SUMMARY REPORT - TRUST BOARD MEETING (PART 1): 31 st October 2012 Report Title: Executive Sponsor: Report Authors: Report discussed previously at: Meridian Electronic Patient Feedback System Steve Trenchard Executive Director of Nursing and Patient Experience Steve Trenchard Executive Director of Nursing and Patient Experience No previous discussion Purpose of the Report and Action Required To update the Board and provide assurance regarding the use of the recently implemented electronic patient feedback system. Approval Discussion Information Summary of Key Issues All CSUs have implemented the Meridian system. Further work to undertake regarding governance of question setting (frequency, autonomy). System provides a range of immediate and accessible formats for feedback on which improvement action can be taken. Relationship to Trust Corporate Objectives C01: To provide a safe and effective service. C02: To deliver excellent personalised care, treatment and support. C03: To become a provider of choice. C04: To continuously improve the quality and productivity of our services. C05: To build an engaged workforce that is focussed on recovery and the needs of service users and carers. Relationship to the Board Assurance Framework Risk reference: Are any existing risks in the Board No Assurance Framework affected? Do you recommend a new entry to No the Board Assurance Framework (i.e. Trust-wide level 1 risk) is made?
Corporate Impact Assessment OR Board Statements: Assurance(s) against: Legal and regulatory implications The Trust is required to achieve high levels of performance to meet CQC Regulatory Framework. Financial Implications No Equality and Diversity Public, Service User and Carer Performance Management Communication The Trust is committed to providing services of an equally high standard across all groups of patients and this system with enable this to be measured and reported on. The system will be available to members of the public as visitors to the Trust services, carers and patients. Meridian will become an essential component of monitoring patient experience. No Relevance of Report to Monitor s Quality Governance Framework Strategy 1a Quality driving the Trust strategy 1b Potential risks to quality Capabilities and Culture 2a Board leadership, skills & knowledge 2b Promote a quality focussed culture Processes and Structure 3a Roles & accountabilities for quality governance 3b Escalating & resolving issues / managing poor performance 3c Engage patients, staff, other key stakeholders in quality agenda Measurement 4a Quality information is analysed & challenged 4b Robustness of quality information 4c Quality information is used effectively Acronyms / Terms used in the report Attachments Page 2 of 10
TRUST BOARD MEETING (PART 1) 31 st OCTOBER 2012 MERIDIAN PATIENT ELECTRONIC FEEDBACK SYSTEM PURPOSE: 1. To update the Board on progress made regarding the implementation of Meridian across Trust services. RECOMMENDATION: 2. The Board is asked to note and discuss the report. 3. BACKGROUND 3.1 The Trust is in the process of implementing a system of gathering electronic feedback through the use of i-pads across the Clinical Service Units. Unlike the previous system (Patient Electronic Trackers) which was a centrally driven and centrally managed system the implementation of Meridian has been undertaken to encourage local ownership and integration into local governance arrangements. 3.2 As such, the development of standardised reporting and governance arrangements have been led by the Deputy Director of Nursing (Broadmoor) to ensure that Meridian feedback (combined with other patient and carer feedback) has a clear flow from Board to Ward and back again. 3.3 This report provides an update to the Board on the implementation of the I-Pads and the initial feedback received to provide assurance that a) the system is on track and b) that the governance arrangements are robust and able to ensure that improvements based on feedback is occurring. An implementation protocol has been agreed and distributed across all areas and notices are displayed informing patients, carers and visitors of the new approach to collecting feedback. 4. LOCAL SERVICES 4.1 A total of 42 i-pads have been distributed. All inpatient areas have been live since the start of September and the Carer and CRHT questionnaires went live on 22.10.12. 4.2 To date there are no reported significant improvements made as teams are still getting used to this new way of capturing patients feedback. However, judging from the responses from the services users, there are areas where good practice is being highlighted and also areas for action. Once the standard procedure of service user feedback and clinical audit is fully implemented, a consistent approach in the way teams are using the feedback to improve service users satisfaction should be realised. Some wards have already established localised action plans based on initial feedback. 4.3 There are number of ways in which the data can be presented and some initial feedback can be found below: Page 3 of 10
