Reflect upon the impact of the planning

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Unit 20- Care Planning
Processes in Healthcare Practice
Session 8
Objectives
LO4 Reflect upon the impact of the planning of care on practitioners,
individuals, family and carers in relation to own practice.
Discuss the ways in which the individual and family contribute to
evaluation of the care process
Review aspects of the care planning process and their impact upon
the individual, family and carers
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Some guidance and legislation on involving/
engaging service users and family care provision
and quality
World Class Commissioning (2009) – World class commissioning aims to use best practice
from across the world to help PCTs deliver better health and well-being for their
population. Competency three states that this should mean to; ‘proactively build
continuous and meaningful engagement with the public and patients to shape services and
improve health’.
The NHS Constitution (2009) – The NHS Constitution pledged that patients have the right
to be involved in discussions and decisions about their healthcare, and to be given
information to enable them to do this; and the right to be involved, directly or through
representatives, in the planning of healthcare services, the development and consideration
of proposals for changes in the way those services are provided, and in decisions to be
made affecting the operation of those services.
Patient and Public Involvement Forums (PPIFs) (2003) – A PPIF was established as an
independent statutory body for each NHS trust and PCT in England. The aim of the PPIFs
was to improve the quality of NHS services by representing the views and experiences of
patients, their carers and families, through monitoring and reviewing NHS delivery, seeking
the views of the public about those services and making recommendations to the NHS
accordingly.
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Family and friends as partners in planning:
Valuing family and friends
importance of communication between individuals, family, friends and
professionals
Consideration of what is important to the individual
Recognition of the individual as part of the family unit
Promotion of rapport with the individual, family, friends and professionals
Recognition of the right of family and friends to be involved
Provision of individualised care and support
Addressing issues which affect plans
Basing plans on an individual’s priorities in alliance with family, friends and
professionals
Use of facilitators where needed
The importance of involving service users and
family in quality evaluation.
By involving service users shows that people who are involved in decisions
about their health and care tend to:
1. Report greater satisfaction with the services they receive
2. Experience less regret about the decisions they have been supported to
make and are more likely to say that the decision made were most
appropriate for them
3. Make fewer complaints than those who were not involved in decisions.
4. Personalised care and support planning and shared decision making
reduce unwarranted variation in the provision of care, treatment and
support by ensuring that all decisions are informed decisions based on
personal preferences
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It is a legal duty
Promoting the involvement of people in their own health and care is a key
component of Clinical Commissioning Groups (CCGs) and NHS England’s statutory
duties.
Shared decision making and patient choice Section 14U of the National Health
Service Act 2006 (as amended by the Health and Social Care Act 2012) specifically
states that CCGs must promote involvement of each individual, their carer and
(should there be any) their representatives in decisions relating to the prevention
or diagnosis of illness, or their care or treatment.
Section 14V states that CCGs must, in the exercise of their functions, act with a
view to enabling individuals to make choices with respect to aspects of health
services provided to them.
NHS England is under equivalent legal duties in relation to individual involvement
and choice under sections 13H and 13I respectively.
Methods for assessing service quality
Methods such as questionnaires,
focus groups, structured and
semi-structured interviews,
panels, complaints procedures.
Graffiti Walls –
http://thurrockccg.nhs.uk/comp
onent/phocagallery/1-publicengagement-event/detail/5-
graffiti-wall
Customer feedback
Type of observation- Quality
Audit (CQC)
Online forums
Focus groups
Involving in meetings and panels
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SERVQUAL
SERVQUAL is a multi-dimensional research instrument, designed to
capture consumer expectations and perceptions of a service along
the five dimensions that are believed to represent service quality.
How do individuals and families contribute
to care provision and quality
Communication
Making care plans together
Involving in meetings
Providing personalised care
Questionnaire or survey on experiences
Working in partnership
Shared decision making
Active listening
Responding and dealing with complaints
https://www.youtube.com/watch?v=jsYQ98N363g
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Health and Social Care Act 2008 (Regulated
Activities) Regulations 2014: Regulation 9 Person
Centred Care
The intention of this regulation is to make sure that people using a
service have care or treatment that is personalised specifically for
them. This regulation describes the action that providers must take to
make sure that each person receives appropriate person-centred care
and treatment that is based on an assessment of their needs and
preferences.
