Calvary Health Care Sydney

South East Sydney and Illawarra

Area Health Service

Patient and Carer Experience Report

Rehabilitation and Palliative Care Journeys

July, August, September 2008

 CONTENTS
PATIENT AND CARER EXPERIENCE REPORT................................................1
JULY, AUGUST, SEPTEMBER 2008.......................................................................1
CONTENTS..................................................................................................................2
1. INTRODUCTION....................................................................................3
2. METHODOLOGY...................................................................................4
EXECUTIVE SUMMARY...........................................................................6
3 (a). Top 3 Positive Aspects of patient and carer experience:...........6
3 (b). Top 3 Negative Aspects of patient and carer experience:.........6
3 (d). Trend Analysis:.............................................................................10
DISCUSSION...........................................................................................10
COMPARATIVE ANALYSIS....................................................................19
APPENDIX 1 THE STORIES...................................................................19
APPENDIX 2 ANALYSIS SPREADSHEET.............................................19
1. INTRODUCTION

Calvary Health Care Sydney Ltd. (CHCS) is a "Non-declared", Affiliated

Health Organisation listed in Schedule Three of the Health Services Act 1997.
It is owned and operated by Little Company of Mary Health Care Ltd,
(LCMHC) a national organisation established to manage the health, aged and
community services of The Sisters of the Little Company of Mary (LCM) in
Australia. The Sisters of the Little Company of Mary is an international
religious order of Catholic sisters who first arrived in Australia in 1885 and
commenced providing services as a public hospital in 1966. Today, LCMHC
provides services in every capital city and many regional centres in the
following states and territories - ACT, NSW, SA, Tasmania, Victoria and
recently the Northern Territory.

Calvary Health Care Sydney is situated in Kogarah and serves the St. George
district for Rehabilitative and Aged Care services. The CHCS Palliative
Service serves the St. George and Sutherland Shire for both inpatient and
community services.

Beds in operation at CHCS are:

• Capacity of 43 Palliative Care beds budgeted to operate at 88%

occupancy
• 45 Aged Care Rehabilitation inpatient beds budgeted to operate at
84% occupancy with capacity of 53 beds
• 10 Day Rehabilitation Unit beds operating on a Monday to Friday basis.

The average length of stay (LOS) for the inpatient Rehabilitation wards is
19.36 days and the average LOS for inpatient Palliative wards is 18.49. The
combined average LOS for CHCS is 18.91 days. Both service streams
provide extensive community services.

The CHCS Palliative Care Service is the largest specialised comprehensive

palliative care provider in NSW. It incorporates community, inpatient, and
follow up bereavement services and Pastoral Care as its core business. The
service's primary patient catchment area is contained within the Sutherland
and St. George areas. On occasion, out of area patients are accommodated
in the inpatient unit. The integrated approach to care delivery is based on a
holistic framework. Referrals are sourced from both the public and private
hospitals in the area. Primary health carers such as the General Practitioner
or Generalist nursing services are also able to refer. The actual patient or
their carer may also self refer. All referrals are assessed for specialist
palliative care need based on the Palliative Care Australia Standards.

CHCS operates a large multidisciplinary Community Rehabilitation and

Geriatric Service (CRAGS) which incorporates a 45 bed inpatient
rehabilitation unit, day rehabilitation program and an extensive range of
community based services. The role and function of CRAGS is that of
assessment and intervention, case management, care planning, and referral
and placement support where appropriate. Calvary has substantial
experience in facilitating the integration and expansion of rehabilitation
services within the St. George Area. Its community and aged care services
include:

• St George Aged Care Assessment Team (ACAT)

• Placement Service (Nursing Home, Hostel, Respite and CCP Liaison)
• Podiatry Service (Centre based and domiciliary)
• Driver Assessment & Rehabilitation Service
• Continence Advisory Service
• Neuropsychological assessment and treatment
• Dementia Specific Day Care Centre
• Occupational Therapy services including home assessment, equipment
prescription and home modifications
• Physiotherapy including hydrotherapy, home assessment, Mobility
Group, prescription of exercise programs and equipment
• Speech Pathology assessment and intervention
• Dietetics services
• Medical oversight from Rehabilitation Specialists and Geriatricians
• Social Work services including advocacy, assessment, care planning
and liaison
• Veterans Home Care service for South East Sydney
• Program of Appliances for Disabled Persons (PADP) and the
Equipment Loan Pool (ELP)
• Transitional Aged Care Services (TACS)

The major source of funding for operations is through South Eastern Sydney
Illawarra Area Health Service (SESIAHS). This is provided by an annual
recurrent subsidy which is historically based rather than activity driven (52
publicly funded beds).

