One-page profiles in hospitals – Something to shout about!

By Julie Malette, HSA Canada

Julie Malette

Julie Malette

Our work in health care settings is fairly new in Canada.  In November, I worked with the North Bay General Hospital’s Mental Health team and I am quite excited about the direction they are taking in terms of listening to the patient voice and focusing on being more person-centred.  We spent two days focusing on person-centred thinking and one day on person-centred reviews.

The hospital’s mental health department is currently transitioning from traditional multi-disciplinary team meetings where the focus is often on clinical goals and meetings are lengthy, to what they call the ‘One Patient One Plan’ approach where mini-team meetings occur weekly with a core team of supports and focus on the patient’s priority goals.  We will be working together to look at how person-centred thinking skills/tools can be helpful with this approach.

Soon, I will also be spending time with key leaders from both the mental health and the medicine departments of the hospital to support them to develop their one-page profiles.  The hospital would like to start with its leaders who will then support their staff in developing their own one-page profiles.  This is a very important step. One-page profiles in hospitals could totally revolutionize the way patients and staff are supported. It means that healthcare workers will be supported to understand the person, not just the condition and that patients will be able to communicate what is important to them and how best to support them. Starting from within means we can really embed the concept of using one-page profiles deep within the culture of the hospital and this will give it the commitment it needs to grow and be used well by both staff and patients.

Our colleagues in the UK have already introduced one-page profiles into two hospitals and their recent pledge for NHSChangeDay (to support patients and colleagues working and using health services throughout England to create one-page profiles) has significantly raised the profile of what this could achieve in health. Nurses, Hospital Chaplains, Patients, Therapists, GPs and Hospital CEOs are mobilizing to have their own one-page profiles in support of the pledge. I’d love to see something like this happen in Canada.

I’ll keep you updated on how our own health one-page profiles are progressing and leave you with these thoughts: Imagine you were in hospital and your healthcare team really got and understood you as a person. Now imagine you are a health professional and because of a simple, easy to read sheet of paper you had all the information at your finger tips to make someone feel understood, well cared for and well supported when treating them. This is what one-page profiles in health could help us to achieve. To my UK colleagues – I wish you every success in your pledge. To my Canadian friends – what about doing something similar here?!

 

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One-page profiles during long hospital stays

Several years ago Shelley Dumas was involved in a terrible car accident.  She was very seriously injured and used a one-page profile during her long hospital stay.

 Written by Shelley Dumas

Shelley Dumas YouTube Video

Shelley Dumas YouTube Video

Laura Buckner developed a one-page profile for me during my 5 month rehabilitation hospital stay after an automobile accident.  The focus of this  was supporting me in the hospital environment, including what people liked and admired about me and what was important to me at this time.  Laura asked several friends to send their thoughts about what they liked and admired about me (really lifting my spirits).  Then she spent time with me, asking what was important to me and how staff and visitors could support me during my hospital stay.

I observed doctors, nurses, technicians, therapists, aides and visitors stopping to read the large (11×17) laminated purple profile posted in two places in my room.  They were hard to miss.  I began to notice a difference in these people’s perceptions of me and they began to talk to me about the information in the profile.

One doctor said, “this should be in everyone’s room.”  A registered nurse and professor at the local university nursing school asked for a copy so that she could include it in her courses. Everyone would stand, read and re-read it when they came in or left my room.

It was working!  One of the ways it helped me was by communicating to everyone how important it was to me to have all my necessary items in reach. I had learned very early that I must have my cell phone, nurse’s call button, TV remote control, and my bed tray close by. These items were my security system and kept me in positive control of my life while I was there. Because of my one-page profile, people visiting me and staff would always check that they were in place before leaving my room.

All of the professionals began to know me as someone other than their typical patients and I developed several relationships that have remained in place even three years later.  The importance of having the one-page profile posted in my hospital room was unbelievably helpful during one of the most stressful times in my life.

