NLG(16)181 DATE OF MEETING April 29 th 2016 REPORT FOR Trust Board of Directors Public REPORT FROM Mrs Tara Filby, Chief Nurse CONTACT OFFICER Mrs Jo Loughborough, Patient Experience Practitioner SUBJECT National Inpatient Survey 2015 - Overview BACKGROUND DOCUMENT (IF ANY) National Inpatient Survey 2015 REPORT PREVIOUSLY CONSIDERED BY & DATE(S) NA EXECUTIVE COMMENT (INCLUDING KEY ISSUES OF NOTE OR, WHERE RELEVANT, CONCERN AND / OR NED CHALLENGE THAT THE BOARD NEED TO BE MADE AWARE OF) Note areas of improvement and areas for consideration HAVE THE STAFF SIDE BEEN CONSULTED ON THE PROPOSALS? NA HAVE THE RELEVANT SERVICE USERS/CARERS BEEN CONSULTED ON THE PROPOSALS? Yes ARE THERE ANY FINANCIAL CONSEQUENCES ARISING FROM THE RECOMMENDATIONS? NA IF YES, HAVE THESE BEEN AGREED WITH THE RELEVANT BUDGET HOLDER AND DIRECTOR OF FINANCE, AND HAVE ANY FUNDING ISSUES BEEN RESOLVED? NA ARE THERE ANY LEGAL IMPLICATIONS ARISING FROM THIS PAPER THAT THE BOARD NEED TO BE MADE AWARE OF? NA WHERE RELEVANT, HAS PROPER CONSIDERATION BEEN GIVEN TO THE NHS CONSTITUTION IN ANY DECISIONS OR ACTIONS PROPOSED? NA WHERE RELEVANT, HAS PROPER CONSIDERATION BEEN GIVEN TO SUSTAINABILITY IMPLICATIONS (QUALITY & FINANCIAL) & CLIMATE CHANGE? NA THE PROPOSAL OR ARRANGEMENTS OUTLINED IN THIS PAPER SUPPORT THE ACHIEVEMENT OF THE TRUST OBJECTIVE(S) AND COMPLIANCE WITH THE Supports the Improvement of Patient Experience of Care NA 1
REGULATORY STANDARDS LISTED ACTION REQUIRED BY THE BOARD For information 2
National Inpatient Survey 2015 Summary and Picker Report of 17 Questions to Focus Improvement. It s not how good you are, it s how good you want to be. 3
This report contains the summary of the 2015 National Inpatient Survey and an accompanying review of the 17 questions highlighted by Picker, requiring consideration. Page 33 draws together these areas which are presented as being the areas we deteriorated in most since 2014, the questions ranked by highest number of respondents and the questions that were most important to patients overlaid onto these 17 questions. The 2015 survey action plan is currently under development with Patient and Staff Experience Group. The 2014 action plan is attached on Pg 34 and 35 for reference. What our National Inpatient Survey 2015 Report shows us This survey has highlighted the many positive aspects of the patient experience at Northern Lincolnshire and Goole NHS Foundation Trust and it is envisaged that this report will help shape the actions required to improve during 2016-2017. It is also good to take a moment and celebrate what aspects of care we are doing well. Background. A total of 1250 patients from our Trust were sent a questionnaire. 1202 were eligible for the survey, of which 541 returned a completed questionnaire, giving a response rate of 45%. The response rate for our Inpatient survey in 2014 was 44%. 81 Trusts are included in the comparison data. Key facts about the 541 inpatients who responded to the survey: ο ο ο ο 26% of patients were on a waiting list/planned in advance and 71% came as an emergency or urgent case. 54% had an operation or procedure during the stay. 49% were male; 51% were female. 6% were aged 16-39; 19% were aged 40-59; 22% were aged 60-69 and 52% were aged 70+. Our results This survey has highlighted the many positive aspects of the patient experience. ο Overall: 84% rated care 7+ out of 10. ο Overall: treated with respect and dignity 82%. ο Doctors: always had confidence and trust 81%. ο Hospital: room or ward was very/fairly clean 98%. ο Hospital: toilets and bathrooms were very/fairly clean 96%. ο Care: always enough privacy when being examined or treated 91%. This is excellent and very reassuring that confidence in doctors remains very high and has even increased since last year. The cleanliness of our hospitals remains excellent as shown by the ratings. 4
If we review where our improvements were in last year s survey, these are the 8 areas of care which we had improved on from 2013-2014. Hospital: shared sleeping area with opposite sex Care: staff did not do everything to help control pain Surgery: what would be done during operation not fully explained? Surgery: not told how to expect to feel after operation or procedure Surgery: anaesthetist / other member of staff did not fully explain how would put to sleep or control pain Discharge: not given any written/printed information about what they should or should not do after leaving hospital Overall: not asked to give views on quality of care Overall: Did not receive any information explaining how to complain This time it indicates that our most significant improvements are:- 2012 2013 2014 2015 Hospital: felt threatened by other patients or visitors Nurses: sometimes, rarely or never enough on duty - 1 % 6 % 6 % 3 % - 48 % 49 % 51 % 44 % Care: more than 5 minutes to answer call button - 20 % 22 % 24 % 17 % Overall: not treated with respect or dignity 24% 28% 24% 18% 2 Overall: rated experience as less than 7/10-22 % 25 % 22 % 16 % Remember the lower the number the better. There are some great aspects highlighted here that mirror some of the hard work teams have accomplished to make improvements, such as staffing. This in turn may be reflecting the parallel decline in time taken to answer call bells. This year on year improvement can be far more reassuring in many respects than the national benchmarking, as it shows that internally we are making a difference. 5