2. METHODOLOGY

In order to engage directly and meaningfully with patients and carers who
have recently experienced health care at Calvary Health Care Sydney, ten
interviews with service users, using a methodology supported by NSW Health,
were conducted.

The NSW Health supported methodology, which uses the Picker Patient
Centred Dimensions of Care, was applied. This approach focuses on critical
aspects of the patient’s experience of health care as identified through
extensive research undertaken by the NRC+Picker Institute (USA). The NSW
Health approach has adapted the findings to define the key dimensions of
care as valued by patients and carers.

The eight Patient-Centred Dimensions of Care provided by NRC+Picker are

as follows:
1) Access to care
2) Respect for patient’s values, preferences and expressed needs
3) Coordination and integration of care
4) Information and education
5) Transition and continuity
6) Physical comfort
7) Emotional support and alleviation of fear and anxiety
8) Involvement of family and friends

Patients identified both positive aspects and negative aspects of care in

relation to each of the eight dimensions.

The journey being captured at Calvary Health Care Sydney was the inpatient
experience for both the Rehabilitation and Palliative Care service streams.
This would also, in some instances, capture those patients who had
experienced services delivered by Calvary’s Community Rehabilitation and
Geriatric Services Team and Calvary’s Community Palliative Care Team.

The following criteria were used to determine participant eligibility for the
project:
• admitted from an acute facility
• stayed more than 7 days and
• reside within the community and may/may not have a carer.

Ten interviews were conducted between July and September 2008. Most
interviews took approximately an hour. All interviews were undertaken by two
staff - one acting as scribe and the other as lead interviewer.

The staff who conducted the interviews had received training on how to
interview patients and capture patient stories using this methodology.

Potential interview subjects were identified through iPM. A report listing

discharges for the previous fortnight was used to identify candidates for
interviewing. Patients were randomly contacted using this list.

Discharged rehabilitation patients were contacted by phone to determine their

interest to be interviewed. Appointments were made with those who
responded positively, and a letter inviting them to participate, a Patient
Information Sheet, and the Consent Forms, were mailed to them. A
reminder/confirmation call was made the morning of the interview.

Due to the fragile nature of the palliative care patient group, it eventuated that
discharged palliative care patients had already passed away when they were
randomly selected for contact from the iPM list. It became necessary to target
those patients who were presently experiencing an inpatient stay. Patients
from the ward were randomly selected to be interviewed.

All interviews conducted were face to face interviews. Patients discharged

from the rehabilitation service were interviewed in their homes. Patients
experiencing a Palliative Care Patient Journey were interviewed in their rooms
on-site in the hospital.

On completion of the interviews, the story was written by the scribe. The story
along with a thank you letter was sent to the patient/carer for review and an
opportunity to make amendments.

EXECUTIVE SUMMARY

P os itive a nd ne ga tive a s pec t of pa tie nt e x pe rie nc e ,

findings from 1 0 inte rvie w s in SESIAHS
N e g a tive / D is a g re e Po s itive / Ag ree

Acce s s to C a re

R e s p e ct for p a tie n ts

C o o rdina tio n a n d in te gra tio n o f ca re

In form a tion an d e d u catio n

Tra n s itio n a n d co n tin u ity

Ph ys ica l co m fo rt

E m o tio n a l s u pp o rt

In vo lve m e n t o f fa m ily a nd frie n d s

4 3 2 1 0 1 2 3 4
n u m b e r of in te rvie w e e s

3 (a). Top 3 Positive Aspects of patient and carer experience:

1. Coordination and integration of care

2. Emotional support and alleviation of fear and anxiety
3. Access to care

3 (b). Top 3 Negative Aspects of patient and carer experience:

1. Physical comfort
2. Emotional support and alleviation of fear and anxiety
3. Information and education
3(c). Exemplars:

Positive:

