Appendix 2 Patient Experience Framework N.B. Staff should be discouraged from printing this document. This is to avoid the risk of out of date printed versions of the document. The Intranet should be referred to for the current version of the document.
Contents: 1 Introduction... 16 2 Principles... 19 3 Current Position... 4 Implementation... 23 5 Communication... 25 6 Roles and Responsibilities... 25 7 Training... 26 8 Monitoring and Evaluation... 26 9 Conclusion... 27 10 Appendices... 27 10.1 Appendix 1 Patient Experience Update 10.2 Appendix 2 - Committee Infrastructure... 32 10.3 Appendix 3 - Patient Experience Divisional Action Plan Template... 32
1 Introduction The NHS touches our lives at times of basic human need when care and compassion are what matters most (NHS Confederation) 1.1 Patients and carers have a right to experience respectful and professional care, in a considerate and supportive environment, where their privacy is protected and dignity maintained. A high quality experience should be fundamental, underpinned by appropriate standards. 1.2 There has been significant national media attention in recent years highlighting poor patient experience, notably: - Maidstone and Tunbridge Wells NHS Trust Mid Staffordshire NHS Trust The Patients Association report: Listen to Patients, Speak up for Change (2010) highlights the prevalence of poor care in Hospitals across England and Wales. 17 patient stories are published which depict deprivation of the fundamentals of care and the impact this has had on individual patients and their families The Older Peoples Commissioner: Privacy & Dignity in Welsh Hospitals The Ombudsman Report (2011) Care & Compassion, citing poor standards of patient care in Hospitals 1.3 It is imperative that Aneurin Bevan Health Board learn the lessons from the negative patient stories that have been experienced by so many across the UK. 1.4 Aneurin Bevan Health Board is committed to continually developing and improving care provision for patients and their carers, ensuring all who access services, from primary care through to hospital-based services, have an experience that reaches societies widely held expectations that they will be cared for safely, by knowledgeable, skilled and compassionate staff, as covered in the Health Board Dignity Plan (2011) and Dignity Campaign: Look Closer: See Me.
1.5 The Aneurin Bevan Health Board s aspiration is to consistently be a top performing organisation, achieving best in class status for the delivery of excellent patient care. The Health Board has developed a clear set of priorities that provides an organisation wide focus for the planning and delivery of service redesign. This Framework is designed to provide the pathway to success, and build on enhancing the Health Board s reputation. This can be seen diagrammatically as follows: Eliminate inequalities in health status through partnership, ownership and empowerment. Improve our public health Delivering Patient Centred Services Focus on safety, excellence and quality Best quality, evidence based best patient experience we can provide first time, every time. Skill up and trust our workforce to deliver excellence. Empower our staff Achieve better use of resources Reduce waste and variation. Patient Centred Services taking every opportunity to organise services around the citizen and balancing our whole system of care 1.6 The Aneurin Bevan Health Board Patient Experience Framework and Plan underpins the Health Board s aim and mission statement for the communities of Gwent, which is: - Working with you for a healthier community Caring for you when you need us Aiming for excellence in what we do
The aim is based on the fundamental expectation that care for every patient should be given in the same way as we would want our family, friends and loved ones to be cared for. The Delivery Framework 2011/12 (WG) identifies that patients across Wales need to feel confident that, when they access healthcare services, their local NHS organisation will deliver the services they need in an effective and timely manner without harm or variation, with a greater focus on prevention, quality outcomes and patient experience. Together for Health A five year vision for the NHS in Wales (WG 2011) identifies the need to improve patient experience and guarantee dignity and respect for patients. 1.7 According to the Department of Health (2008) patients simply want the NHS to do the following: Do not harm me Make me better Be nice to me In practical terms the expectation is that patients and carers will experience safe and effective care that is individualised, respectful, supportive and considerate. 1.8 Evidence has shown that in order to address the complexities of achieving a positive patient experience, it is vital that the following components are visible: A clear vision and supportive culture Transformational leadership Clinical and professional engagement Empowered staff, patients, families and carers A safe environment
1.9 The Patient Experience Framework and Plan sets out the direction for achieving the many advantages associated with effective engagement of patients and families. These benefits are: - Improved clinical outcomes Responsive patient and family services Enhanced patient and family satisfaction Enhanced staff satisfaction Improved recruitment and retention of staff Effective learning environments Reduced health care costs 2 Principles In order that every patient who uses Aneurin Bevan Health Board Services has a positive experience, from primary care through to hospital, the following strategic principles must be embedded throughout the organisation. They have to be adopted by all staff and linked to the key components of achieving a positive outcome. These key components are: Culture - The culture of the organisation must be one of valuing every person and ensuring that they are treated with dignity and respect. Leadership The key purpose of leadership and management is to provide direction, gain commitment, facilitate change and achieve results through the efficient, creative and responsible deployment of people and other resources. Integral to this is not only the ability to work with a broad range of staff and external partners, but to develop the culture and attitude that facilitate work with patients and service users to bring about change (cross reference: Leadership and Management Development Strategy). Safe Dignified Care This means that we do no harm to patients, by ensuring that the environment is safe and clean and by reducing avoidable harm. It also means that we give patients more control over their own care, and care for every patient in the way we would want our family, friends and loved ones to be cared for. Workforce We will trust, skill-up and enable our staff to deliver excellence, valuing them and their contribution. The Patients Voice This means listening to our patients and carers, as individuals and collectively, to understand how we can better provide patient centred services.
