Inpatient Experience at Kingston Hospital NHS Foundation Trust

Inpatient Experience at Kingston Hospital NHS Foundation Trust Trust Board Item: 7.5 20 May 2014 Enclosure: F Purpose of the Report: The report provides a comprehensive overview of the Trust s national adult inpatient survey results for 2013 as well as feedback themes from the Friends and Family Test. In terms of the inpatient survey 2013, the Trust s performance fell below the expected range on 3 questions. The Trust has also worsened on 8 questions, and no significant improvements have been made since the last survey. The report includes an action plan that takes into account the different sources of feedback and focuses on actions to fundamentally shift the inpatient experience. FOR: Information Assurance Discussion and input Decision/approval Sponsor (Executive Lead): Duncan Burton, Director of Nursing and Patient Experience Reinette Nell, Patient Experience Authors: Improvement Manager, and Fergus Keegan, Deputy Director of Nursing for Patient Safety Author Contact Details: Extension 2504 Reinette.nell@kingstonhospital.nhs.uk Financial/Resource Implications: None Risk Implications Link to Assurance Framework or Corporate Risk Register: Legal / Regulatory / Reputation Implications: Reputational Reputational CQC Risk Profile Strategic Objective 1 To ensure that all care is rated amongst the top 20 nationally Link to Relevant Corporate Objective: for patient safety, clinical outcomes and patient experience Document Previously Considered By: Patient Experience Committee and Executive Management Committee Recommendation & Action required by the Trust Board : The Trust Board is asked to NOTE the Inpatient Survey 2013 results and the improvement themes identified via the Friends and Family Test, the areas where significant improvement is required, and to APPROVE the action plan. The Board is also invited to COMMENT on the plan and suggest any alternative areas of focus. 1

Executive Summary Inpatient Experience at Kingston Hospital NHS Foundation Trust 1. This report provides a comprehensive overview of the Trust s national adult inpatient survey results for 2013 as well as feedback themes from the Friends and Family Test. It also outlines an action plan designed to improve the inpatient experience. 2. The tenth national survey of adult inpatients was conducted between September 2013 and January 2014. The CQC published the Inpatient Survey 2013 results for all Trusts on 8 April 2014. The sample consisted of patients aged 16 years or older, who had at least one overnight period in hospital in July 2013. The survey consisted of 78 questions. The Picker Institute conducted the survey on behalf of the Trust. The CQC presents the results each year, benchmarking Trusts nationally. The CQC weights the scores of each participating Trust by age, gender and route of admission. By doing this each Trust, in effect, has the same age, gender and route of admission profile and it means that scores are then comparable across Trusts with different profiles. The CQC does not compare, or recommend comparing Trusts overall performance. 3. The Trust s performance was below the expected range (red score) on 3 of the 78 questions. For all other questions the Trust s performance fell within the expected range (orange scores). The Trust also performed below the expected range overall for the section of the questionnaire that relates to Waiting List and Planned Admissions. There are no areas where the Trust performed above the expected range (green scores). The Trust has also worsened significantly since the 2012 survey on 8 questions. Although there are 18 questions where the Trust s scores have improved since the last survey, these improvements are not statistically significant. The Trust s overall performance in the 2013 survey is worse than in 2012 (where the Trust had achieved five green scores and no red scores, and also improved significantly on 7 questions, compared to the 2011 survey). 4. The Friends and Family Test has been in use on adult inpatient wards at the Trust since February 2013. Benchmarking with other Trusts has consistently put Kingston in the bottom quartile of Trusts nationally since May 2013. An analysis of improvement comments from the Friends and Family Test has shown that patients have identified food, perceptions of staff numbers and communication with patients as the main areas requiring improvement on inpatient wards. 5. It is clear from the inpatient survey results, and consistent bottom quartile position of the Trust within the Friends and Family Test, that there is significant room for improving inpatient experience. The multitude of actions taken previously within the Trust, whilst showing signs of improvement in some areas, have not been sufficient to shift out overall position when compared to the best performing Trusts. It is the Trust s ambition to be amongst the best performing Trusts in the country for patient experience and therefore alternative steps are required to drive a shift in experience and therefore how patients rate it. An inpatient experience action plan for 2014/15 has been developed that outlines actions to fundamentally shift the inpatient experience. 6. In previous years the Trust has had a sampling month of July for the national inpatient survey. For 2014 the sampling month will be changed to August to allow the Trust more time to implement actions arising from the survey and the Friends and Family Test feedback. Whilst as many actions as possible will be implemented ahead of August 2014, it is possible that the full extent of the benefits of the action plan may only be visible in the results of the 2015 survey. 7. The Trust Board is asked to NOTE the Inpatient Survey 2013 results and the improvement themes identified via the Friends and Family Test, the areas where significant improvement is required, and to APPROVE the action plan. The Board is also invited to COMMENT on the plan and suggest any alternative areas of focus. 2

