SOUTHAMPTON UNIVERSITY HOSPITALS NHS TRUST 2010 National Inpatient Survey Report July 2011 Report to: Trust Board - 2 nd August 2011 Report from: Sponsoring Executive: Aim of Report: Joanne Dimmock, Head of Patient Partnerships and Information and Julia Barton, Associate Director of Nursing & Patient Experience Judy Gillow, Director of Nursing and Patient Services 1) To report the findings of the 2010 National Inpatient Survey Trust report. 2) To identify trends and compare outcomes of the survey with the 2010 survey. 3) To approve the proposed action plan based on those areas where the Trust falls in the lowest quartile or has deteriorated since 2010. Review History to Date: TEC 8 th June 2011; Patient Experience Steering Group 29 th June 2011 Assurance Framework: PO1c; PO2b; PO2G Recommendations: Recommendations from TEC : Noted that areas of poor performance were in the 2011/12 PIF. Approved the proposed actions for improvement. 1.0 SUMMARY Trust Board members are asked to note : The trends in the survey and ratify the proposed process and actions for improvement agreed at TEC in June 2011. Identify any areas that require further assurance/information. 1.1 The Trust receives two separate reports on it s annual Inpatient Survey results: An internal report from the Picker Institute, our survey provider, showing the actual number and percentage of responses to each element of the questions. It also includes data from previous years for comparison and highlights those differences that are statistically significantly better or worse than the previous year. This report enables benchmarking with 75 other Trusts who also use Picker as their survey provider. A national report from the Care Quality Commission which enables comparison of results between Trusts, and is available in the public domain. This report shows results in three RAG d sections which are : o o o The lowest scoring 20% of Trust (red) The middle scoring 60% of Trusts (orange) The highest scoring 20% of Trusts (green) This report enables benchmarking with 161 acute and specialist healthcare providers.
1.2 In comparison with the 2009 Inpatient Survey results, the 2010 Survey reveals that the Trust is an average performer overall, but has deteriorated in some areas: 59% of the 88 questions demonstrate no statistically significant change 36% demonstrate statistically significant deterioration 0% demonstrate statistically significant improvement. 3 of the 66 questions are in the top 20% of trusts 12 are 1 point off the top 20% 40 are in the middle 60% 23 are in the bottom 20% Overall, this position indicates that despite significant patient experience improvement programmes in 2010, the trust still faces significant challenges in ensuring these are not only represented in local real time patient surveys but also in the national survey. 1.3 The areas in the bottom 20% cluster into several key themes : Patient information/communication regarding medication, pre and post clinical procedure. Hospital food Choice of admission Delayed discharge Ward environment noise at night and same sex agenda 2.0 INTRODUCTION TO THE NATIONAL REPORT 2.1 This report presents the results of the eighth survey of adult inpatients in NHS trusts in England, which involved 161 acute and specialist NHS Trusts. The Care Quality Commission (CQC), the independent regulator of all health and adult social are in England published the results on 21 April 2011. 2.2 Nationally, responses were received from more than 66,000 patients with a response rate of 50%. Participants were all 16 years or older, had at least one overnight stay during August 2010 and had not been admitted to paediatric, maternity or psychiatric departments. The survey was carried out in October 2010 so there is the potential for a 2-3 month time lag between experience and survey. The Picker Institute state confidence in reliable answers despite this time lag however current inpatients always rate their satisfaction more positively in the Trust s real time survey. 2.3 The results facilitate benchmarking for each trust, demonstrating areas of strength and those requiring further improvement. Questions are grouped under the following sections: Admission to Hospital The Hospital and ward Doctors Nurses Your care and treatment Operations and procedures Leaving Hospital Overall experience About you 2
