Training is underway at London Road Community Hospital

LRCH Patient Centred Journey

LRCH Patient Centred Journey

Written by Jo Harvey of Helen Sanderson Associates 

In my first three training sessions at London Road Community Hospital (LRCH) in Derby I trained 10 staff each time. Last time I walked into the training room to find 22 staff packed in like sardines. There were nursing staff at all levels, healthcare assistants, therapists, ward receptionists and even the facilities manager.  What a buzz.  The day-long session was intense but incredibly rewarding.

I am mentoring two LRCH staff, Keith and Zoe, to be official trainers on site.  They’ve both got a very easy way with them and during my sessions they contribute to the day sharing their examples. Last week Keith was leading the warm up and he kicked off by asking everyone to share one thing that no-one would know about them. Keith then neatly segued into his training patter.  “So,” he said, “This is what personalisation is all about.  It is just a case of knowing and understanding more about our patients as individuals, as whole people.  We are really very good at the medical stuff here – but wouldn’t it be great to be good at this too?”

That’s my cue.  It’s my job now to explain how we can put personalisation into practice by using a series of person-centred tools.  I talk about one-page profiles and how they are used to understand what makes a person tick. I explain how patients and staff alike can use these profiles and about every aspect of the patient-centred journey we are creating at the hospital.  By the end of the day my delegates have completed their own draft one-page profiles and also a short version which the patients will be able to see on notice boards around the wards.  Importantly, I make sure everyone is clear on their responsibilities. Everyone is involved in the patient journey.

Yet, even with more than 50 staff trained, we still haven’t reached critical mass with the training. This hospital has 101 beds across four wards, staffed by a huge team.  The time to really push forward with implementing the patient journey will be when enough people understand how it works and how it can help them.

Because we’ve known that implementation will take time, we’ve started with the easiest part of the patient journey. This is a tool we call ‘Good Day’ and it requires a member of staff to ask each patient, each day, what would make that day a good day for them.  The question can be asked by any member of staff i.e. healthcare assistants, hostess, therapists not just nursing staff and the answer written on a white board above patients’ beds.

One of the first requests was that the patient would like to see the staff dance – so they did. It was a wonderful ice-breaker.   But then another patient said that they wanted to die. We had talked in the training about this: how to explain to patients, very simply, that the team couldn’t help with that.  Was there one little thing that would help them have a bit of a better day? Perhaps a hair wash or an extra cup of tea or a newspaper to read?  It is about asking the question with confidence and responding to the answer with confidence too.

The implementation of patient one-page profiles will be a little more challenging. It has been agreed that admissions staff will start filling out the profiles – and that the ward receptionist will take photographs for the profile the day after admission. The good news is that a staff nurse, Amanda, has now been appointed as flow co-ordinator, in charge of admissions. She is based at the Royal Derby Hospital, where most of LRCH’s admissions come from. She has been developing one-page profiles as part of her admissions process and sending these with the patient to the London Road.

In the meantime I have one more training session booked at LRCH and after that I’m handing over to Keith and Zoe to carry on with the training. My role will change so that I pop in from time to time to help with any blockages in the implementation process. We’ve come a long way already, with much more work to be done – but we are making progress.

 

Realizing the vision – one-page profiles in Canadian health care

Julie Malette, HSA Canada

Health colleagues starting work on their one-page profiles

Health colleagues starting work on their one-page profiles

I recently wrote a blog and left you with the following thoughts and vision:

Imagine you were in hospital and your healthcare team really got and understood you as a person. Now imagine you are a health professional and because of a simple, easy to use tool you had all the information at your finger tips to make someone feel understood, well cared for and well supported when treating them. This is what one-page profiles in health could help us to achieve. To my UK colleagues – I wish you every success in your pledge. To my Canadian friends – what about doing something similar here?!

In a few short weeks, this vision has already started to spread and important initial thinking and planning has begun.