Figure 1: Dashboard showing overall satisfaction 4.4 The above figure of 83.13% is an overall level of satisfaction across all scores for the initial 429 responses. 4.5 This can be further broken down into ward areas, question types, comment and question analysis. Figures 2 & 3 provide examples of how data is represented in pie charts. Figure 2: Analysis by Question Page 4 of 10
Figure 3: Analysis by Question 4.6 In addition to numerical data Meridian also provides the opportunity to submit written comments as shown in Table 1. Table 1: Comments Received Positive Comments Negative Comments Suggestions for change/development 7/8/2012 I am happy with all of staff and the staff are very kind. I really appreciate it. Thank you so much 7/8/2012 I am suicidal but happy that I am in a place of safety and I have made some good friends. I am enjoying the Olympics 9/8/2012 Staffs are doing an excellent job. 9/8/2012 I get better in the hospital. 13/8/2012 No. Everything is brilliant in terms of the service provided 24/8/2012 Thankful to everybody that they help me on my way to a better life. 15/8/2012 The Dr was rude to me 18/8/2012 Certain staff are always late. 18/8/2012 Some patients are too loud. 5/9/2012 Still feel like I am not being heard. Same as last time but definite improvements are here 12/9/2012 People do not answer the phones for periods in the day e.g. handover. 12/9/2012 The toilets are always blocked and not sorted fast!3/9/2012 Less bureaucracy 10/10/2012 Some staff have attitude problems 7/8/2012 Knowing when u will have your ward round instead of being randomly called as it makes u nervous and unsettles u and your day 13/8/2012 More things to do on ward as it can be quite boring and be given times when u will see consultant instead of being given it last minute. 23/8/2012 Should be available in different language. 24/8/2012 New patients to be introduced by the staff to existing patients. 12/9/2012 I feel supported and listened to by the staff An information booklet would be useful. Page 5 of 10
Positive Comments Negative Comments Suggestions for change/development 12/9/2012 Meridian feedback is user friendly 12/9/2012 I was very happy that hospital admission was avoided and I remained at home with my family 24/9/2012 Majority of staff are polite and helpful. 5/10/2012 Very good service all the staff work very hard it can be a very. Demanding job, at times 15/10/2012 Staff are always available to talk to. 15/10/2012 Everything is good 11/10/2012 Staff could come out of the office more and chat to patient so there off the computers 12/10/2012 Staff should listen more to the patients, to be more polite. 3/9/2012 I would like to know much more information about my illness and my facs 16/9/2012 Yes if possible could we have more senior doctors or nurses on duty especially over the weekend, so to get a second opinion rather than wait till Monday, because if I was wrongfully assessed it is not humane to keep an innocent person against his will or her will 4/10/2012 More activities 10/10/2012 Supper and dinner is too early, 5pm is too early in my opinion 11/10/2012 Not certain about some questions because I do not understand well English. 4.7 NEXT STEPS FOR LOCAL SERVICES There is ongoing work taking place with Meridian Optimum and Dementia services in devising questionnaires for this particular client group. The Speech & Language therapist is assisting with this piece of work. Therapy questionnaires are being built to capture feedback across the 3 boroughs. Matt Barnfield from Communication department is currently working with Meridian personnel to upload all the questionnaires on the trust website as an alternative method for carers and service users to feedback about their experience whilst using or accessing our services. Communication team is working on producing pamphlets and posters for carers and clinical environments. i-pad mounts to be fixed in each of the nominated sites so that feedback can be captured accordingly. Live information boards for each inpatient site will be installed so that service users/carers/visitors can see progress at a glance. 5. BROADMOOR HOSPITAL 5.1 Meridian was piloted on two wards throughout July 2012 to ensure that the safety, security and integrity of the machines was suitable for secure settings. Once the technology was proven to be safe Meridian went live in Broadmoor Hospital with the survey made up of eight questions and two comment areas on 3 rd August 2012. At this point patients have completed 264 separate surveys using 23 i-pads. Details of which can be seen below. Page 6 of 10
