Lost - PowerPoint Presentation

Slide1

Lost competence: patientologyCompliance among difficult patients

Morten Sodemann professor of global & migrant health, The Migrant Health clinic, Odense University Hospital & University of Southern DenmarkStine Lundstrøm Kamionka Ms Sci Economics  & Business Administration, Intl Management , Child & Adolescent Psychiatry at Center of Suicide Prevention and Center of ADHD & Migrant Health Clinic Odense University HospitalSlide2

BackgroundMigrant health outpatient

clinic (somatic hospital setting): 1500 complex abandoned immigrant patients (compliance issues, medically unexplained symptoms, low literacy, significant communication barriers, navigation problems)Fee for interpreter use

(2013) +

electronic

appointment letters (2014)Knowledge translation project: What is a vulnerable/difficult patient? 10 year Cohort of HIV patients: hidden compliance issuesPatient case coordination study (immigrant patients & suicidal adolescents)Observation of patient care processes over timePatient and HW interviewsSlide3

Interviews with experienced language interpretersWhich

fears do patients express to you?Common stress points?What do patients misunderstand?What do patients ask you after the consultation?Why do they call you

again

later ?Slide4

Secret life of patientsLearn from interactions

: adapt, chose and deselect health care Avoid: humiliation, scolding, guilt, shame, insecurity, conflict and ambiguity

Seek

:

respect, doctors recognition as good patient with accepted diagnosis, meaning, kindness, trust, and functional real-time supportShow up where and when they (think) they get thisStay

away

from

departments

where they don’t (think) they’ll get thisUnwittingly: counterproductive perceptionsAccumulate unsolved problems because we fail to helpIllness = invisible swing door poverty Become less literate + more confused + slower time perceptionHinders compliance but patients don’t tell doctors about this (will if asked)Slide5

The making of a difficult patient & how HWs adjust health care

Likeable

competent

Likeable incompetent

Unlikeable

competent

Unlikeable

incompetentAttention, bonus info,forgiveness, time tospeak, extra follow-up,more optionsLess info, more scolding,no invitation to speak, Less follow-up

,

less

options

Quality

depends

heavily

on

i

nterpersonal relations

Mobility

through knowledge

Easy

Unpredictable

Difficult

Morten SodemannSlide6

Medical errors involving disabled, vulnerable, ethnic or difficult patients not

recordedErrors ”unavoidable” in these cases…Outlier-patient challenges are invisible Slide7

10 % of patients are outlier-patients

So: we don’t have a plan for 10 % of our patients?Slide8

Result

?Patients check out and leave it

u

p to the

health care systemwithout telling usSlide9

Hospital check-ups: What makes patients stay away?

Hospital routine (not a patient routine):”what we usually do””just in case”Hospital memory in patient care processesMeaningless to the care processNo new info, no new procedures, no implications

Doctors

are

unprepared, delayed, stressedHyperspecialization = not my jobNo plan for next visit – so why bother?Slide10

Patient care coordination- who cares?

Fragmentation: Every wagon, link and railway track has its own management, purpose & speedCare process: meaningful to HWs, patient and organisation at the same time - challengeSlide11

Increasing neccessity forclean patients with 1 diagnose

Patients not fiting clean referral criteria rejectedDemoralised chronic swing door patients Slide12

Vulnerable patients become invisible orphan patients

No single specialist departmentNo patient organisationToo complex for hospital – too complex for family doctorsSlide13

How do I know it’s you?

Peter Smith

Sunset

drive 112

CopenhagenSlide14

Texting is a patient inventionNeed help, appointment?

RemindersRunning informal contactClarificationFearsFeelingsHidden phone numberSlide15

Patient – doctor ”contract”Open outpatient

clinicHome visits = less stress, more receptive, better listening, more motivationPatientsideaPatientsidea

Patients

ideaSlide16

Talk, show and support: Actively address and reduce fear,

axiety and misperceptionsIs it cancer?Will I become handicapped?NeedlesScannersPersonsEnvironmentSlide17

Migrant health clinic no-show: 7 %

( instantly rose to 30 % when e-box electronic

appointment

letters

introduced)Overall hospital no-show: 13 %40 % of no-shows are not patient errorsSlide18

Cross diciplinary migrant health clinical team

saves 33,000 USD per year per patientTime saves money Slide19

Health care professionals need patientology & patient

literacySlide20
Slide21

Ethnic patient coordinator training programme (voluntary, 8 modules)

Migrant health teams (regional incl psychiatric hospitals)Slide22

”Cardiac arrest team” for Vulnerable patientsAnnual training in

communication, equity barriers, vulnerability, patient supportSlide23

Letters are never read (as intended)

Patients look for recognizable

patterns/simple information

and skip the rest

Patient reads:”We have cancelled your appointment”Because text is highlighted as important

You

have an

appointmentSlide24

Do

you have a gardener?Remove weed that does no goodFertilize coherence and flow in care processesWater innovation and constructive HW attitudeIdentify patient stress pointsInterview and follow patientsSupport

plants

that need it http://www.fastcodesign.com/3059787/ideos-ceo-on-how-to-lead-an-organization-creativelySlide25

The most expensive incident for a hospital is when something goes wrong with patients

(Torben Mogensen, hospital vice-director) Outlier-patients more likely to go wrongSlide26

Lots of

ambiguity and uncertainty in patient care processesOften more than 3-4 different actors involvedHealth care more fragmented and unlinked than we

realize

Patients

often not in same room as the expertise they needWe fail to learn from patients that are dislinkedHW individually see problems in care process but nowhere

to go with

their

insight