Patient and carer experience Exemplars

1 Coordination and integration of • I had asked to have mum’s toenails clipped
care and it was done the next day.
• When mum went home for the first time,
they had equipment put in place.
• I had a problem with my bowel, so I rang
the community nurse who was looking after
me. He said what he thought I should do,
but that didn’t work, so I tried something
else, but that didn’t work either so he
suggested coming to hospital. He got me in
that same day.
• I’ve been to Calvary three times in the last
four years… An Occupational Therapist
came to my house, each time I was in.
• On the last day the physiotherapist said,
“would you like to come to outpatients?” I
didn’t think I needed it, but seeing he
suggested it, I thought I should take
advantage of it.

2 Emotional support and • I got very downhearted one day, and my

alleviation of fear and anxiety doctor sent one of the girls to take me out
for a drive to Cronulla. They had asked me
“if you weren’t here, where would you like to
be?” I had said I’d love to be by the water,
the rougher the better. If I stayed in hospital
too much, I’d become institutionalised.
• I know I’ve got someone if I need help. I
can ring them at night if needs be, if I’m
worried about anything I can always get to
them. It builds up confidence and I can get
help if I need it. They’re interested to know
how I’m going, what’s happening to me.
They speak to my doctors on my behalf. It’s
good to know they’re there for me. One
nurse, she’s very, very good. I could ring
her any time I needed her. She used to
phone me to see how everything was going.
• Social work has been excellent. I have an
intellectually handicapped son. I am
worried about him when I’m not around
anymore. She’s been helping him. He’s
accepted that I’m not going to be around all
the time.
• The staff have been absolutely terrific.
They are so good. If I’m in their hands I
know I’m going to be safe. The doctors are
great. I haven’t found a doctor yet, that
doesn’t talk to you like a doctor and that’s
what I like. I don’t understand about every
piece of medication, but I understand what
they’re trying to do. I understand they’re
trying to relieve things. I understand that
I’m not going to get any better, I’m not going
to walk again. Now it’s a matter of how
we’re going to go into this. The doctors are
direct, straightforward and considerate.
• We’ve known all along that Ken had cancer.
We’re comfortable with it. We’ve had

3 Access to Care
Negative:
Patient and carer experience
1 Physical comfort
support offered all the time. Pastoral care
and social work have always let us know all
the time that support is available.
• Initially, I was told that I would have to wait
another fortnight to get into to Calvary
Hospital, but the same afternoon the sister
came to me and said you are going to
Calvary within the next hour. The transfer
went very smoothly.
• The most positive aspect of my care at
Calvary was the access to care. Both times
I needed to come to Calvary I only had to
wait two days for a bed.
Exemplars
• I missed my double bed from home,
because they had a little tiny bed. Maybe
one night I could fall, because I had so
many falls. I felt like crying. I ask two or
three times for side rails. It was scaring me.
I missed my bed and electric blanket. I was
cold. They gave me blankets but I was
always cold.
• They had put me in the Independent Living
Unit before I was discharged. The bed was
difficult to make there as it was pushed into
the corner, so I had problems making the
bed. The nurse moved it for me. At
Calvary you don’t strip the bed, to make it,
you pull it down and pull it up. I’m used to
stripping the bed, letting it air, rubbing my
hand over it, laying sheets, blankets, quilts.
Just pulling it down, and pulling it up is not
sanitary.
• What they’re doing now in building a pool is
excellent, except at the time I was scared
stiff! I would get up at 6.45am, have my
shower and wait for breakfast, and then it
was like an earthquake, they were
excavating right under my bathroom and my
bed.
• Knowing my own body, 8 Panadol per day
is too much for me. I’d be sound asleep,
and the lights would go on, and the Nurse
would be there with 2 Panadol, and I’d have
to take them. I said no a couple of times,
and she left them there and I chucked them
down the toilet the next morning.
• Jacqueline: I was taking him off all his
tablets at home but when Rudi came here
they started them all again. I was a little bit
annoyed because when Rudi was
discharged they gave him five days worth of
Chemotherapy tablets but they ran out on a
Sunday. Rudi: When we did try to get more
tablets the supply had run low so I had to go
without the tablets for a week until new
stock came.
• Most of the time the ward seemed very
noisy. Mostly I slept well but the there was
a lot of talking. I didn’t get bothered about it
though. Generally when I asked for

