Patient Experience Strategy Published: June 2017 Find us online at cornwallft
1.Introduction At Cornwall Partnership NHS Foundation Trust (CFT) we believe in delivering high quality care. We care deeply about the quality of the care our patients, their carers and families receive from us. While we know and accept we don t always get it right, with the ongoing development of this strategy our plan is to maintain a cycle of continual listening, learning and service improvement; working together with our patients and partners in care, to ensure the precious feedback and intelligence from experience is routinely captured, and put to use most effectively. 2. What is patient experience? When we talk about making sure people have a good patient experience we mean doing more than just meeting their physical needs, we need to meet their emotional needs too by: providing high quality care in a comfortable, caring and safe environment, delivered in a calm, compassionate, respectful and reassuring way; giving people information, achieving high standards and enabling people to make choices, feel confident and in control; actively listening and talking with people, empowering them as an equal; treating them with openness, honesty, respect, and with dignity. Being a carer can be isolating and having your service makes me feel less alone. The people I have come in to contact with seem to understand my concerns and worries. It is a very important service for people like me who are struggling with a caring role. Carer for a patient of CFT 1
Why is patient experience important? Our overarching aim is to ensure patients, their families and carers receive an experience that not only meets but exceeds their expectations of services at the Trust. data could have indicated problems at an early stage) Putting Patients back in the Picture a national review into complaints handling by Ann Clwyd, MP and Professor Tricia Hart, focuses on four areas for change: improving the quality of care improvements in the way complaints are handled improving access and responsiveness A problem has to be believed and taken on board seriously instead of simply dismissed, before it can be looked at and resolved. Patient of CFT High quality patient, carer and family experience: is a right under the NHS Constitution for England greater perceived and actual independence in the complaints process whistleblowing. We want to demonstrate that the Trust is able to listen and respond to the views of patients, their families and the local community and to use feedback constructively and innovatively to inform local service improvements. While setting some further key objectives, this updated strategy is not meant to be definitive: the Trust also encourages new ideas and creativity from staff and partners in terms of improving patient experience. helps the Trust maintain and increase public confidence contributes to sustaining the Trust s reputation as a healthcare provider of choice increasingly important in a financially constrained and competitive environment is a key component of high quality care has been linked to reduced healthcare costs has been linked to better health outcomes forms part of the Trust s Quality Account can be an early warning for poor quality care (reviews at eg Mid Staffordshire NHS Trust have shown that a greater focus on patient experience 2
3. Aim of the strategy The aim of this refreshed strategy is to continue to develop a culture throughout CFT that places the quality of patient experience at the heart of all we do: where seeing the person in the patient is the norm. The work we have done over the past few years has positioned us to: deal with concerns promptly, by talking with patients and carers as soon as we are aware of their need for help. We spend as much time as it takes, listening so that we fully understand problems, and offer choice in methods of resolution, designed to best meet the needs of the people involved Local context The Trust s vision is to be a first class provider of services, offering top quality care in every way. The importance of patient experience and public involvement features strongly in the Trust s values and behaviours: Our values and behaviours: Delivering high quality CARE. C Compassionate services A Achieving high standards R Respecting Individuals E Empowering People regularly with our external stakeholders; gathering feedback from patient and carer representative groups, and updating on actions taken as a result of this feedback; we will be engaging with patients, carers and staff in the coming weeks to agree how we might do this better. We will look at countywide and local solutions design a wide range of bespoke Meridian patient feedback surveys which are actively used throughout the Trust National Context Government policy places an emphasis on the importance of personalising services particularly within healthcare, where patient experience is recognised as an equal partner to safety and effectiveness in achieving quality. I feel extremely lucky and grateful to have been given help by some amazingly special individuals. Patient of CFT 3
Our values and behaviours are based on feedback and ideas shared by Trust staff, patients, carers, Governors and the partners we work with as a result of an extensive consultation. These are the values we will embrace when liaising with our patients, carers and families, our partners and each other at work. Through these values we aspire at all times to deliver high quality care. Our values are important to us in everything we do: how we behave with patients, their carers, the partners we work with and with each other our business and service planning and how we all make decisions the selection and appointment of colleagues with the same values to work in the Trust staff experience at work, including induction and training, appraisal, communication, problem solving and organisational change Equality and diversity We need to take positive action to make sure all patients, and visitors to the Trust have good experiences and can influence the services we provide. Cornwall has a diverse community and we have a commitment to working with representatives of all communities to provide accessible and appropriate services. Working with partners We need to continue to work closely with partners such as NHS Kernow, local authority social care services, and voluntary and community sector organisations, to make sure the services we deliver are accessible, appropriate and joined up. The patient experience cycle We believe the six key areas set out below need to be addressed in order to capture measure and improve patient experience. 4
