The Health Facilities Management Association’s ninth annual conference, held recently at Brighton, had important pointers for clinical staff as well as non-clinical personnel. NICHOLAS MARSHALL reports.
This was suggested at the HEFMA conference, at which advances in patient choice were highlighted. Clearly, staff collectively in the healthcare setting must work cohesively to achieve highest clinical, service and environment standards enabling the best possible patient outcomes.
A current lack of NHS responsiveness to non-clinical patient requirements needed to be addressed, the conference heard. Individual care, rather than institutional care, had to be offered. Patients wanted, in addition to access to excellent clinical care, changes spanning their whole experience – from better meals at times that suited them to more privacy.
A satirical look at the healthcare scene was presented at the start of the conference by The Treason Show, and the portrayal of how empathy and communication were lacking in healthcare organisations grabbed attention and attracted a large measure of applause.
The conference was chaired by broadcaster, writer and comedian Simon Fanshawe who underlined how the event facilitated drawing out what could be done to deliver the best standards of services as the health sector moved ahead.
Angela Coulter, chief executive, Picker Institute Europe, said healthcare organisations wishing to actively attract patients needed to consider the state of their reputations, improve services as appropriate and adequately market these services. With patient choice being pushed to the fore, “risks are great” if no action is taken.
Gaining a favourable reputation involved a number of factors including levels of clinical quality, cleanliness and healthcareacquired infection rates, and the state of the environment in which healthcare was provided.
Research indicated that patients wanted fast access to reliable health services, more choice, and more say. Many patients wanted more privacy, and there was room for improvement with cleanliness and food. Children and young people wanted better entertainment facilities.
Overall, satisfaction about care was improving although the provision of care was seen as quite paternalistic. There was a need to reject the idea that, with “free” healthcare, patients should “make do” with a “one size fits all” service.
There were growing concerns about cleanliness, and patients wanted more information about standards of hygiene – it was difficult for them to personally judge what standards were being achieved.
Angela Coulter said that, in introducing widespread choice, the NHS was embarking on an “extraordinary experiment” which would lead it into “very unchartered waters” – what would happen as further choice options were rolled out was unknown.
Bob Ricketts, head of demand-side reform, Department of Health, said “choice will drive change”. There was strong evidence that patients wished for, and would exercise, choice.
Providing patients with choice and empowerment was good for patient outcomes.
Even a modestly sized shift of patients away from a Trust as a result of individuals exercising choice could significantly affect the organisation’s bottom line. Providing more choice would be “not a comfortable journey” particularly for service providers. On choice, the “starting gate” had just been opened. The NHS was changing, but was a long way from putting the public at the heart of service design.
Recent surveys suggested that patients did not feel at the centre of the NHS.
Only 44% of patients were satisfied with their choice of doctor, and 57% experienced problems contacting their general practice or local healthcare centre by telephone. Seventy per cent of patients said they were not sent copies of any letters between the hospital and their GP.
Of respondents taking part in a consultative study, 61% said that being given more information about their health conditions would make a large difference, and 63% stated that being able to see a GP within 24 hours would be a major improvement.
Establishing a set of high level principles regarding choice would help ensure a consistent approach to the introduction of choice across NHS care, Bob Ricketts stated.
It was noted that all individuals were entitled to choice about their healthcare provision and the services used. Choices offered should reflect an individual’s beliefs, values and chosen lifestyle as well as clinical need, and choices should be offered at “decision points” along the patient’s care pathway where this improved the patient experience and was clinically safe.
The choices offered should be clinically appropriate and in accordance with professional guidelines. Appropriate information and support should be available to empower individuals to make an informed choice. Patients exercising informed choice should also take some responsibility for their choices made. Choices should be affordable, and the choice an individual made should not prejudice the treatment he or she received.
In the area of informing choice, it was ascertained that “quality” information was available at Trust or provider level but not at more local levels, and that comparative information was not always available across all providers of NHS care.
Furthermore, clinical quality benchmarking and information was poorly developed. GP recommendations on providers were seen as based on an informal network of “intelligence”, Bob Ricketts said.
Nigel Kee, director of nursing, clinical governance and quality improvements, Walsall Hospitals NHS Trust, said understanding the contribution of others to healthcare delivery was important, as was mutuality of support and flexible working.
Changes in the healthcare landscape involved technology, a shift towards more community-based care, greater choice for users of healthcare services, the establishment of a “failure” regime, the prioritisation of resources and, possibly, rationing in service provision. Workforce reshaping would progress with new roles developed, existing roles redefined, roles extended and expanded, and supportive education and development in place. Private Finance Initiative (PFI) would, for some, provide an incentive to invest in higher quality environments, but it was noted that improvements in healthcare delivery did not necessarily require additional funding.