2 Emotional support and
alleviation of fear and anxiety
3 Information and education
something the nurses did it straight away so
I didn’t worry about the talking. I was also
close to the lift so I heard the lift bell quite a
lot but that didn’t bother me. It was more
the laughing and talking. The noise from
the room next door seemed very close
too…. Being near the front desk was very
noisy. I didn’t hear anything negative, it
was just the noise.
• At first, I was frightened about being moved
around. It is traumatic being moved around
and not knowing where you are. Especially,
I was a bit confused at the beginning.
• She told me she went to the toilet in the
middle of the night by herself as she is used
to doing that at home, but the nurse spoke
to her in a manner which upset her for days.
This experience really stayed with my mum
for a while and she was scared that if she
complained, that the nurse might retaliate.
She asked that I did not complain when this
had just occurred.
• I was in a four-bedded room, but I couldn’t
handle it. There was a woman in the bed
opposite me screaming, “Please God take
me”. I wanted to go. I was there for two
days and that lady was screaming the entire
time. This made me most upset, as I was
all right compared to the others in that
room. The only problem was that my
bowels didn’t work. That’s what got me
down. It was like a morgue… I should’ve
never have been put in a room with others
who were that sick… After a week they
asked me to move into a four-bed ward
again. I was scared again but they kept me
in a single room. I could see them all in my
mind. I just lost a friend to cancer. I really
couldn’t cope.
• The room is a bit noisy when they’re all
having their break out there but that doesn’t
really worry me, they’ve got to eat
somewhere. Sometimes it’s depressing
conversation which I can do without. If
they’re talking generally I don’t mind, but if
they’re talking about how long Harry’s got to
live…
• I thought, I’m in trouble, and I don’t know
where to turn.
• My daughter came by train from the Central
Coast. The first time she came she got
there about 10.00am, but another time there
was a hold up on the train so she got there
11.45am. She asked the nurse if she could
stay a little longer but struck a nurse who
said no. If she’d only come from another
suburb, but she came from quite a distance.
• Being taught how to move around may have
been helpful. The physiotherapist
suggested some alternative methods, but
some of them weren’t too good. For
example, I was worried about Ken slipping
on the tiles. As much as they were trying to
look at alternatives, they weren’t
 appropriate for home. If only someone had
shown me the easy way to do things.
• I found some procedures were not clearly
explained like the visiting hours. Also there
seemed to be inconsistencies between the
nurses. Some allowed me to do things for
myself but others wouldn’t let me and
insisted I wait for their help. There does not
seem to be a lot of communication between
the nurses. On occasions this made me
very frustrated and hence I had a few spats
with the nurses. I found this poor
communication affected my family as well.
My wife started to tell me I was not to do
things for myself. It has created
disagreement amongst us. If the nurses
spoke with her and told her what I am
capable of I think it would make everything
much easier.

3 (d). Trend Analysis:

This is the first collection of Patient Journey Stories at Calvary Health Care
Sydney. It is anticipated that this process will be repeated in the future with a
similar cohort of patients. Trend analysis and comparative analysis will be
possible with a series of patient stories conducted in the future.

DISCUSSION

This series of patient/carer journeys has offered great insight into the
experience of users of services provided at Calvary Health Care Sydney.
Overall, comments were overwhelmingly positive, but some constructive
feedback was obtained.

Access to Care

Several patients commented on how quickly they were accepted into Calvary:

“Initially, I was told that I would have to wait another fortnight to get into to
Calvary Hospital, but the same afternoon the sister came to me and said you
are going to Calvary within the next hour. The transfer went very smoothly.”

“The most positive aspect of my care at Calvary was the access to care. Both
times I needed to come to Calvary I only had to wait two days for a bed.”

However, a palliative care patient and his wife highlighted the time delay
between clinic appointments:

“Ken: I was attending the clinic weekly. It was hard to schedule

appointments in the clinics.

Mrs. Ken: They booked appointments 3 weeks ahead. A lot can happen in
3 weeks – it’s a long time for a person to be waiting.”
Respect for patient’s values, preferences and expressed needs

All patients praised the treatment they received by the staff they came across
during their patient journey. Several patients commented on how they
appreciated the appropriate level of encouragement from the staff in the gym:

“The gym is good. The girls are great. They know exactly how far to push
you. They really listen to you. I like feeling like I am allowed to make my own
decisions. The gym staff are good listeners; I feel like I am in control.”