This week, I spent time with four leaders at the North Bay Regional Health Centre to explore how one-page profiles could be used with their staff as well as patients at the hospital.  The Centre has 2600 employees and supports approximately 11,189 inpatients and 235,777 outpatients in one calendar year.   We had a difficult time containing our excitement about how one-page profiles could help the Centre deliver their vision and mission, support their values and overall organizational strategy.  All of this aimed at revolutionizing the way patients and staff are supported.  One-page profiles could help patients to have a stronger voice during their stay in hospital or their out-patient appointments and ensure that the patient voice guides the personalization of health services.  Patients could also be supported to prepare a one-page profile at discharge to then share with community health services when they leave hospital.  In terms of the benefits for staff, the one-page profiles would help them in providing personalized supports to patients but they would also help the hospital in tapping into staff strengths, skills, interests and passions and supporting staff in their important work.

Thank you to our colleagues in the UK who have already introduced one-page profiles into two hospitals and their recent pledge for NHSChangeDay (to support 1000 patients and colleagues working and using health services throughout England to create one-page profiles). This has inspired the North Bay Regional Health Centre to consider introducing and supporting the development and use of one-page profiles at scale across the organization (2600 employees + patients).

The first step taken this week was to support the VP of Mental Health, Addictions and Senior Services, the Director of Psychiatric Rehabilitation and Recovery Program, the Patient Family Partnered Care Coordinator, and the Coordinator of Clinical Practice and Standards to develop their own one-page profiles.  They have also made plans on how they will be sharing their profiles at the hospital and are excited about exploring how to strategically move forward at scale.

Although this is still in the very early stages of planning, we are excited about the difference it will make in people’s lives.  We will keep you posted on our efforts and learning.

 

A #OnePP is for life – not just for NHS Change Day!

Me and the girls in Norway

Me and the girls in Norway

I can’t believe it’s just three days until NHS Change Day! I started the week chasing the Northern Lights with my family. I finally saw them in Norway, which was so amazing, only to get a tweet from George last night, telling me that you could see them in the UK too!

After a short holiday I rejoined the twitterverse on Wednesday, and thanks to the gentle encouragement of @revdavesouthall I linked up with the wonderful @wenurses .This morning (at 7am!) I talked on skype to Midwife Shawn Walker, and she has very kindly shared her one-page profile with us.

Another first this week was a one-page profile for a consultant from Leeds Teaching Hospital, Graham Sutton. Graham is not on twitter, but thanks to GP Gwen Elias who introduced me to Graham, he did not need too much persuading! We hope to share this with you on Change Day.

Helen Bevan and I, celebrating 1000 #OnePP

Helen Bevan and I, celebrating 1000 #OnePP

I have been presenting at the Microsystems Festival in Sweden this week, sharing how one-page profiles can make a difference in health, as one part of a new patient-centred journey. Helen Bevan was presenting there too. As you will remember from the first blog about NHSChangeDay, it was Helen who suggested our pledge, so I took the opportunity to celebrate achieving it with her!

Now I am looking forward to Change Day, and seeing how far we can get past 1000. I know that there are some great events planned around one-page profiles, and I look forward to seeing and hearing how these go on twitter on Monday. I am with Charlotte, at the #EMCD14 event ‘Patient Centred Care – Compassion in practice’ at Chesterfield Royal Hospital. I’ll be presenting about personalised care and one-page profiles. Charlotte is running a one-page profile workshop in the afternoon – She’s produced this great video to help others run their own workshops around the country too.

Michelle is at Bispham Hospital in the morning doing two one-hour sessions on one-page profiles with NHS Executives, Spiral staff and possibly some GPs. Then off to St Ann’s Hospice in Stockport in the afternoon to do something similar with staff there.

Jo will be at London Road Community Hospital in Derby with Chief Executive Sue James working with staff and patents.

There are lots of local events happening too and I’d like to say a big thank you to everyone taking part and especially to those people using one-page profiles to achieve positive change in their work and their life.

We are not stopping here! A one-page profile is for life, not just for NHS Change Day! We are committed to supporting people who have been introduced to them in these past two months, to use them well and achieve real choice and control. By sharing our learning – we hope to continue growing our community of health workers and patients using one-page profiles. Join us is this journey by following this blog where we will share people’s individual experiences.

See you on twitter on Monday #OnePP #NHSChangeday

Care not just cure: Can one-page profiles help achieve change in the NHS?