We have remained consistent with our internal comparisons other than the following areas where we have shown a significant decline statistically. Hospital: shared sleeping area with opposite sex Discharge: not given any written/printed information about what they should or should not do after leaving hospital 2012 2013 2014 2015-13 % 13 % 7 % 12 % - 36% 37% 30% 37% Whilst we wish to see no deterioration, we are aware of some issues around mixed sex accommodation and have already instigated a robust review of our process to address this. What must be noted is that from a patient experience perspective is that when rating importance of questions, mixed sex rates very low in patient importance. Information on discharge around medications formed part of our action plan from, last year s survey and is still in progress. General discharge advice needs some continued work, from verbal instruction but also written information. The following table reflects the questions as responded to by the largest number of people, so this would translate as the areas to focus, however this may not mean that these are the questions that mattered most to patients, so caution needs to applied. Ranked Problem Scores scores significantly better than average scores significantly worse than average Trust Average The problem score for your Trust Average score for all Picker trusts Problem scores 50%+ Lower scores are better Trust Average 55 Discharge: delayed by 1 hour or more 82 % 85 % 73 Overall: not asked to give views on quality of care 71 % 69 % 5 Planned admission: not offered a choice of hospitals 71 % 68 % 61+ Discharge: not fully told side-effects of medications 62 % 59 % 36+ Care: could not always find staff member to discuss concerns with 62 % 59 % 74 Overall: Did not receive any information explaining how to complain 62 % 59 % 64+ Discharge: not fully told of danger signals to look for 61 % 56 % 66+ Discharge: family not given enough information to help 55 % 51 % 58 Discharge: not always a plan in place for continuing care when transferred [50] % 32 % 6
Problem scores 40% - 49% Trust Average 51+ Discharge: did not feel involved in decisions about discharge from hospital 47 % 44 % 33 Care: wanted to be more involved in decisions 46 % 41 % 30 Nurses: sometimes, rarely or never enough on duty 44 % 38 % 37+ Care: not always enough emotional support from hospital staff 44 % 41 % 47 Surgery: not told how to expect to feel after operation or procedure 44 % 40 % 52 Discharge: Not given notice about when discharge would be 43 % 43 % 57+ Discharge: did always get enough support from health or social care professionals. 43 % 44 % 53 Discharge: was delayed 42 % 41 % 15 Hospital: bothered by noise at night from other patients 41 % 39 % 21+ Hospital: food was fair or poor 41 % 39 % Problem scores 30% - 39% Trust Average 65+ Discharge: Family or home situation not considered 39 % 36 % 23+ Hospital: did not always get enough help from staff to eat meals 38 % 34 % 9 Admission: had to wait long time to get to bed on ward 38 % 32 % 59 Discharge: not given any written/printed information about what they should or should not 37 % 33 % do after leaving hospital 24+ Doctors: did not always get clear answers to questions 35 % 30 % 32 Care: staff contradict each other 35 % 31 % 50 Surgery: results not explained in clear way 33 % 31 % 34 Care: did not always have confidence in the decisions made 32 % 27 % 41 Care: staff did not do everything to help control pain 32 % 29 % 63+ Discharge: not given completely clear written/printed information about medicines 30 % 27 % 27+ Nurses: did not always get clear answers to questions 30 % 30 % Problem scores 20% - 29% Trust Average 26 Doctors: talked in front of patients as if they were not there 28 % 23 % 38 Care: not always enough privacy when discussing condition or treatment 27 % 23 % 45+ Surgery: what would be done during operation not fully explained 25 % 23 % 6 Planned admission: should have been admitted sooner 25 % 24 % 60+ Discharge: not fully told purpose of medications 25 % 25 % 62+ Discharge: not told how to take medication clearly 24 % 24 % 46+ Surgery: questions beforehand not fully answered 23 % 21 % 35 Care: not enough (or too much) information given on condition or treatment 23 % 20 % 31 Care: staff did not always work well together 22 % 21 % 71 Overall: did not always feel well looked after by staff 22 % 20 % 7 Planned admission: admission date changed by hospital 22 % 19 % 67 Discharge: not told who to contact if worried 21 % 20 % 16 Hospital: bothered by noise at night from staff 21 % 20 % 3 A&E Department: not enough/too much information about condition or treatment 21 % 22 % 29 Nurses: talked in front of patients as if they weren't there 20 % 18 % 7
