THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST COUNCIL OF GOVERNORS REAL-TIME PATIENT FEEDBACK

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1 THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST COUNCIL OF GOVERNORS Agenda item 4(vi) Paper D REAL-TIME PATIENT FEEDBACK Report Purpose: Decision / Approval Discussion Information Brief description of the item and any significant issues: The NHS Next Stage Review 1 indicated that quality should be at the heart of a reformed NHS with patients experience forming a key part of the assessment of quality. Measuring patients experience is essential if we are going to improve quality. Knowing what and how to measure is a challenge for the Trust to consider. This briefing paper sets an overview of why feedback systems may be useful, current and future plans in achieving Real Time Patient Feedback and the type of systems we, as a Trust, should consider. An executive summary precedes the body of the paper the content of which, in order to fully inform Governors, is taken from Board and other papers.

2 THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST COUNCIL OF GOVERNORS REAL-TIME PATIENT FEEDBACK EXECUTIVE SUMMARY The DoH will shortly require all hospital Trusts to collect real time feed back from its patients, using technology to collect data during or immediately after treatment to both enable fast response and to be used to form part of the Quality Account. The Trust has, therefore, set up a project aimed at introducing an innovative system to obtain and share patient feedback on health care contacts measuring experiences which patients feel are important to them when they experience them based on the feedback, developing and improving service delivery either straight away or as part of commissioning The elements to be measured, product evaluation and costs have been considered, resulting in two bespoke system options with the capacity to include Trust designed questions flexible, affordable (Trust ownership) real time reporting features the ability to be used for other applications such as an out patient self booking system a research and audit application. A Patient Feedback Project Group, chaired by the Director of Quality and Effectiveness, of clinical and non clinical staff, patient representatives and a Governor (MAH), along with staff from the IT department, exists to look at the implications of setting up such a system in a phased way consider use in all in and out patient areas excepting critical care units Design processes to support project success Mitigate risk. 1 Mary Ann Hargreave Public Governor March 2010

3 1. INTRODUCTION Systems to increase the quality and pace of patient feedback to support service improvements with an emphasis on the patient s perspective should be developed to meet the recommendation that quality should be at the heart of a reformed NHS 1. The challenge is to find measurement systems, which will provide timely and accurate information to the organisation and be easily accessible and appropriate for both inpatients and outpatients, including children and adolescents. 2. WHY IS THIS NECESSARY? It is recognised that feedback from patients is very useful for improvement and redesign of services in addition to providing benchmarking between services and organisations. Further benefits include provision of data to allow professionals to reflect on their own practices, to inform commissioners about the quality of services and to help patients choose high quality providers. Whilst the Trust currently requests patients to participate in satisfaction surveys these tend to be isolated to particular clinical services, therefore the results cannot be compared across the organisation, or the emphasis is on satisfaction rather than the patient s experience. The National Patients Survey has some advantages in that the standardisation of the questions allows between organisation benchmarking, however the results are old when published and it is not possible to access the source data thereby preventing local interpretation and analysis. The Department of Health 2 has announced that it will shortly require every hospital Trust to collect real-time feedback from its patients, which should involve the use of technology to collect data on patients experiences during or immediately after treatment. Trusts are encouraged to obtain regular feedback with faster turnaround of results than is possible from national surveys. To be able to respond to these demands, it is recommended that the Trust considers the purchase of technology systems that are as flexible as possible, and where Trust staff can influence which questions will be asked of patients and set up the reporting mechanisms whereby results will be disseminated around the Trust. 3. HOW DO WE MEASURE? Current Practice As this system is being developed, the Trust continues to collect patient opinion via: 1. Individual Directorate Lead initiatives collating patient opinion of service delivery 2. Patient Reported Outcome Measures (PROMs) 3. NHS Choices website 4. Patient Focus Groups 5. Patient Representation on Groups 2

4 Future Plans Several systems to measure the patient experience are available and representatives from the Trust have been involved in demonstrations and product evaluation presentations. The following options have already been considered by a small team under the direction of the Director of Quality & Effectiveness: Three in-house solutions Three full-managed service solutions Three web-based solutions Two options specifically aimed at children and young people. Two systems in particular have been identified as suitable based on the following criteria: Flexible on-line question design tool Flexible on-line reporting tool Real time reporting Not hardware specific Affordable initial and ongoing costs Support for wider applications possible, e.g. research & audit. The recommendation is that, for the most part, floor or wall-mounted kiosks with touch screens be used to capture patient feedback. The number and type of kiosks to be deployed still needs to be established in association with Clinical Directorates, Estates and IT. Currently, however, the plan is to provide a kiosk in every out-patient area and in-patient ward with the exception of critical care units. The information from the kiosks would be uploaded via the WiFi network, or the mobile phone network, to the external server. As the hardware would be owned by the Trust, it could be used for other applications, e.g. as information points and for patients self-booking into Outpatient Clinics such as ECG and X-ray. 3

