PATIENT AND PUBLIC ENGAGEMENT AND EXPERIENCE (PPEE) STRATEGY Patient Experience at the heart of everything we do

Transcription

1 PATIENT AND PUBLIC ENGAGEMENT AND EXPERIENCE (PPEE) STRATEGY Patient Experience at the heart of everything we do 1

2 An explanation of some of the more technical terms and phrases used within the strategy is available at the end of this document Introduction At Airedale NHS Foundation Trust (ANHSFT) we aspire to practice what we preach by making sure that good patient experience is at the heart of everything we do, both within the hospital and also whilst caring for patients in community settings. We want to know what matters to patients, their relatives and carers to make sure we provide a patient centred service. top down process that attempts to build upon current good practice while setting an ambitious framework for changing the way that we do things through putting patients at the heart of everything we do. We have engaged from the very beginning with patients, public, relatives, carers, community groups and staff to ensure that this strategy reflects what is important to them. As set out in Helping the NHS put patients at the heart of care (Department of Health 2009), We want to get the basics right, fit services around patient lives, treat them as individuals and not as a set of symptoms and work with them as equal partners. This means that listening, understanding and responding to the views of our patients and the local population is central to how we improve our current level of service and plan more effectively for the future. We want the patient to be in control of their healthcare from the outset. We want patients to experience excellence leading to Airedale truly being the hospital of choice for the local community. This strategy sets out our approach over the next three years. It will be delivered through more detailed annual implementation plans overseen by the Trust Board. The strategy has been put together through a bottom up and a The Trust Board is fully committed to lead and champion new ways of working in line with the philosophy of No decision about me, without me, which is an important message running through this strategy.

3 What is patient experience? Patient experience: feedback from patients on what actually happened in the course of receiving care or treatment, both the objective facts and their subjective views of it. Definition taken from Dr Foster s The Intelligent Board 2010 Patient Experience. A member of Craven Health Task Group, Denise Birkett, drew this picture, to describe her feelings about coming into hospital. Denise says she does enjoy being a patient but she felt it was important to be able to leave the ward safely. She wants to be able to understand the written information being given and would find this easier if it is done in Easy Read. She would like to be able to choose nice food from the menu, so picture menus may help. She loves talking to people so would enjoy being in a bay to talk to other patients, but increased visiting hours would be a great help. It would also be helpful to have access to a TV. Instead of receiving messages from staff that friends or family have telephoned, she would like to be able to speak to them herself. It is also important to Denise to have clear information about when she will be able to go home. 3

4 National and Local Context Achieving good patient experience is a priority running through a range of national Government legislation, performance frameworks and guidance documents, not least the NHS Constitution, (Department of Health March 2012), A Framework for NHS Patient Experience (Department of Health, February 2012) and Quality Standard for patient experience in adult NHS Services (National Institute for Clinical Excellence NICE, February 2012). However, we believe that listening to our patients in order to improve the quality and responsiveness of our services is fundamental to what we do. It gives reality to increased patient choice and guards against poor standards of care. Put simply it is the right thing to do, particularly at a time when the NHS is subject to increasing demands and financial and reputational pressure. We believe that consistently good patient experience should go hand in hand with high quality care and patient safety to define what we offer as well as our reputation within the local community. Collecting and analysing patient feedback as part of a rigorous continuous improvement process benefits patients and staff as well as increasing our efficiency by helping to get it right first time. We believe that Airedale starts from a position of some strength, with a reputation as a high quality District General Hospital, with valued and increasing community services. There is visible local support and strong connectivity with the local population. There should be more events of this nature where staff from the hospital come out into the community and reach out to meet different groups (Comment made at community event held in Keighley on ) 1. Our view is supported by a number of recent external accreditations e.g. being short listed and awarded a highly commended (second place) in the Health Service Journal Acute Trust of the Year 2011 and a finalist in the Nursing Times Awards for Privacy and Dignity for developing a Dignity Room. We performed well in an unannounced Care Quality Commission inspection in 2011 in respect of dignity and nutrition issues with which we were fully compliant. However, there is no room for complacency as patients, understandably, want more information and increasingly expect to be involved in all parts of their care and treatment. 1 As a result of this comment, there is now a programme of further events in place. 4

