The Patient Satisfaction: A Strategic Tool for NHS Services Management, Patients with Stroke - Research Paper Example

Patient satisfaction: a strategic tool for NHS services management, patients with stroke BS’c Health Services Management with Public Health Acknowledgement I would like to thank family and friends for their support while I was carrying out this research. They always had faith in me, although I didn’t. My brother, in particular, has always encouraged me because he believed in my abilities. David Newbold’s contribution to my work was considerable, not because he was very strict, but because he offered every possible help so that I was able to achieve my utmost and I am deeply indebted to him for that. Abstract Stroke has been viewed as an enviable disorder affecting the elderly. In the past, many patients who suffered a stroke were regarded as being beyond help, and there seemed to be little that could be done to make them comfortable. However, recent research studies have shown that there is a lot which can be done to prevent stroke and the NHS is offering increasingly better treatment and follow-up care. According to Smith (2006), in the past three to four years, there has been evidence of possible methods of intervention: the creation of stroke units for instance, immediate scans for new cases etc… In 2005, national statistics provided an opportunity to demonstrate how recent developments have improved the efficiency and care of stroke victims. The health department is working to develop a comprehensive national stroke strategy. This research discusses the possibilities open to patients, who have suffered a stroke, enabling them receive the best care and management during rehabilitation. Contents Abstract ……………………………………….......………………3 1.0 Chapter 1 Introduction, Aims and objectives …………….…………..5-7 1.1 Chapter 2 literature review ……………………………………………8-17 1.2 Chapter3 Conclusion ……………………...……………………...........18 1.3 References …………………………..……………………………........19-23 Chapter One Introduction The World Health Organisation (WHO) has defined stroke as a clinical syndrome caused by rapid transformation of the focal and global disturbance of cerebral functions that lasts for a period of not less than twenty four hours. This transformation may cause death (World Health Organisation, 2005), and very often results in disability. Mallik recommends that Patients below the age of 45 years should be given consistent care and instant brain scanning during the forty eighty hours after stroke has been diagnosed (Mallik, 2009). In the United Kingdom, stroke is the third most common cause of death, using up 4% of National Health Service (NHS) (Slotboom, 2007). The government has sponsored public awareness through the slogan ‘saving lives our healthier notion’ and, as a result of this, deaths among the elderly suffering from strokes have fallen by 40% and stroke victims are now able to deal with a severe secondary occurrence through psychological intervention, (Markusl 2010). Owing to a government backed research programme, stroke management (standard 5) has been initiated. Changes affecting access to diagnostic and rehabilitation procedures offered by specialists have helped to reduce concerns concerning the treatment of patients suffering from stroke. In fact, patient satisfaction is an area in which stroke management has been transformed. In 2006, the National Sentinel audit proposed stimulus guidelines on stroke management, so that other bodies dealing with stroke would realise the importance of stroke management rather than treatment. Both government and international health organisations have also contributed to stroke management awareness (Hirsch, 2008). Research has shown, for instance, that quick response to stroke reduces the risk of disability and death considerably. Care Pathway’s are developed in order to facilitate rehabilitation in which the conditions affecting the patient are analysed and later used to try to curb repercussions. Modern stroke management, involve an interpersonal of experts specialising in stroke use client expectations in order to execute effective strategies for rehabilitation (Gresham, 2004.) Patient is assessed individually and is helped along the path of recovery by a team of experts such as psychologists, physiotherapists and speech therapists. Such an approach has considerably diminished the recurrence of strokes. Aims and objectives To investigate if stroke patients obtain satisfaction during stroke management and rehabilitation To investigate what measures should be taken to provide patient satisfaction during stroke management and care Methodology The various methods, approaches and procedures used in accomplishing this research are noted in this section. This study begins with an in-depth understanding of the research aims, objectives and hypotheses which provide a foundation for the problem phenomenon. The success of this research is subject to provision of relevant information in accordance with the objectives underlying the research problem. In summary the research intends to explore patient satisfaction. Moreover, the mostly this research is been read it and make a lot of notes different