Improving patient experience is the responsibility of all staff, regardless of position, staff group, profession or location of work. It is everybody s business to improve experience for patients, carers and colleagues whatever the setting. Patient experience will only improve if staff are motivated and inspired to make the improvements that need to happen and get involved with action, as the way to achieve transformation is through the mobilisation of staff to drive change. Staff need: A clear vision. To be trained and feel safe, confident and empowered to resolve problems and change practice or escalate issues to an appropriate person if resolution / improvement cannot be achieved. A culture of pride in the service delivered and in the staff who deliver it. If we fail to meet expectations then patients will become disenchanted. We do not want patients to have a negative perception, which could consequently damage the reputation of the Health Board. We therefore need to concentrate efforts into turning potential damaging experiences into positive ones and clearly demonstrating how we have changed as a result of the feedback. Greater emphasis needs to be placed on finding effective ways of listening to and acting on user feedback. 3 Way Forward 3.1 Encouragingly, there is a high level of activity in relation to patient experience demonstrable across Aneurin Bevan Health Board. Organisational learning through informal, formal or escalated complaints processes and compliments is increasingly recognised as a vital part of service improvement.
Whilst the overwhelming method of choice for eliciting feedback remains the satisfaction questionnaire, there is a trend towards more creative approaches that seek to dig down and root out qualitative information. This goldmine of feedback is then used to inform staff reflection, action plans and ultimately service improvements, from individual comments and patient stories to collective views about services via focus groups. A number of areas have produced patient information booklets, have introduced patient story telling, as well as real time innovations referred to as graffiti or grumble boards. Individual, personalised feedback from patients / clients focus on: - Satisfaction Surveys Carer Clinics Patient Diaries Story Telling Graffiti Boards 3.2 Patient and Family Centred Care Programme Aneurin Bevan Health Board have been selected to join the Patient and Family Centred Care Programme working with the Kings Fund and the Health Foundation. This development programme offers tested techniques to improve both processes of care and staff patient interactions. The programme aims to improve the capacity of NHS organisations to: Deliver high quality patients experience in the broadest sense, incorporating all dimensions of quality, including clinical effectiveness Promote improvements in the experience of staff Promote patients experience as high on the quality agenda Build on the synergies that exist between safety and patients experience This methodology will be used to align service delivery with the patients experience.
3.3 The Fundamentals of Care (WAG 2003) provides an extensive opportunity to review patient experience with an annual survey conducted each Summer. 3.4 A standardised patient experience questionnaire has been developed for inpatient services which has the ability to elicit views from every patient (Appendix 1). In terms of primary care, patient views are currently determined via the Quality Outcomes Framework. 3.5 Transforming Care is a vehicle to improve patient experience and has been rolled out for all Wards within Aneurin Bevan Health Board. The programme has been adapted by NLIAH for Theatres and Maternity Services and implementation has commenced. Community modules are also in development. 3.6 With regards to staff, the Organisational Development Strategy has highlighted the importance of culture surveys and leadership development. The Health Board has also commenced the roll-out of the Aston Team-Based Working. Work has also been undertaken to develop education programmes specific to patient experience, commencing at induction and following through with continuing professional development. 3.7 There are a number of metrics that are currently produced from the 1000 Lives+ programme, which are monitored in the Quality Dashboard, including: - patient mortality falls pressure ulcers healthcare acquired infection All of these link to the Standards for Health Services: Doing Well Doing Better, the Annual Quality Framework and the Delivery Framework 2012/13.