Problem scores 10% - 19% Trust Average 25 Doctors: did not always have confidence and trust 19 % 19 % 28 Nurses: did not always have confidence and trust 19 % 22 % 44+ Surgery: risks and benefits not fully explained 19 % 17 % 70 Overall: not treated with respect or dignity 18 % 16 % 4 A&E Department: not given enough privacy when being examined or treated 18 % 21 % 42+ Care: more than 5 minutes to answer call button 17 % 17 % 69+ Discharge: Staff did not discuss need for further health or social care services 17 % 17 % 14+ Hospital: patients using bath or shower area who shared it with opposite sex 17 % 12 % 68+ Discharge: Staff did not discuss need for additional equipment or home adaptation 16 % 19 % 72+ Overall: rated experience as less than 7/10 16 % 15 % 22 Hospital: not offered a choice of food 15 % 20 % 49 Surgery: anaesthetist / other member of staff did not fully explain how would put to sleep or 14 % 14 % control pain 11a Hospital: shared sleeping area with opposite sex 12 % 8 % Problem scores 0% - 9% Trust Average 39 Care: not always enough privacy when being examined or treated 9 % 9 % 13a Hospital: patients in more than one ward, sharing sleeping area with opposite sex 6 % 5 % 18+ Hospital: toilets not very or not at all clean 4 % 5 % 20 Hospital: hand-wash gels not available or empty 4 % 4 % 19 Hospital: felt threatened by other patients or visitors 3 % 3 % 17 Hospital: room or ward not very or not at all clean 2 % 3 % 8 Planned admission: specialist not given all the necessary information 2 % 3 % Picker also provide an improvement map which maps out the questions which matter most to patients, those around relational aspects of care, such as confidence and trust. By benchmarking with the other 81Trusts we can have additional information about how to direct our improvement goals. The following questions lay furthest away from average and matter the most to patients Overall: not treated with respect or dignity Overall: did not always feel well looked after by staff Care: did not always have confidence in the decisions made Care: not always enough emotional support from hospital staff Care: staff did not do everything to help control pain Care: not enough (or too much) information given on condition or treatment Doctors: did not always get clear answers to questions Care: wanted to be more involved in decisions Care: not always enough privacy when being examined or treated Care: could not always find staff member to discuss concerns with 8
The following pages 9-31 contain the work undertaken by the Picker team to provide the 17 questions based on worst problems scores in comparison to Picker average or historically are worse than previous. The final pages, 32-33 in this document provides mapping over of these two documents findings and initial proposal. Pages 34,35 contain 2014 National Inpatient Survey Action Plan. 9
17 Questions to Focus Improvement Northern Lincolnshire and Goole NHS Foundation Trust 2 nd February 2016 10
Contents 17 Questions to Focus Improvement Admission Q9. Admission: had to wait a long time to get a bed on ward The Hospital and Ward Q11a. Hospital: shared sleeping area with opposite sex Q14+. Hospital: patients using bath or shower area who shared it with opposite sex Q23+. Hospital: did not always get enough help from staff to eat meals Doctors Q24+. Doctors: did not always get clear answers to questions Q26. Doctors: talked in front of patients as if they were not there Nurses Q30. Nurses: sometimes, rarely or never enough on duty Your Care and Treatment Q32. Care: staff contradict each other Q33. Care: wanted to be more involved in decisions Q34. Care: did not always have confidence in the decisions made Q36+. Care: could not always find staff member to discuss concerns with Q38. Care: not always enough privacy when discussing condition or treatment Operations and Procedures Q47. Surgery: not told how to expect to feel after operation or procedure Leaving Hospital Q58. Discharge: not always a plan in place for continuing care when transferred 11