“They just work miracles in the gym. The physiotherapists are such caring
people. They understand each patient. We’re all different. I have
emphysema. I’ll do so much at the gym and then my breathing will be a
problem. They’re so understanding. They told me to stop when I was having
trouble breathing and have a rest. The gym was hard work but I needed it.
No point in going if you were going to sit down and watch. I can only praise
them.”

One patient’s carer commented on the contrary:

“Mum just wasn’t happy going to physio. They need to understand that it can
be difficult for the elderly. My mum has a heart condition and it was difficult
for her the second time around.”

The interviewees acknowledged, on several occasions, that they were treated

with respect, and that their requests were always considered:

“They respect people at Calvary. The doctors, nurses, everybody says hello.”

“What I liked about Calvary is getting dressed in my own clothes and walking
around. No woman likes to be walking around in her nightdress and sleeping
in it at night.”

“I was awake early and usually showered first, provided they let me keep my
nightgown on as I could go back to sleep again before breakfast arrived.”

One patient provided an example where she and her fellow inpatients asked
to have their lunch in the patient lounge room so they could watch the
Olympics during lunchtime and their request was granted:

“It was just a matter of speaking with them, you can’t break the rules, I
understand that. You just had to ask, and it was either yes or no, no hassles.”

On one occasion a patient felt that she was not regarded in relation to her
medication management needs:

“Knowing my own body, 8 Panadol per day is too much for me. I’d be sound
asleep, and the lights would go on, and the Nurse would be there with 2
Panadol, and I’d have to take them. I said no a couple of times, and she left
them there and I chucked them down the toilet the next morning.”
Coordination and integration of care

Most patients were impressed by the coordination of care provided. It

appears that Calvary’s internal service referral systems operate efficiently:

“I had asked to have my mum’s toenails clipped and it was done the next day.
When I phoned the doctor, they got back to me immediately.”

“One nurse, she’s very, very good. I could ring her any time I needed her.
She used to phone me to see how everything was going. If I had a problem
with pain, I would speak with her and she would speak to the doctor in the
hospital and it would be sorted within a couple of days.”

“I had a problem with my bowel, so I rang the community nurse who was
looking after me. He said what he thought I should do, but that didn’t work, so
I tried something else, but that didn’t work either so he suggested coming to
hospital. He got me in that same day.”

“The staff in the gym are so caring. On the last day the physiotherapist said
“would you like to come to outpatients?” I didn’t think I needed it, but seeing
he suggested it, I thought I should take advantage of it.”

“An Occupational Therapist came to my house, each time I was in.”

One patient was confused about the coordination of his care:

“Jacqueline: Rudi’s hands were still a problem. The Doctor’s and nurses said
he needed to go to Prince of Wales for a check up. We couldn’t understand
this. Why couldn’t he go up to St. George which is almost next door! Rudi:
They still sent me to Prince of Wales by ambulance even though it was much
further.”

Another patient described a scenario where one of her medications was left
off her chart and she struggled to manage her condition. She acknowledged
that the issue was addressed the following day.

Another patient was disappointed that his medication needs had not been
anticipated in advance:

“Jacqueline: I was taking him off all his tablets at home but when Rudi came
here they started them all again. I was a little bit annoyed because when
Rudi was discharged they gave him five days worth of Chemotherapy tablets
but they ran out on a Sunday. Rudi: When we did try to get more tablets the
supply had run low so I had to go without the tablets for a week until new
stock came.”

Two patients experienced difficulties with front-line patient care:

“When I did get to the shower she left me there on my own. When she came
back I told her she had left me for 15 minutes. She became defensive and
said she didn’t.”

“I had someone in the shower to watch over me but they never dried me,
except for one nurse. I never said to them I’m not completely dry. That was
just minor.”

Information and education

Some patients related that their information needs were not satisfied:

“Being taught how to move around may have been helpful. We were offered
help with showering but Ken didn’t want that as he is private and modest.
The physiotherapists were excellent at showing me what to do to help Ken
get into bed. The physiotherapist suggested some alternative methods, but
some of them weren’t too good. For example, I was worried about Ken
slipping on the tiles. As much as they were trying to look at alternatives, they
weren’t appropriate for home. If only someone had shown me the easy way
to do things.”

