As many of you may know, our Director of Primary Health and Community Care, Martin Hefford, yesterday spent his final day at Counties Manukau Health before taking up a new role as CEO at Compass Health. I would like to take a moment to acknowledge the enormous impact Martin has had, despite being with us for only a little over a year. His leadership and skills have taken our organisation a long way in helping us build and develop our Localities programme and whole of system view which will significantly benefit the population of Counties Manukau in years to come. I wish him very well in his new role and know we will be hearing of success from Wellington very soon.
I also have great pleasure in welcoming Benedict Hefford who replaces Martin as Director of Primary Health and Community Care. Benedict has spent the last decade working with the National Health Service in the UK, particularly in the development of primary care. He is also Martin’s brother and therefore extends the proud tradition of Heffords in Counties Manukau. Welcome Benedict – we look forward to working with you.
Thanks goes to everyone who responded at length to my last post about the First World War. I was really moved by some of the stories staff and readers shared about their connections to this global event, and I intend to incorporate these into my blog in coming months.
Finally, some of you may have read a post entitled Re-visiting Visiting by our very own Dr Mary Seddon on the Team Counties Blog last week. For those who have not, I would like to republish it here. It is a very profound and moving post which deserves to be exposed to as wide an audience as possible. I really want to lend it my support as I think it raises profound and thought-provoking issues which speak to the heart of who we are as a healthcare organisation. I hope you enjoy reading it as much as I did.
Published 23 January, 2013
Many of us will face having a family member in hospital and come up against restrictive visiting policies. My Dad was admitted to Tauranga Hospital last August with painless obstructive jaundice. The family, which is large (7 children, 15 grandchildren and 6 great grandchildren), gathered to be with him when the diagnosis was confirmed as inoperable pancreatic cancer. To see him diminished was hard for us all but something that eased our anxiety was the fact that Tauranga Hospital has committed itself to a Patient and Family Centred Care approach.
Dad was last in Tauranga Hospital about 8 years ago and the contrast for me was stark. Back in 2004 he had spent a few days in ICU, which had open visiting and the family felt included. It helped that I had worked there as a medical registrar. However, when he was transferred from ICU to a surgical ward there were restrictive visiting hours and the non-verbal body language of the staff made you feel most unwelcome if you tried to be there at other times. There was no opportunity to discuss his care with the doctors – a harried on call house surgeon would do their best but they were not involved in his care.
This time, however, the surgical wards could not be more accommodating. There was never any hint of a restriction and both nurses and doctors were forthcoming with information about his illness (with his permission) and how we could care for him. Being a big family we organised ourselves so as not to overwhelm the place (Dad was in a 4-bedded room) and it was nice just to be able to pop up in the morning and see how his night had been, or to sit with him as we all adjusted to the new reality. In the midst of a terrible time we were grateful for being welcomed and helped as we took on the role of carers for his final few weeks at home.
So it is painful for me to see the impact of our restrictive visiting policies on families here at Middlemore Hospital when we know that the experience can be much better. Several of our sites have already moved to welcome families – medical wards 33 and 2 have made the change and have noticed a decrease in the tension and confrontations that sometimes resulted from restricting family access. Of course Kidz First has understood the benefits of having families present for many years but it was not always the case: 30 years ago parent involvement was still considered unnecessary and unhelpful. We wouldn’t consider restricting parents’ access now and hopefully we can get to the same place with families of adult patients.
Currently at Middlemore Hospital we do not differentiate families from general visitors and most units restrict the presence of families to six hours in the afternoon/evening. Such restrictive ‘visiting’ policies were developed in a completely different social and medical context. We now have very short hospital stays and patients with long-term chronic illnesses. There is good evidence that greater family presence and participation improves patient and staff satisfaction, decreases length of stay and improves discharge planning. Some studies also suggest that it decreases hospital-associated infections and adverse events such as patient falls and medication errors.
In hospital, we are guests in our patients’ lives for a very short time. It is the resilience of families that will shoulder the ongoing care in the community yet it is difficult for families to be confident partners in care if they are not welcomed as such. Take a look around at our current ‘visiting’ signs – most speak of our wish to control our ward environment rather than welcoming families.
We have drawn a line in the sand: The Patient and Whaanau Centred Care programme will be launched in the first week of March. Although this programme has many strands, one of the first tasks is to look at how we can welcome families to be with their loved ones during their hospital stay.
Hospital visiting policies and culture are often entrenched and hard to change so for the last 18 months we have been working to understand the barriers to greater family participation by surveying staff and patients about their perceptions. Commonly stated reasons for restricting families are:
- Security fears
- Issues of privacy/confidentiality
- Concerns of increased noise
- Some staff are uncomfortable with providing care in front of family members
- Concerns about increased infection risk
- Concerns about the large families in our communities
While accepting that staff are sometimes anxious about welcoming families as partners in care, it is so evidently the right thing to do that we will have to work through these barriers. Some of the issues above have proven to be exaggerated when actually studied (staff should look out for the ‘myth busters’ series coming to the Daily Dose) but we will need to work through processes to maintain staff and patient security, and educate our community about the changes we are making and their role in ensuring that this is a positive change for us all.
When I was a nervous first year house surgeon, Dad said that if I kept the patient front and centre then I wouldn’t go too far wrong. Patient and Whaanau Centred Care is the embodiment of this advice.
Dr Mary Seddon, Clinical Director – Centre for Quality Improvement
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