Q59. Discharge: not given any written/printed information about what they should or should not do after leaving hospital Q64+. Discharge: not fully told of danger signals to look for Q66+. Discharge: family not given enough information to help 17 Questions to Focus Improvement Northern Lincolnshire and Goole NHS Foundation Trust approached the Picker Institute to report on 17 questions where they performed worst during the 2015 Inpatient Survey. This report is the result of this analysis. These questions have been selected as the Trust either scored significantly worse than the Picker Average, significantly worse than the previous year, or scored badly in comparison to the Picker average. Questions have been selected from across the patient journey and have been presented in chronological order. Admission Q9. Admission: had to wait a long time to get a bed on ward All Patients All Patients This Trust *Yes, definitely 15 % 12 % 38 % 32 % *Yes, to some extent 23 % 20 % No 63 % 68 % This frequency table compares the results of Northern Lincolnshire and Goole with all Picker Trusts. The problem scores for each are emphasised in bold and indicate the combined result from less than positive responses. Remember lower scores indicate a more positive experience and are therefore better. This question was selected as an area for improvement because Northern Lincolnshire and 12
Goole scored significantly worse than all Picker Trusts. The bar chart presents some additional analysis which demonstrates that the Diana Princess of Wales Hospital problem score for this question was quite a bit higher (and therefore worse) than Scunthorpe General Hospital. In fact, Scunthorpe received a Problem Score similar to that of the Picker Problem Score. 2012 2013 2014 2015 Admission: had to wait long time to get to bed on ward 30 % 34 % 37 % 38 % This graph presents a historical comparison of the Trust s problem scores with the annual Picker Average. The green bars indicate your trust's problem score for the question whereas the orange line represents the Picker average. The graph clearly shows that that Northern Lincolnshire and Goole s results have steadily been declining for Q9. 13
The Hospital and Ward Q11a. Hospital: shared sleeping area with opposite sex Patients who did not stay in critical care area This Trust All Trusts *Yes 12 % 8 % No 88 % 92 % Q11a has also been selected because Northern Lincolnshire and Goole NHS foundation Trust scored significantly worse than the Picker average, but this question was also selected because the Trust scored significantly worse on this question in 2015 when compared to 2014. Of the patients who did not stay in a critical care area, 12% shared their sleeping area with a member of the opposite sex in comparison to 8% of patients surveyed across Picker Trusts. Some freetext comments noted this as an area for improvement: I felt I should have been told I was going on a mixed ward. Didn't like to complain, but had to so that I could be moved to all-female. Ban mixed wards When I was first admitted to hospital I was in a ward of women. I fell asleep and when i woke there were men on either side of me. One man was asleep but the other man *** to himself and i was afraid and felt very vulnerable - It didn t help to be told brusquely that it was normal now in hospital. (*** indicates illegible handwriting or profanities) 14
2012 2013 2014 2015 Hospital: shared sleeping area with opposite sex 13 % 13 % 7 % 12 % In 2014, Northern Lincolnshire and Goole s problem score significantly improved from 2013 and the Trust scored better than the Picker average. However, this year the Trust scored significantly worse than 2014. Q14+. Hospital: patients using bath or shower area who shared it with opposite sex Patients who did not stay in critical care area This Trust All Trusts *Yes 17 % 12 % Yes, because it had special bathing equipment that I needed 1 % 1 % No 77 % 82 % Don t know / Can t remember 6 % 5 % On Q14 the Trust scored significantly worse than the Picker average. Historically both Northern Lincolnshire and Goole s problem score and the Picker Average have remained roughly consistent, without any significant changes in the results. 2012 2013 2014 2015 Hospital ; Patients sharing bath or shower with opposite sex 17% 18% 16% 17% 15
Q23+. Hospital: did not always get enough help from staff to eat meals Patients who needed help to eat meals This Trust All Trusts Yes, always 62 % 66 % *Yes, sometimes 18 % 19 % 38 % *No 20 % 16 % 34 % Northern Lincolnshire and Goole scored 4% worse than the Picker average on Q23+, which compares the results of patients who needed help eating meals. The bar chart compares the Trust s results with the UK Picker Average. The blue bar represents the overall range of responses to these questions, which for this question is approx. 40%. The black line indicates the Picker average and the yellow triangle marks the Trust s result. Hospital: did not always get enough help from staff to eat meals 2012 2013 2014 2015 35 % 37 % 33 % 38 % Although there was some improvement in Northern Lincolnshire and Goole s score in 2014, there has been a slight overall decline in the response to this question. This is the first time, since 2012, that the Trust has scored worse than the Picker Average. 16