“I had a bad experience with two doctors. They were not regular doctors and
they were young. They bustled in whilst I was showering. They are, I’m
afraid, overseas staff. They did not really talk to me. They came in, talked
amongst themselves, and just left. They did not explain what they were there
for.”

One patient described his struggle with accessing information to facilitate his
autonomy:

“Sometimes I find the nurses a bit over the top. I am fighting for
independence but they want to do too much for me. I yelled at one which I
felt bad about but I really wanted to try and do things for myself. She didn’t
really seem to be listening to me when I told her I wanted to have a go myself.
I found some procedures were not clearly explained like the visiting hours.
Also there seemed to be inconsistencies between the nurses. Some allowed
me to do things for myself but others wouldn’t let me and insisted I wait for
their help. There does not seem to be a lot of communication between the
nurses. On occasions this made me very frustrated and hence I had a few
spats with the nurses. I found this poor communication affected my family as
well. My wife started to tell me I was not to do things for myself. It has
created disagreement amongst us. If the nurses spoke with her and told her
what I am capable of I think it would make everything much easier.”

Positive feedback regarding knowledge of the availability of support was often

highlighted:

“They gave us instructions, so we knew who to call. We knew it was 24hrs,

we knew the office hours, after hours. We got a pamphlet, and knew the
times to phone. We knew that we could leave a message on the answering
machine as they had a meeting on Monday mornings and then they were out
on the road.”

Transition and continuity

Most patients were satisfied with the transition to home and continuity of
service. In particular, they appreciated the discharge instructions related to
their medications:

“My medications were well explained to me before I left Calvary.”

“The Webster Pack has been helpful after I went home. You just burst the
bubble. It’s better than picking up bottles when you can’t read what they are.”

One patient commented on the timing of being offered further services:

“Now that I have been home for a few days and feeling better, I miss physio,
but for me this is not very easy because I don’t have transport. One day, my
physiotherapist tried asking me if I would like to come back for rehab but I
was so mixed up. I had lots of blood tests, and afterwards I was very weak.
He asked me something but I asked to be left alone as I was dizzy.”

In another instance:

“After my mother got stronger and I could see that she could come home,
nothing seem to be happening. The doctors were a bit slow discharging her.
I had to ask to make it happen. They could have moved her home quicker.
The follow up assistance after discharge has been slow. I’m still struggling
with the services. There is lots of paperwork. My mother gets a bit lonely
during the day.”

Physical Comfort

Mixed responses surfaced regarding the physical comfort of the environment.

Overall, patients acknowledged that the patient rooms in the wards at Calvary
were satisfactory:

“It’s a nice, calm ward. It’s fantastic. You just relax, it’s really good. Noise is
not an issue.”

“The room is lovely. I have a beautiful view. It’s good fun seeing the planes
go off during the day. I let my imagination run away with me and often wonder
where they’re going.”

“It was like saying goodbye to friends. They [new patients] come in, some are
worried, scared, you introduce them, you’re nice to them, they’re visitors say
hello to you, and before you know it you’re friends. It was a lovely
atmosphere. One of the nurses used to say ‘this is the happiest ward in the
hospital’.”
Patients also expressed appreciation for Calvary’s same gender rooms policy:

“I was in a four bed ward – four ladies, no men thank goodness.”

“At Calvary I only shared with women which was much better.”

The beds were regularly commented upon:

“I also noticed that the beds were also good because I could lower them right
down so I had no difficulty getting out of bed.”

“The room is quite comfortable and the bed is fine.”

“The bed is quite comfortable.”

“The bed is as comfortable as any bed.”

However, one patient related that she was worried about falling out of the bed
due to the absence of rails.

The temperature was highlighted by many:

“When you left your room, it was quite cold. I would get really cold going to
the dining room and at certain parts of the hospital you freeze. I would
always put on a coat or jacket.”

“The only problem I find is that the temperature seems to vary quite a bit. At
times I feel quite cold which is very unusual for me.”

“I missed my … electric blanket. I was cold. They gave me blankets but I

was always cold.”