Measuring experience, not satisfaction Simply collecting information in itself has no value; it is how the information is used that matters. Patient satisfaction and the perceptions of the public are important, however the information we can use to really transform services comes from the experiences of people using those services. When scrutinizing the evidence presented and actions taken as a consequence, our Board is seeking assurance not reassurance. As well as being efficient professionals, these people really are the epitome of compassion and caring. Through gentle and tireless persistence these members of staff have taught me the principles and how to apply them. Patient of CFT 4. Strategic objectives We will build on our existing work over the past three years. Using Meridian, we will continue to further develop robust systems and processes for gaining both quantitative and qualitative feedback from patients. This means gathering lots of information about how people feel about the services we deliver on a regular basis. Collating information from across the Trust to benchmark services, measure performance, inform commissioners about service quality, improve public accountability and provide evidence for regulators; asking people what it is like to use a service and where issues and problems may lie. This also involves using methods such as interviewing patients and their families to capture their personal stories...waiting room could be set up in a more service user way. Posters, whilst useful, can be overwhelming. Maybe some more positive pictures? Information could be kept in folders for people to access Patient of CFT 5
Objective 1: Every service within the Trust will use patient experience to gain insight and identify opportunities for improvement. It is important that all services within the Trust see how they contribute either directly or indirectly towards a positive patient experience. Each area needs to reflect on the feedback we get from patients and carers to identify opportunities for improvement. The delivery plan to establish a Patient Experience Group (or work with an existing complementary structure eg, patient safety) with membership from the operational services, setting standards, and sharing learning across the Trust focus on patient experience to reduce the Trust s top five reported incidents, beginning with disruptive, aggressive behaviour and then focusing on tissue viability focus on supporting corporate teams, building in patient experience to committee s terms of reference; in particular the Strategic Education Group, the Prevention and Reduction of Restrictive Interventions Group, and the Patient Safety Collaborative Objective 2: To develop a methodology to demonstrate changes in practice through feedback from patient experience. You Said We Did, and enable holistic, thematic reviews of patient experience feedback. The delivery plan to further develop a quality dashboard to demonstrate the effective gathering and use of patient feedback in service development and improvement across all service areas; this will need to be co-designed with patients and staff to develop a mechanism to synthesise the collection of all forms of patient experience data; this will need to be codesigned with patient experts and staff to feedback to patients and their representatives on a regular basis. Further work is required to find the best way of presenting this information so messages are heard to review Trust public engagement structures in collaboration with patients, carers and staff to develop a more fit for purpose approach. This will require co-design work with operational services Keep to set dates and times. Keep correct details of clients. If you cancel make sure you have right info because in some of our circumstances it makes us feel worse off when we have been thrown to the side - it s disheartening. to continue with the development of a library of short films and the collection of patient stories, for use in staff training and for the Trust Board and other key meetings Patient of CFT 6
Objective 3: Building on our previous work; to continue to analyse complaints and PALS data to inform service improvement Patient feedback, concerns and complaints provide an opportunity not only for us to put things right where they have gone wrong but also to learn important lessons and develop new approaches in order to improve our services. We also recognise the way in which we handle complaints can either improve the experience of patients or indeed worsen it. The delivery plan To establish a Complaints Review Group to review the handling of a sample of actual complaints from start to finish reviewing the actions and any service development; looking for assurance that Trust-wide learning has taken place as a result. To raise the profile of the work of the independent investigators, and support them as a group. Objective 4: To develop Trust-wide training for staff on PALS and complaints. We recognise the way in which we handle complaints can either improve the experience of patients, or indeed worsen it. The delivery plan: to explore the development of complaints handling training for staff to highlight training needs from theme based analysis eg customer care and communication skills training 7
Appendix 1: The patient experience data collection should be: service and locality specific in real time or near time wherever possible carried out on an on-going basis as part of everyday service delivery use quantitative methods to identify themes and trends use qualitative methods for more indepth research into patient experience accessible to patients in terms of the method and language used shared with staff to help involve them in identifying solutions Patient experience data needs to be analysed rigorously and the actions arising should be informed by other data, such as complaints, serious incidents, safeguarding, PALS and by staff feedback. The patient experience cycle: Choosing the right patient experience tool: Services should consider what patient experience collection methods they should use. One size does not fit all, and the methods chosen need to be appropriate to the service and patient group. We need to use quantitative methods to provide ongoing monitoring of patient experience for quality and performance purposes and qualitative methods to enable more indepth patient/carer engagement and investigation of experiences, attitudes and beliefs. The Patient Experience Team are available to support colleagues and pick up specific pieces of work as required eg. Semi structured interviews post restraint; values based recruitment as assessment days. 8
