Patient Experience, Engagement and Involvement Strategy. Seeing the Person in the Patient *

Patient Experience, Engagement and Involvement Strategy Seeing the Person in the Patient * Version: Ratified by: Date ratified: April 2014 Title of originator/author: Title of responsible committee/individual: Date issued: June 2014 1a Quality Assurance Committee Hilary Fawcett, Quality Governance Lead Patient Experience Group Review date: Interim review: June 2015 Full review: 2017 Target audience: All staff Trust wide * Seeing the Person in the Patient: The Point of Care Review Paper The King s Fund Page 1 of 18

Contents (to be finalised when all amendments completed) Section Title Page 1 Summary 3 2 Introduction 4 3 The Strategy 5 4 How will we do this? 6 5 Culture and capability 7 6 Child and Young People s services 7 7 Turing strategy into action 8 9 References 8 Appendix 1 NICE Quality Standard Statements 10 Appendix 2 Patient Experience strategy - Implementation Plan: Year 1 11 Appendix 3 TRFT Core Values 14 Appendix 4 Factors affecting experience 15 Appendix 5 National Drivers for improving the Patient Experience 16 Appendix 6 Equality Impact Assessment 17 1. SUMMARY It is the prime objective for The Rotherham NHS Foundation Trust (TRFT) to ensure the provision of highest quality care for all patients who use its services. With the required components of quality widely accepted as being the combination of safe, effective care and a positive experience for patients, this strategy sets out the Trust s intention to ensure the best possible experience of care for all patients. This strategy sets out how staff will understand their responsibility in ensuring each patient not only receives excellent clinical care, but that it is delivered in a manner that treats them as an individual, recognises their needs and cares for them with empathy and compassion. The strategy sets out how this will be achieved, how progress will be monitored and within the implementation plan describes a structured approach to involving and engaging patients and working with stakeholders in the development and improvement of service delivery Page 2 of 18

This approach puts further substance and meaning behind the Trust core values: Compassion * Safe * Together (Appendix 1) * Right First Time * Responsible * Respect In High Quality Healthcare for All Lord Darzi states that quality is the organising principle for the NHS with emphasis on patient safety, patient experience and clinical effectiveness. High quality care should be as safe and effective as possible, with patients treated with compassion, dignity and respect. As well as clinical quality and safety, quality means care that is personal to each individual This is the overarching principle that guides the direction of this strategy. Throughout this document the term patient experience is used. The importance of a positive experience for parents, relatives and carers is also fully acknowledged and these groups should be assumed to be included wherever relevant. I was admitted to the Ward after my operation and again was cared for and supported with compassion and understanding of my condition. I was there for 6 days and they were all stars. Patient Opinion TRFT patient 2. INTRODUCTION The overwhelming majority of NHS staff come to work with the intention of providing excellent care to their patients. Unfortunately it is not always the case that patients leave the Trust with a positive impression and feeling their care was as good as it could and should have been, with numerous reasons affecting the possible outcome. (Appendix 2). Patients receiving health care are frequently at their most vulnerable and dependent on others for their care. Whatever the nature or duration of their care, it is a fundamental requirement that their care is delivered with compassion and respect at all stages by both clinical and non-clinical staff. At the same time, staff can be under considerable pressures with increased volume of activity, the need for greater efficiency. The drive to improve the patient experience therefore is linked to the requirement for strong leadership, management and support for staff. There is a strong correlation between staff satisfaction and patient outcome and this can be a factor in addressing reports by a patient that the standard of care depends on who is looking after me Patient experience can be defined as feedback from patients on what actually happened in the course of receiving care or treatment, both the objective facts and their subjective view of it (Dr Foster s Intelligent Board report 2010 - Patient Experience) Page 3 of 18

