Improving our Patient Experience Quarterly Forum. Sheila Adam Chief Nurse and Director of Governance

Transcription

1 Improving our Patient Experience Quarterly Forum Sheila Adam Chief Nurse and Director of Governance

2 The Current Context

3 Welcome! Improving patient experience structure Quarterly forum Monthly delivery group

4 Improving Patient Experience Quarterly Forum Set and Review the patient experience strategy Inform, comment on and develop the Innovation and Improvement aspects of the patient experience agenda

5 Monthly delivery group Drive and monitor key components of the strategy Report back to the quarterly forum on delivery Request help or information or support from the members of the forum

6 Membership Chaired by Chief Nurse & Director of Transformation Chief Executive Chief Operating Officer Community team leads Heads of Therapy services Clinical leads (Medical) Clinical Nurse Specialists Department Senior Nurses Estates and Facilities leads Governor representatives Head of Healthcare compliance Head of Patient Experience Head of Quality Heads of Nursing Healthwatch representative Medical Director Nurse Consultants PALs and complaints teams Patient experience administrator (Secretary) Patient representatives Reception staff leads (community and hospital) Ward Sisters/CNs Outpatient general manager

7 Our first Task and Today s agenda Welcome and Apologies: Sheila Adam, Chief Nurse and Director of Governance Terms of Reference Patient Experience and Engagement Forum setting the framework National Inpatient Survey Presentation - National - presentation of Homerton results Patient Experience and Engagement Strategy - introduction Facilitated workshop - Developing our patient experience strategy and actions Sheila Adam, Chief Nurse and Director of Governance Lucas Daly, Senior Project Manager Picker Institute Europe Daniel Waldron, Director of Organisation Transformation Daniel Waldron Lucas Daly 2014 Proposed Meeting Dates 11.55

8 AGENDA PATIENT EXPERIENCE & ENGAGEMENT FORUM To be held on Wednesday 19 March in Conference Room 1, Education Centre, Homerton ITEM PAPER TIME Welcome and Apologies: Sheila Adam, Chief Nurse and Director of Governance 1 Terms of Reference Patient Experience and Engagement Forum setting the framework 2 National Inpatient Survey Presentation - National - presentation of Homerton results 3 Patient Experience and Engagement Strategy - introduction 4 Facilitated workshop - Developing our patient experience strategy and actions A Sheila Adam, Chief Nurse and Director of Governance Lucas Daly, Senior Project Manager Picker Institute Europe Andrew Cameron, Project Manager Daniel Waldron, Director of Organisation Transformation Daniel Waldron Lucas Daly Proposed Meeting Dates B AOB Date of next Meeting: 18 June 2014 between in Classroom 4/5, Education Centre Please send any apologies or queries to: Margaret Howat, Head of Patient Officer Margaret :

9 MEMBERSHIP Chief Nurse (Joint Chair) Director of Transformation (Joint Chair) Patient member(s) CCG PPI representative Healthwatch representative Governors Chief Operating Officer Head of Healthcare Compliance Ward Sisters/Charge Nurses/ representatives Community Lead representatives Department Senior Nurses Head of Outpatients Head of Adult Safeguarding Head of Patient Experience Human Resources representative Patient Experience Administrator (Secretary) Divisional Representatives Service Manager Quality and Risk Representative Estates and Facilities lead Therapies Representative Central Bookings Service Manager Reception staff leads (community and hospital) Chaplaincy Team Leader Communications Lead Patient Experience and Engagement Coordinator - patient information and PALS