Doctors Q24+. Doctors: did not always get clear answers to questions Patients who had questions to ask a doctor This Trust All Trusts Yes, always 65 % 70 % *Yes, sometimes 29 % 25 % 35 % *No 7 % 5 % 30 % This is one of two questions within the Doctors section of the 2015 Inpatient Survey where Northern Lincolnshire and Goole scored significantly worse than the Picker average. The bar chart demonstrates that patients at the Diana Princess of Wales Hospital gave an overall more negative response than patients at Scunthorpe General Hospital. 2012 2013 2014 2015 Doctors: did not always get clear answers to questions 36 % 39 % 40 % 35 % 17
The problem score for this question has slightly improved since 2014, but it remains significantly worse than the Picker average, as it has been since 2013. Q26. Doctors: talked in front of patients as if they were not there All Patients This Trust All Trusts *Yes, definitely 7 % 5 % 28 % 23 % *Yes, to some extent 21 % 18 % No 73 % 77 % On Q26 Lincolnshire and Goole scored significantly worse than the Picker average. Some of the positive freetext comments note instances of staff talking directly to the patient. However, as the example below demonstrates, there is also commentary of doctors talking as if patients were not there. More information, faster treatment, clear information from doctors. Doctors not talking over you in other languages or arguing about your condition. Doctors: talked in front of patients as if they were not there 2012 2013 2014 2015 31 % 31 % 34 % 28 % As this graph demonstrates, there has actually been a slight improvement in Northern Lincolnshire and Goole s problem score for this question. However, there is not a statistically 18
significant difference between this year and last year s result. In addition, since 2012 the Trust s problem score has always been significantly worse than the Picker average. Nurses Q30. Nurses: sometimes, rarely or never enough on duty All Patients This Trust All Trusts There were always or nearly always enough nurses *There were sometimes enough nurses *There were rarely or never enough nurses 56 % 62 % 32 % 28 % 44 % 12 % 10 % 38 % On this question Northern Lincolnshire and Goole scored significantly worse than the Picker Average. Many of the freetext comments also noted a shortage of nurses. Some examples include: (More staff) the nurses didn't seem to have enough time to administer proper care due to being overworked. Not enough nurses on duty. Care from nurses very good considering the work load 19
2012 2013 2014 2015 Nurses: sometimes, rarely or never enough on duty 2012 2013 2014 2015 On this question Northern Lincolnshire and Goole has actually significantly improved since 2014. However, the Trust s problem score on this question remains statistically worse than average, as it has been since 2012. Your Care and Treatment Q32. Care: staff contradict each other All Patients This Trust All Trusts *Yes, often 8 % 6 % 35 % 31 % *Yes, sometimes 27 % 24 % No 65 % 70 % Feeling unsafe depending who on duty. Some night nurses (agency) were not up to scratch. Not engaging with patients and in one case morose! One contradicted advice of physiotherapist because she liked to get ahead of the physios! I was left feeling very insecure on crutches when still needing zimmer! This is the first of three questions where Northern Lincolnshire and Goole scored significantly worse than this Picker average in the Your Care and Treatment section of the questionnaire. 20
2012 2013 2014 2015 Care: staff contradict each other 31 % 33 % 38 % 35 % Following a steady decline in the preceding three years, Northern Lincolnshire and Goole s problem score slightly improved this year. However, as in 2014, the Trust s 2015 result remains statistically worse than the Picker average. Q33. Care: wanted to be more involved in decisions All Patients This Trust All Trusts Yes, definitely 54% 60 % *Yes, to some extent 36 % 32 % 46 % *No 9 % 9 % 41 % This is the second question within the care and treatment section where the Trust scored statistically worse than average. However, it is also important to note that both the Diana Princess of Wales Hospital and Scunthorpe General Hospital scored similarly. 21