Through this strategy the aim is to determine what it is like to be a patient, or their relative or carer, at the Trust, from their own perspective. Why is the experience of patients important? 1. First and foremost is the moral obligation that people at their most vulnerable should be treated with the utmost compassion and respect. 2. Professional codes of conduct set out this requirement and it is mandated within the regulatory frameworks of the Care Quality Commission and Monitor. 3. There is evidence that a patient experiencing fear and anxiety can suffer delayed recovery. Good communication with patients can contribute to wellbeing and reduction of stress. For patients with long term conditions, good communication, information and education is vital for effective selfmanagement and could prevent unnecessary hospital admissions. 4. Good patient experience is beneficial for business and financial reasons, enhancing reputation, affecting patient choice and commissioning decisions as well as avoiding the waste of valuable resources when we do not get it right first time. 5. A number of national drivers set out the imperative to focus on improving the experience of patients and are summarised in appendix 3. A theme which runs throughout is the drive towards a more open, transparent way of delivering care, with care delivered in an environment where the experience of the patient is paramount. Engagement with patients Patient and public engagement is defined as the active participation of citizens, patients their carers and their representatives in the development of health services and as partners in their own care. This includes the planning, designing, delivery and improvement of health services. Why is engagement important? 1. It is not possible adequately to define and improve the experience of patients without engaging them in the process. Good engagement is beneficial to patients, staff and the organisation. It means services are more responsive to individual needs, are developed with a stronger focus on patients and local community and can lead to improvement in quality of care. 2. On a one to one basis it means patients feel involved in their own care. They are treated as an equal partner who has some power to influence, and develop stronger and positive relationships with health professionals. 3. Staff can gain greater understanding of patients needs and perspective and see the benefits of improved patient compliance which results from patients use of a service which better meets their needs. Improved patient experience will only take place effectively with active and meaningful engagement of patients and is therefore a central element of this strategy Page 4 of 18

I am really sorry I have to leave all the wonderful nurses on the ward as they treat all their patients with kindness, respect, dignity and friendship. Also, the receptionists Lynn and Tom. Patient Opinion, TRFT Patient 3. THE STRATEGY The National Institute for Health and Clinical Excellence (NICE) has developed a quality standard and clinical guidance for patient experience and this will drive the direction of the strategy. The Trust will prioritise key areas for improvement annually based on this guidance with the goal of achieving the quality outcomes described by NICE and summarised at appendix 1. This clinical guidance offers evidence-based guidance on ensuring a good experience of care for people who use adult NHS services. Objectives for year 1 are set out in the implementation plan at appendix 2, which will be monitored via Patient Experience Group (PEG). This high level plan will be supported by detailed action plans developed and monitored via PEG Central to improving the experience of papers will be the strengthening of processes whereby patients are consulted with and involved in the development and improvement of care and the approach and objectives for for year 1 in achieving this are set out in the implementation plan There will be a review of the strategy at least annually with the appropriateness of these key areas re-assessed and adjusted if appropriate, or as targets are achieved. This process will be linked with the annual Quality Accounts consultation process, ensuring involvement of patients, staff, governors as well as external stakeholders such as Healthwatch. The following valuable sources of data and information will be analysed and acted upon by the Patient Experience Group in order to measure progress : Surveys: Patient Experience Questionnaires Friends and Family Test: staff and patients Local patient surveys National patient surveys Patient stories A valuable method for seeing the person in the patient, patient stories, told in the words of the patient or extracted from complaints letters, can help make the patient experience alive and relevant particularly for example in committee meetings. Patient Feedback Patient Opinion Patient Forums and listening events Complaints, concerns and compliments Via Quality Assurance Walkabouts Healthwatch reports NHS Choices Page 5 of 18

Observation / inspection of practice Quality Assurance walkabouts Executive team visits e.g. night visits Patient led assessment of the care environment assessment (PLACE) Nursing Accreditation Scheme The Trust will seek to: Ensure staff are appropriately recruited and adequately trained to meet these responsibilities Listen to what patients tell us, and use this information to act and improve quality of care Engage and consult with patients, their relatives and carers, including children and young people, those who may be vulnerable or difficult to reach Identify where there is evidence of excellence in terms of patient experience and seek to replicate practice Where there are concerns, carry out thorough investigations using root cause analysis principles, taking necessary action Explore opportunities to benchmark with other comparable organisations. Engage actively with Rotherham Healthwatch and Carers services, seeking opportunities for partnership working Develop use of performance metrics related to patient experience, owned across the organisation and monitored appropriately. If I am unlucky enough to need hospital treatment again I shall request that I be admitted to Rotherham Hospital. A big thanks to every member of their hard working staff Patient Opinion, TRFT patient 4. HOW WILL WE DO THIS? The strategy will directly support the achievement of the Trust s strategic quality objectives. The strategy implementation plan (appendix 2) will be led via the Patient Experience Group, with named leads for the work streams and detailed action plans to support the achievement of annual goals. Roles & responsibilities The Board of Directors is responsible for setting the strategic direction for improving the quality of the experience of patients. The Chief Nurse is responsible for the Trust Quality Strategy and its implementation, and all supporting documents. The Patient Experience Strategy is a key element in the successful delivery of the quality strategy The Deputy Chief Nurse has delegated operational responsibility for the implementation of the strategy and is chair of the Patient Experience Group. The Quality Governance Lead is responsible for supporting the Deputy Chief Nurse in the implementation of this strategy, acting as deputy chair for the Patient Page 6 of 18