10 Patient Experience and Engagement Forum 19 th March 2014, Conference Room 1, Education Centre, Hospital Present: Sheila Adam, Chief Nurse (Joint Chair) (SA) Daniel Waldron, Director of Transformation (Joint Chair) (DW) Rosemary Jawara, CCG PPI representative (RJ) Liz Hughes, Healthwatch representative (LH) Jude Williams, Governor (JW) Talaat Quershi, Governor (TQ) Stuart Maxwell, Governor (SM) Suri Freidman, Governor/ Orthodox Jewish advocate (SF) Lesley Rogers, Head of Healthcare compliance (LR) Sarah Webb, Head of Nursing, CSDO (SW) Joan Douglas, Head of Midwifery (JD) Sharon Roberts, Patient Experience lead ITU (SR) Stella Timms, Ward Sisters/ Charge Nurses/ representative (ST) Lynne de Castro Arenas, Ward Sisters/ Charge Nurses/ representative (LCA) Ruth Stocks, Ward Sisters/ Charge Nurses/ representative (RS) Marion Rabinowitz, Orthodox Jewish advocate (MR) Hilda Walsh, Head of Locomotor Service (HW) Angela Holm, Community Matron/ District Nurse (AH) Louise Egan, Head of Nursing/ IMRS (LE) Debbie James, Head of Outpatients (DJ) Margaret Howat, Head of Patient Experience (MH) Karen Gordon, Head of Quality (KG) Adrian Laugee, Facilities information & Monitoring Manager (AL) Sally Shaw, Head of Advocacy and Children s Therapy Services (SS) Fiona Breen, Service Manager, SWSH (FB) Iyabo Aderotimi, Reception staff lead (IA) Robin Pfaff, Chaplaincy Team Leader (RP) Kim Boakye, Patient Experience and Engagement Coordinator (Patient (KB) Information and PALS) Margaret Bingham-Crisp, Staff Experience Lead (MBC) Lucas Daly, Senior Project Manager, Picker Institute Europe (LD) Minutes: Cindy Hall, Patient Experience Co-ordinator (CH) 1. Welcome Sheila Adam welcomed the members of the forum and introduced the morning presentations and discussions on the National Inpatient Survey for 2013, presentation of results for the 1

11 Homerton This session would be followed by the introduction of the Patient Experience and Engagement Strategy. 2. Apologies for absence Tracy Fletcher, Dylan Jones, Vanessa Cook, Iain Patterson, Janice Kelly, Mark Purcell, Jaime Bishop and Lesley Haines provided apologies for the meeting. 3. Minutes from previous meeting and matters arising There were no previous minutes discussed at this meeting. 4. Terms of Reference: Patient Experience and Engagement Forum setting the framework Sheila Adam There have been many important reports recently to review and digest recently both nationally and locally such as the Mid Staffordshire Public Enquiry, Keogh Mortality Review, the Healthwatch Hackney and the Inpatient Survey. So the question is What are we going to do about it? Moving ahead in context with this requires a different approach and a re-styled governance structure has been developed for the. This will include an Improving patient Safety Committee chaired by SA, Improving Clinical Effectiveness Committee, chaired by Dr John Coakley, Improving Patient Experience chaired by SA and DW as well as the Improving Education and Leadership chaired by DW. These groups will report into the Quality & Patient Safety Board chaired by Tracy Fletcher and this board will report directly to the Board of Directors. The Patient Experience Strategy needed to be reviewed and a new more inclusive approach taken to improving patient experience. This will consist of a quarterly patient experience stakeholder forum to guide the work on patient experience with a monthly delivery group to carry out that work. The stakeholder forum agenda will inform, drive and monitor key components of the patient experience agenda. In addition there will be use of other sources of feedback such as the inpatient surveys, Healthwatch reports and frequent feedback. Information from CQC visits will also be included. The most recent acute hospital inspection from the CQC provided initial feedback on the acute site visit that the is responsive and well led. 5. National : presentation of the Homerton results LD presented the Homerton results. The methodology of the survey stays the same each year to allow for comparisons. The baseline number of patients required is 850 at age 16+; it is a postal survey with the use of a Freephone language line. The response rate for the Homerton was 30% with the national average being 46%.The presentation looks only at the Homerton results compared to the other 76 s who use Picker to administer the survey. In April the CQC will publish the results for all s in England. The responses are adjusted and standardised which allows s across England to compare what patients are saying. This allows for the fact be Homerton has a younger demographic that tend to respond less favourably and also accounts in part for the low response rate. 2

