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The Smallest Things Can Make the Biggest Difference

Project Added:
29 January 2018
Last updated:
12 February 2018

The Smallest Things Can Make the Biggest Difference

Summary

Broken Hill Health Service (BHHS) in Far West Local Health District (FWLHD) implemented the person-centred sunflower tool, to improve communication and build a rapport between staff, patients and carers.

Aim

To improve communication between staff, patients and carers in the Sub Acute Rehabilitation Unit, Medical Ward and Surgical Ward of BHHS within 12 months.

Benefits

  • Provides patient-centred care for people in hospital.
  • Improves the experience of staff, patients and carers.
  • Sparks meaningful conversations and personal connections.
  • Makes carers feel valued and ensures they are included in discussions.
  • Provides a tool that is fast and easy for staff to use in multidisciplinary settings.
  • Acknowledges that each patient has their own history, identity and needs.
  • Quickly builds trust and rapport between staff, patients and carers.
  • Improves the communication skills of staff using evidence-based tools.

Background

BHHS is a 108-bed acute care hospital providing general medical, surgical, obstetric, paediatric, emergency, mental health and drug and alcohol services. The NSW Agency for Clinical Innovation (ACI) Confused Hospitalised Older Persons (CHOPs) program was implemented in March 2015 in the Sub Acute Rehabilitation Unit, Medical Ward and Surgical Ward. In 2016-17, 5976 people were admitted to BHHS. However, feedback collected in April 2015 and April 2016 from patient and carer stories and patient experience trackers, showed that patients and carers often did not feel included in healthcare decisions and wanted staff to communicate better.

Patients felt scared when they did not know what was happening and did not trust the service due to negative experiences (such as miscommunication) in the past. Staff feedback also showed a lack of focus on patient-centred care, with staff reporting that they did not have time to sit and talk to patients, as they had too many tasks to complete. It was determined that BHHS needed to improve communication between staff, patients and carers, to achieve optimal health outcomes and patient satisfaction.

Implementation

  • A working party was formed, comprising people in the ACI CHOPs committee at FWLHD.
  • The sunflower tool was selected as the most appropriate communication tool, as it was already in use within the CHOPs program. The tool allows staff to get to know all their patients, regardless of age or diagnosis, and connect with them in a meaningful way. Patients complete the poster with information such as their preferred name, interests, hobbies, likes and dislikes. This acknowledges the individuality of each patient and sparks conversation, so they feel respected, valued and heard.
  • All patients in the Sub Acute Rehabilitation Unit, Medical Ward and Surgical Ward were invited to participate in the project. Laminated A4 posters of the sunflower tool were placed on the wall in their room and completed with patients and their carers using a whiteboard marker.
  • Staff training was undertaken on how to complete the tool with patients and how to use it to start meaningful conversations. These conversations were held during staff handover, hourly patient rounding and the five patient communication behaviours: Acknowledge, Introduce, Duration, Explanation and Thank You (AIDET). Training was also provided to new staff and graduate nurses.
  • The project is now embedded in daily practice. The sunflower communication tool is also used in the remote facilities in FWLHD and has the potential to be rolled out to other facilities and beyond.

Status

Sustained – The project has been implemented and is sustained in standard business.

Key dates

March 2015 – April 2017

Implementation sites

  • Sub Acute Rehabilitation Unit, Medical Ward and Surgical Ward at BHHS, FWLHD
  • Balranald Multi Purpose Service, FWLHD
  • Wilcannia and Wentworth Health Services, FWLHD

Partnerships

  • NSW Agency for Clinical Innovation

Results

  • Completion of the sunflower tool in the Medical Ward increased from 18 per cent in December 2015 to 96 per cent in February 2017.
  • Completion of the sunflower tool in the Sub Acute Rehabilitation Unit increased from 14 per cent in December 2015 to 100 per cent in February 2017.
  • Completion of the sunflower tool in the Surgical Ward increased from 10 per cent in December 2015 to 70 per cent in February 2017.
  • Feedback collated in March 2016 and March 2017 was positive and showed the tool made a difference to how patients were seen and cared for in hospital. Comments included:
    • “great conversation starter...patient’s  past occupation - a ballroom dancer”
    • “instant connection...we both love horses and country music”
    • “they care”
    • “they understand me”
    • “mum is treated as a person”
    • “I was so impressed, they explained the medications, the staff packed my husband’s bag and it really showed me they care”
    • “it’s such a personal touch, I’m not just a number”.
  • Nurses saw the value in using the sunflower tool and reported that patients felt more comfortable ringing the bell and asking for help. They also found it much easier to engage the patient through simple things such as using their preferred name.
  • The evaluation showed that sometimes information from the previous patient was left on the sunflower tool after they were discharged. The project team engaged the Patient Services Assistant to ensure the tool was wiped clean when the room was cleaned.
  • Moving forward, the team has plans to modify the tool to add ‘what matters to me while I’m here in hospital’. This will make the information more focused and recognise that being in hospital is only a small part of the patient’s history.

Lessons learnt

It’s important to remember that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.

Further reading

Watch a presentation from the Rural Innovations Changing Healthcare Forum 2017

Resources

Contact

Eureka van der Merwe
Nurse Manager, Essentials of Care and Projects Coordinator
Far West Local Health District
Phone: 08 8080 1495
Eureka.VanDerMerwe@health.nsw.gov.au

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