“It’s not at all cold in the room. Sometimes it gets a bit warm in the afternoon.
The hallways are sometimes cold but the ward itself is warm.”

On two occasions patients were disturbed by the surrounding noise:

“Most of the time the ward seemed very noisy. Mostly I slept well but the
there was a lot of talking. I didn’t get bothered about it though. Generally
when I asked for something the nurses did it straight away so I didn’t worry
about the talking. I was also close to the lift so I heard the lift bell quite a lot
but that didn’t bother me. It was more the laughing and talking. The noise
from the room next door seemed very close too.”

“What they’re doing now in building a pool is excellent, except at the time I
was scared stiff! I would get up at 6.45am, have my shower and wait for
breakfast, and then it was like an earthquake, they were excavating right
under my bathroom and my bed.”
Overall, patients were most pleased with the food on offer, the choice
available and the size of the portions:

“The food is fantastic. Whoever the chef is, they should be congratulated.
The quality of food is spot on. The portions are good enough, you have a
choice of small, medium or large. They cater for all appetites. You should
charge more, because the food is first class.”

“The food here is very good. I have no complaints about the food. They’re
plenty big enough portions, there’s enough selection and enough food when it
comes. You can have fresh fruit if you want it and your family can bring it.
The temperature of the food is quite right. I like soup and there’s always soup
on the menu and it’s always hot.”

“I would give the food about seven and a half out of ten. There is plenty of
choice.”

However, some patients offered feedback about some aspects of their dining
experience:

“The menus were very good, exceptionally good, except when you ordered a
piece of fruit and were given metal cutlery to cut it. Metal cutlery won’t peel
an orange or cut an apple. One of the helpers in the dining room used a
plastic knife and did it for me.”

“I enjoyed getting my hot tea in the morning and would have preferred getting
hot tea throughout the day rather than getting iced cold cordial especially at
night.”

“The cereal packets are very difficult for aged people to open, for example,
Kellogs Corn Flakes, you can’t cut open with a knife, so I put my fork through
the top, and used my thumb nail to slowly pry it open. Skippy Crispies, those
you can open straight away!”

“My mother also likes fruit more than sweets as she says, but, they tended to
give hard fruit like apples. Bananas would be better and easier to eat for
older people.”

“You could order fruit from the menu but they did not specify what sort of fruit.
It would be helpful if they did.”

The standard of cleaning was also praised:

“Calvary was very clean and pleasant. The cleaners were fantastic. They
worked very hard and one in particular was very friendly.”

However, one patient identified a perceived gap:

“Sometimes people would go to the toilet and they wouldn’t press the flush
button. How would the nurses know? But sometimes visitors would use our
toilets. I don’t want to criticise the cleaning ladies in any way, they never
cleaned the showers on weekends. There’s four people, I thought well
maybe they could do it once over the weekend. It didn’t worry me greatly but
I noticed it. The ladies doing the cleaning, the were of European background,
not that it mattered, perhaps we shouldn’t talk to them, but they didn’t like to
say good morning. They could’ve been more friendly. Oh well, that’s their
job, and you cant expect everybody to be cheerful.”

It was acknowledged that pain medication was organised promptly and

appropriately:

“I get enough pain relief and it happens quickly. I only have to wait 10-15
minutes, which is fair enough when they have to go and get the drug.”

Emotional support and alleviation of fear and anxiety

Patients expressed mixed feedback with regards to receiving emotional

support and the alleviation of fear and anxiety.

“I got very downhearted one day, and my doctor sent one of the girls to take
me out for a drive to Cronulla. They had asked me “if you weren’t here,
where would you like to be?” I had said I’d love to be by the water, the
rougher the better. If I stayed in hospital too much, I’d become
institutionalised.”

“I know I’ve got someone if I need help. I can ring them at night if needs be, if
I’m worried about anything I can always get to them. It builds up confidence
and I can get help if I need it. They’re interested to know how I’m going,
what’s happening to me. They speak to my doctors on my behalf. It’s good
to know they’re there for me. One nurse, she’s very, very good. I could ring
her any time I needed her. She used to phone me to see how everything was
going.”