Written by Sarah Carr, independent Mental Health and Social Care knowledge Consultant www.sarahcarrassocs.co.uk

Sarah carrOver its long life the NHS has met with many challenges, many from top-down government policy makers trying to find ways to make it more efficient and effective in response to social and political change. However, over the past 10 years considerable pressure for change has been from the bottom-up – from patients, staff, families and friends. We have the idea of the expert patient and patients taking much more of a role in NHS decision-making. All this is very good news and in many places patient-driven initiatives are heralding change. But what do patients, friends and families say they really want? More skilled clinicians? More effective drugs? Better clinical kit? Well yes, but people are also really concerned with the care as well as the ‘cure’. People want to be seen as whole individuals, not just patients who are often reduced to their illness. The person can easily get lost in the system. In response to the need to change nursing practice in the NHS, so it focuses on the person, NHS England has drawn up the ’6 C’s’: care; compassion; competence; communication; courage; commitment

The 6 C’s mean that care in hospital, clinics and in people’s homes must be based on an understanding of the individual and characterised by intelligent kindness, empathy and respect. Nurses are asked to communicate with people about decisions and work in a way that assures individual dignity. But if nurses are being asked to be courageous and have commitment then they need some support too. The challenge of the 6 C’s for a busy ward setting could seem huge. But help is at hand. Look no further than the person who’s on the ward or being supported in their own home. People often have individual strengths, knowledge and preferences that could really help with care and recovery – but very rarely are they given the opportunity to express themselves and what’s important to them. This is why I’m sitting down and analysing 100 one-page profiles to find out what people are communicating, what’s important and among other things, how they can help nurses with the challenge of the 6 C’s. The idea is to start evidencing the difference they can make.

I’ve started with a random sample of 20 people’s Profiles and already things are looking interesting. The people are from all walks of life, of very different ages, life histories and experiences. Their situations are all very different – from an older man with learning disabilities in residential care to a teenage girl in school. People are managing long-term conditions, their mental health or a specific life event such as bereavement or transitions between services. But what this diverse range of individuals have in common is that their one-page profile allows them to communicate the things that are important to them but are often sidelined in conventional health assessments. Yet these things can be crucial for achieving good outcomes, supported self-management, recovery, quality of life and dignity and moreover, for responding to the whole person. Through the one-page profile people communicate their personal qualities, the important people in their life, what affects their personal comfort and mood, their preferred ways of communicating and how they manage their condition. They include things like what food they like and dislike, the clothes they prefer to wear and what makes them laugh – things that may seem small but are meaningful for the individual’s quality of life, dignity and sense of wellbeing. Attention to them costs nothing and will help with individual care and recovery.

Of the 20 one-page profiles I’ve analysed so far the one that stood out the most was that of Chip who was in hospital after an acute stroke. The line in his profile that really struck me was: ‘Have a laugh with Chip…do not show distress to his locked-in syndrome – Chip is still there’. Chip’s daughter wrote about her Dad’s experiences here.

Chip’s story about ‘finding a voice’ demonstrates how effective a one-page profile can be for building the type of nursing practice characterised by the 6C’s. Hopefully we’ll see more examples like this from the 1000 pledged for NHS Change Day. There are plenty of resources available to support you to get started.

What’s my dream and what’s my nightmare? Introducing #OnePP to health worker students

Derek Jones

Derek Jones

Written by @Dr_Derek_Jones

Many years ago as a Basic Grade OT (Band 5 in contemporary NHS speak) I worked at Olive Mount Hospital in Liverpool, an old fashioned institution for people with learning disabilities. Just before I moved on to another part of the OT service a new Clinical Psychologist arrived called Mark Feinmann. Mark started introducing the learning disability service to new ideas like O’Brian’s 5 Service Accomplishments; seeing challenging behaviour as communication; and supported employment. Bearing in mind in the late 1980s early 1990’s the term mental handicap was still in common usage it was not surprising these ideas were seen as a bit revolutionary (and uncomfortable for some people). So that was my introduction to person-centred care.

Fast forward a bit and I was pleased to find myself working at what was then Queen Margaret College in Edinburgh teaching on the BSc Hons OT programme. I retained my interest in person-centred planning and was fortunate to be able to attend a workshop run by Marsha Forest and Jack Pearpoint. This introduced me to graphic facilitation and the planning tools MAP and PATH . From this I learned that communication can be concise, precise, and visionary at the same time. I have to be honest; I didn’t (don’t) feel at ease with some of the more touchy-feely elements (I like urban industrial grit – but that’s another story) but I did like the focus on explicit, measurable action.