Background and Introduction to the Inpatient Survey 2013 8. The Picker Institute conducted the survey on behalf of the Trust. The CQC presents the results each year, benchmarking Trusts nationally. 9. The CQC weights the scores of each participating Trust by age, gender and route of admission. This is because it is known that people tend to answer questions in different ways depending on certain characteristics. For instance, younger respondents tend to be more critical than older respondents, females tend to be more critical than males, and emergency admissions tend to be more critical than elective admission. The weighting is applied so that each Trust, in effect, has the same age, gender and route of admission profile. This means that scores are then comparable across Trusts with different profiles. 10. The benchmark report presents the performance of the Trust on each question, compared with all other Trusts. The benchmark report converts results into scores on a scale of 0 10. A score of 10 is the best possible score, and a higher score achieved indicates better performance. 11. The Trust worked with the Picker Institute to disseminate the findings across the Trust, and to devise quality improvement interventions. A Picker Inpatient workshop was delivered on 2 April 2014. Trust staff, patient representatives and local stakeholders attended and contributed to the development of the action plan. 12. The results that are presented in this report are based on the CQC interpretation of the data rather than the Picker analysis. However, Picker also generates a report that compares the Trust to 76 other Trusts that they work with on this survey. The Picker report provides further analysis of areas where the Trust may wish to take action. These areas are mentioned in the report where they are of particular relevance. Results of the Inpatient Survey 2013 13. A response rate of 43 (351 out of 820 eligible patients) was achieved. This is slightly lower than the 44 response rate for the 2012 survey, and lower than the national average of 49. 14. The Trust s result for each question in the survey report is presented in a bar graph using three colour schemes. Where the black diamond is located in the green section, this means the Trust is performing better than most other trusts in England on this question. A diamond in the red section indicates that performance is worse than other Trusts, and a diamond in the orange section indicates a performance that is about the same as most other Trusts. 15. The results are reported in ten main sections reflecting the patient s journey through the care pathway and a series of questions are asked about each section. The Trust s overall section scores are presented in Chart 1 below. 3

Chart 1: Kingston Hospital overall section scores 16. The Trust s performance was within the expected range for nine of the ten sections, and below the expected range for the section overall for Waiting list and planned admissions. A further analysis showing more detailed scores for questions in the ten different sections is included as appendix B of this report. 17. Each of the ten sections within the report consists of a number of questions. There are three questions where the Trust s performance fell below the expected range. The changes from 2012 to 2013 for these questions are presented in Table 1 below. Table 1: Questions where Kingston Hospital s performance fell below the expected range in the 2013 survey Number Question Section that question 2012 2013 relates to Q8 Had the hospital specialist been given all necessary Waiting list and planned 9.8 7.7 information about your condition/illness from the person who referred you?* admissions Q34 Did you find someone on the hospital staff to talk to Care and Treatment 5.3 4.7 about your worries and fears?** Q40 After you used the call button, how long did it usually take before you got help?** Care and Treatment 5.8 5.2 Scores are presented on a range of 0 to 10. * indicates a score below the expected range according to CQC report only ** indicates a score below the expected range according to CQC report and a score significantly worse than the Picker average 18. There are some areas where the CQC report did not indicate that the Trust s performance fell below the expected range, but the Picker analysis indicated that the Trust s performance was significantly worse than the Picker average. The areas where the Trust performed significantly worse than the Picker average are shown in Table 2 below. 4

