Winter Seminar Person Centred Care Making it Real 4th December 2015, Royal College of General Practitioners, 30 Euston Square, London NW1 2FB Putting people at the centre of healthcare is much talked about. But how do we turn this rhetoric into reality and how do we measure success? This year s Winter Seminar was co-ordinated and chaired by Monmouth Partners and we would like to express our sincere thanks and appreciation for the team s efforts, especially Mark Duman, Director, who chaired the meeting on the day, and Gemma Haddow, Senior Consultant. BHBIA Chair Simon Barnes and Board Director Katy Irving worked with Mark and Gemma to provide guidance and support during the planning and to introduce the day before handing over to Mark s excellent chairmanship. We also have Mark Duman to thank for the following review of the meeting: Round-up of the BHBIA Winter Seminar by Mark Duman (@MarkDuman), Monmouth Partners (www.monmouthpartners.com) and the Patient Information Forum (www.pifonline.org.uk). With all this talk of empowering patients, the 2015 BHBIA Winter Seminar addressed the topic of Person Centred Care Making it Real. Figure 1 In opening the event, it was important for me to set the scene by touching on person-centred care (PCC) issues including: the difference between person and patient centred care potential financial outcomes 30bn savings according to the Wanless Review (1) or some 8-21% of provider costs (Figure 1) from fully engaging and activating the public and patients how to measure patient centricity (focusing on pharma) the changes required by commissioners (payers), clinicians, patients, and providers to truly embrace a PCC approach. NHS England (www.england.nhs.uk) Opening the formal presentations, the discerning Dan Wellings (@danwellings), Head of Insight & Feedback at NHS England, outlined the three gaps (Figure 2) highlighted in the Five Year Forward View (2): 17
Figure 2 Stressing why insight is important, and quoting from the Department of Health s response (3) to The Berwick Report: The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end. Dan went on to outline what his team does: Run various surveys and data collection initiatives, including the GP Patient Survey, Cancer Patient Experience Survey, Staff Survey, PROMs and the Friends and Family Test (FFT) Liaise with the Care Quality Commission and Department of Health on the other national surveys (hospital surveys, adult social care survey, etc.) and work with them on responding to ministerial priorities Support colleagues across NHS England with their insight needs Support the system in collecting data from patients, analysing it and learning from it. Dan spent time outlining the initially controversial FFT (www. england.nhs.uk/ourwork/pe/fft) which broadly looks to bring the Net Promoter Score (www.netpromoter.com/know) into healthcare. 80% of NHS Trusts report that the FFT has increased their organisation s emphasis on patient experience. More important perhaps than the score itself, are the free-text comments which often provide actionable insights for NHS managers and clinicians e.g. My doctor was fantastic and the nursing staff were so caring and helpful. The food was cold and discharge took over 4 hours!. Going on to outline the need for more patient orientated measures, Dan touched on the PROMs programme (www. england.nhs.uk/statistics/statistical-work-areas/proms). At their launch in April 2009 it was the largest collection of patient data in the world. PROMs focus on four surgical interventions with plans to expand them into other areas, including Long Term Conditions (LTCs). Challenges that faced Dan and his team included how to present data appropriately to varying audiences and how to balance national vs. local insight. In closing, Dan kindly provided a sneak preview of the key themes within the imminent NHS England Insight Strategy: 1. Everyone to make better use of already available data 2. To define expected standards of insight use, build insight networks and provide support services from the centre 3. To improve data publication and presentation 4. To make existing tools more efficient and find ways to implement cost savings 5. To increase our power of insight by: a) Ensuring the system fills existing gaps in knowledge of specific patient groups or care pathways b) Exploiting more innovative research techniques such as ethnography c) Driving advances in data analytics to learn more from qualitative feedback d) Linking experience data to clinical data to better understand outcomes 6. To use insight to drive quality through commissioning 7. To harness Insight tools to drive person-centred care. Virgin Care (www.virgincare.co.uk) The effervescent Michelle Hawkins (@FuturesMichelle) enthralled the audience by showing us some things that healthcare can learn from hospitality. Opening by outlining the similar roots of hospitality and hospital, and reminding us that 90% of what establishes the difference between a two-star and a five-star hotel is service. Michelle went on to outline a number of key elements of PCC: Focus on staff Train people well enough so they can leave, treat them well enough so they