4 Implementation 4.1 The implementation plan needs to ensure that there is a coherent and consistent approach to national and corporate policies, namely: - Privacy & Dignity Action Plan (WG) National Dementia Plan for Wales (WG) 1000 Lives programme Standards for Health Services Fundamentals of Care (WG) Transforming Care (NLIAH) The ABHB Organisational Development Strategy Community Health Council HPE Action Plans The Carers Strategy Measure (WG) Each of these key strategies and documents are aligned, enabling continuous improvement for patient experience. They are inextricably linked and should not be seen in isolation. Implementation can only be achieved by engaging and empowering staff throughout the organisation, so that: Every Interaction and Communication Counts 4.2 Driven by a number of corporate plans and groups e.g. Dignity and Privacy, Dementia and Transforming Care, the Divisions and Localities will be responsible and accountable for developing an incremental action plan to guarantee the Health Board achieves excellence in patient experience, which is aligned to the 5 year plan. 4.3 Success could be described as achieved when everyone in the Health Board: Sees excellent patient experience as their business Can quantify their contribution to its overall success Feel proud to be part of that success
4.4 The accountability for the delivery of excellent patient experience ultimately sits with the Aneurin Bevan Health Board. Appendix 2 highlights how delegated responsibility to Divisions and Localities is achieved throughout the organisation, via the Quality & Patient Safety Committee. There are a number of corporate groups which will enable the delivery of key areas. 4.5 Each Division will be required to produce an incremental action plan, jointly developed by staff and patient/carer groups using the template devised (appendix 2). The Primary Drivers, outlined in the driver diagram (appendix 3) will provide the basis for action planning. Key milestones will be developed to help achieve the agreed standards. 4.6 A scorecard approach will be adopted to provide feedback to the Board on patient experience using the headings: safe dignified care, the patients voice, workforce and culture and leadership (see 8.2).
5 Communication 5.1 The Patient Experience Framework and Plan is seen as a dynamic, overarching approach that supports collaborative working with the Community Health Council, Patients Panel and other patient groups and organisations. 5.2 To ensure a range of key stakeholders have an opportunity to be involved, a Patient Experience Steering Group has been established with the aim of ensuring delivery of Corporate and Divisional action plans, based on agreed strategic improvement themes. 6 Roles and Responsibilities 6.1 The Board is responsible for demonstrating commitment to and driving the Framework. 6.2 The Director of Nursing is the Executive Lead for Patient Experience, supported by a designated Independent Member. Together they will monitor progress via the Patient Experience Strategic Group, with reports to the Quality and Patient Safety Committee, through to Board. 6.3 The Director of OD/HR will have responsibility for ensuring patient experience principles are embedded in all job descriptions, recruitment processes and personnel policies. 6.4 Divisional Directors have responsibility for ensuring commitment to the Framework and Plan and the development and implementation of actions plans in their areas of responsibility. 6.5 All staff have a responsibility to ensure that every patient and family member has an excellent experience. All staff must commit to the principles. ABHB Leaders must demonstrate behaviours which are consistent with high standards of care and compassion. All staff must demonstrate that every interaction and communication counts.