12 The survey asks question asked under eight category headings. Lower scores are better. Overall 63% of people rated care as 7+ out of 10 with 88% saying they always had enough privacy when being examined and treated. In the first section Admission to Hospital there were no significant changes since the 2012 results. In the Hospital and Ward section, the was worse than average on eleven questions. The was significantly worse on the question regarding shared sleeping area with opposite sex with an average of 17% compared to other s with an average of 8%. In the Doctors section three questions are significantly worse than average. The patient perception being that Doctors didn t always provide clear answers to questions. The scored 40% compared to a national average of 30%, that patients did not always have confidence and, 26% for the and on the national average 19%. For Doctors talking in front of patients as if they weren t there 32% for the and 24% for the national average. In the Doctors by Speciality section the average for the patient not always having confidence and trust and being talked in front of as if they weren t there 26% and 32% respectively. The figures for General Medicine and General Surgery are at 27% and 36% respectively. The is significantly worse than average on four questions in the Nurses section. These relate to did not always get clear answers to questions for the 47% and the national average 31%; did not always have confidence and trust 39% national average 24%; that nurses talked in front of patients as if they weren t there 30% and national average 19%. The question Nurse sometimes, rarely or never enough on duty for the 53% and the national average 41%. For the area of Nurses by Speciality the the question for nurses: did not always have confidence and trust the average was 39%, for General Medicine it was 35% and General Surgery 46%. The second question for this area was nurses: talked in front of patients as if they weren t there the trust average was 30% with General Medicine 35% and General Surgery 25%. Care and Treatments by speciality the was significantly worse than average in seven questions. HW stated that the perception of patients of their pain levels regarding their levels of pain and the demographic is very subjective. In the section Operations and Procedure the was significantly worse than average on one question which was the surgery risks and benefits not being fully explained with the average at 25% and the national average at 17%. By speciality in this area General Medicine came out at 40% and General Surgery 35%. From the 2012 survey the was significantly worse in eight questions in the Leaving Hospital section. LD stated that the main reason stated for delay in leaving hospital is the wait for medicines. The figures can t reflect other factors that impact on delays such as if there were more patients in the or less staff available on the ward. 3

13 LD went on to express the importance of focusing on the questions that are key to the patients as identified by Picker. Communication with clinical staff, doctors and nurses: these are the essential changes to make. LH asked if the survey is only available in English and does this affect the response rates? LD said that it was hard to accommodate other languages but there are language sheets and a language line available for patients that want to take part. Seventeen patients used the language line. RJ mentioned that it was a very detailed presentation and therefore moving forward and allowing for the services to digest the information is essential. LD replied that additional feedback would be available as well as the report to take this forward. DW confirmed that the information will be accessible to staff. SA announced that the Care Quality Commission (CQC) will publish an adjusted version of the Picker results on 8 th April DW affirmed that the will pull together the themes from the Forum and move forward with them. RJ asked about the information from last year s figures against the national average in order to know about the issues and concerns in driving forward change. DW offered to meet up with RJ to support with this work. SM asked about linking in with Healthwatch comments and the statistical significance of the figures. LD replied that there is a 50% response rate and 5% either side of 45% - 55% so the number has been worked out as statistically significant at 850 for the number of patients to contact as the optimum number for the survey. 6. Patient Experience and Engagement Strategy Daniel Waldron Patient Experience over the next five years has the main aim to ensure that all patients have an excellent experience of all our services through providing person-centred care that takes into account each patient s or service user s needs concerns and preferences. There are two high level success measures with four main objectives that place, quality, culture, patient experience, the values, information and patient choice at the heart of the strategy. There are eight elements of Excellent Patient Experience (October 2011). These elements are: respect; coordination and integration; information; communication and education; physical comfort; emotional support; involvement of family and friends; transition and continuity; access to care. DW asked the Forum what they thought comes under the Framework for other communication? SM believed it was important to include the role of carers, learning disabilities and dementia and how we involve them in terms of patients care and serving the community. DW responded that when the strategy talks of patients it is an inclusive term for carers, families and friends and is explained in the full Strategy document. The new patient feedback system will collate information and data from the community areas as well as the acute site. There will be a clear improvement cycle with local benchmarking and best practice to learn from e.g. Guys and St Thomas Hospital though improvements do take time to embed into the culture. 7. Facilitated Workshop: Developing our patient experience strategy and actions Daniel Waldron and Lucas Daly 4

14 The feedback from the individual groups has been collated and fed back to Daniel Waldron to be integrated into the reviewed Patient Experience and Engagement Strategy. 8. Any other business LH said that the final version of the Healthwatch report on the Hospital will be circulated once completed. 9. Date and time of next meeting 10:00 12:00 18 th June 2014 in classroom 4/5, Education Centre,. Please send any apologies or queries to: Margaret Howat, Head of Patient Experience and Tel: Summary of Actions points AP Action(s) For Status 1 National : presentation of the Homerton results The Inpatient survey results will be published on 8 th April by the CQC (page 4) SA April 2 National : presentation of the Homerton results Will pull out the themes from the report to move forward with.(page 4) 3 National : presentation of the Homerton results DW to support RJ and work through information for the service.(page 4) 4 Patient Experience and Engagement Strategy Put in patient care term and explanation on the front page of the Patient Experience Strategy. (page 4) DW DW DW May 5

15 Patient Experience Strategy a starter for 10

16 Patient Experience Strategic Aim Ensure all patients have an excellent experience of our services through providing person-centred care that takes into account each patient s or service user s needs concerns and preferences. Success Measures To achieve and maintain a position in the top 20% of s for patients and staff experience surveys 90% of staff to be assessed, within their appraisal, as consistently meeting the s values.