website included, BioMed Central and ScienceDirect also, the some material my supervisor was giving to which very helpful. Chapter Two 1.1: Literature review Stroke is a medical problem which occurs as a result of the blood supply to a part of the brain being cut off suddenly. Brain cells require a constant supply of oxygen from the blood in order to function correctly, meaning that if the supply to the brain is cut off, the brain cells in those areas become damaged and die off. The part of the brain affected, and the extent of damage, dictates the severity of stroke (Latchaw, 2003). Stroke may result in a number of salutations but, for the purpose of this study, we shall consider only two conditions, namely; aphasia and hemiplegia. Aphasia is a disorder which occurs when the part of the brain responsible for language is damaged affecting the understanding of language and the ability to read and write. Thus, a person suffering from aphasia may speak incompletely or senselessly and may, among other things, be unable to comprehend conversations or written texts (stroke association, 2011). Aphasia is divided into several types which include: Broca’s, non-fluent, receptive, global, motor and expressive aphasia Smith notes that language pathologists and neurologists clinically screen patients to determine the extent of the brain disorder while speech and language therapists refine the patient’s disorder in a rehabilitation process that is managed over three years (Smith, 2002). In Economic terms, goods are produced to fit customers’ expectations, and this is also the case with stroke management, with patients expecting professionals to attend to them in a satisfactory manner. Markusl (2010), notes that in order to guarantee patient satisfaction, as quoted under the NHS service management, a stroke case needs to be managed from the initial perspective, diagnosis, rehabilitation, prevention and rehabilitation outcomes to discharge and follow-up. This process is on-going, as current hypotheses will always be upgraded owing to technological advances. Indeed, as Markusl’s research has shown, timely dialogue and inquiry reveals client needs and personal involvement in their own medication process helps them to realise potential after recovery (Markusl, 2010). Additionally, research carried out by Gresham in 2004 reveals that a physician, who understands the repercussions on the daily life of a patient is able to assist him/her to overcome distress. Follow up care is particularly important and correct management creates in the patient a feeling of self-worth, vital to the recovery process (Gresham, 2004). One method of dealing with follow up care is referred to as The Care Pathway. It deals with a range of possible settings in which people who have suffered a stroke may receive further care. Organised stroke care saves lives and reduces disability. Pathway relates to a situation where a multidisciplinary stroke management team comes together, analyses a patient’s medical records and develops stroke management criteria to fit the particular case. Medical professionals have, in addition, discovered ways in which they can avoid keeping stroke patients waiting and have designed the procedure afterwards so that stroke management has become a practice rather than a healing process. However, research regarding pathway care in relation to outcome conditions has showed that little progress has been made in ensuring patient independence. In order to improve the situation, a group of professionals with a passion for stroke management have come up with an alternative method referred to as Multidisciplinary Care. The Multidisciplinary model is recommended in preference to Pathway for use in a medical setting. Treatment by physiotherapists, speech and language experts and social workers encourage the patient to attain independence. These specialists are required to work collectively and professionally when treating and rehabilitating stroke patients. In 2010/11, it was decided to implement a national stroke strategy aimed at accelerating the provision of intensive support to care services across a whole spectrum of areas, covering prevention, acute services, and long-term care (Adams, 2003). To achieve this goal, the NHS was given the responsibility of developing strategies for stroke management which included the publication of documents and organisation of website training. An example of stroke management includes a strategy recently developed by the NHS known as Accelerating Stroke Improvement (ASI). This strategy included operational guidance for 2011/12 in order to enhance the comprehension of ASI measures and ensure that the maximum implementation of quality markers could be achieved in 2010/11. It has been designed to promote the improvement of psychological support services for people who have suffered a stroke. The staff employed to manage this particular service are selected for their special expertise and competence in the assessment, treatment and monitoring of people with these specific needs, such as psychologists, psychiatrists, occupational therapists and primary care mental health workers or specialist stroke counsellors. The NHS