“The staff have been absolutely terrific. They are so good. If I’m in their
hands I know I’m going to be safe. The doctors are great. I haven’t found a
doctor yet, that doesn’t talk to you like a doctor and that’s what I like. I don’t
understand about every piece of medication, but I understand what they’re
trying to do. I understand they’re trying to relieve things. I understand that
I’m not going to get any better, I’m not going to walk again. Now it’s a matter
of how we’re going to go into this. The doctors are direct, straightforward and
considerate.”

“We’ve had support offered all the time. Pastoral care and social work have
always let us know all the time that support is available.”

Some distressful examples were relayed:

“I was in a four-bedded room, but I couldn’t handle it. There was a woman in
the bed opposite me screaming, “Please God take me”. I wanted to go. I
was there for two days and that lady was screaming the entire time. This
made me most upset, as I was all right compared to the others in that room.
The only problem was that my bowels didn’t work. That’s what got me down.
It was like a morgue. I was moved the same day as I complained, within
around 20 minutes. If things go wrong they seem to fix it up. I should’ve
never have been put in a room with others who were that sick. I feel that this
[private room] is the best place for me to be. After a week they asked me to
move into a four-bed ward again. I was scared again but they kept me in a
single room. I could see them all in my mind. I just lost a friend to cancer. I
really couldn’t cope.”

“The room is a bit noisy when they’re all having their break out there but that
doesn’t really worry me, they’ve got to eat somewhere. Sometimes it’s
depressing conversation which I can do without. If they’re talking generally I
don’t mind, but if they’re talking about how long Harry’s got to live…”

“She told me she went to the toilet in the middle of the night by herself as she
is used to doing that at home, but the nurse spoke to her in a manner which
upset her for days. This experience really stayed with my mum for a while
and she was scared that if she complained, that the nurse might retaliate.
She asked that I did not complain when this had just occurred.”

Volunteers were highly valued and praised:

“…each patient has got a carer of their own. I have a dear friend who has
been appointed to see me once a week. The idea is companionship and it’s
beautiful. She comes once a week.”

“The volunteers are wonderful. I love to see them come. They’re all very
helpful. Two of them come very Monday and we have tea, toast and eggs.”

“The volunteers are absolute angels. One day I was lying on my bed with not
much to do when suddenly a face appeared at the door and offered me a
beer. That was ten out of ten! I also had a foot massage – the first in my
life.”

“The volunteers spent a lot of time with me which was nice because I didn’t
have visitors during the day. It filled in the afternoon.”

Involvement of family and friends

On a couple of occasions, patients felt that the needs of their family were not
taken into consideration.

One carer was disappointed that her needs were not regarded on an occasion
where she was visiting during her lunch break and was pressed for time:

“I was visiting around lunchtime and wanted to get a sandwich at the

Volunteers Café. I thought it would be nice to have my mother join me in the
café so I asked their permission. They said it was ok, but, when I asked the
staff if I could bring my mother and her lunch into the café even though I
already told them I had their permission, they wouldn’t let me do it.”

Another patient provided feedback related to visiting hours:

“My daughter came by train from the Central Coast. The first time she came
she got there about 10.00am, but another time there was a hold up on the
train so she got there 11.45am. She asked the nurse if she could stay a little
longer but struck a nurse who said no. If she’d only come from another
suburb, but she came from quite a distance. The other times they were more
relaxed.”

Another patient was most grateful about how staff had assisted her son and
his needs:

“Social work has been excellent. I have an intellectually handicapped son. I

am worried about him when I’m not around anymore. She’s been helping
him. He’s accepted that I’m not going to be around all the time.”

This series of patient and carer journeys has highlighted both the positive and
negative aspects of the patient journey at Calvary as recently experienced by
the interviewed patients and their carers. The information gathered from this
project will assist the organisation in identifying areas requiring improvement
as well as acknowledging services and behaviours to be applauded and
maintained. This feedback will be fed back to relevant staff with a view to
creating an action plan to address the issues raised.

COMPARATIVE ANALYSIS

This is the first collection of Patient Journey Stories at Calvary Health Care
Sydney. It is anticipated that this process will be repeated in the future with a
similar cohort of patients. Trend analysis and comparative analysis will be
possible with a series of patient stories conducted in the future.

APPENDIX 1 THE STORIES

Attached

APPENDIX 2 ANALYSIS SPREADSHEET

Attached