2.4 Survey scoring is calculated according to trust best responses out of 100, so a score of 80 does not mean 80% of patients, rather a score for that question of 80 out of a possible maximum of 100. Not all questions are scored, some are filter questions designed to filter out respondents to a corresponding set of questions. Confidence intervals are calculated, creating a measure of how accurate scores are if all potential patients had been questioned (i.e. we can be 95% certain that if all patients had been surveyed, the true score would fall within this interval). 3.0 SUHT METHODOLOGY AND SAMPLE 3.1 A total number of 850 patients discharged in August 2010 were sent postal questionnaires to their home addresses with a covering letter from the Director of Nursing and a language sheet and freepost envelope. Non-responders were sent a reminder card after 2 weeks and a repeat questionnaire after a further 2 weeks. 3.2 The Picker Institute runs a free phone helpline which includes immediate access to interpreters in over 100 languages. 3.3 Of the 850 patients identified for the sample, 823 were eligible and 405 returned a completed questionnaire, giving a final response rate of 49%. The national response rate was 50%. 3.4 In 2009, the response rate was 53%, compared with 52% for all Trusts. 4.0 RESULTS 4.1 Overall Results 4.1.1 Overall 64 questions were subject to scoring and benchmarking. There were no questions which did not meet 95% confidence intervals. 4.1.2 The results demonstrate deterioration from the 2009 Survey in terms of an increase in the number of responses in the red category. There were more responses in the amber category in 2009 and 2010 compared with 2007 and 2008. RAG Rating 2007 Survey 2008 Survey 2009 Survey 2010 Survey RED: Rated as being in the lowest scoring 20% of trusts 10 (16%) 8 (13%) 6 (9%) 11 (17%) GREEN: Rated as being in the highest scoring 20% of trusts. 5 (8%) 8 (13%) 1 (2%) 1 (2%) AMBER Responses fell within the middle scoring 60% (orange) of trusts, 47 (75%) 46 (74%) 57 (89%) 52 (81%) 3
4.2 Results in top 20% of Trusts Do you think hospital staff did everything they could to help control your pain? Results on or one point below the threshold for top 20% Trusts Were hand wash gels available for patients and visitors to use? Were you given enough privacy when discussing your condition or treatment? Did you feel you were involved in decisions about your discharge from hospital? Results in bottom 20% of Trusts Were you given a choice of admission dates? Were you bothered by noise from staff at night? Did you use same bathroom or shower as patients of the opposite sex? How would you rate the hospital food? Did you get enough help from staff to eat your meals? Did staff explain the risks and benefits of the operation or procedure? Did a member of staff explain what would be done during the operation or procedure? Did a member of staff answer your questions about the operation or procedure? Were you told how you could expect to feel after the operation or procedure? What was the main reason for your delayed discharge? Did you receive clear written information about your medication? Results on or one point away from the bottom 20% of Trusts Were you given enough privacy when being treated or examined in A&E? How do you feel about the length of time you were on the waiting list? Did you ever share a sleeping area with patients of the opposite sex? Were you ever bothered by noise from other patients? How clean were the toilets and bathrooms that you used in hospital? Did you have somewhere to keep your personal belongings whilst on the ward? Did you see patient/visitor hand wash posters or leaflets on the ward? Did doctors wash or clean their hands between touching patients? Did a member of staff say one thing and another say something different? Were you given enough privacy when discussing your condition or treatment? Did a member of staff explain how your operation or procedure had gone? How long was the delay to discharge? Did hospital staff explain the purpose of the medicines you were to take home? Did a member of staff tell you about the medication side effects to watch for? Were you told how to take your medication in a way you could understand? Did hospital staff give your family or someone close to you all the information they needed? 