Moving forward to today, I am working at Northumbria University, still teaching OTs (amongst others) and for some years have been researching and teaching around chronic pain. Over the years I have also continued to do some teaching around social policy.  I have watched with a degree of frustration how those ideas from the 1980’s around person-centred planning have become mainstream but often bureaucratised and poorly delivered. My enthusiasm has however been reignited by one page profiles (onePP). The idea is so simple yet elegant in its design and challenging in its content. It resonates with contemporary ideas around co-production and partnership between people who use services, their carers, and professionals.

Inspired by the potential value of onePPs my colleague and I (Steph Whittington) have incorporated them into one of our first year OT modules. The content of the module covers policy, legislation, health inequalities, and digital technologies. In the next couple of weeks as part of a practical workshop students (around 40 in total) will complete their own onePP (which of course means me and Steph will also have to do one). Students will then be encouraged to share with University staff as part of the personal tutor system and with educators when they go on placement. In the spirit of focussed actions with measurable outcomes that is going to be the goal for now – but I have some thoughts about where I would like to see this go.

1) I want students to be sharing their profiles with service users where possible and tying this in with the “Hello my name is..” campaign. Of course introducing onePPs is not going to be appropriate on every occasion and in every setting.

2) I will be encouraging my academic colleagues to produce their own onePPs. At the very least I see them being shared with students; but maybe also as part of University admissions and recruitment open days (that’s maybe pushing it for now). It’s never too early to let potential students know they will be working with us as part of a learning journey (oops slipped into the hippy stuff there) rather than passive recipients of teaching.

3) Related to my current research focus on chronic pain and self management, I see great potential for onePPs. Most chronic pain is managed in the community and one of the things we know from our research is that people often do not get to see the same health professional at each consultation. Furthermore these consultations are time limited and (just to make matters worse) vets tend to get more education on pain than health care professionals! So, onePPs offer a vehicle for getting important information across to the health professional in a way that is structured, focussed, and relevant.

(© Microsoft Office Clipart)

(© Microsoft Office Clipart)

If that’s my dream, then (in the context of University programmes) what’s the nightmare? It goes like this:

  • D introduces onePP on a small scale; it works really well
  • Manager E genuinely thinks it’s great and wants to roll it out across programmes
  • This has to be approved by a committee, which genuinely thinks its great and is so important it should be a formalised requirement
  • Because it is a formalised requirement (and important) B decides a periodic audit is required to make sure everyone is doing it
  • Because it is a requirement and part of a system people don’t control, time spent doing it is resented and the audit eats into already limited hours in the day
  • The production of onePPs gets added to a list of boxes to be ticked; a mechanical process rather than a powerful person-centred thinking tool .

I hope that doesn’t happen; it has to be organic (I’m more of a hippy than I thought); people need to make a choice. I guess my job is to make it attractive. I have been doing some teaching around nudge theory recently and this maybe holds some potential for encouraging uptake. You could see the provision of onePP templates and other resources as a nudge – it makes it easy for people to do.

The module I mentioned earlier has a Scoop.it site (a collection of relevant resources), which you can access here: http://www.scoop.it/u/derek-jones (along with other collections on chronic pain, and research methods and methodology)

http://about.me/jonesderek

https://www.researchgate.net/profile/Derek_Jones2/publications/

1000 pledged! And the difference it has made

Written by George Julian

tweetHello. I’ve been given the chance to write this guest blog as Helen is on holiday chasing the Northern Lights as I type and not able to share her thoughts this week.

My name is George and I’m a freelance knowledge transfer consultant. What this means is that I work with people to ensure the right information (from research, practice, and personal experience) gets to the right people, at the right time to help improve things. For the past few weeks I’ve been working with colleagues at HSA to support their work around One-Page Profiles for NHS Change Day.

I’ve been aware of the impact of one-page profiles in learning disability for a number of years. Then about two years ago when my Dad was given a terminal cancer diagnosis a chance conversation with Helen reminded me of their value for capturing an individual’s voice, especially when living with a complex health situation. My Dad didn’t get to use a one-page profile but I remain completely convinced that they have an extremely valuable role to play in healthcare. You don’t need to take my word for it though, take Adam’s, Lynne’s and Theresa’s.

