National cancer survey kick-starts care transformation

London’s hospitals recently found themselves straddling the fence between addressing patient concerns raised in the 2012 National Cancer Experience Survey and grappling with this year’s less than favourable results.

St George’s Hospital, Tooting, was one of nine London hospitals featured in the bottom 10 performing trusts in the country, despite introducing a patient experience improvement programme in response to the 2012 findings.

‘Better communication between patients and staff will go a long way to addressing many of the survey’s concerns’

However, it is important to put this in perspective and highlight aspects of the survey’s methodology, along with a unique challenge facing cancer care in the capital.

No one questions the importance of patient experience and the good news is that better communication between patients and staff will go a long way to addressing many of the survey’s concerns. This isn’t rocket science and is simply a case of raising both clinical and non-clinical staff’s awareness of the sensitivities around cancer patients, their condition and the often life changing questions they put to staff.

We know good communications is key to improving patient experience and that is a low cost, high return investment that simply requires individuals to be a little more thoughtful and considerate.

Small things count

That answer may come as something as a disappointment to a management change guru but the fact remains that patients are telling us that the small things count and if you repeatedly get them wrong it becomes a big problem.

These simple but important lines of communications include not being able to answer a patient’s questions properly, listening to what they say and making eye contact with them, making assumptions about what you think they do and do not know, excessive waiting times with no explanation of why they are waiting and repeated requests for the same personal information at different points in the care pathway.

‘People who have a good experience of care are a lot less likely to spend time filling in a survey than those who haven’t’

St George’s has an 85 per cent patient satisfaction rating but there is obviously room for improvement requiring concentrated focus on patient experience from the start to the end of the care pathway. After all, you don’t win a race by running to the tape but by running through it.

In response, St George’s has implemented a number of changes in partnership with Macmillan Cancer Support, including the Sage and Thyme level 1 communications training programme.

The model was designed by clinical staff at the University Hospital of South Manchester to train all grades of staff in listening and responding to patients who are distressed or concerned.

Its introduction at Guy’s and St Thomas Hospital last year dramatically improved patient experience and we hope it will have a similar impact at St George’s together with the other improvements, including a major review of written material offered to patients, setting up a dedicated cancer patient helpline, establishing patient workshops and refurbishment of oncology outpatients areas.

The national survey helped kick-start these improvements but there are some aspects that do raise questions.

Time lag

Participating patients are identified between September and November before being asked to complete the 65-question survey 3-6 months later, between January and March of the following year.

The time lag between patients being identified and asked to complete the survey is lengthy and it is questionable how much information they will have retained about their cancer care in the intervening period.

We are aware that once patients are given a diagnosis of cancer it is very difficult to retain any further information at that time and such a lengthy survey may be asking too much of many patients.

We also know people who have a good experience of care are a lot less likely to spend time filling in a survey than those who haven’t, or simply quick tick their way through it.

More real time data needed

A survey that could produce more real time data would be more accurate and allow hospitals to respond more quickly to patients’ concerns.

Survey participants are also drawn from inpatients and day patients, meaning a sizeable proportion will have undergone surgery.

The problem is some of these patients may simply come in for a surgical procedure and do not require any further additional treatment. This means a large number of the survey’s questions are irrelevant to their experience.

‘A city of more than 8 million people does require some flexibility to get things right’

It is also important to note that the patient pathway in London is more fragmented than elsewhere in the UK, with people often having to move between different sites for treatment instead of the “one stop” service offered elsewhere in the UK.

A GP in London can refer a suspected cancer patient to one hospital for diagnostics, which then refers them somewhere else for surgery, after which they can be sent to a third site for radiotherapy.

It makes a huge difference to patient experience when you consider the time, expense and general confusion of having to find your way around various sites.

London is also the gateway and home for many new arrivals to the UK, throwing up the challenge of handling patients with different cultural values and a sometimes poor grasp of English.   

These should not be seen as an excuse to improving patient experience in the capital, but a city of more than 8 million people does require some flexibility to get things right.

June Allen is the Macmillan lead cancer nurse at St George’s Healthcare Trust