Manchester Royal Eye Hospital Outpatient Improvement Programme Improving choice throughout the patient journey
From humble beginnings The Manchester Royal Eye Hospital was first opened in 1814, over 200 years ago! The founder of the institution was William James Wilson. At the time, the only provider of eye surgery was the Manchester Infirmary, and the surgeon best-known locally for his eye expertise had recently died. William James Wilson founded the Manchester Eye Institution on 21st October 1814 with much local support. Within a year, a second doctor was recruited to help see all the patients who needed eye care and over the course of their first year, they saw approximately 1885 patients! A new building was needed to see all the patients and in 1838 a house was bought, heralding a new name: Manchester Eye Hospital. Royal status was sought and granted by Her Majesty in 1865 and gave us our current name, Manchester Royal Eye Hospital. Over the course of 40 years, growing demand meant the hospital moved twice, doubling beds each time. to a fantastic modern facility In 2009, Manchester Royal Eye Hospital moved once more into a 500 million development just a stone s throw from its previous location. Spread over 3 floors, the hospital now has a 24 bedded ward, emergency centre, five theatres and countless rooms for outpatients and treatments. The hospital is run by over 500 dedicated staff, including over 30 consultant ophthalmologists. Advances in technology and disease research means management of conditions is very different now compared to 1814. We have a dedicated imaging department and in-house specialist optometrists and orthoptists. Our nursing team are also specially trained in ophthalmology. Each year, we receive over 59,000 referrals, see over 231,000 patients in outpatients, treat over 10,000 patients in theatres and cater for 1,200 emergencies! Demand on our limited capacity has never been higher, and it s a testament to the excellence of our ophthalmic expertise and trusted staff. Indeed we get high satisfaction scores, with 98% of patients recommending us.
Introducing the Outpatient Improvement Programme Over the last 12 months, we ve done huge amounts of research in outpatients. Some have been studies calculating times while other research has been discussion based with staff and patients. The other useful variation in the research is that some focusses on what should work better whereas other research focusses on what has worked better, so we know what needs improving further and what has already been proven to work well and should be maintained longer term. Beyond the research, we ve also delivered some changes in outpatients that have profoundly impacted on patient experience. All of these are to be celebrated and we ve outlined just a very small handful here. Listening Case Study: Patient Listening Events + Experience Based Design Patients and carers who had used, or are currently using, services at Manchester Royal Eye Hospital are invited to attend an informal gathering organised by Claire Davies, our Patient Experience and Quality Lead. It is a great opportunity to discuss items such as; how we communicate with our patients and carers, way finding and signage, methods of appointment notification. There is also a free-style discussion for general feedback. We held Patient Listening Events in October 2014 and most recently in September 2015. In February 2016, we also held an Experience Based Design event, with over 100 patients and staff co-designing services with specific focus on patient letters, communication channels, waiting times during clinic and more. The main objective of these events is to provide an opportunity for patients, carers and staff to recommend developments to help improve the experience. Lots of ideas were generated for improvements we could make in the future.
There have been two themes from the research. The first was one of choice: patients want to be able to choose how they interact with the hospital and its staff over the course of their journey, from booking appointments all the way to discharge information. A second theme was patients are incredibly proud of hospital staff in all groups, but find the processes antiquated, inefficient and inflexible. The approach of the Patient Listening Events and Experienced Based Design Events has been incredibly well received, and we promise to do more in the future. Listening Case Study: Extending Patient Experience Trackers Patient experience trackers (PETs) are an extremely quick and easy way of collecting live patient feedback. We ve been able to make some improvements for patients based on the feedback offered through the trackers and we want to capitalise on early success. It s important that we get feedback in enough volume to enable a useful analysis. As such, the hospital has invested on two fronts. Firstly, the feed your PET campaign saw response rates increase more patients and carers were using them. Secondly, the hospital has purchased additional trackers, for all the outpatient areas and also our off-site clinics in Altrincham, Trafford and Withington. Having PETs in all areas enables staff to get accustomed to encouraging patients and carers to complete the survey. This enables us to detect specific opportunities for improvement in each area and for data to be looked at over time for trends or patterns. We re proud to have extended the PETs across all outpatients and, more importantly, using the information they collect to drive improvement.
Listening Case Study: Time in Motion in the Macular Treatment Centre Our teams have worked hard so patients only need to attend a single appointment, made up of multiple steps. We call this a one-stop-shop. The perception is that waiting times are coming down between appointments on the same day, though we don t have any robust evidence of this across all departments. In September 2015, staff in the Macular Treatment Centre conducted a time in motion study to audit the total time patients are in the department as well as how much time is spent waiting. This study provided very interesting results. Each patient spent an average of 51 minutes with clinical staff undertaking tests, assessment and having treatment. In addition, the same patients spent an average of 1 hour 50 minutes in the waiting room. This audit demonstrates that patients are waiting too long in clinic. We ve had some ideas to reduce waiting times which we are going to deliver in the Outpatient Improvement Programme. Improving Case Study: Patient Pagers Outpatient departments have been highlighted as a high priority, specifically patient waiting times and how we should not only keep patients informed, but also provide the ability to leave the clinic environment without the fear of missing their appointment. The pager system allows patients and their carer or family the freedom to leave the clinic environment for refreshments, move outside to make phone calls or get a breath of fresh air without the fear of missing their appointment. Following a very successful trial in Clinic B and 2 other areas, we ve purchased enough units for patients to use across all nine outpatient clinics. Patients absolutely love the freedom the pagers provide.