You can watch a Youtube video of Shelley talking about her hospital experience here.

Armed with a one-page profile

An excellent example of how a one-page profile can achieve what might seem like small practical changes to a person’s personal care in hospital but which can have a huge impact; improving their overall hospital experience, reducing anxiety, promoting clear communication and regaining control.

Ellen's one-page profile

Ellen’s one-page profile

Written by Ellen’s mum, Cath Barton

Ellen is my gorgeous 14 year old daughter.  She loves to dance and can light up a stage.  She enjoys spending time with her friends, shopping, chatting, listening to music and watching movies.  We all value time together at family gatherings, afternoon tea with Granny and visiting Grandma and Grandad in Scotland.  Ellen doesn’t have a disability but like all of us, has things that are important to her and ways that she wants to be supported.

When Ellen was eight, what started off as back ache soon became much more serious and within 24 hours she was completely immobile and being admitted to hospital with a bone infection in her spine. As you can imagine a whole range of emotions were experienced for both Ellen and our family; worry, fear, anxiety, confusion.

After several sleepless nights (myself and Ellen), fainting incidents (just me not Ellen), mounting stress levels and anxiety (everyone) I found myself ranting at a doctor, not about a lack of care but a lack of personal support for my daughter.  It wasn’t to apportion blame but it made me realise that they couldn’t support Ellen in a personal way if they didn’t have the information to do this.  Ellen wasn’t sleeping because she couldn’t suck her left thumb because the cannula was in her left arm but the medical staff didn’t know that this was important.

We needed to share information in a clear, concise way, without the risk of forgetting something important and to regain a feeling of control for us both in a scary environment. Being familiar with person-centred approaches I knew that a one-page profile would support us to share the information in a detailed way.  I chatted with Ellen about what made a good day and a bad day in hospital and we used this information to tease out what was important to her and what good support for her would look like.  It was quickly typed up at home when my husband stayed with Ellen and I returned to hospital feeling more hopeful, armed with good information.

The one-page profile was shared with the nurses on the ward, doctors, radiologists, phlebotomists; in fact it came with us anywhere we went in the hospital and was shared with everyone we came into contact with.

The difference was overwhelming; yes the worry, fear and anxiety still lingered because it was a difficult time but a few simple changes meant better days for Ellen and me, no further ranting from me and a feeling of achieving control and good support.  The information shared didn’t have any impact on the resources or time of the staff, just that they did things in a different way that worked well for Ellen.

Ellen was told the name of the nurse who was responsible for her that day, first thing in the morning rather than late morning.  This reassured her and got her off to a better start.  Staff knew how important it was to Ellen to take her blanket with her so she would feel comfortable in an often scary place.  They even checked it was safe for her to take it in with her when she had her MRI scans, which was hugely important as I wasn’t allowed in.  One of the most important things was avoiding Ellen’s left thumb and left arm for blood tests and cannulas.  Ellen was really brave with the many blood tests and procedures she had to have but her comfort relied on being able to suck her thumb whenever she wanted..  After we shared Ellen’s one-page profile, all the blood tests were taken on her right thumb and right arm and comforting thumb sucking was resumed.

The practical things that changed were hugely important, small differences, huge impact, which improved our hospital stay.  The one-page profile also supported us to regain control in an environment where often control can be lost and helped me to know that, although I put my trust in the medical profession, I still had a role as Ellen’s mum to advocate on her behalf and to share valuable information which improved things for everyone.  I think it also improved my reputation, that I wasn’t a ranting mum just one that knew her daughter best.

Having a one-page profile while we were in hospital made a tremendous difference and experiencing it first hand, I wanted to share the positive story.  Around the same time, at a Learning Disability Partnership Board meeting, feedback was given that someone had not had the best experience whilst in hospital.  We knew we could improve this.  So after conversations, meetings and learning more, working together with East Lancs Service User Network, family members and the hospital liaison nurse a hospital profile was developed for people with a learning disability.  This is in a standard format that is recognised by the hospital and contains person-centred information so the person can have quality support whilst in hospital.

