Cultural shift in the value of patient time

Purpose

Time: Ours to organise, ours to spend and equally ours to waste- but what about when that control is taken. In a culture where our days are filled with loved ones, work and activity, we choose to balance our time across these. However, when you are admitted to an acute hospital, this aspect of choice is often taken away.

As physiotherapists one of our key roles in inpatient care is to improve and regain function to allow our patients to return to their home at their baseline level. By making simple changes- getting patients dressed into day clothes, walking to the toilet and sitting in a chair for meals there can be a clear correlation with the speed of a patient's rehabilitation.

Approach

The powers of social media are often broadcast, showing that themes or ideas could spread across the world in a matter of hours, and the #endpjparalysis movement has been no different. This, the concept that patients shouldn't be encouraged to fall into the 'sick role' during hospital admission. Although something you'd think natural, across many acute wards on observation you will find patient's in bed, causing struggles with nutrition and basic daily tasks. The #endpjparaylsis movement aims to shift the culture of hospital routine to maintain a parallel to daily routine. Through the power of social movement, professionals across all healthcare disciplines are able to connect, share ideas and develop opportunities, creating a platform to reform the way we deliver our services in relation to this concept.

This has been seen across many UK hospitals in recent months and is gathering momentum, and at the start of 2017 has been piloted across elderly rehabilitation wards at Salisbury Hospital, and then later across medical/surgical wards. Here we created and used  resources for patients and relatives, training for staff,  and staff even wore pyjamas for a day to highlight the importance of this social movement.

Outcomes

From comparing the baseline and resultant pilot data it has been clear to see that in most cases, patients who not only mobilise daily, but wore their own clothes, consequently had shorter lengths of stay and anecdotally more positive outcomes of their admission. As a result, from May 2017, the project will be rolled out across medical and surgical wards with collaboration from the MDT, patient and more importantly relatives to forge a path for an improved inpatient stay.

Implications

In the future of healthcare we must now see patient time as a currency, something which we all have the responsibility to spend in the best way. We must ask ourselves: why is this patient not going home today? Is that reason good enough that you'd be happy to waste another 24 hours of patient time. It is not one profession's role to promote and lead this, but for us all to be advocates for change and transform practice to accommodate this.

Patient time is the most important currency in our work; the promotion and dedication to this concept is the platform for future developments. Though this may take time to develop in practice, the benefits are clear.

Top three learning points

  • Function-focused care is more beneficial to patients to allow a parallel to ‘normal’ function. This consequently reduces the demand on discharge.
  • Small changes to practice can make a big difference to patient experience in hospital. Anecdotally, patients and relatives are happier, less anxious, and more on board with the MDT if patients are up and dressed.
  • There are many challenges in the acute environment, but when people have found their “why” (Simon Sinek Ted Talk), they are motivated. Followers follow the followers!

Fund acknowledgements

League of Friends Charitable Funds

Additional notes

This work was presented at Physiotherapy UK 2017.