The Twelve Outpatient Standards The Outpatient Standards were developed by the Consultants for Change group, a team of seven consultants from across all the Central Manchester Hospitals. Manchester Royal Eye Hospital is proudly adopting these standards with support and much appreciated guidance from the Transformation Team. These standards are supported through an operational policy and Manchester Royal Eye Hospital has assessed performance against these in June 2015 and January 2016. If you d like to see the results, get in touch with Glyn Wood, Business Development Manager at glyn.wood@cmft.nhs.uk 1 We will be caring and professional in our delivery of your care 2 We ask that you are courteous and respectful towards our staff behaviour 3 We aim to see you in the most appropriate clinic with all the relevant medical information 4 Before clinic we will supply clear information about the appointment and what to expect 5 Our staff will be present throughout your clinic journey to help and guide 6 We will ensure outpatient areas are clean and maintained to a high standard 7 Our target is to see you within 30 mins of your scheduled appt time. We will keep you informed of any delays 8 We will listen to you and plan your care with you 9 We will offer you a choice on where and how we deliver your care whenever possible 10 You and the relevant care professionals involved in your care will receive a clinic letter within 5 working days of your visit 11 Your appt will not be cancelled at less than 4 weeks notice 12 We will continually strive to improve our delivery of care based on your feedback
Space for Your Notes or Ideas Now you know a little about how we ve researched and improved over the last 12 months, we re proud to tell you want we want to achieve in the next year or two. The next few pages give you more detail
The Outpatient Improvement Programme Through our research, we ve identified over 30 different projects. We ve then put these projects into 5 distinct groups. In each group the projects are similar or dependent on one another. To ensure each project is progressed as quickly and safely as possible, five Working Groups will be formed, each consisting of staff from all disciplines, and patients if they would like to coproduce services. These groups are illustrated below. This is an incredibly ambitious agenda, sure to test what we are capable of. Therefore, it is imperative an overarching Board monitors the five Working Groups to keep the project work on track and supported. The Board will consist of a small multi-disciplinary team. Each Working Group has the opportunity to revolutionise a part of the outpatient journey, from the time the patient is first referred by their GP or optician, right up until leaving after their final appointment. Our Outpatient Improvement Programme will be the first in the hospital to offer patients the option of joining as a professional. So many patients have so warmly provided feedback and had such great ideas it made sense for patients to work alongside staff on a regular basis.
What do we actually plan to do in these Working Groups? Health Records The purpose of this working group is to ensure that when patients attend clinic, their clinician (and his/her team) has access to all the relevant medical information they need to conduct a complete and comprehensive discussion. Clinicians will have sufficient information about their patient s history to be confident in their proposals for treatment. Patient Access The purpose of this working group is to dramatically extend the ability for patents to contact the hospital to find answers to their questions. The focus of the team will be to ensure patients have a large choice of methods to contact the hospital, while also providing a speedy and accurate response. Patient Flow and Expectations The purpose of this working group is two-fold. Firstly, we want to ensure patients are empowered to understand the specific activities they will be asked to participate in during their appointment, how long they would be here and what their appointment will achieve for them. This will be known before the appointment. In addition to and in tandem with this, the working group will investigate and deliver changes which improve efficiency during appointments which have multiple stops, reducing the waiting times between each step and ensuring patients are always aware of any waiting times. Specialist Customer Care The purpose of this working group is to capitalise on and enrich those elements patients say we excel in already, that being fantastic staff who are caring, considerate and compassionate with patients. Clinic H The purpose of this working group is to conclude staff and patient consultation on changes to the physical environment in Clinic H to provide additional clinical rooms/space and enhanced patient comfort. Based on this consultation exercise, a plan for implementing those changes will be developed and managed to completion, with minimal impact on clinical activities.
Space for Your Notes or Ideas Getting Involved The success of a programme as large and ambitious as the Outpatient Improvement Programme will be dependent on the energy and enthusiasm of staff and patients. We ve a great foundation to work from and every individual has a key role to play. Quality of care and patient experience lie at the heart of everything we do at the Manchester Royal Eye Hospital. All staff are invited to support this programme by being experts in their roles and sharing in developments, committing to learning about the changes coming ahead and, most importantly, enjoying working together. If you d like to learn more about the Outpatient Improvement Programme or join as a Work Group Member, please get in touch with Glyn Wood, Business Development Manager at glyn.wood@cmft.nhs.uk