Making Better Use of Patient Feedback
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1 Making Better Use of Patient Feedback 1. Sign the register 2. Help yourself to water and fruit 3. Introduce yourself to your neighbours - #hellomynameis 4. Tweet about today on #UCLPquality 1
2 Making better use of patient feedback Fiona McKenzie, Patient Insight and Involvement Lead, UCLPartners 2 8 th September 2016
3 Mapping patient experience efforts Visited 8 London Cancer trusts, covering 10 hospital sites Spoke with 21 staff who had some form of responsibility for patient experience at their trust including Patient Experience Leads, Deputy Chief Nurses, Lead Cancer Nurses, Patient Experience Project Managers, CNS Asked 22 questions covering: o o o o Patient experience team, remit, resources and engagement Real-time feedback measuring patient experience Trust Board-level engagement Areas of focus and challenges in improving patient experience 3
4 Biggest challenges in improving patient experience Around 40 comments from staff about this, focused on: Measuring improvement making effective use of real-time feedback Embedding culture that delivers high quality patient experience Staff morale and vacancies Resources dedicated to patient experience Leadership and influence at Trust Board level Getting first impressions right every time Preconceptions of patients and carers Prioritisation Diverse population and needs 4
5 Real-time feedback measuring patient experience All are measuring improvement in patient experience through some form of real-time feedback How - between 8 and over 100 surveys have been prepared for use Data analysis is provided by patient experience facilitators or project managers, some systems do their own analysis, or some performance teams Real-time doesn t really mean real-time feedback to staff Measuring patient experience without duplication and helping others to do this well was a core focus for all we spoke with 5
6 Types of frequent feedback collected Friends and Family Test Inpatient site specific surveys NM Outpatient surveys Comment boxes Mystery shoppers Triangulating national survey results/realtime feedback and complaints RFL UCLH HHUT BHRUT BH PAH WH
7 Data analysis Patient experience team Individual departments Informatics CNSs PALs NM 1 RFL 1 UCLH HHUT BHRUT BH PAH WH
8 Feedback to drive improvement Electronically - dashboard/login system on pull basis Face to face - weekly/monthly meetings Results displayed on noticeboards Electronically - ed to staff monthly NM 1 1 RFL UCLH HHUT BHRUT BH PAH WH
9 Common challenges Low survey response rate Obtaining demographic ally representativ e survey responses Obtaining feedback from outpatients Number of surveys in place Lack of consistency in feedback results between wards Making efficient use of data for improvemen et NM Lack of consistency in survey feedback and collection method between wards Providing feedback to staff consistently RFL Highlighting postive feedback to improve staff morale Sharing lessons learned across the trust UCLH HHUT BHRUT BH PAH WH Ensuring anonymity for honest feedback 9
10 For more information please contact: Fiona McKenzie Patient Insight and Involvement
11 Patient feedback and insight Laurence Bruce 8 th September
12 Agenda What is insight? Surveys and other forms of feedback Friends and Family Test The So what? question Insight and Feedback Strategy 12
13 The Insight Team at NHS England We run: GP Patient Survey Staff Survey National Cancer Patient Experience Survey VOICES survey of Bereaved People PROMs (Patient-Reported Outcome Measures) The Friends and Family Test We also liaise with CQC and DH on the other national surveys (hospital surveys, adult social care survey, etc) We support the system in using insight to improve quality: Collecting data from patients, analysing it and learning from it We also support colleagues across NHS England with their insight needs 13
14 What does insight mean? Using qualitative and quantitative data to inform what we do Using whatever data sources we have - not just surveys but a whole range of market and social research techniques and the patient voice The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end A promise to learn a commitment to act The Berwick Report 14
15 Insight comes from many sources There are a wide range patient data sources No one source is better than others They all have different strengths and weaknesses, and hence they have different uses Commissioners, providers of services, and policy and support services can all benefit from using a range of tools 15
16 Surveys
17 National surveys GP Patient survey (NHS England, twice a year 880,000 responses) Community & Mental Health survey (CQC, annual 13,500 responses) Inpatient survey (CQC, annual 62,000 responses) A&E survey (CQC, every 3 years 39,000 responses) Outpatient survey (CQC, every 3 years 72,000 responses) Maternity survey (CQC, every 3 years 23,000 responses) Cancer Patient Experience survey (NHS England, annual 70,000 responses) Patient Reported Outcome Measures (PROMs) (NHS England, 127,000 annual completions) VOICES survey of Bereaved People (NHS England, annual 22,000 responses) Staff survey (NHS England, annual 255,000 responses) Adult Social Care survey (Department of Health, annual 73,000 responses) 17