National End of Life Care Programme defines the guidelines for palliative care for patients who have suffered a stroke. The rehabilitation process should ensure that, when a patient has suffered a stroke, the rate of dependence and after stroke trauma is minimized. Where possible, rehabilitation should take place in the patient’s home. It is recommended that stroke cases be handled individually, in keeping with the patient’s wishes. Patients are, therefore, given information concerning their impaired condition with the aim of restoring lost functions and helping them adapt to independent life. Aphasiac patients, for instance, lose language coordination, but SLT experts are able to help restore language cognition (Papathanassiou, 2005). Follow-up care would include such aspects of patient monitoring as weighing up the practical implications of the drug warfarin, versus aspirin, in preventing recurrent strokes, as well as including therapeutic techniques to improve motor function. Improvement in treatment and preventative measures, family and friends support initiatives all contribute to improving the functional abilities of patients suffering from stroke, especially the elderly (Hudson, 2007). Fawcus, (2004) demonstrates that the rehabilitation process is carried out as a cyclical sequence of events. Once a patient’s needs are identified and analysed, short and long term goals are set, enabling medical professionals to achieve the patient’s rehabilitation. Finally, an assessment is carried out to determine the viability of the rehabilitation programme. Practising professionals in this field must create a legacy to commit their juniors in colleges and institutions dealing with aphasia and hemiplegia to focus on the transformation of the discipline to suit technological change. The second area of relevance to this paper is hemiplegia, in which body parts such as the arm, leg or trunk are affected. This may be as a result of stroke, but may also result from injuries to the spinal cord or CNS. Research studies conducted by Smith (2002) show that if the left part of the brain is injured, hemiplegia is right-sided; and if the left hemisphere of the brain is injured or damaged, then it is right-sided. Also, Hemiparesis is weakness on one side of the body. It is less severe than hemiplegia, the total paralysis of the arm, leg, and trunk on one side of the body. However, the patient can move the impaired side of his body, but with reduced muscular strength. Moreover, Hemiparesis can be caused by a number of medical conditions, most related to the brain or spinal cord. Some of the conditions that have hemiparesis as either an indicative symptom or as a result of the condition itself include, muscular dystrophy and brain tumors, also, loss of motor skill, for example, People with hemiparesis often have difficulties maintaining their balance due to limb weaknesses leading to an inability to properly shift body weight. This makes performing everyday activities such as dressing, eating or using the bathroom more difficult. The treatment for hemiparesis is the same treatment given to those recovering from strokes. For example, health care professionals such as physical therapists they play a large role in assisting these patients in their recovery (Lagerqvist, e.tc, 2006). Hemiplegia, likewise, is a common clinical condition resulting from strokes. Though there is no visible lesion on brain, an MRI scan can confirm the infarct location in the basal pons at an early stage after stroke onset. Rehabilitation it helps hemiparetic patients of learns different and new ways of using and moving their weak arms and legs. Moreover, It could be possible with immediate therapy people who go through from hemiparesis may finally recover the progress. For example, the professional who involved in hemiparesis rehabilitation include: A medical professional that is familiar with new treatments and established practices. A psychiatrist is ideally the one who will manage a stroke patient’s entire rehabilitative process. Physical therapists specialist in treating disabilities related to large movement. They can assist with strength, endurance and range of motion problems. They can also help stroke survivors get back the use of weak arms and legs through coordination and balance skills exercises. Occupational therapists they help survivors relearn the skills needed to perform everyday activities and fine motor skills, such as picking up a pencil. They also help survivors learn how to change their environment to meet their new needs. New criteria are currently being developed by many countries in terms of a response to stroke, which include: a quick response team through the emergency services, once stroke is suspected; the prompt transfer to a stroke management setting in the hospital in which there is a multidisciplinary team with a keen interest in this procedure. A hospital setting is recommended for stroke victims, although mild stroke victims may be treated as outpatients. Various types of brain scan and computer aided instruments are used to assess the extent of damaged neurons and the likelihood of secondary infection. At this stage, the patient is referred