How to deliver on patient experience promises

Transforming Patient Experience

If you have been working hard to promote patient engagement and experience you could feel that your time has come - never before has this area of work had such a high profile - but, how can we make the most of this opportunity to make a real difference for patients? Sam Hudson explains.

Transforming patient experience – practical steps you can take now.

1. Know how you are doing

Do you know how experience is currently measured in your service and whether improvements are made as a result?  Do you know what this activity costs and what the benefits are? Once you have a plan, you will need to create a compelling vision for the culture change that will be required.

2. Give experience some “air time” 

How much time do you spend each week talking about patient experience? For an experience programme to be successful it needs to be embraced by leaders, central to your core organisational vision and strategy and considered on an equal footing with clinical effectiveness and safety in your quality reporting. Commissioners need to make sure that their decisions are informed by knowledge of patient experience.

3. Motivate your staff 

Recognise the link between patient experience and staff well-being and develop plans for improving both. Make the focus on understanding and delivering a positive patient experience an integral part of staff induction, staff development and staff appraisal.

4. Tell me a story

Stories are a powerful tool for engaging staff including senior leaders. They can be collected in a number of ways and there is considerable value in staff hearing patients’ stories directly. It can sensitise them to patient experience, helps them to “own” the data and acts as a motivator to do something about it.

5. Raise the stakes

Patient experience is of equal importance as clinical quality and patient safety.  Demonstrate organisational commitment to understanding patient experience to improve services and co-designing improvements with patients as partners by discussing reports on patient experience at your key meetings. 

6. Show me the money

Build and articulate clearly the business case for investing in the measurement and improvement of patient experience. Dedicate resources to capture, understand and use patient experience, through both storytelling and numerical data.

7. Incentivise

Providers and commissioners need to develop shared patient experience goals as part of developing good working relationships. Incentive systems need to be aligned so that they recognise and reward innovative patient experience measurement and improvement in local organisations.

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Best practice case studies – colleagues from around the NHS explore the approach they have taken and the difference it is making

Nottinghamshire Healthcare provides integrated healthcare services, including mental health, learning disability and community health services. The trust employs over 8300 staff from 100 sites, with a turnover of £409m.

The trust wanted patient experience to be the most important measure of its success and has pioneered a vibrant, integrated and creative approach to engaging all parts of the organisation in a unique approach to patient experience.

Building on an award-winning involvement approach it ensured that listening and responding to service users and carers was key to all the trust’steams.

In order to do this two involvement centres have been developed where service users and carers work with the trust to improve patient experience and services - this has been key to the trust’s approach.

Service users and carers have worked with the trust to develop:

• A survey that is used by over 200 teams in the trust. All comments are analysed by themes for each area and reports produced quarterly for the board, directorates and each team/ward.
• Online feedback via Patient Opinion – including live postings workshops using iPADs on wards
• A vibrant Listening to You poster is regularly sent to teams to capture issues raised and to publicise responses
• Action plans for each directorate that are developed collectively with service users. Key issues are agreed from the range of feedback, including PALS and complaints, and plans are monitored and updated quarterly.

Paul Sanguinazzi, head of involvement at the trust, comments:

“This initiative has had a real impact on the culture of our teams and how they respond to feedback. Our partnership with service users and carers means that together we can respond quickly to issues and drive real and meaningful service improvements”

Our top tips would be:

• It is critical to focus at team level so they have and own feedback, understand its importance and can act on it
• Involve patients, service users and carers from the outset – they will help set meaningful measures, review your approach and champion progress
• Use positive feedback to promote and recognise good teams – use the power of a good example.

As a result of the trust’s approach:

• Survey responses and Patient Opinion postings have increased dramatically over the last year. 
• Changes made in response to feedback are highlighted in a distinctive Annual Involvement Report, part of an award winning suite of products.
• The Listening to You posters display changes from teams across the organisation.
• The Service User and Carer Experience Action Plans advertise the actions each directorate is taking.