5 Medical staff should be available at visiting times so that visitors/ relatives can ask questions. (Comment made at community event held in Keighley on ) 2 Our challenge for the next three years is to better understand and, therefore, be better able to meet this rising level of expectation supported by relevant information and choice to meet individual healthcare requirements. We need to continue engaging in community settings, including working with GPs and other partners across the local health community. The current position where are we now? A great deal of staff energy and endeavour is already channelled into engaging with patients and the public as a means of improving the patient experience in many parts of the organisation. There are several examples of good practice across the Trust, but no overall consistency of approach. 2 Relatives evenings are held on several wards when clinical and nursing staff are available to talk to relatives and carers. We already have: Board commitment to implementing this strategy. Regular review of a limited range of patient experience indicators at Board and Board sub committee level. A PPEE Steering Group chaired by a Non-Executive Director, which includes patient and community representatives. An initial work programme in place based upon a comprehensive audit of patient experience activity across the Trust. PPEE Policy agreed in August A governance and PPEE infrastructure in place. Recent implementation of both internal and external audit recommendations on patient experience. A PPEE Operational Group with the authority to collect detail of all PPEE engagement activity happening within the hospital and within community settings which: o Identifies any gaps across the organisation (building a jigsaw and finding the missing pieces). o Identifies issues highlighted by patients and the public. o Shows actions taken as a result of these issues. o Demonstrates that improvements have been made as a result of these actions. o Proves that we have informed patients and the public of these changes. o Collects evidence that patients and the public feel their experience has improved. 5

6 Examples of current patient engagement activities include: Trust involvement in national surveys, with working groups looking at what needs to be done to make improvements to future results. Involving volunteers in carrying out real time surveys with medical and surgical inpatients, maternity services, physiotherapy services and endoscopy outpatients, with a steering group overseeing how the information collected is acted upon. Service specific surveys, including those for patients cared for in the community. A Patient and Carer Panel, of twenty people who have a close interest through experience of being a patient, carer or visitor to Airedale Hospital and who provide the Trust with invaluable information from the patient, carer, visitor point of view. A Youth Panel, made up of groups of young people from surrounding districts, which specifically has a younger point of view of how care and services are delivered. Using the strong body of Foundation Trust members to provide feedback on a range of topics. Acting on complaints and patient, advice and liaison service (PALS) issues. Comment boxes, relative evenings, and focus groups. Involving lay and staff volunteers as feeding buddies. NHS Choices and Local Involvement Networks (LINks soon to be HealthWatch) Vision patient experience Our vision is that the importance of understanding and improving the patient experience becomes fully embedded into the everyday work of the Trust within a strategic framework where comprehensive analysis of patient feedback leads to continuous service improvement and informs future healthcare planning. This is closely aligned to the Trust s overall strategic vision: To be the hospital chosen by the community for putting patients first, providing excellent, innovative and diverse services, delivering safe standards of care, all underpinned by the relentless pursuit of efficiency. It is also consistent with the view put forward by patients and the public to have a local hospital and healthcare services that are responsive to their needs. This means having staff who are respectful, communicate effectively, show compassion, and provide safe care. Patients believe it is often the small things that make a difference, which can only be discovered by staff asking, listening and acting upon what they find out. 6

7 Make sure that the patient knows where the toilet/bathroom is. (Taken from FT membership survey Jan 2012) Improving the patient experience will be an inclusive part of all other major Trust strategies, such as quality and safety ; being open ; communication ; and estates. We want patients to be involved and engaged in decisions that affect aspects of their visits to all Trust premises. This may include signage and car parks, or ward layout and bathroom design. It may involve having clear explanations of what will happen during an operation or procedure, alongside information leaflets that can be easily understood. What must we do to make it happen? The Trust is committed to creating the right culture to deliver this vision within the organisation and the local healthcare community. There is no quick fix or instant blueprint for success which is why we have adopted a rolling three year timescale for this strategy. We will continue with the bottom up and top down approach described in the introduction. We will raise the profile of patient experience at every opportunity, to build on the many areas of good practice within the hospital and within the community. We will also share and bring in good practice from other organisations. For example, learning from other Trusts with good patient satisfaction results, or introducing customer care training that is successfully used in some retail organisations. Achievement of our vision will depend enormously on the skills, expertise and commitment of our staff. We will continue to value and respect our staff and everyone who receives our services. This includes the many volunteers who provide enormous support and who will play a significant role in the ways that we can improve patient experience. We also recognise and value the role played by carers who are a valuable source of information in helping us improve the way care is provided and ensuring there is continuity of care for the patient. We are aware that it is not just about finding out what people think of our services. This information must be used effectively so people using our services leave satisfied. If people leave satisfied, this will be a massive motivator for everyone who is part of the Airedale family. It will also build our reputation and brand as these messages are spread throughout our local community. We must make sure we let people know that we have listened. We must let them know about the improvements we have made as a result of what they have said through the You said we did strategy. 7

