It takes courage to admit that you got it wrong, and courage to try to set things right. The Royal Melbourne Hospital (RMH) is a highly respected institution and prides itself on the quality of care provided to patients. However, even in the best organisations, sometimes things happen that are not ideal. It is how we respond that makes the difference – do we ignore them and hope for the best, or do we admit our faults, examine our mistakes and try to learn for the future.
When the hospital received a complaint from an elderly patient’s daughter, it followed best practice and responded to and addressed her concerns. Usually, that is where the story would end, however, this time they decided to go further. They saw an opportunity to document the experience for a wider audience within the organisation and to use it as a teaching and learning tool. Thus the journey of making Lola’s Story, and with it a new approach to listening to patients, began.
"We are not just talking about a bunch of figures or graphs on paper - these are real people that have real experiences with us."
Lola had been a patient at the hospital. An elderly woman, she had communication difficulties following a stroke and was quite frail. Her daughter spent a great deal of time with her at the hospital and felt that her mother was overlooked by staff who didn’t make the time to try to understand her needs or what she wanted from her care. She also felt there was a lack of communication between staff and Lola’s carer’s (herself and other family members) and that there was no interest shown by staff in initiating or pursuing conversations about Lola’s care.
The complaint came to the attention of senior staff within RMH. There had been discussions within the executive leadership for some time about ways that patient stories could be utilised constructively to improve practice. Sharon McGowan, Executive Director of Communications and Community Relations, Associate Professor Denise Heinjus, Executive Director of Nursing Services and Allied Health, and Liz Cashill, Consumer Liaison and Integration Manager had all seen the way patient stories had been utilised elsewhere, in Australia and internationally.
They had used patient stories at some committee meetings, but wanted to reach a wider audience. In order to do this they made a conscious decision to move away from seeing the recording of such a story in terms of risk. Instead they saw it as an opportunity – to acknowledge a failure to provide person centred care and to use it to inform better practice in the future.
Part of the decision to film the story stemmed from the situation itself. Lola’s daughter was an experienced aged care professional, with a robust understanding of best practice in the area of caring for older people. Most importantly, perhaps, she was keen to work towards creating something positive from her mother’s experience. As Sharon says, “we had clearly a very detailed complaint, clearly a very articulate carer, and somebody that wanted to help us change things.”
The process of filming and showing Lola’s Story has also been a learning experience for the team involved. While they all feel there are things they would have done differently with hindsight, a lot has been learned from the process and this has informed subsequent use of patient stories and other strategies to embed patient centred care into practice.
The experience producing and sharing Lola’s Story has given impetus to using patient stories further within RMH. A second patient story, Florence’s Story has been filmed, and is now used for staff training. As well, the hospital is continually expanding the contexts where patient stories are shared verbally. They now open all quality committee meetings and Board of Directors meetings with a patient story.
Patient stories are just one of a raft of strategies being used by RMH to put patient experience front and centre, and ensure that person centred care is delivered across the organisation and by all staff, all the time. All staff are required to complete an online training package on Partnering with Consumers and Person Centred Care. Other training resources include Florence’s Story, as well as videos on person centred care and on providing health care to the ATSI community.
The hospital has also been surveying patients after discharge about their experience of the hospital and its care. The survey is sent by email to all patients who provided an address. The hospital has also implemented the Partnerships in Care Strategy, endorsed in early 2014. The strategy is multi-pronged and aims to empower consumers as well as build workforce capacity.
These strategies all form part of a concerted organisational push to ensure that person centred care is something that is central to clinical practice in every profession and every occasion of care. Ultimately it is about remembering what a hospital’s performance is actually about . As Sharon says, “we are not just talking about a bunch of figures or graphs on paper – these are real people that have real experiences with us.”