Ellen made a full recovery after a few months, went back to dancing and continues to light up a stage.  Honestly, I hope never to have to use a profile for being in hospital again, but if it happens I know I have a resource that supports us to have a better experience.

One hospital in the north of England has introduced one-page profiles for all patients. This hospital is on a journey with Helen Sanderson Associates to embed person-centred thinking tools deep into its culture. Read more about its journey from this blog site: www.personalisinghealth.com

Four steps to using one-page profiles in hospital

Written by guest blogger Tracey Bush, Managing Director of Spiral Health CIC

Read Tracey’s one-page profile

Tracey Bush

Tracey Bush

I was trying to explain to someone today about what it means to be a Community Interest Company in the health service. We are in fact the only hospital of our kind that operates in this way in the UK and as such it makes sense for me to talk about how this makes us different. It is these differences that have driven our push to be person-centred and to embed one-page profiles in our culture.

The easiest way to describe it is to compare us to an Academy in the education sector. Whereas most schools are funded and follow the protocol set out by their local authority, Academies have more freedom to use their budgets in the way that suits their individual school, teachers and pupils. We operate within the NHS but our CIC status allows us to direct our resources in the areas that we have identified as most important. A good example of this is how we have links with local schools and provide teaching on hygiene and infection control as a preventative measure to illness. We can do this because we have prioritised this type of community work and we therefore make it happen.  Our CIC status means we can be innovative and creative in our approach whilst still being part of the NHS.

I’m a qualified nurse and for 17 years I worked at a senior level within social care, moving back into health in 2012 when I joined Spiral as Managing Director. My background in social care gave me a good understanding of the results that can be achieved through person-centred practices and I have been using one-page profiles personally for over eight years.

Our hospital provides rehabilitation and health care for up to 40 people at a time. We take referrals from other hospitals and support our patients to return back to their own home and life in the way that works for them. This sometimes requires intensive physiotherapy, or extended medical care but in every scenario part of the recovery is about instilling the person with confidence and empowering them to recapture their independence. It is this part of our role that makes using one-page profiles so vital.

One-page profiles capture the important information about a person, aiding better communication, understanding and support.  In social care we would invest a great deal of time producing profiles with people and these would form the bases of a person-centred care plan and then regular person centred reviews. For obvious reasons this exact formula couldn’t be replicated in a hospital setting (the transient nature of patients, staff and visitors to name a few) but we wanted to make the tool work for our patients, to improve their experience and enable us to support them well as individuals. We worked with Helen Sanderson Associates to develop a person-centred journey and it was part of this process that highlighted the need to introduce a way of capturing rich information about our patients using one-page profiles. This is what we have learnt:

1)      Understand your environment and your team: People who have worked with one-page profiles before or who have experienced the benefits personally know that they are powerful tools for aiding communication, understanding and providing personalised support. It isn’t easy though to introduce any new way of doing things into a well established environment or team and you need to have an excellent understanding of what is in place in order for it to work.  Being person-centred is something that most healthcare professionals see as part of their role and it can feel strange to them to formalise it. We found that by using tools such as working/not working and by developing a one-page strategy we were able to identify existing practices that would be enhanced by using profiles.

2)      Be realistic: Some of our patients might only be with us for up to five days and it would be unrealistic to develop a profile as detailed as you might see used elsewhere. The solution is to decide what information is most important to capture in order for us to support that patient to the best of our ability. We have found that by using whiteboards behind a patient’s bed we could note the information that is important to and for them and add to it throughout their stay.

3)      Listen to the feedback: Aimlessly introducing a new process without validating its worth is sure to get peoples’ backs up. Very early on we started to collect feedback from patients and their visitors about the use of the one-page profiles. We wanted to know whether by understanding them better as individuals we had improved their hospital experience. Learning about someone’s love of animals or favourite TV programme can lead to great conversations and better relationships, not just between patients and nurses but amongst each other and visitors. Taking the time to sit with someone and ask them what is important has led to some rich insights and enabled us to make support and care decisions based on the individual and not just their condition.