Table 2: Questions in rank order of highest scores Rank Question Question Text Score No. 1 7 If I wanted to, I know how to make a complaint or 95.00 compliment 2 4 I know how to contact staff if I need them 89.49 3 8 The care plan has been discussed with me 88.02 4 2 Staff do everything they can to maintain my privacy, including making sure my personal information is not overheard 79.84 5 1 I feel staff are respectful of me 78.71 6 6 The environment is clean and tidy 75.00 7 3 I have been given the right amount of information to make 74.41 a decision & have choices 8 5 I feel confident my concerns would be listened to and acted on 69.14 5.2 Meridian is now a standing agenda item at the Patients Forum where Paul Knowles (the Meridian Implementation Lead) feeds back results and trends as well as updating significant issues with regard to surveys and results. Figure 4 below shows how comparisons can be made across wards both in terms of the number of questionnaires returned and the overall satisfaction. Figure 4: Percentage satisfaction and No. of Completed Questionnaires 5.3 An additional survey on Night Time Confinement (NTC) has been devised and the Senior Management Team are presently consulting patients on their views about this proposed change. The numerical and written feedback is now being utilised to advise the NTC Project Board at Broadmoor Hospital and forming a large part of the Page 7 of 10
FAQ circular for all patients. The information has also been used as part of the patient focus groups regarding this projects implementation. 5.4 NEXT STEPS Paul Knowles has led on this project and provided the initial contact with Optimum Contracts at Broadmoor Hospital CSU he will continue with this responsibility on behalf of the Nursing Directorate. Embed the Governance Umbrella into practice, senior staff to seek evidence when in clinical areas of governance process adherence. Ward display boards for Meridian information need to be agreed; purchased and fitted. This may prove difficult in some wards, particularly the Paddock, due to the physical layout. The Trust need to agree on a process for question changes and update to ensure patient validity and to avoid patients becoming bored. Need to agree location of pedestal machines to be cited and utilised in Reception and the Visit area. Process for usage of Meridian machines for audit purposes needs to be circulated by Sarina Martin, Head of Clinical Effectiveness, as soon as possible. We feel this has been a positive introduction with meridian for direct patient feedback. We need to continue to encourage its use and ensure positive changes to practice. 6. SPECIALIST AND FORENSIC SERVICES 6.1 There are i-pads allocated to all areas as below: 1 x Meridian ipad for all 20 WLFS wards 1 x Meridian ipad for Cassel 1 x Meridian ipad for GIC 3 x Meridian ipad for forensic services reception areas 1 x Meridian ipad used for demonstration purposes 6.2 Specialist and Forensic Services CSU have completed the first phase of implementation which was to install the Meridian system in the in-patient clinical areas. They are now in the second phase which is to build up participation on the part of service users as many service users do not wish to use the device. In order to increase participation, the Meridian lead along with a service user recovery and involvement worker will attend ward community meetings to support service users with regard to understanding the value of participation. 6.3 The total number of questionnaires completed is 340. As shown in Figure 5 the best score is in response to the question The care plan has been discussed with me and the worse score is to the question I feel confident my concerns would be listened to and acted on. Page 8 of 10
Figure 5: Questions in Rank Order of Satisfaction 6.4 Over a period of time a Heat Map (Figure 6) can be produced and shared with teams and the Heads of Service which will show trends and highlight of low performance. Figure 6: Trend Heat Map Page 9 of 10
6.5 NEXT STEPS Build up participation - complete end of October 2012 Introduce protocol complete 8th November 2012 Activate governance process with regard to cycle of improvement and systems for monitoring implementation and reporting up and down commence 15th November 2012 Review of questions January 2013 7. SUMMARY This update report provides a high level summary of the progress being made across CSU s in relation to the implementation of Meridian. The project is still in the early stages of being embedded into day to day governance structures. To help with this a governance framework for patient experience has been established which, after further refinement, will be approved at the next meeting of the Quality Committee. RECOMMENDATION 8. The Board is asked to note and discuss the contents of this report. Page 10 of 10