8 Strategic aims and priorities As part of our PPEE strategy and vision we need to dig deep and think big, whilst at the same time have an emphasis on impact and outcome (not just process). 1. CHANGING CULTURE across all disciplines, which will include patient and public direct involvement, the use of the patient story and customer care type training. To ensure continued Board focus on patient impact within an integrated governance performance framework. Patient experience... at the heart of everything we do and no decision about me, without me, will be embedded across the organisation and become part of Airedale s culture. To achieve this we propose : To promote the concept of no wrong door across the Trust in terms of individuals taking responsibility for helping and dealing with patients. Answering the telephone or assisting a visitor to the hospital is everybody s responsibility. To improve links/contacts with community groups as a means of more local people and minority groups becoming involved in decision-making. To raise the profile of patient experience within our processes and structures e.g. as a standard agenda item at all departmental, staff, ward and community meetings. To encourage staff to find new interesting ways of engaging with patients and the public. To have an automatic method in place for engaging with patients and the public at times of a proposed service change no matter how big or small. To introduce different innovative methods of patient experience training/awareness-raising sessions for staff There should be a way of assessing suitable people from within the community to take part in forums, panels etc. There is a need to break away from the usual suspects being over represented in groups. (Comment taken from member of a patient user group) 8

9 How we will know we have done this: By 2012, high level patient experience metrics will be agreed and considered at all Board meetings. By 2012, a patient story will be included on every Board meeting agenda. By 2012 we will have undertaken an evaluation and assessment of all patient access points e.g. telephone, visitor reception points and web site with a view to providing a more patient focused first point of access By 2013, a mystery shopper initiative will be introduced, to monitor our consistency of approach and assist in staff development. By 2013, we will include a patient experience element to all staff appraisal and individual development plans An annual review will be in place to assess evidence of culture change. This will include: o That patient experience is more central to all that we plan and do o That levels of patient engagement activity are increasing internally and externally. o That innovative staff training/awareness-raising sessions of patient experience, are embedded. o That satisfaction scores are increasing in all surveys undertaken. 2. LEADERSHIP AND COMMITMENT To achieve this we propose : To demonstrate Board and senior management team long term commitment to improving the patient experience through its dealings with patients, staff and local healthcare partners. To commit to a centralised resource to oversee and coordinate the improved patient experience programme, making use of the inherent skills and expertise across the organisation from staff, governors and volunteers. To embed active patient and public engagement in the annual planning and business planning programme at both strategic and operational levels. 9

10 How we will know we have done this: By 2013, each Executive Director, Non-Executive Director, Clinical Director and General Manager will have improving patient experience as one of their personal objectives that are subject to appraisal. By 2013 each of the senior management team will have taken part in at least one patient engagement activity during any one year. By 2013 various methods will have been utilised to involve and engage with patients and the public in the annual planning and business-planning programme. By 2013 patient experience is a standard agenda item at all relevant meetings. The PPEE Steering Group will continue to be led by a Non-Executive Director and an Executive Director. 3. KEEPING PATIENTS SAFE Improving patient experience will sit alongside the provision of safe high quality care. With dementia patients, ensure they are not able to leave the ward alone and unattended. To achieve this we propose : To demonstrate publicly that patient experience is one of the three Trust priorities, the others being patient safety and clinical effectiveness, known as the three pillars of quality. How we will know we have done this: Year on year, evidence of improved patient experience will be explicit within the Trust s Quality Account. There will also be evidence of public involvement in the decision making process of what our patient experience priorities should be. 4. SERVICE STANDARDS Specify and publish standards that patients can expect and ensure that these are measured and achieved. To achieve this we propose : To develop and publish standards of patient experience by way of full engagement with patients, their representatives and the public. e.g. maximum waiting times for clinics (in line with NICE quality standards) How we will know we have done this: By 2013 have an initial set of standards in place that have been identified through strong public engagement, with systems in place to measure achievement. (Comment taken from survey undertaken with FT Members) 10

