Beyond the Francis report: How a person-centred NHS would care for patients and nurses

Image 6When the NHS recovers from the publication of the second Francis report into the failings at the Mid Staffs NHS Trusts, it will be time for a bold new direction.

Together with colleagues, I have been developing a personalised approach to hospital care that acknowledges the needs of both patients and nurses.  The first hospital we have been working with has just received a glowing report from the Care Quality Commission – and we are now talking to a second. Our vision is different because, for the first time, it brings person-centred thinking into the setting of a hospital ward.  Person-centred thinking focuses on understanding what matters to individuals and how they want to be supported in hospital.

In a person-centred NHS, managers would also take the time to understand what is important to their nursing staff and what support they need to work effectively. When staff are known as individuals with passions and talents, managers can deploy them into roles where they excel. Nurses who feel safe and supported will be empowered to deliver truly patient-centred care.

What could this patient-centred care look like?

  • What if you only told your story once and every time a nurse or professional asked you more questions, they were building on what you had already told them?
  • What if you were known as a person and people knew a little about what mattered to you as an individual?
  • What if you knew a little about the nurses and staff, so that they felt like people as well?
  • What if you knew who your ‘team’ was and when they were coming each day, as well as a nurse who was responsible for making sure you were comfortable and had as good a day as possible?
  • What if you had an opportunity to tell people safely how your hospital experience was going for you, whilst there was still an opportunity to make it better (rather than a questionnaire after you have left?)
  • What if night staff saw their main role as helping you sleep well?
  • What if you were part of the planning and decision-making about when you transferred or were discharged home?
  • What if you were contacted after you arrived home to see how you were getting on?

We have developed these questions into a patient-centred journey which we are implementing with the senior management team, nurses and health professionals at a hospital in Bispham, Blackpool.  Managed by Spiral Health, this nurse-led rehabilitation unit has 40 beds and patients stay for between one day and six weeks, with an average stay of sixteen days.

A patient booked into Bispham for rehabilitation such as physiotherapy would first receive a visit from the unit’s assessor, Zandra. Zandra would meet the patient in hospital and start to develop a patient-centred profile (called one-page profile in education and social care) about what is important to the patient and how to support her. This would include information about how she usually sleeps, her hobbies, interests and family. During that conversation, Zandra would have built on the notes she read about the patient and talked about what the unit could offer her – also giving her a chance to discuss her own expectations of the unit. They would have decided together the best day and time of day for her to arrive. Zandra would then check the information that she was happy to have shared on a profile, which would be posted above her bed, for staff to read.  Nothing medical or confidential would be included in this profile.

When the patient arrived, the receptionist would know she was due and would have read her one-page patient-centred profile.  She would welcome her by name and as she was taken to her bed the patient would see a display of the staff team, each with a photo, and details of their role, as well as a little bit of personal information that staff were happy to share about their hobbies and interests.

Within an hour, the patient’s named nurse would have met her and completed her admission. It would have been clear to the patient that the nurse knew all the information she had previously told Zandra, as the conversation built on that. Her patient-centred one-page profile would be on the notice-board behind her bed, large enough for people to read.

The patient’s named nurse would introduce her to her ‘team’ by showing her the mini profiles of the physiotherapist who would be working with her, and any other professionals, and a timetable of when these sessions were likely to be.  The nurse and patient would then decide the best visiting times, personalising them depending upon mum’s energy levels and what was possible for her family and friends.  The nurse would tell her about the unit’s volunteers, asking whether she’d like to be introduced to someone with similar interests, then she would take her on a tour of the unit.

Each day, the nurse responsible for her care that day would ask her what a good day would look like for her. She might say, it would be walking an extra three steps unaided, or writing a letter, or having a good game of scrabble. The nurse would write this on her notice-board and at the end of the day the night nurse would ask how the day had gone.

The night nurse would be responsible for helping the patient to have the best night’s sleep possible – this is not just about sleeping tablets, but a range of ways to help patients sleep well, including individual soothing music and eye masks.

After five days, the nurse manager or a volunteer would talk to the patient privately and ask her about two things that were going well, two things that could be better and two things that she would like to see in the hospital in the future. This information would both be used to improve her stay immediately and to give feedback directly to staff.

Her progress would be discussed with her and the therapists involved in her care, around her bed, rather than separately in multidisciplinary meetings, reflecting the ‘nothing about me without me’ philosophy of the unit. Finally, when it came to thinking about discharge, she would be asked how and when she wanted to leave. Her updated profile would be sent to the health professionals who would be involved with after she left hospital. A week later, she would get a call from the hospital to check how she was doing at home.

This vision is beginning to take shape at Bispham and we believe it can be a reality here and in other hospital settings, too. We’ll be reporting on progress in future blogs and will also address, in detail, the issue of how to be person-centred with nursing staff so they feel empowered to be part of this deep culture change.

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