Experience Group and supporting relevant governance structures within Directorates The Patient Experience Lead is responsible for ensuring implementation of the strategy in relation to the management of complaints, concerns and compliments. Also responsible for maintaining an oversight of processes which ensure that learning is identified, monitoring of implementation of action plans for improvement and supporting Clinical Directorate leads in achieving this The clinical directorate senior leadership team, triumvirate holds responsibility for ensuring engagement and involvement within their area of responsibility, and ensuring implementation of this strategy and associated plans for delivery. Each directorate will have a named individual with responsibility for patient experience who will be a member of the directorate governance group, also representing the directorate at the Patient Experience Group. Responsible for ensuring Trust processes for effectively managing and responding to complaints, concerns, compliments, are fully implemented, and via the directorate governance groups ensuring learning is identified, monitoring action plans to completion All Staff are responsible for ensuring that people accessing our services are treated with warmth, courtesy and helpfulness recognising Trust core values and the diversity of the population. Staff must familiarise themselves with this strategy and understand their responsibilities. Culture and Capability Strategic direction within the People and Organisational Development and the direction of the Nursing and Midwifery Strategy supports delivery of this strategy. A new people, staff communication and engagement strategy is being developed and this will provide consistent and regular dialogue with all staff, involving them in the process. A new performance management system will be launched in April 2014. This will measure employees contribution against delivery of their objectives and also how they have performed in relation to the Trust values. The Trust is developing a leadership philosophy that promotes transformational leadership and team effectiveness to deliver better quality patient care. Integral to the theme of the Trust s nurses and midwives care strategy to recruit well, the Trust will embed the use of assessment centres to ensure that the selection of staff meets both the competency and behavioral standards in line with the Trust values. This is designed to ensure that applicants have the required qualities and talents for the Trust s three goals to be safe, caring and reliable The Trust will continue to work in partnership with NHS Employers as one of the pilot sites for values based recruitment. Children and Young People s Services This strategy is applicable to patients of all ages and approaches which are specific to the needs and age of children and young people will be developed within the Family Health Directorate Page 7 of 18

It s fair to say I was scared and worried as I have never had anything like this so I was in fear of the unknown but the staff were brilliant at putting me at ease and explaining everything that was going on. Patient Opinion, TRFT patient Measuring and monitoring progress The Patient Experience Group (PEG) is the forum through which the implementation of the strategy will be led and monitored. Named leads from each Directorate, both clinical and corporate, will attend the PEG and will have clear understanding of their responsibility in implementing this strategy within their own department of division. PEG will receive reports from directorate governance groups based on their local plans for contributing to the success of this strategy, increasing patient satisfaction and involvement with service design. Where appropriate to ensure a focused and consistent approach, task and finish groups will be established, reporting to PEG. PEG is accountable to the Operational Quality, Safety and Experience Group (OQSEG) and will provide quarterly assurance reports to this group and to the Quality Assurance Committee, a committee of the Board. 5. REFERENCES NICE Quality Standard: Adult Patient Experience http://guidance.nice.org.uk/qs15 Care Quality Commission: Essential Standards of Quality and Safety www.cqc.org.uk Monitor www.monitor-nhsft.gov.uk Seeing the Person in the Patient: The Point of Care Review Paper The King s Fund Page 8 of 18