Adam, is 14, an avid tweeter, a poet, companion of Charlie his pet dog, and has spent more than half his life in hospital, probably meeting more NHS staff already than most of us will in our entire lives! Adam heard about one-page profiles as a result of our twitter campaign for NHS Change Day. He decided to write his own and his Mum, Zoe, shared a blog post with her thoughts, it’s well worth a read. Zoe states:

“The beauty of one-page profiles is that the writer, be he or she, a manager, nurse, doctor, domestic, patient or family member decides what is important to him or her. To Adam his one-page profile is about giving him a voice, to me it is about giving Adam equal autonomy to his teenage peers”.

Another person who decided to write a one-page profile after seeing our NHS Change Day twitter campaign was Lynne. Lynne echoes Zoe’s points, she feels that her one-page profile has the potential to work as a conversation opener and that most importantly it captures her, as a person, not someone with a long-term condition. You can read Lynne’s blog and see her profile here:

“I love the result of my one-page profile. It talks about Lynne, the whole person. If you read it you can learn more about me and especially you can see what’s important to me. And that’s how I want the NHS to see me – not Lynne the Patient – but Lynne the Person!”

The third profile I mentioned above, was written by Theresa. Theresa is an undergraduate social work student who had recently heard about one-page profiles in a lecture, when her Mam was admitted to hospital as an emergency. Theresa shares how concerned she felt:

“It is embarrassing as I recall us trying to tell every nurse we saw the things about my mam that would ease her anxiety, and attempting to describe her ‘old self’ to them, so they would view her as a person, instead of a ‘lifeless’ patient. We wanted the staff to understand how important she was to us all”.

Theresa wrote a one-page profile for her Mam, describing what was important to her, and bringing her to life. The staff responded incredibly positive to this and when Theresa’s Mam came to leave hospital it was shared with the social worker arranging her care package:

“The social worker was amazed, and said that every patient should have one of these! She said that she felt like she knew my mam, even though she had only just met her”.

So there you have it, three examples of patients and partners in the health service advocating for the value of one-page profiles. HSA committed to a pledge of supporting 1000 one-page profiles for NHS Change Day 2014 from staff and patients. At the end of last week we had secured 860 pledged profiles and this week Alternative Futures Group have pledged 150, taking us past our target to 1010 pledged one-page profiles.

I’m delighted I’ve been able to support this work, and am thrilled at the success so far. I look forward to seeing how many more pledges we can get and following the difference that they make. You still have time to get involved if you’d like and don’t forget there are a wealth of resources here. Thank you to everyone who has pledged so far.

One-page profiles – A Patient and A Parent’s View

Written by Adam’s mum, Zoe

Adam and Zoe

Adam and Zoe

My son Adam first learnt about one-page profiles through twitter.  The pledge for 1000 one-page profiles is an NHS Change Day initiative to encourage people to produce, as the name suggests,  one-page profiles; A page setting out the important things the writer would like others they deal with within the NHS to know about him or her.

When Adam heard about these profiles he was keen to write one. Although only 14, Adam has spent more than half his life in hospital. Adam has complex, multiple health problems and severe physical impairment. He is seen by literally hundreds of NHS staff, some who know him really well, others who have never met him before.

Adam’s one-page profile enables him to tell everyone who meets him the things he thinks it is important for them to know. For Adam this is how he talks (by blinking); that he has a good understanding of his own health and, when well enough, likes to be included in decisions. Adam has also chosen to tell staff about his interests; his  hobbies and also about his pet dog Charlie. Adam loves chatting with staff so wanted them to know things he likes to talk about.

Adam is now cared for by an excellent team of staff who include Adam, when he is well enough, in decisions. This hasn’t always been the case. Too often elsewhere assumptions were made ( interestingly more by doctors than nurses)  that as a child with severe physical  impairment, Adam must ( despite glowing school reports showing this clearly was not the case and a string of awards to his name for creative writing) inevitably completely lack understanding. In the bad old days doctors did not engage with Adam at all, let alone about his healthcare, so I can fully understand why Adam focused on how he communicates and his cognitive skills in his profile.

The beauty of one-page profiles is that the writer, be he or she, a manager, nurse, doctor, domestic, patient or family member decides what is important to him or her. To Adam his one-page profile is about giving him a voice, to me it is about giving Adam equal autonomy to his teenage peers.

We both hope one-page profiles will become the norm within the NHS, produced and read by all.