The trust’s quality ratings are improving. In the National Community Mental Health survey 82 per cent of people rated the services as excellent, very good or good – up from 80 per cent the previous year. This put the trust in the top 20 per cent of comparable trusts in the country. The trust’s own survey shows its service quality rating increasing to 86 per cent last quarter, up from 83 per cent over the last four quarters.

Northumbria Healthcare Foundation Trust delivers integrated acute and community health and social care to the residents of Northumberland and North Tyneside. It is the largest geographical trust in the UK covering 2000+ square miles. Northumbria employs almost 9000 staff. Our real time patient experience programme was launched in June 2010. Annie Laverty explains.

“Our business is about service and people. We connect with thousands each day:  

• 500 people attend A&E
• 300 people are admitted
• 750 people attend outpatients.

We collect and use patient experience feedback across all of our sites. We have found that there is no “silver bullet” that will fix everything and, as such, we have needed a range of methods. 

We have adopted the seven core domains identified by the Picker Institute in 2009 as the priority measures for our patient experience programme.

Our aim has been to target the measures that matter most to patients and to re-orient service goals and improvement processes based on this understanding.

Key features of our measurement plan:

• Measurement is timely. Fortnightly face-to-face patient interviews have been central to our approach. Approximately 400 patients are interviewed each month. Results are reported to staff within 24/48 hours of capture.
• We also gather “right time “data at approximately two weeks after discharge. Evidence suggest that this is the time that patients are typically at their most dissatisfied and therefore able to provide us with a more rounded picture of our care.
• The metrics we use are meaningful to both staff and patients.
• Measurement of patient experience is first used to demonstrate the impact of change and then continued as ongoing performance measures.
• A small number of our most important metrics have been chosen and reported as widely as possible staff at an individual, site and specialty level.
• Our infographics programme allows all performance to be transparently shared with patients and the public.
• Early results are impressive. Patients are now reporting better care across all the domains that matter ‐ these improvements were highly significant (p= 0.01) and achieved within the first six months of real time reporting.
• The latest national outpatient survey results show that Northumbria falls within the top five of all participating trusts with regards to dignity and respect, rating of doctors and overall impression of care.

Key things we’ve learnt:

• The benefits of real time reporting at team level.
• Executive management team support is crucial.
• Ensure patients & families are part of your improvement team.
• Focusing on things that matter most to both patients and staff has made sense.
• Investing in improvement rather than measurement has helped.
• Qualitative feedback appears particularly important to staff.
• Transparency of reporting matters.”

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The impact a coordinated approach has made at Bristol Community Health

“At Bristol Community Health we have found that the patient experience focus has helped us to bring teams together during a time of organisational change. We have seen substantial culture change with staff really showing that they value what patients are saying about our services.   

We took a co-ordinated approach to collecting and using patient experience data and used various methods to collect information from patients and service users.  This programme has revealed the importance of a supportive co-ordinator for activities which engage patients. In addition, our dedicated Questionnaire, Interview and Survey Group has brought clinicians and the public together to develop and implement the work. 

Key successes include:

• We have used some new ways to engage district nurses in service improvement and have found that patient feedback information has helped them to identify a number of service improvements including ways of managing patient expectations.  
• In the Podiatry service improvements have been made in the way information was provided to patients.
• The Walk-In clinic service has used patient feedback obtained through Dr Foster to make as evidence of the need to increase capacity.
• Changes have been made to the way the diabetic retinopathy service is administered due to feedback from patients. For example, times when the phones are open have been changed and trained volunteers are being used to support staff to call patients who have not made appointments and to obtain patient feedback.

We use a variety of feedback methods quantitative data from questionnaire based surveys (postal and face to face), qualitative data from semi-structured interviews, in-depth interviews, observational data, focus groups, experience based design and community outreach with “easy to ignore” groups. We are about to distribute Freepost postcards to obtain patient feedback.

As far as possible, we try and involve staff in drawing up action points arising from patient feedback, through team meetings, email networks and so on. The outcomes of survey work and actions are reported to senior management and progress is charted on a database and actions identified to improve patient experience of services.”

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The Experience and Engagement Surgery 

Have your questions answered.