7 Training The Organisational Development Strategy will incorporate training specific to patient experience, commencing on Induction and following through to Continuing Professional Development, examples include: - Communication & listening skills/customer care Privacy & Dignity awareness Patient and public involvement techniques: Observations of Care, Story Telling etc Patient safety/infection control Equality and diversity/awareness of legislation Equality Impact Assessment Information and metrics Leadership development Transforming Care Responding to complaints: Putting Things Right An overarching education framework will need to be developed. 8 Monitoring and Evaluation 8.1 The Patient Experience Strategic Group will provide the overall direction of travel to deliver the plan and monitor compliance, reporting to the Quality and Patient Safety Committee. There is a need to draw on a wide range of sources and types of information formal and informal, real-time and periodic, quantitative and qualitative, ad hoc and systematic. The key for the Health Board is to triangulate those various sources of intelligence so the reality of the situation can be assessed and consequently acted upon. A Patient Experience scorecard approach will be adopted to illustrate performance, using qualitative and quantitative measures. This will give assurance to the Board and ultimately change practice. An example scorecard can be seen overleaf. The components of Patient Experience highlighted earlier in the document will have applied metrics which, when analysed together, will build a picture of each user experience. 8.2 The Patient Experience Scorecard will enable triangulation of information, to illustrate performance and secure service change, based on the philosophy that: - Every Interaction and Communication Counts
PATIENT EXPERIENCE EXAMPLE SCORECARD SAFE DIGNIFIED CARE CULTURE & LEADERSHIP QOF results annual FoC results annual Delivery framework:- - pressure ulcers - C diff - dignity plan Transforming Care quarterly performance to include direct care time PATIENT EXPERIENCE: Aston roll out Divisional compliance Culture Survey Delivery against 12 key actions: Dignity Plan Platinum Corporate Health Standard compliance EPISODIC CARE THE PATIENTS VOICE Experience Surveys Patient Stories Complaint analysis CHC feedback WORKFORCE Appraisal compliance Sickness absence (Tier 1: delivery framework) Awards 9 Conclusion 9.1 Aneurin Bevan Health Board has made great strides throughout the organisation to obtain patient views. The patient experience framework and plan provides an approach and clarity to enable Divisions and Localities to gather information to improve practice at the frontline and provide assurance to Aneurin Bevan Health Board that continuous improvement to patient outcomes is being achieved. 10 Appendices
Appendix 1 Patient Experience Framework Progress summary - September 2012 Primary Driver Progress Leadership Band 7: Empowering Ward Sisters Leadership Framework introduced. All Ward Sisters completing the programme & preparing a portfolio of evidence. Band 8a Senior Nurse Leadership Framework produced and will be launched in the Winter. A development Programme for Clinical Directors has been executed in collaboration with Cardiff & Vale uhb A Managers competency-based framework & resource pack is about to launched across ABHB. Aston Team-Based Working continues to roll out across various teams, focussing on areas where there are consistently high sickness levels. Aston principles have been incorporated into the Leadership day in the Transforming Care Programme. Workforce & OD are developing a Coaching Strategy supporting the leading for reliability agenda. The Leading for Quality and Improvement (LQI) intensive delivery framework (NLIAH) is being run for Divisional Management Teams, supporting and enabling individuals and teams to drive forward an identified piece of service change and modernisation. Culture The 1000 Lives Culture Survey has been completed, results have been shared with the Health Board. It will be replaced this year with the Welsh Government Staff Survey, to be completed post- Christmas. An ABHB Behaviours Framework has been produced. This is available via the Intranet (Dignity Page) & is cascaded
during Induction. The Dignity Action Plan has been reviewed, with a positive report from the Commissioner for Older People regarding ABHB progress. Workforce Values-based Job Descriptions have been developed for Band 5, 2 & 3 in Nursing. Establishment reviews have been conducted across the nursing family. The Perfect Ward concept is being piloted in Unscheduled Care. Patient Voice Designated staff from each Division have received 2 day training in Digital Story Telling. 1000 Lives + mini collaborative for Story Telling is progressing well in ABHB. The programme is called 1000 Voices & has developed of a database for story telling, a How To Guide & patient consent form. A Patient Satisfaction Survey has been designed & standardised across Divisions, as part of Transforming Care see attached. Surveys are being collated monthly & results displayed on Ward Knowing How We Are Doing Boards. Patient Satisfaction Survey Fi... Ward 4/1 in NHH has achieved 100% satisfaction in June & July. Ward B7, RGH achieved 95% satisfaction. Safe, Dignified Care ABHB have made good progress with the Transforming Care agenda with all Wards now participating (100% compliance). Direct Patient Care Time has increased by an average of 11.5% in Wards where 2 nd Activity Follows have been performed (post the introduction of Transforming Care). The Fundamentals of Care annual Audit saw an overall 5% increase in organisational score 2009 2011. The auditing has been completed for 2012. Results are in the process of being