Table 2: Areas where the Trust performed significantly worse than the Picker average in the 2013 Inpatient Survey Trust Average Admission: had to wait long time to get to bed on ward 49 33 Hospital: food was fair or poor 48 42 Nurses: did not always get clear answers to questions 39 31 Nurses: did not always have confidence and trust 29 24 Nurses: sometimes, rarely or never enough on duty 47 41 Care: wanted to be more involved in decisions 51 43 Care: could not always find staff member to discuss concerns with 75 58 Care: more than 5 minutes to answer call button 31 17 Surgery: not told how to expect to feel after operation or procedure 50 42 Surgery: anaesthetist / other member of staff did not fully explain how would put to sleep or control pain 22 15 Surgery: results not explained in clear way 38 31 Discharge: Not given notice about when discharge would be 50 43 Discharge: not fully told purpose of medications 30 23 Discharge: not fully told side-effects of medications 65 58 Discharge: not fully told of danger signals to look for 60 54 Discharge: not told who to contact if worried 26 20 Overall: Did not receive any information explaining how to complain *questions highlighted in yellow were also significantly worse than the Picker average in the 2012 survey 68 58 19. The Trust s performance worsened significantly on eight questions since the 2012 CQC Inpatient Survey. Changes from 2012 to 2013 are presented in Table 4 below. Table 4: Questions where Kingston Hospital worsened significantly since the 2012 survey Number Section Question 2012 2013 Q9 Waiting to From the time you arrived at the hospital, did you feel that 7.6 6.7 get a bed you had to wait a long time to get a bed on a ward?** Q11 Hospital Did you ever share a sleeping area with patients of the 9.7 9.1 and ward opposite sex?** Q40 Care and After you used the call button, how long did it usually take 5.8 5.2 treatment before you got help?** Q54 Leaving Before you left hospital, were you given any written or printed 8.2 7.1 hospital information about what you should or should not do after leaving hospital?** Q55 Leaving Did a member of staff explain the purpose of the medicines 8.6 8.1 hospital you were to take at home in a way you could understand?* Q58 Leaving Were you given clear written or printed information about 8.6 7.7 hospital your medicines?* Q59 Leaving Did a member of staff tell you about any danger signals you 6.0 5.0 hospital should watch out for after you went home?* Q62 Leaving hospital Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital?** 8.6 7.3 Scores are presented on a range of 0 to 10. * indicates a statistically significant deterioration according to CQC report only ** indicates a statistically significant deterioration according to CQC report and Picker analysis 20. Although the CQC report did not indicate a statistically significant worsening in terms of whether people had received written information explaining how to complain, the Picker analysis does indicate that this area has worsened significantly since the 2012 survey. 5

21. There are 18 questions where the Trust s scores have improved since the last survey; however these improvements are not statistically significant. The changes from 2012 to 2013 for these questions are presented in Table 5 below. Table 5: Questions where Kingston Hospital improved from 2012 to 2013 (albeit not statistically significant) Number Question 2012 2013 Q4 Were you given enough privacy when being examined or treated in the 8.7 8.8 A&E Department? Q7 Was your admission date changed by the hospital? 9.2 9.3 Q15 Were you ever bothered by noise at night from other patients 5.6 5.9 Q18 How clean were the toilets and bathrooms that you used in hospital? 7.9 8.2 Q19 Did you feel threatened during your stay in hospital by other patients or 9.6 9.8 visitors? Q21 How would you rate the hospital food? 4.9 5.0 Q22 Were you offered a choice of food? 8.4 8.7 Q25 Did you have confidence and trust in the doctors treating you? 8.7 8.8 Q26 Did doctors talk in front of you as if you weren t there? 8.5 8.7 Q29 Did nurses talk in front of you as if you weren t there? 8.9 9.0 Q31 Did a member of staff say one thing and another say something 8.0 8.1 different? Q33 How much information about your condition or treatment was given to 7.8 8.1 you? Q36 Were you given enough privacy when discussing your condition or 8.4 8.5 treatment? Q37 Were you given enough privacy when being examined or treated? 9.4 9.5 Q43 Did a member of staff explain what would be done during the operation or procedure? Q48 Afterwards, did a member of staff explain how the operation or procedure had gone? Q63 Did hospital staff discuss with you whether additional equipment or adaptations were needed in your home? Q69 During your hospital stay, were you ever asked to give your views on the quality of your care? Scores are presented on a range of 0 to 10. 8.5 8.7 7.5 7.6 7.3 8.0 1.7 2.2 22. There were no areas that were significantly better in 2013 than in 2012 according to the CQC report. However, the Picker analysis indicated that there has been a significant improvement since the 2012 Inpatient Survey in terms of patients feeling threatened by other patients or visitors. 23. Although there are no areas where the Trust performed above the expected range according to the CQC report, the Picker analysis indicated that the Trust s performance was significantly better than the Picker average in terms of single sex bathroom facilities and receiving copies of letters sent between hospital doctors and GP s. Friends and Family Test improvement themes 24. The results of the inpatient survey 2013 offer a useful source of feedback. These results also correlate with the real time feedback the Trust gathers through the Friends and Family Test. 25. The Trust implemented the Friends and Family Test on all its adult inpatient wards in line with national guidance from February 2013. 26. National benchmarking data is available for April 2013 onwards. Although the vast majority of patient feedback is positive (with over 90 saying they would be extremely likely or 6