5 As part of the evaluation process a local company supported a two week pilot in the Ophthalmology Out-patients Dept, an example of the questions used are presented in Appendix WHAT DO WE MEASURE? 3 The Institute of Medicine s definition of patient-centred care suggests that when measuring patients experience the following should be considered: compassion, empathy, responsiveness to needs, values and expressed preferences co-ordination and integration information, communication and education physical comfort emotional support relieving fear and anxiety involvement of family and friends. 4,5 Whilst other UK based studies undertaken specifically to determine patient priorities and important factors, advise that the following should feature in measurement of the patients experience: having confidence in staff clear information and communication staff knowledge and experience clean facilities being treated with dignity and respect. It is also recommended that staff representatives should be engaged in the planning process, therefore a Patient Feedback Project Group has been established, chaired by the Director of Quality & Effectiveness, with staff representatives from clinical and non-clinical departments and a member from the Council of Governors. The overall purpose of this Group is to Ensure that there are in place proper processes for the setting up and monitoring of Real Time Patient Feedback systems within the Trust. The overall aim of this project is to introduce an innovative system to obtain and share patient feedback on healthcare contacts, measure the things that patients tell us are important to them, use this information to develop/improve service delivery, in commissioning, the Quality Account publish the results. The terms of reference for the Group are attached as Appendix 2 and include final evaluation of feedback systems, design of the core Trust survey questions and designing and leading a data collection and improvement strategy. 4

6 5. WHAT WILL IT COST? Ideally we would aim to implement a real-time patient feedback system which involves putting access points in all out patient and inpatient areas, with the exception of the critical care units. This would allow patients to complete a questionnaire immediately after their out-patient appointment or at the time of discharge for inpatients. Multiple access points would enhance and improve existing systems for patient feedback allowing focus on areas of dissatisfaction and monitoring of improvements in addition to providing a function for local questionnaires and to support clinicians to become more responsive to the patient experience. However, the more access points provided, the greater the implementation costs. Current estimates from preferred providers suggest that initial funding of between 99,500 and 145,000 is necessary to equip the whole Trust, with additional annual running costs of between 9,000 and 30,000. Variation is based on software provider and hardware options. A phased approach to implementation is recommended, concentrating on adult out patient services first, then adult in patient services. Children and adolescents may require separate software systems from those provided for the adults. It is recommended, therefore, that this be explored separately, although children s services have been included in the financial estimations. 6. RISKS AND RISK MITIGATION The obvious risk associated with this initiative is that it is expensive and there is no guarantee that it will be successfully applied. We could review the information already collected within the Trust and collate the information with that collected through the NHS Choices web site and the National Patient Satisfaction Survey into a Trust wide report, which would be a cheaper option but this would not satisfy the requirement to be responsive in real time. The establishment of a Project Group to oversee this initiative with regular reports to the Trust Board should mitigate unnecessary risk. 7. SUMMARY Systems to increase the quality and pace of patient feedback to support service improvements, with an emphasis on the patient s perspective, have to be developed. There are a variety of systems available, several have already been deemed as unsuitable for this Trust. Members of the Board have given their support to the Patient Feedback Project Group in order to evaluate some bespoke systems for implementation throughout the Trust, using a phased approach. 8. RECOMMENDATION In striving to implement real time patient feedback systems the Trust continues to collate and act upon current patient opinion. The Board has approved the proposal 5

7 to implement a system for measuring real-time patient feedback and to support the Patient Feedback Project Group in evaluation of suitable systems for collection of data. The Board and Council of Governors will receive regular reports of detailed proposals and progress. Diane Palmer Director of Quality and Effectiveness Anne Marie Troy-Smith Quality Development Manager February