Quantitative patient experience surveys comment cards online surveys telephone surveys hand-held electronic devices eg tablets Qualitative focus groups one to one interviews patient diaries / patient stories / videos patient panels Action plans Collecting patient experience data is the start of a process not the goal. Data must be analysed to identify areas of excellence and areas for further investigation or service improvement. The results should be reported in a format that can be easily read, understood and then acted on by teams. Action plans based on patient feedback must have: actions that are SMART (Specific, Measurable, Achievable, Realistic and Time-bound); actions that focus on improving the way services are delivered in order to improve patient experience for the greatest number of patients Completed action plans should be forwarded to the Patient Experience Team to enable the patient experience database (Safeguard Ulysses) to be updated with evidence. 9
Appendix 2(a): NICE Quality Standard 15 List of quality statements Statement 1. Patients are treated with dignity, kindness, compassion, courtesy, respect, understanding and honesty. Statement 2. Patients experience effective interactions with staff who have demonstrated competency in relevant communication skills. Statement 3. Patients are introduced to all healthcare professionals involved in their care, and are made aware of the roles and responsibilities of the members of the healthcare team. Statement 4. Patients have opportunities to discuss their health beliefs, concerns and preferences to inform their individualised care. Statement 5. Patients are supported by healthcare professionals to understand relevant treatment options, including benefits, risks and potential consequences. Statement 6. Patients are actively involved in shared decision making and supported by healthcare professionals to make fully informed choices about investigations, treatment and care that reflect what is important to them. circumstances, their ability to access services and their coexisting conditions. Statement 10. Patients have their physical and psychological needs regularly assessed and addressed, including nutrition, hydration, pain relief, personal hygiene and anxiety. Statement 11. Patients experience continuity of care delivered, whenever possible, by the same healthcare professional or team throughout a single episode of care. Statement 12. Patients experience coordinated care with clear and accurate information exchange between relevant health and social care professionals. Statement 13. Patients preferences for sharing information with their partner, family members and/or carers are established, respected and reviewed throughout their care. Statement 14. Patients are made aware of who to contact, how to contact them and when to make contact about their ongoing healthcare needs. Statement 7. Patients are made aware that they have the right to choose, accept or decline treatment and these decisions are respected and supported. Statement 8. Patients are made aware that they can ask for a second opinion. Statement 9. Patients experience care that is tailored to their needs and personal preferences, taking into account their 10
Appendix 2(b): NICE Quality Standard 14 for service user experience in adult mental health List of quality statements Statement 1. People using mental health services, and their families or carers, feel optimistic that care will be effective. Statement 2. People using mental health services, and their families or carers, feel they are treated with empathy, dignity and respect. Statement 3. People using mental health services are actively involved in shared decision-making and supported in selfmanagement. Statement 4. People using community mental health services are normally supported by staff from a single, multidisciplinary community team, familiar to them and with whom they have a continuous relationship. Statement 5. People using mental health services feel confident that the views of patients are used to monitor and improve the performance of services. Statement 6. People can access mental health services when they need them. Statement 7. People using mental health services understand the assessment process, their diagnosis and treatment options, and receive emotional support for any sensitive issues. Statement 8. People using mental health services jointly develop a care plan with mental health and social care professionals, and are given a copy with an agreed date to review it. Statement 9. People using mental health services who may be at risk of crisis are offered a crisis plan. Statement 10. People accessing crisis support have a comprehensive assessment, undertaken by a professional competent in crisis working. Statement 11. People in hospital for mental health care, including patients formally detained under the Mental Health Act, are routinely involved in shared decision-making. Statement 12. People in hospital for mental health care have daily one-toone contact with mental healthcare professionals known to the patient and regularly see other members of the multidisciplinary mental healthcare team. Statement 13. People in hospital for mental health care can access meaningful and culturally appropriate activities 7 days a week, not restricted to 9am to 5pm. Statement 14. People in hospital for mental health care are confident that control and restraint, and compulsory treatment including rapid tranquillisation, will be used competently, safely and only as a last resort with minimum force. Statement 15. People using mental health services feel less stigmatised in the community and NHS, including within mental health services. 11