18 National surveys development Surveys were set up at different times, and with different purposes Ongoing revision of surveys with CQC and Dept. of Health Insight strategy will look at data presentation and a central resource 18
19 Other sources Friends and Family Test (FFT) Patient stories E.g. HealthTalkOnline, Patient Voices Online reviews E.g. NHS Choices, Patient Opinion, iwantgreatcare, Trust websites Complaints Letters to the CEO PALS feedback Healthwatch Feedback tools & apps E.g. Hospedia, Synapta Social media E.g. Twitter, Facebook, plus listening tools Local surveys In-depth interviews Focus groups Patient forums Public meetings Voluntary sector organisations 19
20 Friends and Family Test
21 Friends and Family Test How likely are you to recommend our <ward / A&E department / other setting > to friends and family if they needed similar care or treatment? 1 Extremely Likely 2 Likely 3 Neither Likely nor Unlikely 4 Unlikely 5 Extremely Unlikely 6 Don t know Why?
22 Friends and Family Test FFT Real-time Ward-level / service groupings Effective for service improvement Can be used as early-warning system Not representative, not comparable National surveys Robust, comparable data at Trust level Data on a range of issues Suitable for performance management Not meaningful to front-line staff Have not historically changed behaviours Is not a survey It has different characteristics from national surveys FFT is a real-time local feedback tool; putting the patient voice centre-stage in health service improvement. FFT and National surveys are complementary sources of Insight FFT is a formative measure: it provides data to improve services National surveys are summative measures: they provide an accurate picture of relative performance 22
23 Friends and Family Test Over 10 million responses received across healthcare settings The FFT review has clearly demonstrated that the FFT is making a difference to patient experience: 4 out of 5 trusts said that the FFT has increased emphasis on patient experience. The key strengths of the FFT are reported as: its real-time nature, inclusivity, free text comments. Some examples of service improvements: Silent/soft closing bins Medication alerts Patient preferred name Staff introductions Transfer of staff Menu choices Activities Parking concessions Extended visiting times Improved lighting Lights out at night Timing of medications New call bells Personal possessions Health snacks Self medication Toilet shelves Silent phones Staff training Towel rails Social meal times Meet and greet 23
24 So what?
25 How do we make sense of it all? So many sources that we risk missing the wood for the trees Need to understand what the different types of data are good for, and when to use them Support better presentation of data 25
26 Data presentation 26
27 Methodologies pros and cons Usability Robustness
28 Balance between local and national collections - ownership 28
29 Making it easy 29
30 Insight Strategy Draft plans
31 The role of NHS England Promote the use of insight by policymakers, commissioners, healthcare providers and the public, and encourage a feedback culture in the NHS Develop a centre of excellence of insight, with various resources to support colleagues Continue to develop the FFT and to review and refine the survey programme
32 The roles of providers and commissioners Healthcare providers Understand the experiences of both patients and staff Gather local data to understand performance Use FFT to make continuous improvements Commissioners Review insight needs and ensure infrastructure is in place Use the different available sources at the right times in the commissioning cycle Understand the experiences of patients through the use of insight and design services based on patients needs
33 What we will do 1) Encourage everyone in the health system to take on active roles in the use of insight, including patients and the public 2) Support commissioners and providers by publishing a series of Bite-sized guides to Insight (eg. How to commission insight)
34 How we will achieve this 1) Improve how data is published and presented 2) Build strong insight partnerships between local organisations and with the voluntary sector 3) Fill gaps in knowledge about specific services and groups of patients 4) Take advantage of innovative research techniques to gain new forms of insight
35 Things to think about Review your insight needs Are you regularly listening to people in your area? What insight do you have? Where are the gaps? What don t you know? How can you fill the gaps? Can the national data give you what you need? Has something similar been done somewhere else? What could you do locally? Could you partner with another organisation? 35