11 5. WELL INFORMED PATIENTS Build upon and promote the concept of a more informed patient better able to challenge and contribute to higher standards of service and challenge sub-standard care. Communication should involve dialogue with families and carers To work with clinical teams in partnership with other health and social care professionals, to ensure people are given sufficient information to enable them to make choices and decisions about their care. To use fully, the patient information hub. To assess and seek to roll out to other specialties the Acute Care Team initiative which is making it possible for patients to contact the team directly, if they feel substandard care is causing deterioration to their relative s health. To communicate in a way in which people can understand, to make sure they have understood and to give patients and families the opportunity to ask questions. (comment made at community group workshop on 12 May 2011) To achieve this we propose : To improve our understanding of actual patient expectations when deciding which services will be provided by the Trust as opposed to relying on what we might think is most appropriate for them. To measure actual patient experience against these expectations. To improve upon the consistency and extent of patient information produced within the Trust and make maximum use of professional (EIDO) leaflets. To improve the satisfaction scores of Airedale patients within the inpatient national survey concerning their involvement in decisions about their care. Patients and families need an explanation in a language they can understand. (Comment made at community group workshop on 12 May 2011) 11

12 How we will know we have done this: By 2013 to investigate and trial new ways of assessing methods of evaluating patient expectations e.g. local patient research, piloting work with individual GP practices, involvement of governors etc By 2013 have a patient information policy in place. By 2014 have evidence that the initiative started by the Acute Care Team has spread to other specialties. By 2015 have patient information standard accreditation. Show a year on year increase in enquiries to the patient information hub. Show a year on year improvement in the national inpatient survey to the responses to the questions of patients being involved in decision making. 6. UNDERSTANDING THE PATIENT JOURNEY Create a better understanding of the whole patient journey so the Trust is in a better position to make real and sustainable improvements to the patient experience. We are individuals and one size does not fit all (Comment made at community group workshop held on 12 May 2011) To achieve this we propose : To have internal and external systems in place that will provide the Trust with factual information of how and from where a patient receives care and treatment. This will involve both primary and secondary care and social care services. To appreciate the nature of real patient journeys and work with GPs and others to ensure that patients complete their journey smoothly. To build upon partnerships working with other public sector and voluntary organisations to develop a joined up approach. 12

13 Where appropriate, to develop continuity of relationships with patients rather than as a series of one-off episodes of care. To require more of a whole person approach to underpin a stronger Airedale brand allowing patients to feel a sense of belonging to the Airedale family. How we will know we have done this: This will be a longer term goal with annual checks on progress being made as follows: - o A mapping exercise will be undertaken to explore the different ways of partnership working with public sector and voluntary organisations and other key groups. o Working with IT colleagues, an information system will be developed to identify the patient journey at any given time. o Systems will be in place to demonstrate that each different part of the hospital system is communicating well with the other. o There will be an action plan in place to determine where and how the patient journey can be improved and ultimately, assess its effectiveness. 7. MEASURING PATIENT SATISFACTION To have assurance that we are measuring patient satisfaction and experience consistently across the Trust To achieve this we propose : To compile, complete and analyse the jigsaw of evidence of patient engagement activity in a structured and comprehensive way. To record the changing improvement to patient experience across the hospital and within the community. 13