17 Objectives Develop a culture that places the quality of the patient experience at the heart of everything we do All patients to receive care that meets their expectations and is in line with the s values All patients have the information they need to make choices, and feel fully involved in the planning and delivery of their care To ensure that the methods used for measuring and monitoring patient feedback are fully integrated and aligned with objectives set out within the strategy

18 NHS Patient Experience Framework 8 Elements of Excellent Patient Experience October 2011

19 Patient Experience Definition Respect including: cultural issues; the dignity, privacy and independence of patients and service users; awareness of quality-of-life issues; and shared decision making Coordination and integration across the health and social care system Information, communication, and education on clinical status, progress, prognosis and processes of care in order to facilitate autonomy, self-care and health promotion Physical comfort including pain management, help with daily living activities and clean & comfortable surroundings

20 Cont.. Emotional support alleviation of fear and anxiety about issues as clinical status, prognosis and the impact of illness Involvement of family and friends on whom patients and service users rely, in decision-making and demonstrating awareness of their needs as care-givers Transition and continuity as regards information that will help patients care for themselves away from a clinical setting, and, planning, and support to ease transitions Access to care for example time spent waiting for admission or waiting time for an appointment

21 H L Transactional Efficient and impersonal Chaotic, rude and indifferent Efficient and personal Chaotic and personal L Emotional H

22 H L Transactional Efficient and impersonal Chaotic, rude and indifferent Chaotic and personal L Emotional H

23 Patient Experience Element Transactional Emotional Respect for values, preferences, and expressed needs Coordination and integration of care Information, communication, and education Physical comfort Emotional support Welcoming the involvement of family and friends Transition and continuity Access Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

24 Measurement Approach Integrated model that monitors a range of quantitative and quantitative metrics. Drives improvement through tracking progress against the strategic objectives, improvement plans and the 10 point framework Easily accessible and understandable reports that can be aggregated from the service or ward level upwards and fed directly into performance dashboards Covers both acute and community services and effectively measure the patient experience at all points along the patient pathway.

25 Improvement Cycle Agree Priorities and Measures Review Identify improve ment Measure and monitor Plan improve ment Report

26 Excellent Patient Experience. Staff Skilled, competent and upholding the values Leadership behavior committed to quality and role model to others Local services adopting values and setting the culture Organisational Values Safe, Personal, Effective and Responsibility

27 Over to you In groups of 5 or 6, please consider... Are the proposed objectives right? What should our priorities for improvement be under the 2 areas you have been asked to consider

28 National Inpatient Survey 2013

29 National patient surveys Part of the National NHS Patient Survey Programme Designed by Picker Institute Europe for CQC Questionnaire covers all aspects of the patient journey 76 trusts contracted Picker to carry out this Survey Standard questions and survey methodology for all NHS trusts: - Sample of 850 patients aged Postal survey: initial mailing plus two reminders - Freephone and LanguageLine available - Patients discharged in August - Survey fieldwork between October 2013 and January 2014 Picker report followed by national CQC findings & CQUIN

30 National NHS Surveys: Structure Care Quality Commission London Co-ordination Centre Picker Institute 76 Picker s Approved Survey Contractor eg Picker Other Approved Survey Contractors 81 non-picker s eg Your Total of 161 s

31 Room for improvement o o o A summary score to show where there is room for improvement HIGHER scores indicate a GREATER PROBLEM LOWER scores reflect fewer reporting a problem. BETTER performance Example: Did you have confidence and trust in the doctor examining and treating you? o Yes, definitely 75% o Yes, to some extent 20% Room for improvement o No 5% Improved from last year (30%), but still not on a par with average (20%)

32 Significance of testing The t-test o To determine whether or not a statistically significant difference exists between two datasets P1 = Sample 1 problem score P2 = Sample 2 problem score N1 =Sample 1 base size N2 = Sample 2 base size o o o Accounts for whether the difference is due to chance or not (as with all probability tests) Tests whether the means of two datasets are equal Employed to determine whether significant differences in problem scores exist in your data (i.e. historical, specialty, Picker average)

33 Survey activity o 247/828 eligible patients responded o response rate: 30% (average 46%). o 68% were emergency or urgent admissions (average 57%) Route of admission Age 6% 4% 22% 68% Emergency Elective Something else Not answered 28% 7% 19% 15% 32% Not answered

34 Results

35 Using your summary scores Picker average: Benchmarking Average on 26 Better on 0 Worse on 36 Trends: Same as 2012 on 58 Better on 0 Worse on 3