2012 2013 2014 2015 Care: wanted to be more involved in decisions 45 % 50 % 45 % 46 % There is no statistical difference between Northern Lincolnshire and Goole s 2015 and 2014 results. Since 2012, only the 2013 and 2015 problem scores for this question were statistically different to the Picker average. Q34. Care: did not always have confidence in the decisions made All Patients This Trust All Trusts Yes, always 69 % 73% *Yes, sometimes 25 % 21 % 32 % *No 6 % 6 % 27 % This is the third question within the Care and Treatment section where Northern Lincolnshire and Goole NHS Foundation Trust has statistically different results to the Picker average. The Trust has scored 5% higher than the Picker average. The bar chart compares Northern Lincolnshire and Goole s results with the UK Picker Average. This diagram suggests that Northern Lincolnshire and Goole s problem score is towards the top end of the range of responses. 22
Care: did not always have confidence in the decisions made 2012 2013 2014 2015 - - 33 % 32 % This year s result to this Q34 can only be historically compared to 2014. Although there has been a slight improvement from last year, this change is not statistically significant. In both 2014 and 2015, Northern Lincolnshire and Goole scored statistically worse than the Picker Average. Q36+. Care: could not always find staff member to discuss concerns with Patients who had worries or fears This Trust All Trusts Yes, definitely 39 % 41 % *Yes, to some extent 37 % 37 % 62 % *No 25 % 22 % 59 % Although the difference between Northern Lincolnshire and Goole and the Picker average is not statistically significant, this is still a question where the Trust could focus improvement. Many of the freetext responses indicated difficulty in being able to discuss concerns with staff members. For example in response to the question Was there anything that could have been improved? : Communication skills and listening to the patients concerns and family who can probably explain the situation better. 23
Care: could not always find staff member to discuss concerns with 2012 2013 2014 2015 66 % 69 % 67 % 62 % Over the past three years there has been a steady improvement in Lincolnshire and Goole s problem score for this question. This is the first year since 2013 where the Trust did not have a statistically worse score than the Picker Average. Q38. Care: not always enough privacy when discussing condition or treatment All Patients This Trust All Trusts Yes, always 73% 77 % *Yes, sometimes 19 % 17 % 27 % *No 8 % 6 % 23 % No privacy when discussing my condition with doctors. This is another question in the Care and Treatment section of the questionnaire where Northern Lincolnshire and Goole scored 4% worse than the Picker average. In addition, the 24
issue was raised within the freetext comments However, there was no significant difference in responses from the Diana Princess of Wales Hospital and Scunthorpe General Hospital. Care: not always enough privacy when discussing condition or treatment 2012 2013 2014 2015 31 % 30 % 26 % 27 % Between 2012 and 2014 there has been a steady decline in Northern Lincolnshire and Goole s problem score for this question. Operations and Procedures Q47. Surgery: not told how to expect to feel after operation or procedure Patients who had an operation / procedure This Trust Yes, completely 56 % 60 % *Yes, to some extent 29 % 27 % 44 % *No 15 % 13 % All Trusts 40 % 25
In the Operations and Procedures section of the questionnaire, Q47 drew the most negative response, with 44% of patients who had an operation / procedure reporting a less than positive response to the question Beforehand, were you told how you could expect to feel after you had the operation or procedure?. This is 4% worse than the Picker average. Surgery : not always told what to expect or feel after an operation or procedure 2012 2013 2014 2015 39% 54% 40% 44% Between 2013 and 2014 Northern Lincolnshire and Goole saw a statistically significant improvement in patient response to this question and in 2014 the Trust scored better than average on this question. However, during the 2015 survey a larger percentage of patients gave a negative response. Leaving Hospital Q58. Discharge: not always a plan in place for continuing care when transferred All Patients This Trust All Trusts Yes, definitely 46 % 61 % *Yes, to some extent 35 % 50 % 22 % 32 % 26