Successful healthcare services – and therefore organisations – would be those which had the most effective teams and the ability to respond to change and opportunity more quickly than others, Nigel Kee said.
Steve McGuire, director of capital estates and facilities management, Guy’s and St Thomas’ Hospital NHS Foundation Trust, described in detail the Trust’s innovatively designed Evelina Children’s Hospital – the first new children’s hospital in London for more than 100 years.
Involvement of children, parents and staff was critical in how the new hospital and its services were shaped, and every opportunity was seized to create the optimum patient environment. Recognised was the way in which facilities management frontline staff had a huge impact. A wholly fresh approach to facilities management was developed, with new-style jobs created, career paths defined, special focus placed on quality, and training modules formulated. Much was learned from the hotel sector.
It was established that the rules of convention could be broken – and that it was all right to be creative and have fun. The feeling of brightness and fun – essential ingredients in young patients’ outcomes – was emphasised where possible. For example, the contract for cleaning the glass in the hospital’s huge atrium stipulated that the operatives be dressed as Superman and Spiderman.
Simon Cox, managing director, ISS Mediclean, considered that a service organisation should not “cherry pick” what was provided in the healthcare setting, and had to appropriately recognise that its provision was within hospital environments. He pointed out how ease of public access to some areas needed to be addressed – it could be easier for an individual to gain access to an intensive care ward than to hospital kitchens. He believed PFI hospital schemes provided opportunities to design into premises features that reduced the likelihood of healthcare-acquired infections arising.
Simon Cox called for long-term solutions to design out infection to be worked on now, and for training provision for facilities management and other support areas to be improved.
Iain Anderson, managing director, Sodexho Healthcare Services, said he personally considered that all those providing hotel services in the healthcare sector should join in a revolution to make available real choice for patients.
Although it was obvious, it had to be remembered that patients had everyday experiences of customer service and choice, and that they were becoming increasingly sophisticated consumers. Furthermore, patients valued a sense of normality when they entered the unfamiliar environment of hospitals.
Society had been reshaped, and choice and change were now evident in immense proportions. Expectations of choice and service standards had increased hugely. Patients might have to make menu choice decisions in hospital a day ahead of when meals were served – such advance ordering would not be acceptable in their usual environment. Individuals staying in a hotel who found their rooms unsatisfactory in terms of cleanliness would expect to be able to complain and have action taken. In the hospital setting, individuals were without points of reference for the cleanliness of their “space”.
Though the delivery of clinical services had advanced enormously, the providers of hotel services were “still delivering institutional care in a society which values individuality,” Iain Anderson commented. Today, patients were more likely to compare in-hospital services with the equivalent services – such as those in the catering area – they encountered generally.
Hotel services had the greatest opportunity in the patient environment to make a difference to patients each day. “I firmly believe that the opportunity to pay for additional items is the way forward,” he said, adding that this enabled greater patient choice and the possibility for hospitals to gain additional revenue. Providers of hotel services needed to analyse how they operated, and to reassess what they considered to be acceptable and not acceptable in terms of customer service. The implications of consumerism needed to be fully thought through, and the ways in which service was currently provided challenged.
“Agenda for Change is an opportunity for improvement, motivation, and making patient choice matter. Patients are people. Let’s create a culture that provides choices and meets challenges to move from institutional care to individual care,” Iain Anderson stated.
Claire Perry, chief executive, Lewisham Hospital NHS Trust said choice was wanted but wondered how the practicalities of offering it were going to be achieved and if the envisaged pace of change was realistic. To be considered was whether the marketing of an organisations facilities and services would be a wise investment or a waste of public funds.
Karen Caines, international health consultant, Institute for Health Sector Development, said that patient choice should not be “flight from poor service”, and maintained that there had to be other levers than just patient choice for achieving improvement.
She described World Health Organisation criteria relating to the functions and objectives of health systems. The criteria embraced respect for patients’ dignity, confidentiality, the right to determine access to personal information, the ability to participate in healthcare provision choice, and the quality of amenities.
Measured was how health systems scored on “responsiveness” to the nonclinical aspects of patient treatment. The premise that the value of the “responsiveness” was linked to the income level of the individual was wrong –in poor and rich countries, the same values were attached to “responsiveness”.
The UK had not done well in a “responsiveness” league table, and the implications stemming from its underperformance needed to be addressed, Karen Caines stated.
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