Exploring the patient journey: a collaborative approach to patient-centred improvement in healthcare.

Despite widespread endeavours over many years, patient-centred care continues to evade some areas of healthcare. This can be clearly evidenced by regular reporting of sub-standard care and the findings of national patient experience surveys which repeatedly highlight a number of common contributory factors. Amongst these include a predominant culture of secrecy and blame rather than openness and support; failure to listen and respond to staff or patient issues; workloads and time constraints; fragmented teamwork; an overriding focus on targets rather than people; in addition to varying perceptions and interpretations of, and expectations and priorities for patient-centred care (PCC). These occur between patients, staff, educationalists, policy-makers, healthcare managers and the public. These factors, which are further reinforced by this study’s review of empirical studies of patient-centred care, strongly indicate that new approaches to improvement, that involve service providers as well as service users, are called for. Addressing this call was an interest of this study. Action research was selected because this promotes a collaborative and democratic approach to research-based organisational, social and cultural change and improvement. In this study, which was also underpinned by the philosophy of patient-centred care, action research was combined with the Patient Journey. This is a patient-centred improvement, and, or, practice development process developed and tested by Campbell et al (2004) at the City Hospitals Sunderland NHS Trust. By combining the action research and Patient Journey (PJ) processes, this enabled the generic potential and effectiveness of the approach to be concurrently investigated and established as will be explained. Through the collaborative efforts of a participating 25 member Vascular Patient Journey project team, data was gathered during the process through team discussions, mapping and interviews with 17 service users. 75 issues were identified using inductive thematic analysis; 34 of which emerged from the data of service users, 35 from service provider data, and a further six jointly emerged from both datasets. These provided powerful catalysts for change and points of learning which the team, empowered by their involvement in the process, used as the evidence-base from which to action change, as discussions in this thesis will demonstrate. They will also illustrate why more should be done to involve multidisciplinary teams as well as service users in improvement

Patient Journey Action Research: A collaborative and evidence-based approach to quality improvement in healthcare

Project aim and objectives To implement, test and evaluate a structured, evidence-based, collaborative approach to continuous quality improvement in healthcare and explore its wider potential as a model for improvement. Actions taken (including methods used) Patient Journey Action Research (PJAR) improvement project implemented and evaluated in an acute NHS Hospital Trust. The action researcher/project facilitator was external to the Trust but worked in close collaboration with NHS management; a core PJAR project team of 25 interdisciplinary NHS staff; 11 patients with peripheral vascular disease and 6 care partners. Supplementary methods included qualitative interviews with patients and care partners; mapping of Vascular Patient Journey; matrix sampling; PJAR project team meetings. Evaluation through qualitative interviews and/or questionnaire. Measures and Outcomes Measures included • Monitoring via a PJAR Steering Group comprising NHS Trust Management; NHS Executive Committee/Trust Board, Ethical and Research & Development Governance Committees and Bournemouth University. • PJAR meeting notes and ‘Issues and Solutions’ change document - audit trail of improvement. Outcomes: • Poignant catalysts for evidence-based change were quickly identified and effectively implemented where resources supported this. • By also inviting feedback from participants about what worked well, a more balanced approach to service review was achieved. This was reported to enhance team morale and motivation for initiating change and sustaining continuous quality improvement. Learning outcomes and conclusions Strengths; • The ARPJ achieves results as a collaborative, evidence-based and balanced approach to improvement that involves people with first-hand knowledge and experience. • Real involvement - patient and care partner participants valued the opportunity to be actively involved and able to ‘make a difference’ through their contributions. Limitations: • Requires significant buy-in from NHS Trust management and ARPJ team participants. • Time • Dependent on the qualities, attributes, knowledge and people skills of the ARPJ facilitator. Conclusions: • The ARPJ offers as a generic model for healthcare and services review and evidence-based improvement. • The outcomes may have wider reaching impact. For example the potential to “shift thinking” about how clinical care pathways are reviewed and what services are “like from the patient perspective”; and to trigger “cultural shift across the whole hospital”

The context of healthcare education in 2017: The future nursing professional

Keynote lecture examining healthcare education in the wider context and the changing face of nurse education and practic

Patient Choice for Older People in English NHS Primary Care: Theory and Practice

In the English National Health Service (NHS), patients are now expected to choose the time and place of treatment and even choose the actual treatment. However, the theory on which patient choice is based and the implementation of patient choice are controversial. There is evidence to indicate that attitudes and abilities to make choices are relatively sophisticated and not as straightforward as policy developments suggest. In addition, and surprisingly, there is little research on whethermaking individual choices about care is regarded as a priority by the largest NHS patient group and the single largest group for most GPs—older people.This conceptual paper examines the theory of patient choice concerning accessing and engaging with healthcare provision and reviews existing evidence on older people and patient choice in primary care