Patients often tell us that being in hospital is boring - they need a distraction from their health issues and the monotony of lying in hospital beds
The Patient Engagement System was originally set up for exactly this purpose – as a way to give patients access to different entertainment options
In October 2014 a brief survey was undertaken to identify what one change we could make to the physical environment to improve patient experience. The chart below shows that the most common request was for internet access and we now have free WiFi available anywhere on our grounds 24 hours a day. What was also clear was that providing a range of entertainment options would significantly improve people’s experience. This included access to movies, music, games, reading material and multimedia devices.
We teamed up with the digital innovation team at Vodafone to trial iPads at the bedside in one ward at North Shore Hospital. Ward 7 was selected because it is a busy orthopaedic ward, which means that the patients are a mix of age, gender, ethnicity and ability, making it a perfect place to test a system that needs to work for everyone.
We also needed to make sure that whatever system we put in place would not put undue pressure on staff, so finding a busy clinical environment allowed us to make sure any administration of the system was as simple as possible and able to be easily accommodated within clinical routines.
We provided iPads to our ward patients at the bedside so they can access the outside world. By enrolling the devices on Vodafone's mobile device management system we have been able to determine the content (i.e. apps and shortcuts to web pages) and add device security so that they can be locked if they leave the campus.
Devices include access to:
- health-related content (including ward orientation information and pain management advice)
- internet browsing
- communications tools (Skype, Facebook, Twitter, and other social media)
- free TV
- other TV and movie options for those with accounts (such as Sky Go and Netflix)
- music and radio
- online books and news
- Friends and Family Test
- information about the Well Foundation
The devices are not fixed and most patients simply prop them up on their meal trolley. We did trial mounts that clamp to the meal trolley but these were quickly discarded because the angle was not ideal for viewing and the mounts took up too much space on trolleys. Having the devices untethered has allowed family members and visitors to use them, either by the bedside or in the family room while patients are sleeping.
The iPads are connected to the internet (via Hospital Hotspot) and allow full access to whatever content patients want. We have security measures built into our WiFi, to prevent people accessing explicit content for example, but no other security measures were imposed on the iPads. The devices are reset between patients to ensure that no personal information is left on them after people leave the ward.
The iPads were installed in March 2016 during Patient Experience Week. Staff volunteers attended the ward to help those less familiar with iPads. Within the first few hours of 'going live' patients were using online banking, accessing Facebook, using Skype to contact grandchildren in Australia, and managing businesses from their hospital beds.
An exciting development was that one nurse used Google Translate to communicate with a woman who only spoke Mandarin. This encouraged us to include a translation app, which is now installed on every device.
Since that time we have been collecting feedback from patients, which has been overwhelmingly positive. People appreciate being able to continue with their everyday lives as much as possible while they are in hospital. It is also a distraction from health problems - nurses notice that people use their call bells less because they have something to take their minds off pain for example.
The devices have also become a social tool, for example patients sharing rooms have also been selecting music that they all enjoy singing along to!
"It's a very advanced ward. They give us this tablet thing and we can use it"
"I'm getting good at technology while I'm here....we have the iPad in the room"
"This iPad tech is such a good idea. I'm not bored anymore. Hospital stay has never been better"
Patient Experience Reporting System (PERSy)
A new electronic survey system that will enable us to connect with our more than 600,000 people and learn about what and what isn’t working so that we can tailor everything we do to meet the needs of our population
Creating a way of systematically measuring health outcomes directly reported by our patients that will help clinicians better understand the effect of disease and care on a patient's daily life and the patient's preferences and needs
Sophisticated analytics that will enable us to better understand the relationship between our staff experience and patients' experience
The Friends and Family Test results for Ward 7 during the pilot show that even some 'detractors' who had not had a positive experience still commented that the iPads were a great initiative
The only criticism of the system was the unreliability of the internet connection, many patients commented that the connection was often slow, or dropped out repeatedly making it frustrating to use
What started as a way to give patients some entertainment options and relieve boredom has quickly become an important tool to empower patients to be more in control of their hospital experience, and to stay connected to their normal lives.
The feedback from patients has been so positive that we now plan to roll the devices out to the majority of our inpatient beds. However, there is more development we can do to get maximum benefit out of the system.
We want to design and develop:
- a Waitemata DHB 'portal' that will allow us to have much more control over the content, layout and user experience on the devices. This will also create a platform that people can download onto their own devices and use in the community. The DHB portal will also allow functionality such as pop-up windows to encourage people to provide feedback, or to direct them to certain content
- personalised health content so that the health information on a device will be totally relevant to the person in that bed
- capability to use devices for two-way communication. Currently patients can complete our online experience survey from their device but we want to increase the communication capability. This might include using tools such as video-conferencing (or Skype) so that family members can be part of ward rounds if they cannot be at the hospital in person. Or, it might include videoing ward rounds so that family members and patients can watch them again to better understand what was said, particularly for people on medications which affect their memory or ability to concentrate on what is being said
- integration of meal ordering so that patients can see the menu and order their meals through the device
- a smart nurse call system so that patients can call for specific reasons such as pain relief, help to get to the bathroom, food and drinks etc
- patients access to their own clinical records at the bedside using the device
- a more formal programme of volunteer support so that people can easily access help to use the devices if they need it