Enhanced Recovery: Patient centred change

This folksonomy or “word cloud” has been created on wordle using the words which make up the Department of Health’s recently published guide on enhanced recovery. The larger the word, the more times it appears in the text.

The words “patient” and “patients” appear in large text and should be the focus of any enhanced recovery pathway. In our experience, putting the patient at the centre of change has enabled us to overcome some of the challenges of introducing change.

When an enhanced recovery pathway runs between primary and secondary care, and across multiple departments and professions within a hospital, it can be difficult to influence and persuade others to change. Our approach was to always bring it back to the patient. We had a rule, each step of the pathway had to directly benefit the patient and add value to their experience. Any step which was included for the convenience of the hospital or staff was questioned and then re-examined from the perspective of the patient. Putting the patient first galvanised professional groups. It is the reason we all work in healthcare, and it worked brilliantly at providing a focus and common theme to changes.

One example was access to x-ray for our patients after hip and knee replacement. Historically, the hospital protocol was to operate only an emergency service for x-ray over the weekends. This meant that our patients could be delayed in going home for 1-2 days because there was no x-ray over the weekend. Was this part of our enhanced recovery system designed for the benefit of the patient, staff, or hospital?

The situation was not benefitting the patient or the hospital. From a patient perspective, the delay was slowing their rehabilitation, and from a hospital point of view discharge was being delayed.

We worked with the radiology department to change this. Persuading them to rota extra staff at the weekend was easy once we had brought the issue back to the patient. They could see that the old system was designed around staff preference and not for patient benefit.

The change was a success. The weekend x-ray meant that patient discharge was not delayed, and also decreased the backlog and demand for x-ray on a monday which had previously been a problem. The x-ray staff didn’t mind either, they could see that the change was benefiting the patient and the process improved working across the multi-disciplinary team.