For the next two weeks Sam Hudson, head of experience and engagement at the NHS Institute for Innovation and Improvement, is taking your questions on patient experience and engagement.

• Use the comment boxes to post your question for Sam, and take in some of the Q&A below.

Q: Someone has said something inaccurate about my practice on-line – what should I do?  Can I have the comment removed? GP, South England

A: First of all, don’t panic – trust the public, we are able to read comments on-line and tell when they are overly negative.

There are a range of web sites where people can comment on health services and most have a “right to reply” function where you can post a comment from the service perspective.  You can’t have anything removed, although most sites will have a moderation function which means that they check for anything defamatory . 

As the postings are anonymous it is sometimes difficult to know the full picture of what went wrong.  However, people who make comments online will generally appreciate some kind of response and it sends a message to future readers that you take their feedback seriously. Social networking is as much about listening as it is about participating.

Online feedback is an issue across the service sector and there is software now available to support you to “collate” the conversations about your service.  An immediate action would be to dedicate some time in your practice to monitoring and responding to feedback.  It’s a good idea to keep an eye on NHS Choices and other sites so that you can respond with information on service improvements –that way people can see that you are thinking carefully about what they have told you.

One way to start to manage this on-line activity is to take part – at you next practice meeting, perhaps you could discuss setting up you own on-line presence on a social networking site?

Q: Is there any evidence that mandated involvement works? Clinical Director, USA

A: There is a great deal of evidence that mandated involvement works, but it’s important to get the balance right between the “carrot” and the “stick”.  Even with the law, making involvement a “must-do” it is vital that health services sell the benefits of involvement both to patient care and to staff experience.  There is much to gain from celebrating success and sharing learning with others who may wish to encourage patient participation in the future.

Q: Are there any Trusts who have used patient stories at Board/Committee meetings?  I’ve been asked to bring a discussion paper to our next Quality, Safety and Standards Committee and wondered if there are others who are already doing it? Patient Experience Manager, NHS Trust

A: This is a great idea – you can almost guarantee that your bit of the meeting will be something that people can immediately relate to!

Sharing patient stories is a really powerful way of sending a clear message about service user experience to leaders and motivating groups to do something about it.  There are a number of ways you can do this.  One way would be to start the meeting with a patient story, either in writing that someone can read out, or on film.  It’s best to keep this quite short and to talk afterwards about some of the improvements that are possible based on this particular experience.

The NHS Institute’s ebd approach (Experience Based Design) is all about gathering experience stories – both from staff and patients and there are a number of examples available of sharing these stories at key meetings on the web site. 

In addition, the NHS Wales 1000 Lives Plus programme site provides an overview with advice on how to develop and use stories. 

Q: How do you carry out a “mystery shopper” exercise?  What are the main things to consider? Nurse, Alcohol and Substance Misuse Service

A: Well planned mystery shopping can have a powerful impact on a service.  It is used a great deal in the commercial sector often with both customers and executives taking part in experiencing their service.  However, the health setting makes mystery shopping slightly more complex, particularly if you are going to ask “shoppers” to contact or visit a clinical setting.

The service should be made aware that there will be a mystery shopping exercise taking place within a particular time-frame.  This does artificially change performance (hopefully for the better!) but that’s no bad thing and it means that staff are pre-warned and prepared for the feedback that will be shared with them at the end.  Receiving negative feedback can be really difficult, (we all remember negative things that are said about us more than the positive) particularly if people think that they are doing a good job and have never been told otherwise, so this needs to be carefully managed.

The mystery shoppers will need support too, with your service in particular you would benefit from using a “scenario-based” shop - that way the shoppers can rehearse their stories.      

The mystery shopper activities will need to be well-chosen to target the service improvements you are keen to improve.  For example, you might want to know more about how people find out about services, how easy they are to access, and how joined-up services are, or, you might be interested in the experience of booking an appointment or visiting the service for the first time.  This will be helpful when presenting your themes back to services once the exercise is complete.

One last piece of advice – make every effort when briefing your shoppers to look for the positive and to “catch them being good”.  It’s an old adage from education and will ensure that your results are balanced and any negatives more palatable.