Blacktown and Mount Druitt Hospitals*

In 2012, the NSW Government announced a major expansion of Blacktown and Mount Druitt Hospital to meet the growing healthcare needs of Western Sydney. The Blacktown and Mount Druitt Hospital project included a new clinical services building, which provided a unique opportunity to co-design patient rooms with consumers.

Strategies that made a difference

Carer zones

As part of the project, 40 unique carer zones were commissioned in single rooms across the new clinical services building at Blacktown Hospital. The carer zones provide dedicated overnight facilities for a patient’s carers or relatives. Single patient rooms include a visitor lounge that converts to an overnight bed, so carers can 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.

This concept is well-established in children’s hospitals but new to adult hospitals. The design is unique and uses existing space while maintaining access, privacy, comfort and spaciousness. See the carer zones at Blacktown Hospital video clip.

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 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, enhanced patient orientation and communication protocols
• An education program on the carer zones for staff, patients and carers
• Removing restrictions on visiting hours entirely for carers and significantly for other visitors
• Creation of a carer card to enable carers to take advantage of privileges such as concessional parking and improved access
• Ongoing feedback mechanisms (both formal and informal) established for staff, patients and carers to ensure ongoing improvement of the program.

Outcomes

These initiatives have been positively received by staff, patients and carers. Feedback has included:

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

The implementation of the carer program has had a number of unexpected benefits in relation to productivity and efficiency, including:

• The overnight carer facilities positively impact staff workload, including a reduction in the number of nurse calls
• 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 the patient experience and increased communication between clinicians, patients and carers.

Issues and problems faced?

For some staff there has been a hesitance to adopt this cultural change. Some staff that were initially resistant have identified positive outcomes since the program commenced.

Where to from here?

The carer zones will remain available to patients of Blacktown Hospital for the life of the built 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 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 several organisations across Australia have visited Blacktown Hospital recently to view the innovative new inpatient unit design, which incorporates the carer zones. A number of organisations have flagged their desire to replicate the carer initiative. Information and assistance is being provided through a number of channels, including the Agency for Clinical Innovation.

Learn more about other hospitals that have signed up to the campaign here.