Staff numbers Staff attitude Clinical/ nursing care Pain relief Discharge process Waiting times Privacy and dignity General efficiency Patients Family/ carers Food Housekeeping/fac ilities Bathrooms/Toilets Noise Transport Enclosure F likely to recommend our wards each month), the Trust s performance for the Adult inpatient Friends and Family Test has been in the bottom quartile of Trusts nationally consistently since May 2013. This position has remained static in spite of a multitude of actions that the Trust has undertaken. Although there have been signs of improvement in some areas, the improvements have not been sufficient to shift out overall position when compared to the best performing Trusts. 27. An analysis has been undertaken of qualitative comments that patients made on the Friends and Family Test in Quarter 3 of 2013/14 in order to identify improvement themes for further action. The table below provides information on the number of patients (and percentage of total patients) making comments about different improvement themes. The top two themes were to do with food and perceptions of staff numbers. Improvement comments regarding food were made by nearly 1 in 10 patients (8.9) completing the Friends and Family Test. Comments about shortage of staff (staff numbers) were made by 5.8 of all patients, 5.6 of patients commented on communication issues, and 4.8 on housekeeping/facilities issues (such as TV, Wifi access, call bells, lights and car parking). Table 6: Friends and Family Test - Improvement Comments made by adult inpatients from October to December 2013 Staffing Care and treatment Commu Food/Environment nication Theme Number of patients making improvement comment Percentage of all patients completing FFT (n=1062) 62 20 30 2 13 47 11 13 59 2 90 51 20 16 1 5.8 1.9 2.8 0.2 1.2 4.4 1.0 1.2 5.6 0.2 8.9 4.8 1.9 1.5 0.1 28. Significant improvements will be needed to move the Trust from its current position into the top quartile of Trusts nationally for the Friends and Family Test. Based on the benchmarking scores for March 2014, a 60 shift would be required in respondents scoring their inpatient experience from a rating of Likely to Extremely Likely to move into the top 20 of Trusts for the the Friends and Family Test. Achieving this would require the Trust to deliver a change in experience for patients to rate it in this way. 29. The Trust s response rate for the Friends and Family Test in inpatient areas is higher than the mandated minimum. However, it is possible that the current method of data collection is impacting the way in which patients score their experience. Kingston Hospital NHS Foundation Trust uses tablet computers for data collection exclusively. Other Trusts have opted for a blended approach using written cards, text messaging, tokens dropped into shuts, telephone and online survey methods. It is noteworthy however that of the top 60 Trusts nationally (and the top 30 Trusts when specialist Trusts are excluded from this list), almost all use exclusively paper-based survey methods. This is worthy of further exploration although this does not change the fact that there are areas where improvements are required. 7

Action Plan 30. The Trust s approach to Service Line Management, leadership development and people management are fundamental components of the overall approach to improving inpatient experience, particularly given the intrinsic link with staff experience. As part of the organisational development strategy for the Trust, the development of teams is a key area of commitment. At the end of 2014 the Trust received some additional funding from Health Education South London which has been used to commission April Strategy to undertake away days with each of the inpatient ward nursing and care teams over the next 18 months. These will focus on leveraging team culture and motivational factors, such as competitive spirit, shared purpose, pride and knowing how they are doing, to enable the teams to take action at ward level to improve the patient experience. 31. Patients, staff and local stakeholders attended a Picker Institute workshop on the results of the Inpatient Survey on 2 April 2014. As part of this workshop attendees also considered the areas known to have the biggest impact on patient experience and further information about this is included in appendix C of this report. Workshop attendees identified priority areas for inclusion in the action plan for 2014/15. 32. An action plan was also developed in response to the 2012 survey and it is possible that there are some benefits of the 2012 action plan that will only be seen in the results of the 2014 survey. The Trust has reviewed progress against the actions from the 2012 survey action plan as part of the new action plan that is to be implemented in 2014/15. 33. Whilst in previous years the Trust has had action plans in response to the inpatient survey that have focused on responding to many of the items within it, it was decided that this year s action plan should focus on top key areas from different data sources, such as providing more emotional support for and listening to patients, the speed of answering call buttons, positive patient experience of discharge, and food. In addition to these themes, the action plan also includes actions to fundamentally shift the patient experience and local ownership of this through motivation of local teams to drive change, a campaign on the items of specific focus e.g. staff responding to call bells, the impact that data collection methods may have, and ensuring a robust and enhanced approach to areas that consistently score on the lower end of the range. The Patient Experience Committee approved the action plan contained in Appendix A of this document on 15 May 2014. 34. In previous years the Trust has had a sampling month of July. The sampling month will be changed to August in 2014, to allow the Trust more time to measure whether the actions that have been implemented have been successful. Actions will be implemented as soon as possible, however it is possible that the full extent of the benefits of the action plan may only be visible in the results of the 2015 survey. 35. The inpatient experience action plan will be monitored through the Patient Experience Committee. Recommendations 36. The Trust Board is asked to NOTE the Inpatient Survey 2013 results and the improvement themes identified via the Friends and Family Test, the areas where significant improvement is required, and to APPROVE the action plan. The Board is also invited to COMMENT on the plan and suggest any alternative areas of focus. 8