*No 15 % 10 % Don t know / Can t remember 4 % 7 % This question has been included as Northern Lincolnshire and Goole scored much higher than the Picker average on this question. However, it should be noted that there were only 26 responses to this question and consequently the result should be treated with caution. There is also no historical data for this question. Q59. Discharge: not given any written/printed information about what they should or should not do after leaving hospital All Patients This Trust All Trusts Yes 63 % 67 % *No 37 % 33 % Northern Lincolnshire and Goole Trust scored 4% worse than the Picker average for this question, which is not a statistically significant difference. However, this question was included as an area for improvement because the Trust s problem score for 2015 is significantly worse than it was in 2014. It is interesting to note that respondents from the Diana Princess of Wales Hospital and Scunthorpe General Hospital gave similar responses. 27
Discharge: not given any written/printed information about what they should or should not do after leaving hospital 2012 2013 2014 2015 36 % 37 % 30 % 37 % Between 2013 and 2014, the Trust s response to this question significantly improved bringing the score below that of the Picker average. However, between 2014 and 2015 the problem score significantly increased indicating a less positive experience. Q64+. Discharge: not fully told of danger signals to look for Patients who needed to know about danger signals This Trust All Trusts Yes, completely 39 % 45 % *Yes, to some extent 21 % 21 % 61 % *No 40 % 35 % 56 % Northern Lincolnshire and Goole scored significantly worse than the Picker Average on this question. 28
2012 2013 2014 2015 Discharge: not fully told of danger signals to look for 57 % 64 % 63 % 61 % Since 2013, Northern Lincolnshire and Goole has scored significantly worse than the Picker average on this question. However, there has been a slight improvement in the response to this question but the difference is not statistically significant. Q66+. Discharge: family not given enough information to help Patients whose family or friends needed information on This Trust All Trusts how to care for them Yes, definitely 45 % 49 % *Yes, to some extent 23 % 22 % 55 % *No 33 % 29 % 51 % Northern Lincolnshire and Goole scored 4% worse than the Picker average on this question. In general, the discharge process was an area that was regularly commented upon within the freetext comment section in response to the question Was there anything that could have been improved? Communication generally poor, both patient and carer eg, what tests were made and why and consultant diagnosis options including find diagnosis without consultation. Discharged without consultation with carer and only minimal 29
instructions for after care. shower or phoned my friend to pick me up. 2012 2013 2014 2015 Discharge: family not given enough information to help 50 % 56 % 52 % 55 % There is no significant difference between the 2014 and 2015 responses. However, there has been a slight increase in the Trust s problem score. The Trust has not scored better than the Picker average since 2012. 30
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In summary:- The areas for consideration are:- The two areas we have deteriorated in since 2014:- Hospital: shared sleeping area with opposite sex Discharge: not given any written/printed information about what they should or should not do after leaving hospital And the ranked problems scores based on the largest number of respondents highlighting the issue:- Discharge: not fully told of danger signals to look for Care: wanted to be more involved in decisions Nurses: sometimes, rarely or never enough on duty Admission: had to wait long time to get to bed on ward Doctors: did not always get clear answers to questions Care: staff contradict each other Care: did not always have confidence in the decisions made Doctors: talked in front of patients as if they were not there Hospital: patients using bath or shower area who shared it with opposite sex Hospital: shared sleeping area with opposite sex Finally the questions which mattered most to patients but sit outside the national average, this does not mean that internally we are not making progress with these year on year because out of all these we have improved, barring privacy when being examined which has increased by 1% :- Overall: not treated with respect or dignity Overall: did not always feel well looked after by staff Care: did not always have confidence in the decisions made Care: not always enough emotional support from hospital staff Care: staff did not do everything to help control pain Care: not enough (or too much) information given on condition or treatment Doctors: did not always get clear answers to questions Care: wanted to be more involved in decisions Care: not always enough privacy when being examined or treated Care: could not always find staff member to discuss concerns with 32