4)      Coach Coach Coach: We have found the most effective way of embedding one-page profiles into everyday life in a hospital is to coach nurses on the ward to produce them with patients. It isn’t always easy to imagine something working in practice when learning about it in a classroom setting. By having person-centred thinking practitioners sitting side-by side with our nurses, they have found the approach that works for them. A one-page profile might only take 20 minutes to complete but the quality of the information will enhance the patient’s support for the duration of their stay and beyond.

One-page profiles are the cornerstone of person-centred thinking and by using them, we are committing to knowing and supporting each and every one of our patients well and as an individual. In our case this has formed part of the larger person-centred journey, and is just another one of the ways that we are able to work innovatively for the benefit of the people we care for.

You can read more about Spiral Health’s patient-centred journey and their pioneering approach to health care in the blog Personalisation of Health Services.

 

Finding dad’s voice after his stroke

A powerful example of how a one-page profile can help someone who has suffered an acute stroke to communicate how best to support him as well as helping his daughter advocate on his behalf.

Written by John’s daughter, Lisa Orme

chipMy dad, always known as ‘Chip’ was 65 when he suffered an acute stroke. It was in April 2012 and he experienced a massive bleed on the right side of his brain. He was admitted to the Derby Royal Hospital. It was one of the most fearful days of my whole life. I knew then that things were going to change forever. What I didn’t know, was that we were about to embark on a person-centred journey and that I was no longer just going to be his daughter, I was going to need to be his advocate too.

Dad lost his voice, his normal bodily functions and his pride that day. The first 24 hours were the hardest. Dad could only nod or shake his head and it was down to me to interpret this and advise the nursing team on his behalf. It was heart breaking and frustrating but I had a coping mechanism. I knew about person-centred thinking and used my understanding of him and the tools I’d learnt to advise the nursing team how best to support him. This was particularly important because I couldn’t be there all the time and it was essential that they were still acting on his wishes without me there to advocate them.

Every day in hospital highlighted another challenge for us. I sat with dad talking through his communication and decision making approaches identifying with him what he understood and what he wanted to share. He was able to nod or shake his head enabling me to capture his thoughts into his one-page profile. Once it was completed I shared this with the immediate nursing team. Every day I reviewed the one-page profile with Dad and my Sister to ensure we added new information gathered from his rehabilitation handovers.

I placed Dad’s profile laminated by the side of his bed as well as giving it to sit alongside his care plan. Nursing staff began asking me about our approaches and quickly recognised what was important to dad. Importantly they recognised when he chose not to engage with them as this remained in his control.

Helping dad to remain in control of his situation was my priority. His profile enabled this to happen. Chips connection to his family and the nursing team was so important in the seven weeks he was on the ward. Relationships were developed as the nursing team read and understood more about him from his profile. They learnt to engage with him using the information to promote conversations, laugh, joke, make him smile when he was having a bad day.

Despite his stroke dad was making choices and had capacity. Staff understood what made him more settled and more importantly they understood how he wanted to be supported. The one-page profile quickly progressed and became more detailed ensuring the right decisions were made when agreeing his continuing health care funding for his future nursing care.

Dad was going into a home in the centre of Derby. It was near to his friends and the places he grew up. I felt satisfied that dad would be happy there and made sure I shared pictures and information about the home with him to help him prepare. Sharing dad’s one-page profile with the nursing manager really helped me to engage with the assessment and referral process. It meant that I could clearly say what his needs were and ensure that they had the capacity to support him in the way he wanted to be supported.

Dad’s stroke had been incredibly sad for the whole family but throughout the journey I have been able to support him and help him to communicate by using the person-centred thinking tools. The nursing team briefly knew Chip. To me he will always be dad.