Appendix A Action plan for inpatient experience (to be implemented in 2014/15) Actions designed to shift the approach to inpatient experience overall Area of focus Review approach to gathering patient experience feedback Overall lead Deputy Director of Nursing (Patient Experience) Existing initiatives in place Future actions required Timescale and responsible for action Existing data collection Complete options appraisal for changing the Friends and Family Patient Experience method for Friends and Test from just tablet devices only to alternative methods. This will Improvement Manager Family Test uses tablet include taking into account the impact on patient access, the impact on 15 th June 2014 computers exclusively. FFT scores, the associated resource required for implementation of an National surveys that the alternative approach, and the options for gathering local patient Trust takes part in. experience feedback in addition to the FFT. PALS and Complaints data. Websites such as NHS Care Implement preferred option from options appraisal. Ensure Deputy Director of Nursing Connect and I want great movement beyond data collection to utilising feedback for improvement (Patient Experience) care. and implement the required systems to achieve this. 1 st August 2014 Implementing team development programmes for ward teams Develop a supplemented approach for wards consistently in lowest range of Friends and Director of Nursing and Patient Experience Deputy Director of Nursing (Patient Experience) Senior Sisters/ Charge Nurses and Junior Sisters/ Charge Nurses have taken part in extensive leadership and development programmes. The programme for the senior Sister/ Charge Nurse has focussed on building on leadership and management skills Ward scores and rankings are currently reviewed on a monthly basis. Weekly ward scores are also available. Commission team development programme for ward teams focused on improvement in patient experience and safety. April Strategy has been commissioned to undertake this. Develop detailed design of team development and timetable for implementation. Ensure that all ward nursing & midwifery teams undertake away days for team development. Provide each ward with a clear target to achieve top quartile of Trusts nationally. Sisters and Charge Nurses will develop and implement local action plans based on analysis of FFT every quarter (for all wards below national average). This is to be monitored in service line performance meetings. Director of Nursing (Patient Experience) April 2014 Director of Nursing and Patient Experience May 2014 Director of Nursing and Patient Experience October 2015 Clinical Information Analyst 31 st May 2014 Deputy Director of Nursing for Emergency Services 30 th June 2014 9

Area of focus Family Test Scores Overall lead Enclosure F Existing initiatives in place Future actions required Timescale and responsible for action Ward sisters and charge nurses to monitor response rates weekly and ensure that all wards achieve at least a 30 response rate. This will also ensure that feedback is as representative of people s views as possible. Deputy Director of Nursing for Emergency Services 30 th June 2014 Develop campaign approach for areas of focus of the inpatient experience action plan Deputy Director of Nursing (Patient Experience) Ward teams have received slide packs to raise awareness of inpatient experience feedback and themes for improvement. Develop and implement a supplemented approach for wards that are consistently in the lowest range of FFT score for the Friends and Family Test, with a view to performance managing and supporting areas to ensure performance improves to the required levels in these areas. Develop a campaign on the specific items of focus for the action plan. This will include staff providing more emotional support and listening to patients, responding to call bells, ensuring a positive experience of discharge and improving the experience of hospital food and mealtimes. Deliver a communications campaign for patients regarding support. This will include letting them know who they can talk to about worries and fears, etc. Deputy Director of Nursing for Emergency Services 15 th June 2014 Deputy Director of Nursing (Patient Experience) 30 th June 2014 Patient Experience Improvement Manager 30 th June 2014 Deliver communications campaign to increase awareness of ensuring patients are well prepared for discharge. This could include a focus on ensuring patients know when they will be discharged, the need to check on required adaptations at home, and the importance of involvement in decision-making. Deputy Director of Nursing for Emergency Services 30 th June 2014 10