If these are then mapped over onto the 17 areas to focus on from the Picker analysis. Admission: had to wait a long time to get a bed on ward Hospital: shared sleeping area with opposite sex Hospital: patients using bath or shower area who shared it with opposite sex Hospital: did not always get enough help from staff to eat meals Doctors: did not always get clear answers to questions Doctors: talked in front of patients as if they were not there Nurses: sometimes, rarely or never enough on duty Care: staff contradict each other Care: wanted to be involved in decisions Care: did not always have confidence in the decisions made Care: could not always find staff member to discuss concerns with Care: not always enough privacy when discussing condition or treatment Surgery: not told how to expect to feel after operation or procedure Discharge: not always a plan in place for continuing care when transferred Discharge: not given any written/printed information about what they should or should not do after leaving hospital Discharge: not fully told of danger signals to look for Discharge: family not given enough information to help This provides a 12 point list to consider. In conjunction with Picker feedback via the forthcoming workshop, PSEG feedback and QPEC comments a comprehensive plan of action will be developed for the forthcoming year. This will help shape improvements and enhance the experience of care. It s not how good you are, it s how good you want to be. 33
Appendix 2 - National Inpatient Survey 2014 Action Plan This action plan includes issues identified within the National Inpatient Survey 2014. The 2015 action plan is currently being developed with group involvement; any outstanding actions will be amalgamated into this new plan. The action plan requires the involvement of all staff that are involved in or supports the delivery of care and services within Northern Lincolnshire and Goole NHS Foundation Trust. Issue Outcome Responsibility Actions Timescale Update Consistency and quality of information given to patients and effective communication Discharge Medications are supported by understandable instruction To ensure through named nurse/named clinician approach information is shared in an understandable manner for patients To support use of medication leaflets and verbal instructions for all patients receiving Chief Nurse Medical Director All Staff Chief Nurse Head Pharmacist ( Oct 15 Kate Woodrow Documentation to approved standards and monitored through audit programme Use of named nurse/clinician boards at bedside Patient Feedback/complaints to evidence issues Continue on-going communication actions monitored via PSEG To identify necessary work to facilitate action through pharmacy and documentation groups Discuss with all Oct 15 Updated March 2015 Revised date June 2016 Dec 15 Updated to March 16 Sept 15 Audit of patient notes on rolling programme 2 sets per ward per month Sept 15 Boards at patient bedsides, needs embedding further Sept 15 Themed analysis of FFT now available/complaints themed Sept 15 Communication monitored via PSEG March 16 Named Nurse board work continues Sept 15 awaiting Medicines Management to update progress Oct 15 - Pharmacy service included on care cards Role of Pharmacy team 34
discharge medication leading on this ) Documentation Lead All Staff managers for dissemination to ward staff re: importance To allow for Pharmacy campaign Updated to June 2016 incorporated into bedside folders Work stream will commence in Pharmacy on providing patients with information on their medicines. March 16 awaiting bedside folder to be rolled out Staff talking over patients as if they were not there Not enough nurses on duty For patients to feel valued and included in any discussions taking place around them For patients to feel assured that there is sufficient nursing time to respond to their needs Chief Nurse Medical Director All Staff Chief Nurse Associate Chief Nurses OD&W Gill s Story to be shared with all managers to share with teams Communication & Marketing team to run campaign across Trust Patients to be involved in feedback to teams if problems continue to be identified Ensure up-to-date staffing levels are published and are based on agreed safe staffing levels criteria Clearly identify the nurse in charge Ensure named nurse approach is embedded 24/7 Continue active recruitment methods Dec 15 July 15 Sept 15 Gills story has been to managers meetings and Q&S day SS&CC Sept 15 Campaign to be launched including patient champion regarding 10 top communication tips via PSEG November 15 10 top tips live within care camp. March 16 Actions complete Sept 15 Trust Board having monthly report on Staffing. Published nationally monthly. Sept 15 Red shift leader badges in use Sept 15 All areas using named nursing. Sept 15 recruitment/retention team have plan of work, monitored via OD&W November 2015 Review of all staff rotas ongoing for each area. Introduction of new Healthcare Band 4 posts. 35