to a high quality stroke care unit where the rehabilitation process is initiated. Patients with mild stroke may be transferred to outpatient rehabilitation, and multidisciplinary assessment is carried out. The patient is then transferred from the hospital to home or, in more serious cases, to a care unit. Patients with milder instances of stroke may be treated at home and in the community. The patient and his/her family members, together with caregivers, are crucial to the rehabilitation process so that the education of family members as well as the patient may transform the rehabilitation process. A change in the patient’s setting becomes challenging, as patients have to adapt to a life of dependency and those responsible for providing the care may not be as qualified as the multidisciplinary team in the hospital. At the time of discharge, the entire multidisciplinary crew should be comfortable with the patient’s domestic setting. Hudson (2007), notes that frequent home visits by multidisciplinary members are necessary after discharge. OT ensures that the community and health centre, stroke patients and carers’ issues are identified and comprehensively addressed. Relevant documentation is carried out at the time of the patient’s discharge. Electronic Clinical Communication Implementation (ECCI) is a modern format of electronic documentation. The traditional method of paper-based documentation is still important however (Hudson, 2007). One evidence based programme based on algorithms was developed by the American VA/DoD (Veterans Health Administration and Military Health System) in 2010, superseding previous guidelines which had appeared in 1996 and 2003, in order to manage stroke rehabilitation and improve the quality of life for both patient and family. The recovery programme is based on indicators to be managed after three months following acute stroke and entered into a database (VA/Dod Clinical Practice Guideline for the Management of Stroke Rehabilitation (2010), the algorithm system serves as a guide to clinicians so that they may ‘determine best interventions and timing of care for their patients, better stratify stroke patients, reduce re-admissions, and optimize healthcare utilization’ (Ibid, p. 8). This approach has been criticised largely because it focussed only on post-acute stroke rehabilitation care when patients who have suffered mild forms of stroke also require rehabilitation, which may be carried out initially by a multidisciplinary team in a hospital, but ultimately they will require sympathetic assistance in a home environment so that they may come to terms with mild disability, dependence and so as to prevent the recurrence of a stroke in the future. Research studies reveal that 25% of stroke cases occur below the age of 65 and many adults are unable to return to work after they have suffered a stroke, although they can engage in voluntary activities or participate in adult education. People who are unable go back to their jobs often have problems building a social life so that depression may result (Mallik, 2009) states that assisting people who have had stroke does not really involve helping them with their daily lives, but is all about instilling dependence and control. This would indicate that a multidisciplinary group concerned with rehabilitation should lobby employers, encouraging them to offer a more flexible timetable so that they can cope with the trauma, as strokes may affect a person’s level of activity (Gresham, 2004). However, the NHS Guidelines provide several recommendations as to how the community may be involved in helping people who have suffered from strokes. Smith, (2002) argues that the leisure industry has excellent resources which could involve people who have suffered a stroke in different physical activities. For example, physiotherapists and nurses may advise certain exercise skills and suggest useful sporting equipment. Additionally, local stroke charities may assist patients to engage in various suitable physical activities and, finally, community based leisure centres could offer exercise routines aimed at the rehabilitation of people who have suffered a stroke. The National Stroke Strategy states that ‘rehabilitation after stroke works. Specialist coordinated rehabilitation, started early and provided with sufficient intensity, reduces mortality and long-term disability. Early rehabilitation is effective when provided in specialist stroke units or as part of properly organised early supported discharge and longer-term support in the community, according to need (Bederson, et al, 2009) The disciplines involved in stroke management should operate along these lines. Therapy based rehabilitation is carried out in the community for a period of time. Research carried out by Streiner shows that therapy based rehabilitation has reduced cases of possible death by 37% (Streiner, 2008). The stroke care pathway is a simple resource that provides the user with a summary of the key aspects of care that should be considered for people with stroke at any stage in their care. Also, the content of the pathway is firmly grounded in the evidence base for best practice management of stroke, which