quality care Engaging patients for better treatment outcomes - - PowerPoint PPT Presentation

Systems for patient-centered care Protocols & systems to deliver high quality care

Engaging patients for better treatment

• utcomes

Dhivya Ramasamy

To make eye care work, we need the patient to…

Seek Care Diagnosis & Advice Acceptance

• f Advice

Treatment Self Care Follow up visit

Seek Care Diagnosis & Advice Acceptance

• f Advice

Treatment Self Care Follow up

Acceptance of cataract surgery is reported to be a mere 14% in the community and 45% in hospital based settings

How many of our patients effectively complete their treatment?

Compliance with wearing spectacles among school children remains as low as 30% Glaucoma patients’ adherence to essential annual review visits drops to less than 30% by the fourth year Fewer than 20% of patients receiving spectacle prescription in outreach camps actually procure spectacles

Venkataswamy G, Brilliant G, Social and Economic Barriers to Cataract Surgery in Rural South India: A Preliminary Report; Visual Impairment and Blindness; Dec 1981 T Snellingen, B R Shrestha, M B Gharti, et al. Socioeconomic Barriers to cataract surgery in Nepal: the south Asian cataract management study; Br J Ophthalmol 1998 82: 1424-1428 Gogate P, Mukhopadhyaya D et al. Spectacle compliance amongst rural secondary school children in Pune district, India. India J Ophthalmology 2013; 61:8-12 Sleath B, Blalock S, Covert D, Stone JL, Skinner AC, Muir K, Robin AL. The relationship between glaucoma medication adherence, eye drop technique and visual field defect severity. Ophthalmology 2011 Dec; 118(12):2398-402

Fewer than 15%

• f diabetics are

aware that they must have their eyes tested regularly

Ensuring that patients complete their treatment process

Seek Care Diagnosis & Advice Acceptance

• f Advice

Treatment Self Care Follow up visit

Right Diagnosis?

Barriers to effective service delivery

To the provider

 Lack of integration within

the eye care system

 Lack of trained manpower  Low demand  Poor patient compliance to

treatment advice

 Poor uptake of services  Lack of regular follow up

 Lack of community

leadership in support and promotion

 Lack of policy support  Preference for free services

To the patient

 Poor access

 services are not affordable  lack of a support system

 Poor awareness

 about the services available  about their own eye

condition

 misconceptions  fear

 Lack of confidence in the

provider

 poor previous experience  lack of comprehensive

services

 no perceived improvement

in condition

Owning the problem:

How can we address these barriers that affect effectiveness of eye care services?

Within the Hospital

Aware of

• ne’s eye

condition Seek Eye Care Diagnosis Treatment Recovery Follow up / Self- care

Health education Counselling Make it accessible & affordable Enabling compliance. Examine the barriers Ensuring positive patient experience

PROVIDING INFORMATION ENABLING COMPLIANCE

ENSURE PATIENT CENTERED CARE

Patient Centered Care

Dhivya Ramasamy

Patient Centered Care

• Patient at the centre of

service design & care giving process

• Making services

affordable

• Patient friendly systems

& facility

• "Providing care that is respectful of and responsive to

individual patient preferences, needs & values

• Ensuring that patient values guide all clinical decisions."

PATIENT CENTERED CARE

Demystifying

Patient Centered Care :10 Goals

• 1. Creating Access for patient care
• 2. Maintaining dignity & Being responsive to patient needs
• 3. Enabling informed decision making
• 4. Getting proper informed consent
• 5. Transparent pricing & Minimizing cost of the treatment
• 6. Ensuring follow up for all category of patients
• 7. Ensuring & Facilitating patient feedback
• 8. Ensuring availability of appropriate patient amenities
• 9. Patient is always right
• 10. Putting in place a process of continuous improvement

CREATING ACCESS FOR PATIENTS Goal 1

Patient at Aravind Vision Centre, Manamadurai:

“When elderly patients have to visit the Madurai hospital they need to have someone to accompany them. But one can come alone to the Manamadurai clinic. It is very useful to have this clinic here”

Emergency Patient at one of our Vision Centres:

4 km

ID Card

Creating Access for Patient Care

• Have the hospital / clinic open from 7.30

am to 6.00 pm

– Round the clock Emergency care

• Ensure vulnerable patients & who need

emergency care are given priority

– Young infants, Elderly, Bilateral blind, Physically challenged – Availability of wheel chairs / stretchers

Creating Access for Patient Care

• While referring to other clinics, inform the

patient about the need & document the reason for referral

• While referring to other clinics give the option
• f timing to the patient
• Avoid appointments for treatment, unless

requested by the patient

• Appointments on days convenient to patient

Goal 2

Maintaining Patient’s dignity & being responsive to patient needs

Being “Present”

Daycare Patient: “It was around 1:00pm and it must have been their lunch time. They said what they had to say very rapidly – as if they had to finish saying what they wanted to say – not really caring about us”

Avoid Labeling Patients

Maintaining Dignity & Being Responsive To Patient Needs

• Minimize waiting time

– While advising review visits, document required investigations to be done on arrival

• Inform the patient - if care will be delayed,

location of clinics etc.

