‘First, do no harm’: shifting the paradigm towards a culture of health

Over the past 17 years since the release of the Institute of Medicine report ‘To Err is Human’,1 health services and agencies around the world have increasingly focused on improving the safety and quality of health care. Historically, the commitment by health care professionals to ‘first do no harm’ has produced a focus on the absence of interventions that may cause adverse outcomes. This clinical approach links to the Hippocratic Oath which includes the promise to abstain from doing harm . The Oath reminds clinicians to first consider the possible harm that any intervention might do. This approach to interactions with patients leads to an emphasis on the ‘absence of harm’ rather than a focus on the ‘creation of health’. To improve the care of patients, a paradigm shift is required in the health care services from a ‘disease-based intervention’ model to a supportive ‘health’ model. Just as ‘health’ is not the absence of illness, preventing patient harm is not simply avoiding interventions. To ‘first do no harm’ health services need to actively improve their focus on health and the entire patient experience

How does patient experience fit into the overall healthcare picture?

Understanding the experience of patients provides insight into health care as well as being a crucial first step towards partnering with patients to drive improvement. Increasingly, health care organizations gain feedback from patients about their experience through surveys. Patients are also turning to other avenues, including the internet, to document their experiences. Although long recognised as a domain of quality, evidence of the link between patient experience and clinical outcomes has emerged more recently. Organizations that succeed in improving patient experience have adopted a strategic approach to patient focus that incorporates both patient feedback and consumer engagement. Adopting a patient perspective sees leading organizations moving beyond ‘episodic’ care approaches to an extended patient continuum. The use of patient portals and access to electronic records foster a much needed two-way communication. For the patient’s and provider’s perception of the care continuum to coincide, the ‘continuum’ definition needs to expand to complement population health management. Similarly health care delivery models and payment models will need to change to reflect the care continuum. Patient experience fits into the overall healthcare picture more today than it ever has. As population health management, accountable care, and healthcare reform mature, the efficacy of those efforts depend more and more on how well providers can integrate the design of patient experience and empowerment into the expanding care continuum

Hezhen Conversational Text (3)

欧文抄録:P.326Hezhen is a Tungusic language spoken by the Hezhen living in Heilongjiang Province in China. The Hezhen population is currently about 4600. Less than 10 Hezhen can speak their native language. This paper presents the transcript of a conversation between two such native speakers, You Wenlan and He Shuzhen, recorded at Jiejinkou village in Heilongjiang Province in China on August 13, 2013. You Wenlan, a Kilen dialect speaker, was born in 1946 in Qindeli village; and He Shuzhen, also a Kilen dialect speaker, was born in 1937 in Fujin village.The length of their conversation was about 35 minutes, and the topics including: the weather, flood, constructions of the Jijingkou village, if vegetables are growing well or not, rumours of the villagers and the health problems concerning talkers themselves

Competency Standards and Educational Requirements for Specialist Breast Nurses in Australia

There is substantial evidence that Specialist Breast Nurses (SBNs) make an important contribution to improved outcomes for women with breast cancer, by providing information and support and promoting continuity of care. However, a recent study has identified significant variation in how the role functions across individual nurses and settings, which is likely to contribute to varied outcomes for women with breast cancer. The project reported in this paper illustrates how a set of competency standards for SBNs were developed by the National Breast Cancer Centre. The competency standards were developed through a review of published literature and consultation with key stakeholders. The resulting SBN Competency Standards reflect the core domains and elements of SBN practice seen as integral to achieving optimal outcomes for women with breast cancer. This project identifies the SBN as a registered nurse who applies advanced knowledge of the health needs, preferences and circumstances of women with breast cancer to optimise the individual's health and well-being at various phases across the continuum of care, including diagnosis, treatment, rehabilitation, follow-up and palliative care. The five core domains of practice identified are: Supportive care; Collaborative care; Coordinated care; Information provision and education; and Clinical leadership. A variety of education programs are currently available for nurses who wish to learn about breast cancer nursing. The majority of stakeholders consulted in this project agreed that a Graduate Diploma level of education is required at minimum in order for an SBN to develop the minimum level of competence required to perform the role. The evidence supports the view that as an advanced role, nurses practising as SBNs require high-quality programs of sufficient depth and scope to achieve the required level of competenc

