CHAPTER 3:MODELS AND FRAMEWORKS
D) The Out of Pocket Model
3.6 Conceptual Framework for the Study
The Batho Pele Principles provides a baseline with regard to what the patient can and should expect at a primary health clinic in SA. The Picker Principles and the Institute of Medicine (IOM) Framework provides an outline of how patient experience can be improved. The principles of Batho Pele is also clearly linked to the concept of patient experience as noted by the commonalities with the IOM framework and the Picker Principles and is therefore relevant in the study as a point of reference to improve patient experience in SA. The three frameworks together with the PSIF are used to develop the conceptual framework for the study to provide a point of departure on how to enhance patient experience in the PHS and are discussed below. The PSIF supports the understanding that the patient is at the centre of the reform initiative and this sets the platform for the study. Based on the framework, the survey is designed to obtain a comprehensive understanding of the current patient experience in the primary health clinic and to determine the domains that patients in SA agree to be relevant to the patient experience. The various themes highlighted in the Batho Pele Principles, Picker Principles and IOM Framework is evaluated to determine themes that are applicable to patient experience. In addition the PSIF is used to determine the positive reforms that can result with the use of the proposed model.
68 Consultation
"Citizens should be consulted about the level and quality of the public services they receive and, wherever possible, should be given a choice about the services that are offered".
Batho Pele Principles note that the principle of consultation requires the inclusion of patients when evaluating the quality of services that are delivered within the healthcare context.
Essentially, the inclusion of patients in the assessment of quality is closely linked to the Patient Experience Frameworks.
Service Standards
"Citizens should be told what level and quality of public services they will receive so that they are aware of what to expect".
Batho Pele explains that it is imperative that patients are informed and Patient Experience frameworks support that the patient be included in the setting of standards.
Access
"All citizens should have equal access to the services to which they are entitled;"
Batho Pele explains that citizens should be able to freely access health services. Patient Experience Frameworks also support that access is an important factor.
Leadership and Direction
Good leadership is one of the most critical ingredients for successful organisations. (DoH,2016:12).
Batho Pele Principles explain "that organisations who do well in serving their customers can demonstrate that they have leaders who lead by example, who set the vision, and ensure that the strategy for achieving the vision is owned by all and properly deployed throughout the organisation. They take an active role in the organisation's success" (DoH, 2012).
Customer Impact
"Impact means looking at the benefits we have provided for our customers both internal and external – it’s how the nine principles link together to show how we have improved our overall service delivery and customer satisfaction. It is also about making sure that all our customers are aware of and exercising their rights in terms of the Batho Pele principles" (DoH,2016):13
This is an important aspect that incorporates how the service comes together to provided benefit for the patient.
69 Openness and Transparency
"Citizens should be told how national and provincial departments are run, how much they cost, and who is in charge";
According to Batho Pele Patients should be well informed of the organisational structure and hierarchy.
Redress
"If the promised standard of service is not delivered, citizens should be offered an apology, a full explanation and a speedy and effective remedy; and when the complaints are made, citizens should receive a sympathetic, positive response".
According to Batho Pele the patient is at the centre of the entire health service. When a patient complains, it is important that they are given the attention that is needed and should not be dismissed as being difficult or unappreciative. When someone complains there needs to be an investigation that seeks out to identify the root of the problem so as to prevent the repeat incidence (Batho Pele). Patients should therefore be encouraged to participate in the process of identifying bottle necks or problem areas within the health system.
Involvement of family and friends
"Involvement of and support for family and carers"
According to Picker Principles "this includes the accommodation of family and friends, involving family in decision-making, supporting the family as care-giver and recognizing needs of the family".
According to the IOM "this includes accommodating family and friends on whom patients may rely, involving them as appropriate in decision making, supporting them as caregivers, making them welcome and comfortable in the care delivery setting, and recognizing their needs and contributions".
Courtesy and Respect
"Citizens should be treated with courtesy, consideration, empathy and respect"
According to Picker Principles the quality of life, involvement in decision making, dignity, needs and autonomy.
According to IOM "each patient’s wants, needs, and preferences; gives patients opportunities to be informed and involved in medical decision making; guides and supports those providing care in attending to their patients’ physical and emotional needs; care is customized and incorporates
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cultural competence. Patients’ preferences are likely to change over time and to depend on the clinical problems in question"
Emotional Support
Emotional support—relieving fear and anxiety.
According to Picker Principles "anxiety over clinical status, treatment and prognosis; impact of the illness on self and family; and the financial impact of the illness need to be considered."
According to IOM "suffering is more than just physical pain and other distressing symptoms; it also encompasses significant emotional and spiritual dimensions".
Physical Comfort
Attention to physical and environmental needs
According to Picker Principles this includes the surroundings and hospital environment.
According to IOM "the attention to physical comfort implies timely, tailored, and expert management of symptoms such as pain, shortness of breath or other discomfort".
Co-ordination and Integration Continuity of care and smooth transitions.