Actions related to providing more emotional support and listening to patients Area of focus Providing more emotional support and listening to patients Overall lead Director of Nursing and Patient Experience Existing initiatives in place Future actions required Timescale and responsible for action Nursing recruitment and Team Development sessions to reflect on performance in this Deputy Director of Nursing retention plan was put in specific area of feedback (all wards to have completed (Patient Experience) place to fill vacancies. development sessions) This will also include developing staff skills for October 2015 Ward sister/charge nurse improving experiences of patients with dementia in line with the strategy. leadership development programme is in place and Add addition question to FFT questionnaire to ask patients and Patient Experience majority of ward sisters and carers what we did to provide emotional support to patients and Improvement Manager band 6 nurses have more we could do this is to be feedback to staff via team brief, 15 th June 2014 undertaken this. inpatient screens and quarterly FFT reports to wards. Smaller medical ward areas were created in 2013. Implement Carers Hub (as part of Dementia Strategy). Develop Darzi Fellow (nursing) Matron s rounds are in place plans, identify space and funding opportunities for carers hub - engage August 2015 Staffing levels are displayed carers and partners in concept on electronic information screens on wards Provide comfortable space for patients and carers away from ward Volunteering Project Real time feedback on environment. Develop Forget Me Not Garden space for carers and Manager inpatient wards provides patients (Volunteer Ground Force event) July 2015 information about patients perspectives about the Provide up to date information for patients and carers on support Patient Experience support and care that they available via campaign approach. Improvement Manager receive 15 th July 2014 Actions related to improved response times for patient call bells Area of focus Increasing the speed of answering call buttons Overall lead Deputy Director of Nursing for Emergency Services Existing initiatives in place Future actions required Timescale and responsible for action Recruitment campaign in Add addition question to FFT questionnaire to ask patients Patient Experience place to ensure full regarding their experience of waiting for call bells to be answered Improvement Manager recruitment and zero agency and make results available to staff and patients 15 th June 2014 usage Triangulate staffing planned v actual measurements with responses to FFT question regarding experience of call bells Information Analyst 30 th August 2015 Develop and implement with the matrons & ward sister/charge Director of Nursing & Patient 11

nurse a set of minimum expectations for nursing staff for the time taken to respond to a call bell and the way in which this is done Complete recruitment programme and delivery of zero agency staff Experience 15 th June 2014 Director of Nursing & Patient Experience 15 th December 2014 Actions related to ensuring a positive patient experience of discharge Area of focus Ensuring a positive patient experience of discharge Overall lead Director of Nursing and Patient Experience Existing initiatives in place Existing discharge processes and summaries Future actions required Implement discharge leaflet. This will ensure that patients know who to contact if they are worried after leaving hospital, and also that they are aware of what needs to be arranged for instance transport, medication, appointments going forward, community support contacts etc. Pilot a project of discharge volunteers to improve the patient experience of the discharge process. Timescale and responsible for action Patient Flow Manager 31 st July 2014 Volunteering Project Manager 30 th August 2014 Ensure that patients have more information about the purposes and side effects of medications. This will include the use of leaflets, ensuring that pharmacists have more discussions with patients about these issues Head of Pharmacy 30 th July 2014 Review patient transport services. Ensure that contract delivers improvements in patients experience of punctual transport Deputy Chief Executive 31 st October 2014 Actions related to improving the experience of hospital food and mealtimes Area of focus Improving the experience of hospital Overall lead Director of Estates and Facilities/ Director of Existing initiatives in place Future actions required Timescale and responsible for action A detailed action plan for Further expand the dining companions scheme to improve Volunteering Project food and catering patients experience of meal times. Aim to expand so that every adult Manager improvements has been inpatient ward has at least two dining companions per mealtime. March 2015 developed by the Director 12

Area of focus food and mealtimes Overall lead Nursing & Patient Experience Enclosure F Existing initiatives in place Future actions required Timescale and responsible for action of Estates and Facilities & Gather more detailed feedback from patients, analyse results and Facilities Contract Manager Director of Nursing & implement changes accordingly. This will include capturing feedback 31 st July 2014 Patient Experience and is on the back of the Friends and Family Test, as well as a more in-depth being monitored via the paper-based questionnaire for patients for a set period of time. Patient Experience Committee Dining companions scheme has been implemented and 337 people have been trained. Existing feedback re food has been reviewed to understand areas for focus Dinner plate covers and bowl covers have been sourced and implemented. Sherry is available on prescription. Ice cream freezers have been purchased and are now in use on wards. Work is underway to consider changing food supplier and trial sessions are planned to look at taste, texture and nutritional value. Roll out of hot milk drinks at night is in progress. Complete review of catering provision (and implement changes as per contractual timeframes allow). This will need to include consideration of patients needs, nutritional standards, financial aspects etc. Create separate social dining spaces on wards Implement the use of dementia-friendly cutlery and crockery Implement the use of pictorial menus. Director of Estates and Facilities 1 st August 2014 Director of Nursing and Patient Experience March 2015 Deputy Director of Nursing (Patient Experience) December 2014 Director of Estates and Facilities 1 st August 2014 13

