 2. Young staff they were very young. They are all still doing their uni courses and I don't think at any stage when I was in physio a senior person came along to instruct.

13 Knowing and meeting staff 2. Knowing and meeting staff Meet senior staff if you had access to the head nurse then you raise the issue Name AND profession They introduce themselves but they don t say their classification [profession]; they just say hey I m Joe, I m looking after you today. you need to know whether they re a nurse, PCA, or cleaner Uniforms or different coloured badges green means that she s the matron and blue means he s the cleaner Easy to read ID tags you can t read the writing unless you get up close to it

14 Communication 3. Quality and timing of communication pre-arrival information Going to rehab less frightening and help people fit in On arrival - meet and greet There should be someone there to welcome you, it s as simple as that daily itineraries co-ordinated and communicated to all relevant parties Communication boards in rooms discharge planning involving families and carers follow-up communication post-discharge phone calls

15 Making best use of time 4. Making best use of time Rehabilitation can be excellent I think it was the best thing I ever did by coming here 7/7 service [unless rehabilitation continues on weekends] you may as well go home for four days that [long] weekend we had to rely on our own resources, I could have been home we could have spent less time here had the physio and the hydro been in operation seven days a week

16 Physical environment 5. Physical environment Positive impact natural environments you could see outside, there was a big tree out there, it was absolutely beautiful Noise pollution Banging doors Being in a room with prayers all day [was annoying] they were always praying for me.

17 Patients with complex needs 6. Patients with complex needs She d had a stroke, she d had a heart attack, she s on kidney dialysis out of their routine Many health professionals and appointments Nurses, doctors, social workers, physiotherapists, occupational therapists, speech therapists, audiologists, podiatrists, pharmacists, radiographer. Complex co-ordination of activities Complex communication Flexible systems, customise care for atypical needs

18 Limitations Limitations Small sample size Researcher bias

19 What does your customer want? You ve got to start with the customer experience and work backwards not the other way around Steve Jobs, Apple (1997)

20 Using the information Issue type Description Action Plan Assigned to Commencement date Communication Staff to introduce themself and profession Implement AIDET Acknowledge Introduce Stephen Dec 2010 Duration Explanation Thankyou

21 The next report card Healthcare providers have been praised for designing systems and services for the best interests of BOTH the patients, their families, administrators, and clinicians (The next report, 20??)

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