DID YOU KNOW?

Our Carer Zones project has been honoured nationally and internationally for its innovation, collaboration and consumer engagement. Awards to date include the International Academy for Design and Health Best International Hospital Design 2017, NSW Health Awards Patients As Partners 2016, NSW Health Symposium People's Choice Award 2016 and the Ko Awatea APAC Forum International Excellence in Health Care Improvement Award 2016. Go to Awards.

 

About carer zones 

Overnight accommodation for carers has transformed the hospital experience for patients and carers at Blacktown Hospital. The project has been so successful, it has been nominated for five awards and attracts visitors from all over the world. 
 
As part of the BMDH Project, 40 unique carer zones were commissioned in single rooms across the new clinical services building at Blacktown Hospital.
 
In single rooms, a visitor lounge near the window converts to an overnight bed for carers to stay overnight with an adult patient. 

The patient bed curtain draws across the zone at night to maintain privacy for the carer without restricting nursing access to the patient.
 
The concept is well-established in children’s hospitals but new to adult hospitals. The design is unique, having been developed by architects Jacobs to use existing space while maintaining access, privacy, comfort and spaciousness.


 

I was able to stay overnight with my mum and I am so overwhelmed by the ideas that they created. Every time I come here to the hospital I have to sleep on a chair but thank God for whoever created this idea because last night I actually slept on a bed and I had a great, great sleep. Ruta, carer for her elderly mum

The carer zones were created as a direct result of consumer consultation.
 
“The idea of having carer zones came from a community forum,” said consumer representative Judith Lababedi.
 
“Right at the beginning of the design, a lady put up her hand and made the comment that it would be great if in the new hospital there was somewhere carers and relatives could sleep rather than spend all night sitting in those uncomfortable chairs by the patient's beds.
 
“What was really great was that the architect and the project team took that on board and went away and came up with designs and they're just wonderful,” Judith said.
 
Patients may need their carer to stay overnight for many reasons. Communicating in English may be difficult, they might be confused or they might need the reassurance of a familiar person with them during a health crisis.
 
Before carer zones, staying overnight for carers meant an uncomfortable night in a chair by the patient’s bed. By the time the patient was discharged carers would be exhausted and sore.
 
Carer Ruta Vatau was the first carer to stay overnight at Blacktown Hospital and has since stayed regularly with her elderly mother.
 
“I was able to stay  overnight with my mum and I am so overwhelmed by the ideas that they created,” Ruta said.
 
“Every time I come here to the hospital I have to sleep on a chair but thank God for whoever created this idea because last night I actually slept on a bed and I had a great, great sleep.
 
“It’s so brilliant. It’s great for the carer who wants to stay overnight with their parents… so last night I had a great, great sleep on a bed,” Ruta said. 
 
In the four months since carer zones were introduced, staff, patients and carers report significant benefits from having a carer stay overnight including reduced anxiety, improved patient/carer education and improved satisfaction with their hospital experience.


 
 

Information for health professionals

Blacktown and Mount Druitt hospitals are located in western Sydney and are part of Western Sydney Local Health District.
 
In 2012, the NSW Government announced a major expansion the hospitals to meet the growing healthcare needs of the community.
 
The $312 million Blacktown and Mount Druitt Hospital (BMDH) Project included a new clinical services building at Blacktown Hospital which provided a unique opportunity to co-design patient rooms with consumers.

Before carer zones, the carer experience was ad hoc, causing a variance in carer and patient experience.

 

Cultural change program

To support the commissioning of the new carer zones a number of cultural and operational changes were implemented to improve the focus of staff on the patient and carer experience.

 A co-design approach was taken to the development of the carer program, which included representation from consumers and carers, as well as a very broad range of clinical and non-clinical staff.

Elements included:

• Creation of formal, agreed procedures governing the program in partnership with consumers, including a new patient focused set of rules for Family Members or Carers Staying Overnight with Patients and enhanced patient orientation and communication protocols.
• Removing restrictions on visiting hours – entirely for carers and very significantly for all visitors
• Creation of a carer card to enable carers to take advantage of privileges such as concessional parking and improved access
• An education program on the carer zones for staff, patients and carers and extensive education and in-services provided by Patient and Carer Experience Officer to nursing and administration staff
• Design of new carer amenities including lounges and beverage bars
• New policies for linen supplies
• Ongoing feedback mechanisms (both formal and informal) established for staff, patients and carers to ensure ongoing improvement of the program.

 Staff receive educational resources  and procedure documents to help support everyone's comfort and safety. Both carers and staff are able to provide feedback that ensures continued improvement for the patient experience.
 

Outcomes

 The results of this initiative have been extremely positive with staff, patients and carers reporting

• Improved patient and carer experience. Patients with carers staying overnight have reported reduced anxiety and improved satisfaction while carers have also reported very favourably on their experience
• Improved opportunity for staff-carer communication
• An enhanced opportunity for staff to work in a patient centred care model.

While primarily a patient experience initiative, the implementation of the carer program has had a number of unexpected benefits in relation to productivity and efficiency.

• Staff have identified that having a carer stay overnight can positively impact their workload with a reduced frequency of nurse calls being reported.
• In the Aged Care Ward there has been a six-fold increase in the utilisation of carer education resources as clinicians benefit from improved access to carers and relatives.
• Clinicians also report that the increased opportunity for communication with carers supports better discharge planning, education opportunities and the exchange of relevant information.

What worked?

Increased carer presence has improved patient experience and increased communication between clinicians patients and carers.

Challenges?

For some staff there has been a hesitance to adopt this cultural change. In-services and continual opportunity to offer feedback on their experiences has addressed many of their concerns. Some staff who were initially resistant have identified positive outcomes since the program commenced.

Where to from here?

As the carer zones themselves are a built amenity, they will remain available to patients of Blacktown Hospital for the life of the facility.

To achieve the long-term sustainability of the entire program however, a systematic approach has been undertaken to providing education, information and evaluation opportunities for patients, carers and staff.

The initiative however does not rely entirely on having purpose built carer zones. Even without the built facility, many of the cultural and operational elements of the program could be readily adapted across NSW.
 
Tips for others

Representatives from dozens of organisations from across Australia and overseas have visited Blacktown Hospital over recent months – many specifically to view the innovative new inpatient unit design which incorporates the carer zones.
 
A number of organisations have flagged their desire to replicate the Blacktown carer initiative and information and assistance is being provided through a number of channels including the Agency for Clinical Innovation.

Awards

Finalist - NSW Health Awards 2016
Runner-up - Ko Awatea International Excellence in Health Improvement Awards 2016 (part of consumer engagement program)
Finalist - Ko Awatea APAC Forum Delivery of healthcare and the impact on quals poster finalist 2016
Finalist - WSLHD Quality in Healthcare Awards 2016
Nominee - NSW Premier’s Award for Public Service – Improving Service Levels in Public Hospitals 2016
Winner - NSW Health Awards Winner 2014 – Partnering with Patients (as part of the consumer engagement program)

For more information

Health professionals please contact our Patient and Carer Experience Team for more information about the project.
 
Wendy Cain
Patient and Carer Experience Officer
Tel | 8890 9925 (61 2 8890 9925)
Mob | 0428 521 609 (61 428 521 609)
Email | wendy.cain@health.nsw.gov.au