Kingston Centre’s Ward South 5 and the Short Stay Unit at Monash Medical Centre have become the first sites in Victoria to be recognised by the Institute of Healthcare Improvement as Age-Friendly Health Systems.
Under a state-wide collaboration through Safer Care Victoria, over the last 12 months, both sites have adopted the “4Ms” to provide holistic and person-centred care for our older patients, being: “What matters?”, Medication, Mind, and Mobility.
The 4M method provides a holistic and comprehensive framework that focuses on the patient, to better align healthcare goals with their values.
Leading the team at South 5, Dr Helena Ng, Consultant Physician in Geriatric Medicine, says their primary focus is the “What matters?” element.
“Care is centred around the older person, about their needs and values,” she says.
“Not just in the clinical sense, but what matters to them, their carers and families.”
These sentiments are echoed by Dr Reza Pazhang, Geriatrician in ED at Monash Medical Centre, who recalls a recent interaction with a 94-year-old patient who presented to ED after a fall.
After discovering a mass on the patient’s brain, a vigorous clinical course of action was determined, however, given the frailty of the patient, Dr Pazhang reverted to the “What matters?” element.
“We had to consider – is this the best course of action?” says Dr Pazhang.
He consulted with the patient’s family to understand if the patient had previously expressed any wishes about medical treatment. An open and authentic conversation with the family helped steer the best course of action for the patient, that aligned with his prior wishes of no medical intervention, but to be kept comfortable and pain-free.
For this family, the 4Ms helped avoid unnecessary intervention and aligned the care with the patient’s values.
Dr Alisha Spiteri, Geriatrician in ED and Medical Lead, Monash at Home Aged and Rehabilitation Care, says the “What matters?” element is the centrepiece of the 4M model.
“I sometimes phrase this as ‘what are you most worried about?’” she says.
This question helps the patient better convey what they need, which can help the team better understand what course of action is appropriate in each case.
“We can then decide with them what’s best to address that worry. We can deliver care on a case-by-case basis.”
During the first six months of introducing the 4Ms at South 5, Dr Ng says there was a noticeable increase in spontaneous, positive feedback from both families of patients, and employees.
“It is often the little things that matter to the patients, and acknowledging those little things can make a huge difference for them,” says Dr Ng.
These improvements provide a flow-on effect, with the team experiencing better engagement with their patients.
Dr Pazhang is also seeing the benefits for patients and families, with the daughter of one patient recently expressing, “no one ever listened to me like you did today.”
The valuable learnings and achievements gained through the 4Ms framework have been shared across the organisation, with a view to implementing the 4Ms across more Monash Health areas.
We congratulate Ward South 5 and the Short Stay Unit for achieving recognition for the successful rollout of the 4Ms framework, providing improved, patient-centred care for our community.