Appendix 1 NICE Quality Standard Statements Evidence of compliance obtained via patient experience surveys and feedback. Trusts should have the structures in place to make sure these statements reflect actual patient experience 1. Patients are treated with dignity, kindness, compassion, courtesy, respect, understanding and honesty 2. Patients experience effective interactions with staff who have demonstrated competency in relevant communication skills Additional required process: Staff are compliant with NICE guidance on patient experience, assessed at PDR, measured as proportion of staff who have this assessed as part of PDR process 3. Patients are introduced to all healthcare professionals involved in their care and are made aware of the roles and responsibilities of the team 4. Patients have opportunities to discuss their health beliefs, concerns and preferences to inform their individualised care 5. Patients are supported by healthcare professionals to understand releva treatment options, including benefits, risks, potential consequences 6. Patients are actively involved in sharing decision making and supported by healthcare professionals to make fully informed choices about investigations, treatment and care that reflect what is important to them 7. Patients are made aware that they have the right to choose, accept, decline treatment and these options are respected and supported 8. Patients are aware they can ask for a second opinion 9. Patients experience care that is tailored to their needs and personal preferences, taking into account their circumstances, their ability to access services and their coexisting conditions 10. Patients have their physical and psychological needs regularly assessed and addressed including nutrition, hydration, pain relief, personal hygiene and anxiety 11. Patients experience continuity of care delivered whenever possible by the same healthcare professional or team throughout a single episode of care 12. Patients experience coordinated care with clear information exchange between relevant health and social care professional 13. Patients preferences for sharing information with their partner, family members and/or carers are established, respected and reviewed throughout their care 14. Patients are made aware who to contact, how to contact them and when to make contact about their ongoing healthcare needs Page 9 of 18

APPENDIX 2 Patient Experience, Engagement and Involvement Strategy - Implementation Plan: Year 1 Implementation of this plan will support compliance with regulatory standards as follows: Care Quality Commission Essential Standards: Outcome 1, Respecting and Involving people who use services and Outcome 17: Complaints Monitor: Quality Governance Framework Strategic Objective Action/outcome Timeframe To be completed: Linked to NICE Quality Standard Lead 1. Develop and strengthen Trust systems and processes for evaluation and improvement of patient experience review of Patient Experience group membership to ensure appropriate representation of directorates Named lead for patient experience identified in each clinical and corporate directorate as appropriate, who will attend PEG Q1 Q1 Supports implementation of all statements of the standard Deputy Chief Nurse via Patient Experience Group PEG and sub-groups work plans to be reviewed to ensure they are aligned to the objectives of this strategy required actions are addressed and monitored Q1 Strengthen processes for working in partnership with governors and Trust members to form an integrated approach towards improving patient experience Q2 2. Complaints Management 1. All complaints and concerns a programme of training in complaints Statements 1, 2 Patient Experience and Quality Governance Page 10 of 18

raised with the Trust will be responded to in a timely and empathic manner, in accordance with the Ombudsman's best practice guidelines - Principles of Good Complaints Handling. Parliamentary and Health Service Ombudsman 2009 and Care Quality Commission Essential standards: outcome 17, Complaints management will be delivered to key staff across all Clinical Directorates designed to ensure all understand their responsibilities, and to enhance skills to preparing response letters action plans demonstrating actions to be taken following substantiated complaints will be established, implemented in each Clinical Directorate which will be monitored at each Clinical Directorate Quality Governance and Assurance Group Q2 Q 2 Teams Clinical Directors / Heads of Nursing, Midwifery, Clinical professions 2. The organisation will have a systematic approach to demonstrating learning from complaints, concerns, compliments This will be subject to audit by the Patient Experience Team An audit of quality of complaints against ombudsman standards will be scheduled Q 4 Q 4 Patient Experience Lead 3. Development of systematic processes for patient and public involvement across the Trust Develop and strengthen use of patient stories for delivery at corporate meetings, verbally or written, in the words of the patient using the Patient Safety First framework: Leadership for Safety Q3 Supports implementation of all statements of the standard Quality governance Lead By the end of Quarter 2, 2014/15, one patient story will be developed for delivery at Board and corporate committees as appropriate, which uses the patient s own words. Q2 Develop the role of volunteers to support the Patient Experience and involvement agenda Q2 Deputy Chief Nurse / Page 11 of 18