analysed. Credits for Cleaning (C4C) have been rolled out to the DGH s & Community Hospitals, with YYF just coming on-line. The HIW Dignity & Essential Care Inspection (DECI) Tool has been adapted for use in ABHB and all Wards are undertaking their own DECI reviews. HIW undertook an unannounced Dignity visit to RGH in February 12: an action plan has been prepared to address the deficits but it was noted that staff were kind, caring & respectful and that the environment of care was clean, calm & organised. Internal Audit have completed an audit of Wards examining the implementation of the Dignity Plan. The report is in draft currently with a likely adequate assurance rating. The DVD - Look Closer See Me is now an integral part of the new appointees Induction Programme. There is positive progress with the 1000 Lives+ agenda, with ABHB securing a good reputation on an All Wales basis for enthusiasm, sign-up & successes (notably: NEWS & Sepsis 6, Maternity HAT, Dementia Bundle, PVC & Catheter Bundles) The Health Board has maintained a positive reputation for it s commitment to the Community Health Council HPE programme. We were the only Health Board invited to participate/present at the annual HPE Evaluation event. There is a 45% reduction in Health Care Acquired cases of Clostridium Difficile April September 2012, versus the same period last year. The Health Board has one of the lowest Pressure Ulcer Incidence rates across Wales with September at 0.06% (national Average 3%). St Woolos Hospital went 10 months without the development of a Hospital Acquired Pressure Ulcer. The Health Board has introduced the All Wales Nursing & Midwifery Dashboard,
with all General Wards signed on & using the system. 6 National indicators are being collected, since the system went live in April 2012: Nutrition, Complaints, Pressure Ulcers, Cleaning, PADR and Hand Hygiene. One of the Ward Sisters presented at the Nursing Conference highlighting the importance of the tool in terms of data for improvement.
10.1 Appendix 2 - Committee Infrastructure PATIENT EXPERIENCE IMPLEMENTATION STRUCTURE 10.2 THE BOARD Quality & Patient Safety Committee Chair: Helen Houston Facilities Facilities Management Team Women & Childrens Services and Therapies Quality & Patient Safety Group Mental Health & Learning Disabilities Quality & Patient Safety Group Scheduled Care Quality & Patient Safety Group Unscheduled Care Quality & Patient Safety Group Localities & Primary Care Quality & Patient Safety Groups Dashboard & Metrics Steering Transforming Care Steering Group Fundamentals of Care Cleaning Standards Group Environment Committee Clinical Nutrition Steering Group Safeguarding Committees Continence Group Palliative Care Group Patients Panel Directorates and Services Patient Information Unit Learning Committee 1000 Lives+ Steering Group Mini Collaboratives Patient Experience Steering Group
Appendix 3 - Patient Experience Divisional Action Plan Template Primary Drivers Where are we now? Where do we want to be? 2012/13 2013/14 2014/15 1. Culture 2. Leadership 3. Safe Dignified Care 4. Workforce 5. Patient Voice
PATIENT EXPERIENCE DRIVER DIAGRAM Aim Primary Drivers Secondary Drivers Culture Behaviours consistent, in words and actions, from Board to frontline staff Dignity Plan & Campaign, Dementia Plan & Carers Measure OD Strategy Focus groups and listening events to inform local plans Culture and Leadership Surveys 1000 Lives+ Walkabouts Patients and carers experience respectful professional care, in a considerate and supportive, safe environment, where privacy and dignity is maintained Leadership Safe Dignified Care Clear vision & values Leadership development programmes that reflect patient experience principles Aston team-based working Robust appraisals and objective setting/padr Patient Experience Group Clinical Leadership NSF, NICE, NPSA Guidance QOF C4C HPE HIW reviews & DECI Carers Measure Implementation 1000 Lives+ (core and mini collaboratives) Transforming Care Fundamentals of Care Workforce JD & Person Specs values based Recruitment processes values based Staff recognition event Training needs analysis Establishment reviews Patient Voice 1000 Lives+ Surveys Observations of Care Patient Story Telling Patient/Carer Satisfaction Surveys You Said : We Did boards Accessible and transparent information Complaints Analysis