14 To improve the way we use and act on the results from all national and local surveys. As part of this we are striving to include people with protected characteristics under the Equality Delivery System. To improve the co-ordination and assessment of the full range of patient experience information that is collected from PALS, complaints, incidents, surveys and other sources. To work with the Trust governors to agree a clearly defined role for them concerning patient experience issues, particularly in the way they provide feedback from their local areas. To work with teams across the Trust on the best methods of capturing informal feedback from patients to supplement PALS and formal complaints activity, including improved ways of utilising new technology. To make the best use of existing and new technologies to widen the way we interact with patients and the public. This may be by telemedicine, telehealth, social networking; or text messaging. How we will know we have done this: By 2012 have the Equality Delivery System protected characteristics incorporated into the demographic data set, to provide a better understanding of their patient experience. In 2012, explore the potential of a forum for people of protected characteristics as identified under the Equality Delivery System, to inform care, practice and experience. By 2013 have a system in place to co-ordinate and cross-reference the range of patient experience information that is being collected by different departments, showing improvements made. By 2013 have introduced social networking elements to obtain feedback. By 2014 have completed most of the jigsaw, by filling the majority of gaps where patient engagement activity is not taking place By 2014 have a central computer database operational, collecting and collating patient experience activity, outcomes and evidence of improved patient experience. Being able to demonstrate year on year our Trust improvement in the national and local survey results. 8. LINKAGES The PPEE Strategy does not stand alone but will link to the Trust s overall vision, strategic goals, annual and business planning i.e. o Vision see page 6 o Strategic goals The relentless pursuit of understanding and achieving the best possible outcome for patients whilst maximising efficiency, and To develop both existing and new service priorities, changing the models of service delivery and the requisite shape of the workforce in the years ahead. 14

15 o Annual/business plan The Foundation Trust aims to improve the patient experience by: providing good treatment in a comfortable, caring and safe environment; delivered in a calm and reassuring way; providing information to make choices and feel confident; for patients to feel in control being talked and listened to as an equal; being treated with honesty, respect and dignity. o Our annual patient experience implementation plans will reflect our changing priorities as defined and determined through patient feedback and the annual business planning process. Delivery of the PPEE Strategy will link to and inform other relevant strategies and organisational priorities, i.e. quality and safety; communications; estates; marketing; business development; Trust forward planning; quality account; and equality and diversity. To achieve this we propose : To make sure representation on the PPEE Steering Group is broad enough to have insight into all relevant Trust strategies, plans and priorities. To ensure that the PPEE Strategy becomes a living document able to adapt and change in line with Trust developments elsewhere To have successful delivery of the three annual implementation plans. How we will know we have done this: By 2012, an integrated governance structure and performance metrics will be adopted. By 2015, there will be embedded systems in place to ensure the PPEE strategy continuously reflects and is in tune with all other strategies, plans and priorities within the Trust that involve quality of care and patient experience. Monitoring and Evaluation These strategic aims will be supported by a more detailed annual implementation plan, which will reflect findings and changes in priorities that may develop from national or local directives. As part of the implementation plan, a comprehensive set of performance indicators will be developed that focus on patient impact and which will form part of the high level indicators presented to the Board on a monthly basis. The PPEE Steering Group will continuously monitor progress of the implementation plan. Robust governance arrangements will be in place with clear lines of responsibility. An annual report will be compiled demonstrating outcomes achieved, which will be on the Trust website and publicly available. Service improvements resulting from patient feedback will be Identified and published. There will be an assessment of local partnership involvement in improving the patient experience, benchmarking against other providers and investigating options for joint research where gaps persist in patient expectations. 15

16 CONTACT: If anyone would like clarification or further information about any aspect of this strategy document, please contact: - Karen Dunwoodie, Patient Experience Lead. Tel: E Mail: Karen.dunwoodie@anhst.nhs.uk Date approved: June Date to be reviewed: June 2013 GLOSSARY OF TERMS USED IN THIS DOCUMENT Benchmarking A method of comparing performance and quality information with other similar organisations. Demographic Data Set A collection of information about characteristics of people. Eido Leaflets EIDO Healthcare was established in June 2000 in response to the growing need in the UK healthcare sector for improvements to the informed consent process and produces patient information leaflets that are supplied to health organisations. Equality and diversity Provision of care should not be of a different quality because of such things as age, gender, ethnicity, physical ability, sexual orientation, religion, language, geographical location and social class. Equality Delivery System (EDS) The purpose of the EDS is to support Trusts to improve equality performance and embed equality into everyday NHS business. Executive Director An executive director is a member of the Trust Board and a paid employee responsible for the day-to-day management of the organisation with a specified decision making role. Feeding buddies Volunteers who assist patients who are unable to help themselves, with eating and drinking. Governance A framework through which NHS organisations are accountable for continuously improving the quality of their services, treatment and care.

