Annette Bartley, Director of UK Health Foundation's Safer Patient Network
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Annette Bartley, Director of UK Health Foundation's Safer Patient Network |
Annette Bartley—a registered nurse with more than 27 years experience in health care-is currently Director of the UK Health Foundation's Safer Patient Network. Annette is a founding member of the Wales Faculty for Healthcare Improvement, where she supports the drive for quality improvement in health care across Wales.
Annette leads a unique aspect of the 1000 Lives National Patient Safety Campaign-Wales, a program initiative aimed at improving patient safety and the quality of care at the frontline. The project, Transforming Care at the Bedside (TCAB), focuses specifically on improving patients' experience of care and is being 'tested' in three Welsh pilot sites. TCAB builds upon a successful U.S. initiative established in 2003 by the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement.
In 2006, Annette was awarded a Health Foundation Quality Improvement fellowship, which involved her spending a year based at the Institute for Healthcare Improvement (IHI) in Boston, Massachusetts. She also earned a Master's in Public Health at Harvard University while in Boston.
At IHI, Annette was introduced to the 'TCAB' initiative, a non-traditional quality improvement program. Ideas for transforming the way care is delivered on medical/surgical units come not from the executive suite or a quality improvement department, but from the nurses and other care team members who spend the most time with patients and their families. Patients and family members are fully involved in all aspects of their care and participate in TCAB improvement teams.
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On her return to Wales, Annette's passion about the program's potential to transform care delivery in hospitals, nursing homes, and potentially patients' homes, led her to take the concept to the Welsh Assembly Government, which subsequently appointed her lead of the TCAB pilot program in Wales.
Annette believes that she benefited both personally and professionally from the fellowship experience, noting that: "the fellowship was broader than just one project because it gave me an opportunity to visit another country and understand the complexities of different health care systems. It made me really appreciate the value of the National Health Service [NHS]. The fellowship helped create a network of colleagues and contacts, so when I'm back in the UK I've got a variety of sources that I can call on to further develop this work."
Here are more of Annette's thoughts:
"Quality improvement is often seen as someone else's responsibility, rather than a vital and important part of all health care professionals' roles. Often staff at the cutting edge of care are too busy fire-fighting and doing the important job of caring. They don't really have the time to reflect on how things could be done better.
In TCAB, staff [members] are actively encouraged to generate ideas about improving care and the enthusiasm I witnessed as I visited the pilot hospitals across the States was unlike anything I have seen in my nursing career. Nurses really enjoyed the creative freedom of being able to come up with their own ideas, test them, and make decisions about their effectiveness. They clearly and rightfully 'owned' quality in their units.
When patients and their families enter hospitals, they should have confidence that they will receive high-quality care . . . designed around their needs. TCAB's principal aim is [to] improve patients' experience of care. This will be achieved by empowering patients, their families, ward managers, and other front-line staff to develop, test, and implement changes that will dramatically improve the experience of care and create healing environments.
It helps nurses spend more time with patients by understanding how to make better use of their time. Communications among care providers and patients, and between families and care providers are improved. It also focuses on the redesign of workspace to enhance efficiency and reduce waste. I'm interested in supporting frontline staff, providing them with simple tools and techniques that generate energy for improving the quality of care for patients."
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A key focus of the project is on teamwork. "The premise is that if you haven't got the vitality and teamwork at the front line of care, then quality and safety can be compromised, therefore you're not going to get the best outcomes" Annette explains. "So the idea is that you not only address safety and reliability, but how to develop teamwork, how to keep staff energized and empowered. We are building a model in the UK which will use a multidisciplinary approach and will show how teams can work together to achieve the best outcomes in terms of quality care."
Some teams have implemented a "Patient's Daily Goal" program. Nurses and caregivers ask each patient, "What would be the one thing you really would like to achieve today?" Patients' responses have helped to re-focus the care on their needs, away from staff assumptions of what patients want. This simple question addresses a patient's priorities and care is then planned around accomplishing what really matters for the patient on that day. Surprisingly patients' goals are easily achievable-a bath/wash, hairdo, pain relief, rest/sleep, or check on family or animals.
There is also an efficiency angle. "We look at which aspects of care really add value for the patient, as well as the things nurses or health care practitioners do that add no value or could be done by someone else. So it's also about looking at effective use of time and resources," Annette says. For example, Dear Doctor notes were introduced. These are "sticky note reminders" given to patients and their families to write questions or notes throughout the day. These simple notes prepare patients and their families to have meaningful conversations with the rounding team. During physician rounds, the patient and doctor review the Dear Doctor notes together.
Patients and relatives are actively encouraged to initiate "Condition H" by calling the outreach team if they believe there is health deterioration that has not been responded to appropriately. Since its introduction, Condition H has resulted in few unnecessary calls. According to Annette, "Early indications show some promising results: adverse events have been reduced, cardiac arrest rates have plummeted, some units have gone without any patient falls for nearly a year, and patient and staff satisfaction is continually improving.
