Megan keeps improvement patient-focused in South Wales

Aneurin Bevan is one of two health boards in Wales using ‘model patients’ to help with their quality improvement programmes. Taking an idea developed by the Esther Network in Sweden, the team in South Wales has developed a fictional patient persona, called Megan, as part of their ‘100,000 days’ campaign.

Megan is giving a human face to their aims to improve care, ensuring activity remains focused on what’s best for the patient. The idea is that by seeing things through Megan’s eyes, staff can identify gaps in systems and provide more person-centred care.

Learning from the Esther Network

The Esther Network in Jönköping, Sweden, is widely recognised as a world leader in patient-centred care. It is based on ‘Esther’, a fictional patient, created to help focus clinical and social care on the needs, preferences and anxieties of its service users. It is a simple, multi-agency approach designed to ensure that the patient is always at the centre of care planning and delivery.

Grant Robinson, Medical Director of the Aneurin Bevan Health Board, explains how the idea for a Welsh version of Esther developed following a trip to Sweden around three years ago.

‘We pinched the idea from Göran Henriks, Chief Executive of Learning and Innovation at the County Council of Jönköping. A team, including Dr Alan Willson (joint director of the NHS Wales 1000 Lives Plus improvement programme), went over to explore what could be learnt from the approach and how this could be applied in Wales.’

The Esther Network ended up becoming a key theme in Person Driven Care, a white paper produced by 1000 Lives Plus and supported by the Health Foundation. ‘The Esther Network demonstrated a new way of aligning systems and processes to provide patient-centred care. It’s a really powerful intervention and we could see the potential for enhancing our own improvement programmes’, says Grant.

Two patient personas were adopted in Wales from September 2012 – Freda in North Wales (introduced by the Betsi Cadwaladr Health Board), and Megan in South-East Wales.

Who is Megan?

Like Esther, Megan is a fictitious patient, but it’s been important to make her seem real so she's been given a full back story.

In practice, Megan becomes a generic name for any service user, although retaining the idea of an elderly person with one or more health issues. As Jan Davies, Joint Director of 1000 Lives Plus, explains in a blog on the topic: ‘Using a ‘person’ to frame the conversations moves the discussion away from what is right for ‘us’ – the clinical staff and the managers responsible for services – and over to the people who depend on the services’.

100,000 days: Every day counts for Megan

Megan’s name has now been given to a specific improvement campaign within the Health Board aimed at reducing hospital bed days.

‘100,000 is a realistic evaluation of the number of days in total that patients could be at home every year, instead of in hospital, if the local NHS performed as well as possible’, explains Grant.

The project is looking to make improvements across the whole system, from inpatient care to home support. They are focusing on better chronic disease management and use of day services in order to keep people at home and avoid unnecessary hospital visits. And when hospital care is necessary, the team want to make sure patients access the right services without delay, and don’t stay in hospital longer than needed, with appropriate support made available at home.

Reducing bed days will obviously have a positive financial impact on the Health Board, limiting waste and streamlining care. But using Megan ensures a patient focus throughout all the changes. Clinical teams are being asked to plan improvements to ensure that Megan will be in the most appropriate and safe place for her care and treatment at any given time.

As Grant explains, this is keeping the focus on what actually motivates staff. ‘People have difficulty relating to data and figures, but putting a human face to that information gives it so much more impact. Using Megan really helps to motivate and change behaviour, so that everyone is focused on making care better for her and for patients like her.’