has been drawn from the clinical guidelines for acute stroke and stroke rehabilitation and recovery. Moreover, Pathway relates to a situation where the multidisciplinary team comes together, analyses clients’ medical records and develops stroke management criteria. It is carried out on the basis of skilled knowledge in combination with the health records of the patient (Markusl, 2010) has conducted research concerning Pathway care in relation to outcome conditions. It showed that little progress has been made in comparison with multidisciplinary care in which positive results were achieved. As a result, Papathanassiou (2005) has noted that the multidisciplinary model is to be preferred over Care Pathway. This is largely because the core multidisciplinary team consists of qualified nurses at different levels, medical physiotherapists, speech and language experts and social workers. They are required to work collectively and professionally when treating and rehabilitating stroke patients (Gresham, 2004). Meetings involving the multidisciplinary team after a period of one week are necessary in order to resolve patient queries. Customer satisfaction remains their top priority under NHS service management clause (Mallik, 2009). Many people who have suffered from stroke trust their family members more than medical professionals so that they are encouraged to participate actively in the rehabilitation of the patient. To these ends, family members who nurse stroke patients should be given appropriate counselling at the outset. Patient Satisfaction Patients’ satisfaction is usually associated upon suitability of instruction provided about plan of care, medications, education regarding diagnosis and its treatment, and the information provided about their discharge while they are still in hospital (Tuttas, 2003). Many methods are used to measure patient satisfaction such as phone survey, focus group interviews or personally interviews and written survey usually questionnaire. Most research analyzes patient’s satisfaction or dissatisfaction through questionnaire survey that were carried out with internal consistency, validity and test-retest repeatability so that results concluded are reliable and valid. The research by Staniforth et.al and C.D.A et.al (1997) concluded that stroke patient’s satisfaction is more associated with family support and care. More studies shows that older people relate their satisfaction with care more as compared to younger people (Dorman and Hall 1990; Pascoe 1983). Researches by Pound et.al (1994) and Dijikerman et.al (1996) reveals that patients’ dissatisfaction was largely associated with after stroke care i.e. amount of therapy they received, successfulness of the recovery, instructions and information provided to patient and the services they received after discharge. Another research by Morris et.al (2006) says that lack of nurse and other staff knowledge, poor continuity of care treatment and lack of emotional care also contributes to patient’s dissatisfaction. Some studies ( Pound et.al 1994; Reimer et.al 1996) suggest that stroke patient’s dissatisfaction in is more associated with emotional distress and depression, therefore it is unclear whether the dissatisfaction has aroused due to patient care services or patient’s personal characteristics. Chapter 3 Discussion and conclusion: Over the past few decades, stroke patients rehabilitation programs have been revolutionised, and with the technological advancements, it is expected to continue. A number of methods have been devised for the rehabilitation of patients who have suffered disabilities like aphasia and hemiplegia, due to stroke. The most prominent methods are the following. a) Pathway b) Multidisciplinary As noted by Papathanassiou (2005), the multidisciplinary model is to be preferred over Care Pathway, largely because the core multidisciplinary team consists of qualified nurses at different levels, medical physiotherapists, speech and language experts and social workers. They are required to work collectively and professionally when treating and rehabilitating stroke patients (Gresham, 2004) and customer satisfaction remains their top priority under NHS service management clause (Mallik, 2009). Many people who have suffered from stroke trust their family members more than medical professionals. To these ends, so the family members who nurse these patients should be given appropriate counselling at the outset. The stroke care pathway, on the other hand, is a simple resource that provides the user with a summary of the key aspects of care that should be considered for people with stroke at any stage in their care. Evidence based programme, developed by the American VA/DoD (Veterans Health Administration and Military Health System) in 2010, in order to manage stroke rehabilitation and improve the quality of life for both patient and family, is also a multidisciplinary approach. It can thus be concluded that multidisciplinary approach has been considered to be more effective. References: Abbott AL (2009) Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis. Stroke, 40(10): e573–e583. 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