After an early career spent in surgery as an Operating Department Sister (equivalent to an OR nurse in the United States) Annette worked as a Practice Development Lead, before moving into a broader role within the NHS. As a practice development lead nurse, Annette was responsible for the implementation of nursing in general practice, nursing redesign, and quality strategy with nurses and teams to enable the development of a workforce fit for purpose in the delivery of a quality, effective, and responsive service to meet local and national health strategic priorities.
Annette was appointed as the Associate Director of Service Transformation at North Wales NHS Trust, where she concentrated on improving patients' experience of care, achieved by releasing clinical time, improving access to on line training, and improving patient safety measures.
In her role, Annette calls upon all of her previously gained skills and knowledge to focus on programs related to Patient Safety, Quality Improvement, and Transformation in Health Care.
A Few Words About the National Health Services (NHS)
Since its launch 60 years ago, the United Kingdom's NHS has grown to become the world's largest publicly funded health service. Although funded centrally from national taxation, NHS services in England, Northern Ireland, Scotland, and Wales are each managed separately. The Department of Health (DH) is in overall charge of the NHS with a Cabinet Minister reporting as Secretary of State for Health to the Prime Minister.
A National Health Service trust provides services on behalf of the NHS in England and NHS Wales. Nearly 3 million people live in Wales and use the services of the NHS. Primary Care Trusts are at the center of the NHS. Theses trusts manage local services and are best positioned to understand the needs of the community.
Strategic Health Authorities (SHA) are responsible for enacting the directives and implementing fiscal policy as dictated by the Department of Health at a regional level. In turn, each SHA area contains various NHS trusts that take responsibility for running local NHS services. Each SHA is responsible for strategic supervision of these services.
Strategic Health Authorities are responsible for:
- developing plans for improving health services in their local area,
- making sure local health services are of a high quality and are performing well,
- increasing the capacity of local health services-so they can provide more services, and
- making sure national priorities are integrated into local health service plans.
ENSURING PUBLIC INVOLVEMENT
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The NHS Improvement Plan, published in June 2004, delineated ways in which the NHS needs to change in order to become truly patient led. A key goal of recent policy reform is to make health services more patient-centered. The National Health Council convened a National Advisory Commission on Patient-Centered Care, bringing together a group of experts, patients, family members (known as carers) and champions of patient-centered care to serve as advisors on how to improve patients' experience of care.
A major part of public involvement is recruiting and training members of the general public with no medical training to take part in review teams. For example, in Scotland lay people are part of teams which review the standard and quality of NHS care by visiting hospitals and health service providers throughout the country to measure how well they are meeting the established standards of care. Working alongside other review team members drawn from health care and other professionals, lay people play a vital role by bringing new ideas and helping their fellow team members look at things from a service users point of view.
Over the last few years, the NHS has made great strides towards fully engaging people in the design and delivery of services. They are routinely asked for their views, about their experience of services, to contribute to staff training, and to be members of NHS foundation trusts.
Examples include:
- The NHS Care Records Service is evolving toward a comprehensive electronic record that will provide secure and accessible health information to professionals and patients across the nation.
- The Implementing Patient Involvement within a Prison Healthcare Setting project was aimed at prisoners and prison staff. As a result, prisoner patients are now at the heart of any service redesign and improvement and are integral in the successful implementation of positive change. Prisoners' self esteem, health, literacy skills, and willingness to take ownership of their health have improved. Prisoners who previously abstained from any health care involvement show a 50% increase in interaction.
- The emergency and urgent care network—pharmacies, patients, the public and the voluntary sector—examined the needs of the local population to improve community and home care programs. Emergency Care Centers (ECC)—with a Walk-in Clinic, minor injuries unit, and emergency mental health services—have been established in community settings. The public dials a single number to speak with a triage nurse and patients are fast tracked to the appropriate service. If appropriate, ambulance paramedics bring patients to the ECC or emergency social services staff may visit patients at home.
- Action Diabetes used marketing data and analytical techniques to target people at risk for undiagnosed diabetes. They identified a largely Asian community that shops locally and has a high preference to watch the local cable TV shopping channel. The pilot is working with local retailers and cable TV to raise awareness of diabetes, as well as personalized direct marketing using leaflet distribution door-to-door at high-risk postcode areas. An Action Diabetes bus takes testing and health promotion services to schools temples, mosques, businesses, and community centers in the locality. Diagnosis of Type 2 Diabetes has increased 33%, resulting in many patients receiving treatment much earlier.
- In August 2009, the Department of Health announced the creation of an Equality and Diversity Council that will strengthen the national focus on improving quality in the National Health Service. Its key role will be reporting on equality and diversity issues to the NHS Management Board, including championing improvement and campaigning for change. Lay members are being asked to apply to join the council, which will include representatives from patient groups, NHS staff, social care, and voluntary organizations.
To read more examples of how the National Health System is implementing patient-and-family- centered care, see A National Health Service.
Annette Bartley is married and has two children. She enjoys hiking, movies, and reading novels. If she were not a nurse, Annette would like to try her hand at writing a best selling novel!