According to Picker Principles" information on discharge, continuing care that is organized, continuing support and who to call for help is important".
According to IOM "the requirement to ensure that accurate and timely information reaches those who need it at the appropriate time; addresses the need to manage smooth transitions from one setting to another or from a health care to a self-care setting".
Information
Citizens should be given full, accurate information about the public services they are entitled to receive;
According to Batho Pele the right to information is an important aspect of Batho Pele.
According to Picker Principles "information, communication and education to support clinical status, progress and prognosis; processes of care; facilitate autonomy, self-care and health promotion are needed".
According to IOM "people want to know what is wrong (diagnosis) or how to stay well, what is likely to happen and how it will affect them (prognosis), and what can be done to change or
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manage their prognosis. They need answers that are accurate and in a language they understand. Common to all such interactions is the desire for trustworthy information (often from an individual clinician) that is attentive, responsive, and tailored to an individual’s needs"
Value for Money
Public services should be provided economically and efficiently in order to give citizens the best possible value for money;
According to Batho Pele the emphasis of Bath Pele is service delivery with high quality.
According to Picker Principles: Health workers should provide quality care.
Encouraging Innovation and Rewarding Excellence
"Innovation can be new ways of providing better service, cutting costs, improving conditions, streamlining and generally making changes which tie in with the spirit of Batho Pele. It is also about rewarding the staff who “go the extra mile” in making it all happen"
Innovation according to Batho Pele seeks to identify ways of making improvements that support the general well being of the patient. It therefore is in keeping with the motivation to develop a patient experience model. The principles that have been discussed are used to identify potential domains of patient experience.
The Batho Pele Principles have been contrasted with the Picker Principles and Institute of Medicine (IOM) Framework to identify commonalities that can influence the patient experience.
The Picker Principles and the IOM Framework provides an outline of how patient experience can be improved in developed countries and by itself, the frameworks may not be well accepted in the South African context. Therefore the contrast ensures that the factors influencing patient experience based on the theoretical analysis of the frameworks are culturally acceptable for application in SA.
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The following domains of patient experience that have been included in the study based on the frameworks of Batho Pele, Picker Principles and IOM are as follows:
Table 3. 2: Development of the Domains of Patient Experience
DOMAINS FRAMEWORK
1. Access Batho Pele explains that citizens should be able to freely access health services.
2.The physical state of the infrastructure
According to Picker Principles this includes the surroundings and hospital environment.
According to IOM "attention to physical comfort implies timely, tailored, and expert management of symptoms such as pain, shortness of breath or other discomfort".
3. Involving my family and friends in my care
According to Picker Principles" this includes the accommodation of family and friends, involving family in decision-making, supporting the family as care-giver, recognizing needs of the family "
According to the IOM" this includes accommodating family and friends on whom patients may rely, involving them as appropriate in decision making, supporting them as caregivers, making them welcome and comfortable in the care delivery setting, and recognizing their needs and contribution"
4.Waiting time
According to Batho Pele the emphasis of Bath Pele is service delivery with high quality.
According to Picker Principles: Health workers should provide quality care.
5.The quality of care
According to Batho Pele the emphasis of Bath Pele is service delivery with high quality.
According to Picker Principles: Health workers should provide quality care.
6. Information
According to Batho Pele the right to information is an important aspect of Batho Pele.
According to Picker Principles "information, communication and education on clinical status, progress and prognosis; on processes of care; to facilitate autonomy, self-care and health promotion".
7. Education According to IOM "people tend to want to know (1) what is wrong (diagnosis) or how to stay well, (2) what is likely to happen and how it will affect them (prognosis), and (3) what can be done to change or manage their prognosis".
8. The role of the doctor
According to Batho Pele the emphasis of Bath Pele is service delivery with high quality.
According to Picker Principles: Health workers should provide quality care.
9. Management effectiveness towards positive outcomes
Batho Pele Principles" explain that organisations who do well in serving their customers can demonstrate that they have leaders who lead by example, who set the vision, and ensure that the strategy for achieving the vision is owned by all and properly deployed throughout the organisation."
10.The role of medication According to Batho Pele the emphasis of Bath Pele is service delivery with high quality.
11. Communication "Citizens should be told what level and quality of public services they will receive so that they are aware of what to expect."
12. Patient centred care Batho Pele Principles note that the principle of consultation requires the inclusion of patients when evaluating the quality of services that are delivered within the healthcare context.
13. The role of the nurse
According to Batho Pele the emphasis of Bath Pele is service delivery with high quality.
According to Picker Principles: Health workers should provide quality care.
14. Cleanliness in the clinic
"Citizens should be told what level and quality of public services they will receive so that they are aware of what to expect."
15.Co-ordination and continuity of care
According to Picker Principles" information on discharge, continuing care organized, continuing support who to call for help."
According to IOM "the requirement to ensure that accurate and timely information reaches those who need it at the appropriate time;
addresses the need to manage smooth transitions from one setting to another or from a health care to a self-care setting"
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