Providers must work in partnership with the person, make any
reasonable adjustments and provide support to help them
understand and make informed decisions about their care and
treatment options, including the extent to which they may wish to
manage these options themselves.
Closing the Triangle of Care
Carers Included: A Guide to Best Practice in Acute Mental Health Care
It’s a simple solution…
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The 6 standards of the
Triangle of Care
1) Carers and the essential role they play are identified at first
contact or as soon as possible thereafter
2) Staff are “carer aware” and trained in carer engagement
strategies
3) Policy and protocols re: confidentiality and sharing
information are in place
4) Defined post(s) responsible for carers are in place
5) A carer introduction to the service and staff is available, with
a relevant range of information across the acute care
pathway
6) A range of carer support services is available
And regular assessing and auditing to ensure these six key
elements of carer engagement exist and remain in place.
Closing the Triangle of Care
Carers Included: A Guide to Best Practice in Acute Mental Health Care
A disconnected model of involvement…
Can lead to…
carers being excluded at certain points of the care pathway
failures to share information around risk assessment and care planning
requests from carers for information, support and advice not heard
carers unique and expert view of the person using services can be
missed
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A growing body of evidence shows that a more engaged patient
experiences better health outcomes and lower use of healthcare
services.
The term ‘patient engagement’ encompasses a number of related
concepts, including ‘patient-centred care’ and ‘shared decisionmaking’, all of which build on the idea of involving patients as
partners in their care.
Patient engagement is associated with fewer adverse events, better
patient self-management, fewer diagnostic tests, decreased use of
healthcare services and shorter lengths of stay in hospitals
Impact of care process on individual, friends
and family:
Positive impact: reassuring, shared decision-making, feel involved
and empowered, allows them to ask questions, they feel that they are
being listened to, increased knowledge and understanding, they can
recognise outcomes and work towards shared goals, gives structure
and purpose to care processes, enables advocacy support
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Principles for user involvement
Clarity about the potential for involvement &
influence
Respect for people’s views and experience
Offer support and training
User involvement policies & procedures
An openness to change
A base of support & accountability
Offer payment & other incentives
Ideas about negotiating differences
Power and empowerment
Principles
Active partnership
Doing research with or by people who use services, not to, about or
for them
If research reflects the needs & views of people who use services it is
more likely to produce results that can be used to improve practice in
social care services.
(INVOLVE)
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Principles of service user involvement
Clarity and transparency
Empowerment
Identity
Commitment to change
Respect
Equal opportunities
Theoretical approach
Accountability
Faulkner 2005
Clarity and transparency
Diversity
Respect
Flexibility
Accessibility
SURGE 2005
‘Learning the Lessons’
Service user involvement at all stages and all levels – from design to
dissemination
Project steering group, advisory group
Service users as researchers, reviewers, interviewers.
Integrated research team-based approach
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LL: What was good about it?
Support for Researchers:
systematic debriefing;
peer support
telephone contact with research supervisors
Practical Arrangements
Paid as consultants & expenses;
Administrative support; e.g. information packs, accommodation and
travel arrangements
Involvement and ownership of process as a whole
Design, interviewing, analysis and report writing
Training and team work
Good quality research
Keeping the space
Good service user
involvement
Information and
Communication
Respect
Accessibility
Flexibility
Honesty,
transparency
Support
Training
Payment
Resources
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Negative impact of not involving s.u and
families
Features of ineffective engagement: intrusive, disruptive, time-consuming
Miscommunication
Poor quality care
Breaking the law and legal duty of organisation
Lack of personalised care
Detriment to service users health and well being
Lead to abuse or negligence
Poor continuity of care
Low satisfaction from service user
Service users may move homes
Numerous complaints from service users and families’
Complaints to CQC… etc
Amount of work & co-ordination involved
Expensive
Time-consuming
Personally challenging at times
Difference
Distress
Dissent
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