17 High-level indicators A small number of carefully selected measures to assist the Trust Board identify if the organisation is performing as well as it should be doing. Inpatient national survey An annual survey undertaken in every acute hospital in England, asking patients who have recently used their local health services to comment on their experiences by way of a postal questionnaire. The results from the survey help to identify areas where a Trust needs to improve Integrated governance framework Provides a focus for monitoring and managing the governance of the organisation. Joined up approach Making sure that different parts of an organisation work together effectively. Local partnership involvement To work with other local voluntary, community and statutory organisations. Metrics A collection of performance information, which is usually displayed as statistics in a table format. Mystery Shopper A mystery shopper is an individual who is asked by the Trust to provide information of their experience as a patient. Non-Executive Director A Non-Executive Director is a member of the Trust Board, but does not participate in the day-to-day management of the organisation. He or she is involved in working alongside the Executive team in planning, policy making and strategic decision-making. Operational Group A group of Trust staff who are in a position to take action to make improvements to the way services, care and treatment are delivered. Patient Advice and Liaison Service (PALS) A free and confidential service that aims to advise and support patients, their families and carers. The PALS staff can listen to concerns, suggestions or queries and help sort out any problems. Patient experience indicators Ways of measuring how satisfied patients are with their health care experience. Patient journey A patient journey looks at all aspects of care and treatment provided to a patient within a set period of time. This may involve their treatment within a particular department, or may involve their treatment as they visit different health and social care professionals and different establishments. 17

18 Performance indicators Ways of measuring particular aspects of what an organisation does to see if a service does what it is intended to do and whether it does it well. Patient and Public Engagement and Experience (PPEE) Involving individuals in the planning and development of the services they use and care they receive No decision about me, without me. Patient experience involves various aspects of being a patient. This may include such things as effective communication; receiving care in a timely way; helpfulness of staff; and the clarity of information that is provided. PPEE infrastructure The composition of groups and activities within the Trust that have a role in ensuring patient engagement is taking place with the result of improved patient experience. Primary care The care someone will receive when they first come into contact with health services about a problem. This includes services provided by GPs, dentists, pharmacists and opticians. Protected characteristics There are nine protected characteristics. These refer to a person s age; gender; gender re-assignment; marriage and civil partnership; pregnancy and maternity; race; religion and belief; sexual orientation. Quality Account A Quality Account is a document that provides public accountability on the quality of services provided by a Trust. This is done by engaging with local communities to determine local improvement priorities and measuring and reporting on what matters most to them. Real time survey At Airedale, a survey is undertaken on a daily basis with inpatients who are ready for discharge to determine their level of satisfaction with the care and treatment they have received. This is undertaken by volunteers and the anonymous results are uploaded on to the Trust s computer system. The results are then immediately available for staff to see and analyse. Secondary care Hospital or community care resulting from a referral by a health professional in primary care, usually a GP. Social care Provided by Local Authorities, the independent or voluntary sectors involving a wide range of support to help people carry on with their daily lives. Standards Generally defined as a rule for measuring quantity or quality. The standard of care is the expected level and type of care that is provided under a certain set of circumstances. 18

19 Steering Group Usually made up of high level individuals and/or experts who have a strategic overview and provide guidance on key issues. Strategic framework An overarching vision for the future which defines what is to be done, contains values that determine actions to be taken and outlines goals and action plans. Strategic goal A milestone the organisation aims to achieve Strategic vision Ideas for the way the organisation will develop. Telecare A way of helping individuals remain independent at home by using equipment and response mechanisms. This may involve alarm systems, regular telephone contact, or a range of detectors. Telehealth A way of providing care services using telecommunications. Telemedicine A way of providing medical care, diagnosis, consultation, treatment and health education by using interactive audio visual electronic communication and information technologies. 19