Systematic process in place whereby new service developments include patient involvement in planning Q3 Quality Governance Lead Implement Experience Based Design method of designing a better experience for patients Q4 PEG Processes for involvement will be designed to be inclusive of all members of the community with no group disadvantaged due to disability Focus groups / forums will be designed to be inclusive of all members, where necessary utilizing for example hearing loops, ensuring wheelchair access, interpreters. Focus groups / involvement initiatives will be designed to obtain specific feed back from minority groups Q3 Q4 PEG 4. All staff understand their responsibility in meeting the objectives of this strategy and are aware of the NICE quality standard Full roll out and communication plan of the strategy Liaise with People & Organisational Development re process to include awareness of the strategy and NICE standard in the PDR process, linking with Trust values and Behavioural Framework Q2 Q1 Statement 2 Deputy Chief Nurse / Quality Governance Lead Quality Governance Lead / POD 5. The Trust works in partnership with Healthwatch and patient user groups to identify and implement areas for improvement Strengthen processes for receiving feedback, and acting upon it, from Healthwatch via quarterly reports Use information received to inform annual quality accounts consultation process Q1 Q3 Will inform all statements Deputy chief Nurse / Patient Experience Lead Quality Governance Lead Page 12 of 18

6. The Trust will sign up to the Dignity in Care Campaign Network of Dignity champions established across all Clinical directorates Q4 Statement 1 TBA 7. All patients have same sex accommodation in accordance with national and Trust policy Root cause analysis to be undertaken whenever this standard is breached in line with Trust identification of this as a local Never Event Completed Statement 1 Implemented by chief Nurse Reports to be received at PEG so that the outcome and recommendations can inform relevant work streams Q1 Deputy chief Nurse / Quality governance Lead 8. Achieve a 3 point increase in the overall in-patient, maternity and A&E NPS Achieve a 3 point increase in A&E NPS Achieve a 3 point increase in IP NPS Achieve a 40% response rate for A&E, inpatients and maternity combined Priorities identified from survey for year 1 based on most current survey: Reduction of noise at night Provision of choice of food Same sex accommodation Discharge Planning Q4 Statement 1 Statement 10 Action plan for each priority to be developed to address these priorities by PEG / PEG sub-groups Q1 ALL PEG task & finish group leads Page 13 of 18

Appendix 3 TRFT CORE VALUES Compassion We treat everybody as individuals, showing dignity, kindness and compassion. We respond with humanity and kindness to each person s pain, distress, anxiety or need. We do not wait to be asked. We find time because we care Together We strive to improve health and well-being. We believe that each member of our team makes a valuable contribution towards delivering excellent patient care. We value professionalism. We talk and listen and we rely on each other. Safe We earn trust by putting safety first. We make people feel secure and safe in our care. We take pride in the quality of care we provide. We accept praise and criticism in equal measures and when we make a mistake we learn from it. Right first time We are accountable for our use of public money and take this responsibility seriously. We use our resources wisely for the benefit of the whole community and make sure nobody is excluded of left behind. We know that when we waste resources, we waste opportunities. Responsible We are proud to be part of the community. We are conscious of our impact on the environment, on the economy and on society and we embrace opportunities to make a positive impact on our community. Respect We respect people s aspirations and commitments in life and seek to understand their needs whilst maintaining their privacy. We treat everybody with courtesy and respect and provide them with a healthy and nurturing environment where they feel supported. Page 14 of 18

Appendix 4 Seeing the Person in the Patient Point of Care Review Paper The King s Fund Factors shaping patients experience at individual level Organisational factors Human factors Staff Staff Patient Education, training and Morale Clinical need qualifications Induction, preparation Experience Mental and Physical capacity Job description Health status Ability to speak for self Accountability Tiredness, stress, well-being Spoken English Delegated responsibilities Professional and personal Age attitudes, values Permanent/Temporary Support Social status status Support Spoken English Active family or other support Supervision, appraisal Depression, anxiety, fear Appendix 5 Page 15 of 18