Appendix B Analysis of results for the ten individual sections of the CQC Inpatient Survey 2013 Section 1: The Emergency/A&E Department This section focused on questions related to A&E. The Trust s performance in this section was about the same as other Trusts in England. The Trust s Emergency/A&E Department scores are presented in Chart 2 below. Chart 1: Emergency/A&E Department scores Section 2: Waiting list and planned admissions This section contains questions answered by patients who were referred to the hospital and looks at their experience of waiting, the allocation of an admission date, and whether the hospital specialist had been given all the necessary information about their condition or illness from the person that referred them. The Trust s performance in this section overall was worse than other Trusts. In particular, the Trust fared worse with regards to hospital specialists being given all the necessary information about the patient s condition or illness from the person who had referred them. The Trust s Waiting List and Planned Admissions scores are presented in Chart 3 below. Chart 2: Waiting List and Planned Admissions scores Section 3. Waiting to get to a bed on a ward The Trust s performance was about the same as that of other Trusts for this question. However, the Trust s performance on this question has worsened significantly since the 2012 survey and is towards the lower end of the average spectrum. The Trust s performance on this question was also significantly worse than the Picker average and clearly there is an opportunity for improvement with regards to this area. Chart 3: Waiting to get a Bed on a Ward score 14

Section 4: The hospital and ward This section covers patient experience after admission to a ward and includes questions about mixed sex accommodation and bathroom facilities, noise, cleanliness, feeling safe, hand hygiene, and food and nutrition. The Trust performed about the same as most other Trusts in England on all questions in this section. The Trust s scores for this section are presented in Chart 5 below. Although the Trust was rated about the same as others in terms of single sex sleeping areas, there has been a statisticant significant increase since 2012 in the amount of patients who indicated that they had shared a sleeping area with a patient of the opposite sex. The Trust came close to achieving green scores with regards to single sex bathroom facilities in the CQC report. The Picker analysis showed that the Trust performed better than the Picker average in terms of single sex bathroom facilities. Although there are no areas where the Trust has shown significant improvement since 2012 according to the CQC report, the Picker analysis indicated that there has been a significant improvement since the 2012 Inpatient Survey in terms of patients feeling threatened by other patients or visitors. The Picker report indicated that the Trust s performance was significantly below the Picker average with regards to people s satisfaction with hospital food. It is also noteworthy that an analysis of freetext comments from the Friends and Family Test in Quarter 3 of 2013/14 indicated that hospital food was one of the top two areas for improvement indicated by our adult inpatients. There is an opportunity for improving patients experience noise at night, cleanliness of sleeping areas, availability of handwash facilities, hospital food and patients getting enough help with eating their meals. Chart 4: The Hospital and Ward scores 15

Section 5: Doctors This section measures patient experience of communication with doctors and their confidence and trust in doctors. The Trust s performance was about the same as other Trusts in England in this section. The Trust s scores for this section are presented in Chart 6 below. Chart 5: Doctors Section 6: Nurses The Trust scored about the same as other Trusts in England for patients experience of communication with and confidence and trust in nurses, and whether people felt there were sufficient nurses on duty. The Trust s scores for this section are presented in Chart 7 below. The Trust s performance was towards the lower end of the expected range for three of the questions in this section. The Picker analysis also indicated that the Trust s performance was significantly worse than the Picker average for these questions. They are to do with patients experience of getting the answers that they need from nurses, trust and confidence in nurses treating them and perceptions about the number of nurses on duty. Clearly there is an opportunity for improving these areas. It is also noteworthy that an analysis of freetext comments from the Friends and Family Test in Quarter 3 of 2013/14 indicated that perceptions of staff numbers was one of the top two areas for improvement indicated by our adult inpatients. Chart 6: Nurses 16

Section 7: Care and Treatment This section covers patient experience of the consistency between staff words and actions, involvement in decisions about their care, information about their condition or treatment, sufficient emotional support, privacy when being examined or treated, responsiveness to call buttons, and pain control. The Trust s scores for this section are presented in Chart 8 below. The Trust s performance for this section was about the same as other Trusts in England for seven of the nine questions. However, the Trust performed worse than average in terms of people feeling that they could find someone to talk about their worries and fears, and in terms of getting help when they used call buttons. There has also been a statistically significant deterioration since 2012 in terms of people s satisfaction with the time it took to get help after they used call buttons. The Picker report also indicated that the Trust s performance was significantly worse than the Picker average with regards to the extent that people felt they were as involved in decisions about their care as they would like to be. There is an opportunity for improving patients experience of being able to talk through fears and worries, response time to call buttons, involvement in decisions about their care and treatment, emotional support during their hospital stay, and patients feeling that staff did everything they could to help control pain. Chart 7: Care and Treatment 17