5.0 SUMMARY OF CQC CHANGES 5.1 Appendix A includes the results by question for each annual survey from 2006 to 2010. When comparing 20 09 and 2010 results, analysis demonstrates improvement on 17 questions (26%), deterioration on 31 questions (48%) and no change for 16 questions (25%), however when reviewing results over the last 6 years, it is clear that some of these changes are not statistically significant, but rather reflect normal variation parameters. The following section details those results which are deemed to be statistically significant. 4
6.0 PICKER SURVEY STATISTICALLY SIGNIFICANT CHANGES IN 2010 6.1 The Picker Institute produces a detailed report of the 2010 In Patient Survey, which enables further analysis by showing the actual number and percentages for each question. The Picker Institute carries out the Inpatient survey for 75 Trusts so a further opportunity for benchmarking presents. 6.2 Confidence In Care and Treatment at SUHT 89% of patients at the Trust rate their care as good, very good or excellent 90% say doctors and nurses worked well together 91% said wards were very or fairly clean 85% who used toilets said they were very or fairly clean 88% always had enough privacy when examined or treated A significant improvement on staff respecting patients religious beliefs 5
7.0 SUMMARY OF QUESTIONS IN BOTTOM 20% OF CQC SURVEY AND/OR WITH SIGNIFICANT DETERIORATION FROM PICKER ANALYSIS (E.G. ITEMS FOR ACTION) CQC Bottom 20% 72% not given choice of admission dates 26% of patients experiencing noise at night from hospital staff 28% of patients reported sharing bathrooms and toilets with opposite gender 53% of patients reported hospital food fair or poor 8% not getting help to eat meals (24% not getting help of those who said they needed It) Deterioration In all aspects of communication and information about operations and procedures 45% of patients reported a delayed discharge 25% of patients not being given clear written information about their medications on discharge Picker Statistically Significant Deterioration Hospital Food Fair or poor 41% of patients did not get the food they ordered 19% of patients not being told how to take medications clearly on discharge 8.0 IMPROVEMENT PLANNING PROCESS AND ACTIONS The Trust will take action on those questions falling in the bottom 20% of Trusts as per the CQC benchmark report, and on those where there has been a statistically significant deterioration since the 2009 survey as detailed in the Picker analysis. These areas are summarised in section 7 above. A detailed presentation by the Picker Institute on the survey results was held to Trust staff in May 2011. The survey data has been broken down to division and specialty level and will now be distributed to care groups and divisions to ensure appropriate development of local action plans within the key areas identified. 6
The Patient Experience CQUIN outcomes from the survey were reported in the May/June 2011 Quarterly Patient Experience report. The majority of the areas identified by the survey do not represent new priorities for improvement and many are already included in Trust wide targets and plans. These are: Area for Improvement Choice of admission dates Patients experiencing noise at night from hospital staff Patients reported sharing bathrooms and toilets with opposite gender Patients reported hospital food fair or poor Patients not getting help to eat meals Deterioration In all aspects of communication and information about operations and procedures Trust Action in Progress Previously reported in Patient Experience Q Report. Local Care group Action Plans in Place Monthly monitoring by real time survey and results fed back to care groups matrons. PIF Priority 2010-11 Revision of KPIs Medirest Actions Contract Management Protected Mealtime and Red Tray in place. Minimal awareness of deterioration in patient satisfaction in this area to date. Priority of this issue raised with Divisions. Action Planned Individual Care Groups to Analyse Data and develop local improvement plans. Care groups to continue to deliver local action plans. Night rounds commenced New criteria to