8 Appendix 1 Real Time Patient Experience Pilot The Trust values enormously the views of patients about their treatment here and their experiences in our hospitals. We seek continuously to improve the care, which we provide, and patient feedback is an important source of information to identify areas requiring improvement. The Trust ran a twoweek pilot project to gather patient s opinions about their treatment using a touch screen. We wanted to simplify and speed up the way we capture patient feedback. By asking patients to use touch screen technology themselves we released staff to focus on providing care rather than having them filling in forms. The touch screen was located in the corridor leading to the Outpatient s Department and the simple questionnaire will only consist of 8 questions, in six languages English, Bengali, Chinese, Arabic, Polish and Farsi: No. Question 1. Was your privacy and dignity respected? 2. Did you feel that we tried adequately to inform you of your condition and its treatment? 3. Were you given information in a way you understood? 4. Were you seen within 15 minutes of your appointment time? 5. Were the people who dealt with you friendly and helpful? 6. Did you feel safe during your visit to the hospital? 7. Would you recommend this hospital to a member of your family or to a friend? 8. Overall how would you rate your experience as a patient? Excellent Good Fair Poor Patients were asked which Consultant clinic they had attended and the machine recorded when the information was entered. From this information we were able to produce reports showing the response to each question and any variations through the day. On completion of the pilot a Real Time Patient Feedback Group was formed and Trust Board approval sought to advance the project. 7

9 Appendix 2 The Newcastle upon Tyne Hospitals NHS Foundation Trust Real Time Patient Feedback Project Group Constitution and Terms of Reference Members Cooption Quorum Frequency Director Quality & Effectiveness Chairperson Governor Quality Development Manager Guidelines Co-Coordinator Network Manager, IT EME Services Officer PCPI Co-Coordinator Medical Consultant Matron Other parties will be co-opted as necessary Power to co-opt as and when required Four members to include Chair or nominated deputy. All nominated representatives should send a deputy if they are unable to attend. The Chair should monitor attendance on a six monthly basis Bi-Monthly (with other meetings convened as and when required) Policy Statement High Quality Care for All proposed that all providers of NHS care should produce Quality Accounts to provide the public with information on the quality of care they provide. Aswell as providing statistics on how we are performing clinically the Newcastle upon Tyne Hospitals NHS Trust wish to collate and share with patients information on how they themselves rate their experience with us. We will use this information as a Quality Indicator to promote and further develop our services. Overall Purpose To ensure that there is in place proper processes for the setting up and monitoring of Real Time Patient Feedback systems within the Trust. The overall aim of this project is to introduce an innovative system to obtain and share patient feedback on healthcare contacts, measuring the things that patients tell us are important to them, using this to develop/improve service delivery, in commissioning the Quality Account and publishing the results Terms of Reference 1. To ensure that Real Time Patient Feedback processes are developed and integrated with the quality programme for the organisation as a whole. 8

10 2. To ensure a co-ordinated and coherent approach to the development, deployment and support of Real Time Patient Feedback systems. 3. To assess current Real Time Patient Feedback provision and support within the Trust. 4. To identify and evaluate any sytems, tools /technologies required for this data capture and if necessary procure / develop a range of options if nothing suitable exists currently. 5. To develop and agree the design of the core Trust survey questions. 6. To identify members of a smaller sub-group to prepare documentation for the Project Group. 7. To develop a Trust data collection and improvement strategy in relation to Real Time Patient Feedback. 8. To formulate a Real Time Patient Feedback plan for the Trust with a proposed implementation plan, and to report such recommendations to the Trust Board. 9. To make recommendations regarding priorities and resource requirements. 10. To advise on the direction and implementation of the project 11. To monitor progress and ensure adherence to the project plan/strategy. 12. To seek specialist advice where appropriate 13. To make regular reports and report progress at agreed intervals to the Trust Board and other relevant committees within the Trust. 14. To ensure effective communication and dissemination within each of the participating Departments 15. To consider and recommend strategies for the continuation and development of the initiative after the life of the project Organisational Relationship The Chief Executive has the ultimate responsibility for assuring the quality of services provided by the Trust. The Director Quality and Effectiveness is responsible for ensuring that systems and practices are in place within the Trust and for monitoring continued effectiveness. Reporting Mechanism The Real Time Patient Feedback Project Group will report bi-monthly to the Trust Board. References: 1. Department of Health (2008). High quality care for all: NHS next stage review final report. London: Department of Health. 2. Department of Health (2009). Listening, responding, improving: a guide to better customer care. London: Department of Health. 3. Committee on Quality of Health Care in America (2001). Crossing the quality chasm: a new health system for the 21st century. Washington: National Academy Press. 4. Reeves R, Coulter A, Jenkinson C, Cartwright J, Bruster S, Richards N (2002). Development and pilot testing of questionnaire for use in the acute NHS Trust inpatient survey programme. Oxford: Picker Institute Europe. 5. Acute Co-ordination Centre for the NHS Patient Survey Programme (2007). The 2006 inpatients importance study. London: Healthcare Commission. 9