36 Using your summary scores Differences from the 'Picker Average' All questions Historical changes for all questions

37 Good results 63% rated care as 7+ out of 10 64% felt they were treated with respect and dignity 72% always had confidence and trust in their doctors 89% said hospital rooms/wards were very or fairly clean 88% said they always had enough privacy when being examined or treated

38 Admission to hospital There are no significant differences by average: There are no significant changes since 2012

39 Admission to hospital: External Benchmarking

40 The Hospital and Ward The trust is worse than average on 11 questions:

41 The Hospital and Ward: External Benchmarking

42 The Hospital and Ward The trust is significantly worse on 1 question since 2012:

43 Doctors The trust is significantly worse than average on 3 questions: There were no significant historical differences

44 Doctors: By Specialty

45 Nurses The trust is significantly worse than average on 4 questions: There were no significant historical differences

46 Nurses: By Specialty

47 Care and Treatments The trust is significantly worse than average on 7 questions: Doctors and nurses attitude towards patients not enough compassion shown from staff. Train you staff including doctors on simple patient care i.e., communication, dignity and respect

48 Care and Treatments: External Benchmarks

49 Care and Treatments The trust is significantly worse on 1 question since 2012:

50 Care and Treatments: By Specialty

51 Operations and Procedures The trust is significantly worse than average on 1 question:

52 Operations and Procedures: By Specialty

53 Leaving Hospital The trust is significantly worse than the average on 8 questions:

54 Leaving Hospital: External Benchmarks

55 Leaving Hospital The trust is significantly worse on 1 question since 2012:

56 Reasons for Delay in Discharge 8% 12% 14% 11% 55% Wait for medicines Wait to see doctor Wait for an ambulance Something Else Not answered

57 Overall The trust is significantly worse than the average on 2 questions There were no significant historical differences

58 Overall 10 - I had a very good experience I had a very poor experience 3% 2% 3% 2% 1% 9% 9% 19% 17% 14% 13% 0% 5% 10% 15% 20%

59 Improvement Map 1.0 Picker Improvement Map TM Importance Low problem score 0.0 High problem score 22.0

60 High Problem Score High Importance 1.0 not treated with respect Priorities Plot 0.9 Importance 0.8 room not clean low confidence in doctors low confidence in nurses 0.7 not enough privacy when examined wrong amount of info on condition not enough emotional support poor pain control unclear answers from nurses not told how to take medication slow response to call button toilets not clean 0.6 could not find staff member to not enough help to eat meals unclear answers from doctors discuss concerns not involved in decisions Specialist didn't have not told purpose of medication surgery questions not answered information surgery risks and benefits not staff contradict each other explained not enough nurses social care not discussed home situation not taken into no clear printed info about family account not given information home adaptation not discussed Homerton 0.5 University medicine Hospital 0.0NHS Foundation Low problem score High problem score

61 Patient comments Positive The A&E doctors were very compassionate and interested in what I know about my rare/unusual condition and keen to listen and learn. The A&E nurses were compassionate and supportive and provided holistic care despite huge workloads. The food was very good, there was a choice and it was very appetising and also looked attractive My surgeon and his team are fantastic and I have nothing but praise for their care and continued after care.

62 Patient comments Negative There were mix up with medications. Also nurse was a bit rough and had a poor attitude. It was difficult to get the nurses attention whilst on ward. The food was dreadful, clearly all microwaved within an inch of its nutritional value. There were no fresh fruit and vegetables. I was left to get my own breakfast after a major operation, my lunches/dinners were forgotten. Overall this was the worst aspect of my care. One doctor later in my stay was extremely poor, talking about his take on my earlier diagnosis on the ward within earshot of me but refusing to answer questions in relation to this when asked, shrugged or gave misinformation in response.

63 Summary 36 questions significantly worse than average, and better on none. Lower than average response rate at 30%. Higher than average emergency or urgent admissions at 68% By speciality, General medicine showing high problem score areas, while General Surgery has poorer performances in confidence in Nurses and Staff contradicting information. significantly worse than average across all areas apart from admissions; particularly poor performances for Hospital and Ward, Care and Treatment, Doctors and Nurses.

64 Picker Institute Europe Buxton Court 3 West Way Oxford OX2 0JB Tel: +44 (0) Fax: +44 (0) info@pickereurope.ac.uk Charity registered in England and Wales: Company limited by guarantee registered in England and Wales: Registered office: Buxton Court, 3 West Way, Oxford OX2 0JB