36 How we re going to get there Link datasets in order to understand the full care pathways of patients Link insight data with medical outcomes data Make more efficient use of national surveys Use electronic data collection methods Attach outcomes and experience payments to contracts Develop open text analysis techniques, including of social media Use personalised PROMs as part of care
37 Any thoughts? Does this sound right to you? What kind of support would most help you? 37
38 Thank you
39 TIPS, TRICKS & CHALLENGES FOR PATIENT EXPERIENCE Gary Etheridge, Deputy Chief Nurse, Patient Experience & Head of Safeguarding
40 BACKGROUND 3 years ago the Trust measured patient experience by the results of National surveys and complaints Trust was placed into special measures in December 2013 Historically poor performance in our own and national patient surveys In July Inpatient Friends and Family Test (FFT) score was 38 and 87% of our patients said they would recommend us to their friends and family In July Inpatient FFT score was 66, 95% of our patients said they would recommend us to their friends and family. For five months in summer 2014 our FFT scores were in the 70s
41 IMPROVED COMMUNICATION WITH PATIENTS Patient Information Boards e.g. Patient headboards and a magnet system for communication of safety information Welcome Boards so patients and visitors know key information such as doctors rounds times, who is in charge of the ward and what different uniforms mean Feedback boards explain what the FFT is, show the recent results and the top and bottom 3 responses to the ward s patient survey, and what actions are being taken
42 IMPROVED ENGAGEMENT WITH PATIENTS It s the manner that you deliver your skills and expertise that make the difference Sara Turle - Patient Introduction of Mystery Shopper Scheme Introduction of Patient Stories at Trust Inductions and Trust Board We have been into the communities we serve and run two series of Listening Events Widened accessibility of patient feedback by translating the inpatient survey into the top 10 most requested language and braille. Introducing an easy- read and children- friendly versions We have recruited specific volunteers to speak to patients and help them complete surveys
43 IMPROVED ACTION ON PATIENT FEEDBACK Improved waiting rooms by re-decorating and installing TVs, booklets and activities for children Dementia initiatives: dementia friendly menu, Pet s as Therapy dogs, 50s pop up memory pod. Dementia clocks, and additional signage such as toilet signs and colour coding bays Radios for patients with learning disabilities and specialist radios for blind patients to help provide distractions Improved care for deaf patients by: - Running deaf awareness courses - Restaurant style buzzers - Commissioned a film company to make a training video. - Sourcing new hospital communication books Mealtime improvements; course by course meal service, nutrition boards, nutrition champions, publicity of services e.g. 14 menus
44 THE FUTURE. Stock take - best approach to advancing patient experience agenda. Are our initiatives making a difference? Improve patient engagement by modernising our patient representative group and recruit more specific working groups e.g. for blind patients Introduction of a laminated bedside handbook to be a comprehensive guide to life in our hospitals and how we can help improve their stay Create a Patient Experience Dashboard Continue with our listening Events
45 Thank You
46 Using patient feedback to improve experience at UCLH Lisa Anderton, Head of Patient Experience
47 Using patient feedback to improve experience Our approach to collecting patient feedback How we analyse and use feedback What's next 47
48 Collecting feedback Meridian real-time feedback via ipads and website What National survey monitoring FFT Other tailored surveys 48
49 Collecting feedback 49
50 Collecting feedback Other feedback e.g. PALS, complaints, NHS Choices etc. Other insights volunteers, FT membership Deeper understanding e.g. Pain Raid 2 hours 50
51 Analysing Meridian feedback Real time feedback (self service) Some Meridian reports easily to access (e.g. league tables, question analysis, comment analysis) Downloadable data 51
52 Analysing other feedback PALS and complaints, social media and other platforms No single picture of patient feedback Staff experience? 52
53 Using feedback Locally accessed quality boards and huddles Performance scorecards Board to ward Multiple reports, different priorities trust level themes vs. local action 53
54 Using feedback driving improvements Trust and site improvements Experience based PDSAs in OP 54
55 What s next - feasibility study A range of requirements for optimal patient feedback system For patients - based on preferences and needs (multiple channels, accessible) For staff - straightforward to use and produces meaningful data (intelligent alerts) 55
56 What's next - review of structures and reporting Consolidate discussions single, consistent dialogue Simplify reporting Improved engagement in divisions and across professions 56
57 Questions? 57
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