• Identify specific areas of our service that

require patient information

Monitoring waiting time

Monitoring waiting time

Monitoring waiting time

ENABLING INFORMED DECISION MAKING

Goal 3

Enabling informed decision making

• Counselling
• Information brochures
• Display materials
• Involve the patient’s

relatives & friends

• Ensure understanding

Paying Inpatient:

“When I take my mother for the doctor’s rounds, we are anxious to know what the doctor has to say about her

• eye. But they did not allow us
• inside. The doctor just looked

at the eye and took notes”

Informed Decision Making

• Patient was admitted for RE surgery
• But patient wanted LE surgery
• In Ward, patient herself changed the wrist band.
• This was not checked in ward or block room.
• The block room doctor saw the wristband on the

left hand and blocked the LE

• Surgeon found the error in the Operating room

Involving Patients In Decision Making

GETTING PROPER INFORMED CONSENT

Goal 4

Getting proper informed consent

• For all procedures & processes
• Special consent if the visual outcome is poor
• Ensuring patient understands the procedure &

the risks / benefits involved

TRANSPARENT PRICING & MINIMIZING COST OF THE TREATMENT

Goal 5

Minimal & Evidence based Investigations

• Discontinued culture and sensitivity tests for

all patients

• ECG and physician opinion done only for

select patients

Balance efficacy and cost

Be aware of the cost of your prescription

• Chalazion prescription
• Glaucoma medication
• Rationalize the choice of drug
• Knowledge of drugs is important to choose

the right drug

Patient Cost > Treatment Cost

• Avoid unnecessary review visits
• Rationalize review visits
• Consider all other costs that patient would

incur – travel, food, lost wages, attender costs

Transparent pricing & Minimizing cost

• f the treatment
• Ensuring all activities are taken care the same

day/visit

• Relying more on clinical diagnosis than

investigations

• Minimal & Evidence based investigations
• Package pricing & absorbing unforeseen

expenditure

• Minimal charges for readmissions and

resurgery

ENSURING FOLLOW UP FOR ALL CATEGORY OF PATIENTS

Goal 6

Performance Assessment

• Acceptance rate =
• No. of patients opting for surgery

Total no. of patients advised for surgery

• Follow up rate =
• No. of patients who keep their appointment

Total no. of patients advised follow up

Counselling Written Communication Information brochures Display Material High risk Follow up

Counselling

Counselling

Doctors

Convey necessary instructions Streamline processes

Patient

Provides Specific information Helps clarify doubts

Counselling

Patient aware Flow in daycare Choice of lenses Types of Surgeries

147 29 92 248 201 190 64 148 100 26 85 111 95 27 23

Forgot date Follow-up scheduling Problem Not aware of importance of eye check up Eyes were OK at the time No one to accompany me Financial difficulties Leaves unavailable Too much travel time Too much waiting time in clinic Not satisfied with previous treatment Uncontrolled blood sugar Visited another Ophthalmologist Other ailments more important than DR On wheel chair Taking alternative medicine

Solution

• Specific coding
• Easy transfer of

disease severity E1/E2

• Patient better

aware

• Reminders to

patients Targeted Counseling

• Good

Compliance

• Prevent Vision

Loss Timely Treatment

Emergency coding

Strategy

Code E1 Targeted Counseling Phone calls PRIOR DAY Treatment Status Tracking Missed Patients

Enabling Compliance

• Spectacle dispensing at camps

– Prescription only: 29% – On the spot dispensing: 85%

• One stop services (e.g. In-house physician, lab)
• Follow up at Vision Centers
• SMS reminders for follow up

ENSURING & FACILITATING PATIENT FEEDBACK

Goal 7

Setting the Balance Right

Excellence in Operations Positive Patient Experience

Volume Clinical quality Productivity

Patient Survey

• Outpatients
• Inpatients & Day

Care

• Specialty Clinics
• Pharmacy
• Spectacle Shop
• Paying Patients
• Free Patients
• Camp Inpatients
• Vision Centers

Patient Survey

Survey 1% Sample: >1000 patients per month Outpatients Inpatients & Day Care Specialty Clinics Pharmacy Spectacle Shop Paying Patients Free Patients Vision Centers Camp Inpatients

Patient Survey

General OutPatient Satisfaction Survey

Questioneries

always usually sometimes Never Reception And Registration :

• 1. Did the Staff treat you with care and respect?