Promoting the Implementation of Best-Practice Guidelines Using a Matrix Tool: Focus on Cancer Care

Background/Objectives: Internationally, numerous clinical practice guidelines have been developed and disseminated with the intention of improving patient care. Research indicates that to improve practice in accord with clinical evidence, change is required by individual clinicians and teams of clinicians as well as at an organizational and policy level. A matrix framework has been developed by the Australian Cancer Network's Guideline Implementation Steering Committee, using the theory of innovation adoption. The matrix is based on the characteristics of innovations that favor rapid adoption and wide acceptance. Within this construct, new clinical guidelines are equated to an `innovation'. The objective of the present study was to pilot this matrix tool to assess its usefulness for individuals and organizations aiming to develop strategies to promote guideline implementation in cancer care. Methods: The matrix was piloted at a workshop with 50 attendees, primarily colorectal surgeons and oncologists. Six key areas relating to guidelines were included in the matrix: (i) compatibility with current practice; (ii) relative advantage over current practice; (iii) observability of outcomes; (iv) trialability; (v) simplicity of use; and (vi) perceived barriers. Three examples of guideline recommendations for the management of colorectal cancer were used during the pilot, covering evidence about best clinical care and psychosocial support: (i) people with high-risk rectal cancer should be referred for consideration of adjuvant preoperative or postoperative radiotherapy in a multidisciplinary setting; (ii) people with resected Dukes' C (i.e. node-positive) colon cancer should be referred for consideration of adjuvant therapy in a multidisciplinary setting; and (iii) psychosocial interventions should be a component of care as they can improve the quality of life in patients with cancer. After discussion of the guideline examples, the attendees completed matrix tool forms to document their perceptions regarding the consistency of current practice with the example guidelines and barriers to practice change. Quantitative responses were assessed by frequency analysis and qualitative responses were assessed by thematic analysis. Results: There was consistency in the perceived views of workshop attendees around the six key areas included in the matrix. The perceived barriers that were highlighted by the respondents included the lack of available resources (staff, equipment, and funding); lack of multidisciplinary clinics, referral processes, and access to appropriate services; and lack of knowledge of benefit. Perceived facilitators of change included lead clinicians, consumer advocates, government, service administration, professional colleges, and cancer organizations. Conclusions: The pilot process indicated that the matrix is a tool that could be of use to groups and individuals aiming to develop targeted change strategies to promote evidence-based practice improvement.Colorectal-cancer, Disease-management-programme-evaluation, Disease-management-programmes, Guideline-utilisation

Patient-Centred Care: Improving Quality and Safety by Focusing Care on Patients and Consumers

Patient-centred care is health care that is respectful of, and responsive to, the preferences, needs and values of patients and consumers. The widely accepted dimensions of patient-centred care are respect, emotional support, physical comfort, information and communication, continuity and transition, care coordination, involvement of family and carers, and access to care. Surveys measuring patients' experience of health care are typically based on these domains. Research demonstrates that patient-centred care improves patient care experience and creates public value for services. When healthcare administrators, providers, patients and families work in partnership, the quality and safety of health care rise, costs decrease, and provider satisfaction increases and patient care experience improves. Patient-centred care can also positively affect business metrics such as finances, quality, safety, satisfaction and market share. Patient-centred care is recognised as a dimension of high-quality health care in its own right and is identified in the seminal Institute of Medicine report, 'Crossing the Quality Chasm', as one of the six quality aims for improving care. In recent years, strategies used in the US and UK to improve overall healthcare quality, such as public reporting and financial incentives, have emerged as policy-level drivers for improving patient-centred care. In Australia, a patient-centred approach is supported by the Australian Charter of Healthcare Rights, the National Safety and Quality Framework, other national service standards, reports of state-based inquiries, and a range of jurisdictional and private sector initiatives. Recent national health reform arrangements (such as the Performance and Accountability Framework of the 2010 National Health and Hospitals Network Agreement) provide further incentives to improve patient-centred care by linking it to performance and funding. Another driver for improving patient-centred care is the establishment of a National Performance Authority to report transparently on a range of performance indicators, including 'patient satisfaction' for every Local Hospital Network, public hospital, private hospital and primary healthcare organisation. Against this background, Australian healthcare organisations are becoming increasingly interested in patient-centred care