National Drivers for improving the Patient Experience The NHS Constitution Makes clear the right of members of the public to be involved in decisions about the planning and delivery of local health services. NHS Transparency Agenda A raft of measures aimed at increased public participation as part of its on-going pledge to openness and transparency. Innovations under this programme are said to represent the biggest moves ever taken by any health service anywhere in the world to put transparency and patient participation at the very core of the health system. Care Quality Commission Sets out a regulatory framework based on outcomes. In accordance with the CQC Essential Standards of Quality and Safety, people have the right to expect that their care will be delivered in a manner which respects their dignity. Also sets out standards for complaint management. Compliance with the standards is a legal requirement and part of a healthcare provider s licence to practice Monitor Risk Assessment Framework (RAF) The Foundation Trust regulator responsible for ensuring Trusts remain in compliance with their governance and continuity of services licence, including compliance with the Quality Governance Framework (QGF). The Processes and Structure domain of the QGF requires Trusts to actively engage patients, staff and stakeholders on quality. The RAF sets out their process for ensuring Trusts are well led, from both a quality, service delivery and financial perspective. The NHS Outcomes Framework Launched in December 2010, sets out direction of quality healthcare in England. Based on 5 domains: 1. Preventing people from dying prematurely 2. Enhancing quality of life for people with long term conditions 3. Helping people to recover from ill health or injury 4. Ensuring that people have a positive experience of care 5. Creating a safe environment and protecting people from avoidable harm High Quality Healthcare for All (2008) States that quality is the organising principle behind everything we do Francis Report The report by Robert Francis QC, following the public inquiry in to the failings at Mid Staffordshire NHS Foundation Trust.led to 290 recommendations designed to make the NHS more open, more accountable and more focused on safety and compassion Commissioning for Quality an Innovation (CQUINS) Local CQUINS must include at least one goal covering patient experience Quality Accounts Appendix 6 Page 16 of 18

Document Name: Lead Officer: Annual public reports from healthcare providers about the quality of the services they deliver. They require boards to monitor and assess the quality of the services they provide. EQUALITY IMPACT ASSESSMENT (EIA) INITIAL SCREENING TOOL Patient Engagement Strategy Deputy chief Nurse Quality governance Lead Directorate: Chief Nurse Date/Period of Document: Reviewing oficers: 2015-2017 Quality Governance Lead Function Policy Procedure X Strategy Joint Document, with whom? Describe the main aim, objectives and intended outcomes of the above: You must assess each of the 9 areas separately and consider how your policy may affect people s human rights. 1. Assessment of possible adverse impact against any minority group How could the policy have a significant negative impact on Response If yes, please state why and the evidence equality in relation to each area? Yes No used in your assessment 1 Age? x 2 Sex (Male and Female? x 3 Disability (Learning Difficulties/Physical or Sensory x Disability)? 4 Race or Ethnicity? x 5 Religion and Belief? x 6 Sexual Orientation (gay, lesbian or heterosexual)? x 7 Pregnancy and Maternity? x 8 Gender Reassignment (The process of transitioning x from one gender to another)? 9 Marriage and Civil Partnership? x You need to ask yourself: Will the policy create any problems or barriers to any community of group? No Will any group be excluded because of the policy?/no Will the policy have a negative impact on community relations? No If the answer to any of these questions is yes, you must complete a full Equality Impact Assessment 2. Positive impact: Could the policy have a significant positive impact on equality by reducing inequalities that already exist? Explain how will it meet our duty to: Response Yes No If yes, please state why and the evidence used in your assessment 1 Promote equal opportunities 2 Get rid of discrimination 3 Get rid of harassment 4 Promote good community relations 5 Promote positive attitudes towards disabled people 6 Encourage participation by disabled people x Sets out plans for patient /public involvement inclusive of all, including harder to reach groups 7 Consider more favourable treatment of disabled people x As above 8 Promote and protect human rights 3. Summary On the basis of the information/evidence/consideration so far, do you believe that the policy will have a positive or negative adverse impact on equality? Positive Please rate, by circling, the level of impact Negative HIGH MEDIUM LOW - X NIL LOW MEDIUM HIGH Date assessment completed: Is a full equality impact assessment required? Yes (documentation on the intranet) No X Page 17 of 18

Page 18 of 18