don t want to. If you look after your staff, they ll look after your customers. It s that simple. Richard Branson. This is echoed and evidenced by the work of Michael West www.lancaster.ac.uk/lums/people/michael-west. Design journeys not pathways Think about the goals and motivation of the user (not the organisation) Note what is around them and has their attention How does each step enable them to get to the next? How are the beginnings and endings? What device are they using and what features does it have? What tasks do they want to achieve? What are the barriers and enablers? What is their emotional state in each step? Are they engaged, bored, annoyed? Where are their pain points? Add magic touches Such as providing a Hospital Welcome Pack which includes: soap, hairbrush, tissues, toothbrush, toothpaste, puzzle-book and bag with pop-out toiletry bag. Figure 3 illustrates another magic touch. 18
Figure 3 Figure 5 Figure 6 Invest in customer service Virgin s Customer Care Academy is one element of a bigger cultural change programme for creating exceptional experiences every day at Virgin Care. A simple, yet very potent indicator of what is often missing from our modern healthcare system, comes from none other than Florence Nightingale (Figure 4). Figure 4 Figure 7 Picker Institute Europe (www.pickereurope.org) A considered Chris Graham concluded the formal presentations by quoting Lord Ara Darzi (4): Patient experience is the most powerful lever [for choice and quality] and will be used for service improvement. This statement, made in 2008, really brought patient experience to the fore. Chris stressed the importance of standardisation in measurement in order to ensure accuracy and to facilitate benchmarking. Focusing on the inpatient survey, he showed how such standardisation allowed for the monitoring of longerterm trends but warned the audience that there have been limited changes in the issues that matter most to patients as evidenced in Figures 5, 6 & 7. Chris was heartened that patient experience is now accepted as key component of healthcare quality and that results show that national policies can drive change. However, he warned that there is still a long way to go on PCC and recommended that providers renew their focus on one or two key issues from the survey especially re: relational aspects of care. Pharmaceutical companies may want to reflect on how much insight and improvement work they conduct around patient experience. A hearty Q&A session ensued with all three panellists despite the temptations of a Xmas dinner. (1) webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/publichealth/ Healthinequalities/Healthinequalitiesguidancepublications/DH_066213 (2) www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf (3) www.gov.uk/government/publications/berwick-review-into-patient-safety (4) High Quality Care For All. Department of Health, 2008. 19
We hope this review gives a flavour of the day to those who weren t able to attend. Members were also able to follow the key themes of the discussions in real time on Twitter #BHBIAWinter. The drinks reception and traditional Christmas lunch that followed gave delegates an opportunity to network with colleagues and other contacts. Both the BOBI Awards Committee and the Ethics & Compliance Committee were represented at the meeting and delegates had a chance to chat to the teams about what s new in these areas. We heard from Wilf Iliffe, BOBI Committee Chair about the new Company of the Year Awards and upcoming BOBI entry deadlines (see pages 46-51 for BOBI Awards news). We had some great feedback from members who attended the event; comments from delegates included: I thought the speaker programme was amazing one of the best I have attended for some time. Really senior people sharing real insight, stimulating content, good questions and expertly chaired. The standard of the papers was excellent probably the best that I have seen/ heard at the BHBIA. Charity raffle We would like to say a big thank you to those companies who sponsored some great prizes for the charity raffle: Very relevant content and good discussion about the challenges with patient centricity and how it effects the MR and Business analysis community. It was great to see experts in analysis and MR on the stage. I gained ideas and learnings from all 4 panellists that I could see a direct use for back in the office. Thanks also to those who bought tickets, raising an excellent 593 for the Carers Trust. BHBIA Supports The Carers Trust Carers Trust is a major new charity for, with and about carers. We work to improve support, services and recognition for anyone living with the challenges of caring, unpaid, for a family member or friend who is ill, frail, disabled or has mental health or addiction problems. Their vision is of a world where the role and contribution of unpaid carers is recognised and they have access to the trusted quality support and services they need to live their own lives. Carers website: www.carers.org Babble (for young carers under 18): babble.carers.org Matter (for carers aged 16-25): matter.carers.org 20
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