Improving Health worker — Patient relationship Regina M

Improving Health worker - Patient relationship Regina M. N. Kamoga and Ruth N. Mukiibi Uganda Alliance of Patients Organizations(UAPO) Refresher training for Nurses and Midwives Mulago Guest House , Kampala 16/11/2015

Contents of presentation l l l l l Introduction Factors impacting HW/Patient relationship Patient’s rights and Responsibilities Health workers Rights and obligations Patient involvement to improve HW/Patient relationship Effective communication Facilitating open communication Communicating with your health worker Empowering patients to engage as equal partners Lessons learnt

Introduction Increasingly patients are being recognized as key partners in quality improvement. Involving patients in treatment decisions and disease management is not only cost effective but can lead to better health outcomes.

Introduction cont’d Patients who are active participants in a shared decision-making process have a better knowledge of treatment options and can make informed decisions about their health

Introduction Cont’d Patients and consumers of care need to be at the centre in all efforts aimed at improving quality of healthcare

This is mainly because 'when things go wrong, they are the ones who suffer harm'. 6

And also because……. . Patients and their caregivers see things that busy health-care workers often do not! (WHO Patient Safety) 7

Factors Impacting HW/Patient relationship l lack of trust in patients ability to judge the quality of care lack of self esteem or confidence of the patient to engage as an equal partner with health workers fear of the unknown

Factors lmpacting HW/Pt relationship cont’d…. l l literacy levels , low health literacy Patients feel it is impolite to imply that the H/w doesn't necessarily know best. Health workers not sure of what role patients should play, how and when Ignorance about rights

The rights and responsibilities of patients and health workers l Patients and health workers have rights and responsibilities. l Often patient and health workers are not aware of these or ignore. Its beneficial for both parties to know and understand their rights and responsibilities

Patient’s rights and Responsibilities as spelt out in the patient charter l l l The right to medical care Prohibition of discrimination Participation in decision making A healthy safe environment Proper medical care Be treated by a named healthcare provider

Patient’s rights. . cont’d l l l Right to safety and security Receiving visitors Informed consent Refusal of treatment Be referred for second opinion

Patient’s rights…. cont’d l l l Continuity of care Confidentiality and privacy The patient’s right to medical information Custody of medical records Right to Redress

Responsibility of patients l l Provision of information Compliance with instructions Refusal of treatment Respect and consideration

Health workers rights l l l Safe environment e. g protective gear Continuously develop and advance his professional knowledge, in keeping with the current state of science and its advances. Promotion

The Right to Deny Care l A HW involved in patient care may refuse to examine a patient seeking care a) if prevented from doing so because of the immediate need to care for another patient or b) because of a personal relationship with the patient on condition that he refers the patient to another physician.

Right to deny treatment cont’d l l A HW may refuse to examine and provide further treatment for a patient if his own health or some other obstacle renders him physically unfit to do so. Patient’s health status does not require medical care,

HW obligations l Maintain confidentiality regarding the health of a patient, as well as regarding all data learned while providing healthcare services, irrespectively of whether said data was provided directly by the patient, or learned through an examination/test or through treatment, or learned indirectly through medical documentation or in any other manner. .

Health workers obligation l Provide Information to patients and their family Brain storm

Patient, family involvement to improve HW/Patient relationship l l Is about true partnership Truly collaborative relationships between patients, families and healthcare provider that is based on mutual respect Open and honest communication continually connecting and collaborating /involving to discover, understand, and address patient physical and emotional needs

Patient , family involvement l l l 21 Placing patients and their families at the center of every care decision Providing care that is focused on the person as an individual, in the context of family and community , rather than on the disease Considering patients and their families as the expert on their own needs and values

Patients , family involvemt…cont’d l Need to be encouraged to participate l Need to know they can participate, the healthcare system is not designed to promote participation l Health workers should provide a conducive environment to enable patients participate

Effective Communication Effective communication between the health worker and patient is vital to the diagnostic and therapeutic process. It forms the basis for the health worker-patient relationship.

Effective Communication cont’d l For true shared decision making to take place patients must be given sufficient and appropriate information, including detailed explanations about their condition, treatment options, outcomes, and uncertainties.

Effective Communication cont’d l Health workers should listen to patients and respect their preferences, patients' right to reach decisions with the H/w about their health.

Effective Communication cont’d l l Should be truthful/accurate/complete, reliable, respectful and sensitive to people’s feelings Relevant and tailored content Culturally and linguistically appropriate Involvement of the listener

Effective Communication cont’d l Health worker must be skilled in risk communication l Must check that the patient has understood information and its implications l Use appreciative inquiry , avoid why questions they are intimidating /accusing

Effective Communication cont’d l Avoid the use of intimidating language e. g. at that age you shouldn’t be…. , you are old enough to……. , why did you get pregnant when you knew you were HIV positive? l Give the necessary support to help her cope with the situation

Facilitating open communication Health worker should: l Sit down with patient l Attend to patient comfort l Establish eye contact l Listen without interrupting l Show attention with nonverbal cues e. g. nodding

Facilitating open …cont’d l Allow silences while patients search for words Explain and reassure during examinations l Ask if there are other areas of concern l

Communicating with your healthcare worker l l l Good communication with your health worker can help you feel more confident about the care you receive. Patients should provide information to the doctor openly, even if they feel uncomfortable about discussing some subjects Understand appreciate the working environment

Communicating with your healthcare worker cont’d l l l Before visiting the doctor the patient should write down their concerns and questions/make a mental note in case you cannot write Avoid being confrontational If patients feel uncertain about the information received, they should seek a second opinion

What can hinder patient –H/w communication? l l Patients may feel that they are wasting the H/w valuable time Omit details of their history which they deem unimportant Be embarrassed to mention things they think will place them in an unfavorable light Not understand medical terminology

Empowering patients to engage as equal partners with health workers l Patients must not only understand their conditions, but also become more involved in their own care l Build their capacity; provide them with necessary skills and tools l Healthy literacy

Empowering patients….

Empowering patients cont’d l l l Establish a reporting and feedback mechanism for patients in all healthcare settings, Involve them in all settings where QI policies and guidelines are developed. eg QI Committees Follow up on issues raised

Lessons learnt l Patients must not only understand their conditions, but also become more involved in their own care l An expert patient makes the work of the doctor easier l A personal touch to the health worker-patient encounter makes a whole difference.

ABOUT UAPO The Uganda Alliance of Patient Organizations (UAPO), an Alliance brings together patient organizations from different diseases areas( cancer, epilepsy, sicklecell, HIV/Aids, mental health, Hepatitis B etc). Contact Persons: Regina Kamoga 0752693774, Ruth Mukiibi 0712815978