Section 8: Operations and procedures The Trust performed about the same as other Trusts in England for this section which included the provision of information to patients about procedures, risks and benefits, and answering patient s questions. The Trust s scores for this section are presented in Chart 9 below. There were some areas of this section where the Trust s performance was significantly lower than the Picker average and towards the lower end of the expected range in the CQC report. These areas are to do with not receiving sufficient information about what to expect after an operation or procedure, not having someone explain the risks and benefits of the operation or procedure, and not having someone explain how the operation or procedure had gone afterwards. These are all potential areas for improvement. Chart 8: Operations and procedures 18

Section 9: Leaving hospital This section included questions about discharge arrangements (involving patients, delays in discharge, provision of information about medicines, monitoring condition after discharge, taking into account family or home situation, giving family and carers the information that they need, communication after discharge). The Trust was about the same as other Trusts in England for patient satisfaction relating all questions covered in this section. However, this is a deterioration from last year s position where the Trust was better than most other Trusts on three questions (being given written or printed information about what to do and not do after leaving hospital, being given written or printed information about medicines, and being told who to contact if they were worried about their condition or treatment after they left hospital). There has also been a statistically significant deterioration since 2012 on five of the questions in this section. These are specifically to do with being given written or printed information about what to expect after leaving hospital, having a member of staff explain the purpose of medicines, being given clear written or printed information about medicines, being told which danger signals to look out for after going home, and people knowing who to contact if they were worried about their condition or treatment after leaving hospital. The Trust s scores for this section are presented in Chart 10 below. In addition to the areas that showed a statistically significant deterioration since 2012 in the CQC report, the Picker analysis also indicated that the Trust s performance was significantly below the Picker average with regards to people being given enough notice about when their discharge would be and being fully informed about the side effects of medications, Although there are no areas where the Trust performed above the expected range according to the CQC report, the Picker analysis indicated that the Trusts results were significantly better than the Picker average with regards to people receiving copies of letters sent between hospital doctors and GP s. There are opportunities for improvement across a number of areas covered in this section. This includes improving patients experience of feeling involved in decisions about their discharge from hospital, being given enough notice about when they would be discharged, being given written or printed information about what to do and not do after leaving hospital, being given written or printed information about medicines and side effects, being told who to contact if they were worried about their condition or treatment after they left hospital, and staff discussing with them whether any additional equipment or adaptations were needed in their homes. 19

Chart 9: Leaving Hospital 20

Section 10: Overall views and experiences This section included questions about patients overall experience of care, the extent to which they felt they were treated with dignity and respect, whether they were asked to give their views on quality of care, and whether they were given any information about how to complain. The Trust s scores were about the same as other Trusts in England for all questions in this area. However, it is noteworthy that more than 80 of participants said that they were always treated with respect and dignity, and 80 rated their care as 7 out of 10 or higher. The Trust s scores for this section are presented in Chart 11 below. Although the CQC report did not indicate a statistically significant worsening in terms of whether people had received writtedn information explaining how to complain, the Picker analysis does indicate that this area has worsened significantly since the 2012 survey. There is an opportunity for improving people s awareness of how to make complaints if they need to. Chart 10: Overall views and experiences 21

Appendix C Areas known to impact most on inpatient experience When planning priorities it is important to bear in mind that the aspects covered by certain questions impact more on overall patient experience than others. The Picker Institute has found from many years of research that patients say the greatest indicator of their overall patient experience is whether they felt they were treated with respect and dignity. They have also undertaken an analysis to show which questions most closely correlate with the question about respect and dignity, and are therefore most likely to have the biggest overall impact on patient experience. The table below shows the top 10 questions that impact on patient experience, according to Picker s analysis. As a general principle it can be expected that patient experience will be improved most by focusing improvement efforts on these areas Table 1: top 10 questions that impact on patient experience Rank Question 1 Overall, did you feel you were treated with respect and dignity while you were in hospital? 2 Did you have confidence and Trust in the Nurses treating you? 3 In your opinion, how clean was the hospital room or ward that you were in? 4 Did you have confidence and Trust in the doctors treating you? 5 Do you feel you got enough emotional support from hospital staff during your stay 6 How much information about your treatment or condition was given to you? 7 Do you think the hospital staff did everything they could to help control your pain? 8 When you had important questions to ask a nurse, did you get answers that you could understand? 9 Were you given enough privacy when being examined or treated? 10 How many minutes after you used the call button did it usually take before you got the help you needed? Note: Questions shaded in red Trust score below the expected range according to CQC report and significantly lower than the Picker average. Questions shaded in pink Trust score within the CQC expected range but significantly lower than the Picker average 22