90.4%

5.5% 4%

• 2. Did the staff respond satisfactorily to your queries?

92%

4% 4%

• 3. Were you given proper guidance to move to the various clinics and

counters? 89%

7% 4%

Nursing Care and Counseling :

• 1. Did the nurses treat you with care and respect?

89%

5.5% 5.5%

0%

• 2. How often were you able to get help as soon as you wanted it?

85%

12% 3%

0%

• 3. Were the procedures clearly explained to you?

86%

11% 3%

1%

• 4. Did the nurse take time to answer your doubts and question ?

100% 0% 0% 0% Yes No

• 5. If you were advised cataract surgery were the different type of lenses

explained to you? 100% 0% always usually sometimes Never

• 6. Did you recieve clear aftercare instructions about medines and followup?

88%

10% 3%

0% Doctors Care : always usually sometimes Never

• 1. Did the doctor listen carefully to your codition and problems?

75%

3% 22%

• 2. Did the Staff treat you with care and respect?

95%

4% 1%

• 3. Did the doctor explain about your condition and treatment in a way you

could understand ? 97.3%

1.4% 1.4%

yes No

• 4. Do you think a reasonable amount of privacy was provided during your

interaction with the doctor? 86%

13.7%

Hospital Environment and Facilities :

Always Usually Sometiems Never

• 1. Did you have any difficulty in finding your way about in the hospital?

0% 0%

16%

84% Too High Reasonabl e No idea

• 2. What is your opinion regarding charges and cost of services provided in
• ur hospital?

0% 78% 22%

Did the doctor explain the condition and treatment in a way you could understand?

How well did the staff listen and pay attention to your complaints about your eye condition?

Excellent | Good | Average | Poor

31% 63%57% 40% 79% 33% 61% 37%36%36% 54% 36%47% 30% 47% 28% 14% 36% 48% 30%36% 53% 21% 64% 29% 53%57%54% 43% 53% 48% 65% 42% 67% 61% 43% 21% 7% 7% 7% 0% 4% 11% 10% 7% 11% 4% 11% 5% 5% 11% 0% 25% 14% 7%

Vision Centres, 536 patients

How would you rate the consultation with the doctor, over telemedicine?

Excellent | Good | Average | Poor

Open Comments

SUGGESTION BOOKS

Voluntary Comments

Suggestion Note Book

GROUP DISCUSSIONS

Really Listening to the Patient

Patient Group Discussions

Patient Group Discussions

• Homogenous group
• Topic Guide
• Audio recorded
• Staff observer
• Scripted introduction
• Audio clips: tagged & archived

What patients say…

“One thing that strikes me is that from the moment I enter until my check up is

• ver, everything is systematic”

“Last time I was here, things were much more in control. Today, I see the sisters chatting on the corridors. When I see that I feel that they are not being attentive in the care they are giving me”

Ensuring & Facilitating patient feedback

• Suggestion note books
• Satisfaction Surveys
• Focus Group Discussions

ENSURING AVAILABILITY OF APPROPRIATE PATIENT AMENITIES

Goal 8

Ensuring availability of appropriate patient amenities

• Drinking water
• Proper Ventilation
• Toilet facilities
• Luggage room
• Seating arrangement
• Availability of hygienic food at appropriate

cost

PUTTING IN PLACE A PROCESS OF CONTINUOUS IMPROVEMENT

Goal 10

For Continuous Improvement Of Patient Centered Care

• Patient care dept
• Attending Focused Discussion Group

meetings

• Incident Reporting
• Suggestion corner
• Patient care Improvement committee
• Clinical Meetings on Wednesdays

Patient Centered Care :10 Goals

• 1. Creating Access for patient care
• 2. Maintaining dignity & Being responsive to patient needs
• 3. Enabling informed decision making
• 4. Getting proper informed consent
• 5. Transparent pricing & Minimizing cost of the treatment
• 6. Ensuring follow up for all category of patients
• 7. Ensuring & Facilitating patient feedback
• 8. Ensuring availability of appropriate patient amenities
• 9. Patient is always right
• 10. Putting in place a process of continuous improvement

Within the Hospital

Aware of

• ne’s eye

condition Seek Eye Care Diagnosis Treatment Recovery Follow up / Self- care

Health education Counselling Make it accessible & affordable Enabling compliance. Examine the barriers Ensuring positive patient experience

PROVIDING INFORMATION ENABLING COMPLIANCE ESTABLISHING PATIENT LOYALTY MEASURING PATIENT PROGRESS

It is ourselves we are helping It is ourselves we are healing”

• Dr. G. Venkataswamy

Thank You All