be drawn up PIF priority for 2011-12. Care groups to take local actions based on real time survey. PIF Priority 2011-12 KPI monitoring Monitoring of Q Medirest survey Monitor compliance with protected mealtimes Care groups to analyse detailed survey data and develop action plans for improvement Progress Reporting 1) Quarterly by Care group and Div Governance Committees 2) 6-monthly by Div reports to 3) Exception reports to Quarterly Performance Review 1) Monthly by CG Gov 2) Q By Div. Gov 3) 6- monthly by Div reports to 1) Monthly by CG Gov 2) Q by Patient Exp report to TB 3) 6- monthly by Div reports to 1) Catering Standards Operational Group 2) Catering Overview Group 3) Work with Members Council 1) Matrons Peer review 2) Monthly at CG Gov Committees 3) Q at Div Gov Committees 4) Q at Nutrition Steering gp 5) 6-monthly at 1) Monthly by CG Gov 2) Q By Div. Gov 3) 6- monthly by Div reports to Patients reporting a delayed discharge 25% of patients not being given clear written information about their medications on discharge Local plans to minimise delayed discharge in place. Similar to a question in CQUIN for patient Experience Care groups to analyse detailed survey data and develop action plans for improvement Plan specific improvement initiatives to be delivered by July 2011 in order to affect 2011 survey results 1) Monthly by CG Gov 2) Q By Div. Gov 3) 6- monthly by Div reports to Lead for medication safety to review survey data and work with care groups on specific improvement plans. 1) Monthly by CG Gov 2) Q By Div. Gov 3) 6- monthly by Div reports to 7
9.0 SUMMARY AND CONCLUSIONS Overall the 2010 Inpatient Survey demonstrates there have been a small number of improvements and slightly higher levels of deterioration than in previous years. This however may reflect normal variation limits. The majority of responses indicate the trust remains with the middle 60% of benchmarked trusts which is a similar picture to previous years. For some questions, the survey does not represent significant improvement or deterioration over the last 6 years, which reflects national trends. To address concerns about this, the Department of Health are currently undertaking a review of the questions and methodology used for the National Inpatient Survey. Future approaches are likely to reflect the new NICE standards for patient experience which are due to be publicised for consultation in June 2011. This report has provided a summary of the key areas from the survey for improvement as identified in section 7. The proposed actions and process for monitoring and reporting delivery of these are detailed in section 8. Care groups and divisions will now need to analyse their own specific results and develop local improvement plans as indicated. This final Trust Board report will be submitted to commissioners to comply with the 2011/12 schedule 3 (4) requirements. 8
Appendix A: CQC Benchmark Report Question Comparison Charts 2006 to 2010 Admission to hospital The hospital & ward Doctors Nurses Q 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 2006 65 - - - 66 78 16 88 80 57 53 61 73 76 69 - - 52 90 65 83 90 80 86 76 82 85 67 82 2007 74 83 63 23 49 75 20 87 80 65 51 62 75 78 71 95 58 55 91 68 81 89 80 77 83 86 88 69 83 2008 80 87 64 22 62 84 20 91 80 66 57 61 76 84 77 98 57 55 89 82 83 90 80 86 82 88 86 74 88 2009 82 86 64 65 81 19 92 77 81 70 58 73 84 80 97 58 Q changes 80 90 83 86 78 83 87 72 88 2010 82 83 61 61 81 18 92 75 84 67 55 73 85 80 96 61 81 89 83 83 79 86 87 72 88 Your care & treatment Operations & Procedures Leaving Hospital Q 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 2006 75 67 73 60 55 75 91 82 63 87 80 82 66 89 72 62 76 81 41 69 42 50 71 28 2007 78 71 78 60 56 79 91 85 62 92 85 87 68 91 76 64 67 79 62 82 43 86 72 50 50 74 28 2008 81 70 80 64 65 81 94 84 63 92 85 85 69 88 76 69 60 76 64 83 45 84 74 48 56 77 43 2009 79 70 77 64 55 79 94 84 61 88 83 86 68 91 77 67 55 70 67 85 44 84 74 49 56 75 49 2010 76 69 76 64 61 79 95 87 62 85 79 80 66 90 75 71 57 73 66 81 41 80 70 49 52 74 43 Overall Experience Q 57 58 59 60 61 62 2006 83 74 73 4 13 2007 86 76 77 5 33-2008 91 79 80 8 48 94 2009 87 77 78 10 38 92 2010 88 76 77 12 45 92 CQC Scores 2009 to 2010 Improved: n= 17 (26%) Worse: n= 31 (47%) 9
10 Same: n= 16 (25%)