Title Submitted by Prepared by BOARD SUMMARY SHEET Improving the Patient Experience Sue Hardy Janet Lewitt Date of meeting 30 th September 2009 Corporate Objectives Addressed 5 - Providing care in a clean and safe environment. 6 - Improve performance and capability of staff. 8 - To develop and embed a comprehensive method of obtaining feedback to improve patient experience. 15 - Support services will improve productivity and access to investigation/services in order to facilitate improved clinical outcomes and other corporate objectives. SUMMARY OF CRITICAL POINTS This paper provides an update to the Board on the work that is ongoing within the Trust to improve our patients experiences. Feedback derived from the use of the Patient Experience Tracker will be provided together with developments emanating from the work of the Patient Survey Leads Group. The development of nursing quality indicators. Utilising feedback from the NHS Choices website Patient Experience Month PATIENT IMPACT: Of necessity this must be high as the Trust s reputation is at stake. STAFF IMPACT: This will be high as staff work towards achieving the actions and goals developed. A change in culture and working practices will be required to achieve some of the actions. FINANCIAL IMPACT: A significant investment has been made in the implementation of PET across the Trust. EQUALITY AND DIVERSITY IMPACT: Improvements wrought as a result of the action plans developed will enhance and support the delivery of the Trust s Equality and Diversity Agenda. LEGAL IMPLICATIONS: Failure on behalf of the Trust to improve could lead to an increase in the level of complaints and litigation. RISK ASSESSMENT: Low performance rating for patient experience from external assessment will mean that, if practices do not change, it is likely that the next In Patient Survey, results will be equally poor, or even worse. Risk Rating 4 x 5 = 20. RECOMMENDATION: The Board is asked to discuss the contents of this report and support ongoing work within the Trust to develop and implement the required actions and cultural changes. Page 1 of 10
Introduction The Board will be aware of the Trust s disappointing results from the 2008 Inpatients Survey. As a result of the survey s findings, the Trust has been classified as performance under review under the National Performance Monitoring Framework. It has been acknowledged by the Hospital Management Group (HMG) that significant improvements are required to improve the patient experience that we provide. Activity in this respect is ongoing in a number of major projects: The Patient Experience Tracker (PET) Patient Survey Leads Group Patient Experience Month Development of nursing quality indicators Utilising feedback from NHS Choices website The Patient Experience Tracker (PET) The Board will be aware that we are using Dr Foster s PET, which is a handheld feedback unit that allows patients to answer 5 questions about their experience as a patient in NGH. The data is fed back to Dr Foster electronically and then analysed. Feedback is supplied to the individual Directorates weekly. We commenced with 5 units in March 2009 but now have 30 units in use across the Trust. This allows each ward and A&E to have a dedicated PET and allows for an additional 3 units to be rotated between out patient areas, pharmacy and radiology. Response to the PET project has been very positive from staff and patients alike. A number of question sets have been in use across the Trust since PETs were introduced. 2 final sets of questions have been established (Appendix 1) which have clear linkage to areas of the patient experience that were identified as particularly poor in the 2008 inpatients survey as well as direct correlation with the CQC domains. These questions were put into use across the Trust on 7 th September 2009. Some concerns remain regarding the reliability of the data feedback from Dr Foster but this has improved in recent weeks and discussions with Dr Foster are ongoing to rectify the discrepancies. An analysis of the responses received to date and measured against domains and the patient survey is provided below: Domain PET Feedback Inpatient Survey Score Access and waiting 72.66 80.90 Safe, high quality, coordinated care 58.73 60.90 Better information, more choice 79.71 65.40 Building relationships 67.09 79.70 Clean, comfortable, friendly place to be 88.59 73.60 Focus on the person 89.40 58.10 Learning organisation 92.10 40.00 Dignity and respect 81.23 79.20 It is disappointing to note that our performance in 3 areas is now perceived to be below the standard recorded in the 2008 survey. However, this measure is recorded solely against the 10 PET questions whereas the 2008 survey contained 76 questions throughout the 8 domains. We must continue to strive for improvement in these areas. Page 2 of 10
Future actions include: Reviewing all internal patient satisfaction audits and linking these to the CQC domains, thus ensuring a comprehensive review of patient feedback is obtained. Accessing the criteria from the CQC which is used to designate whether a point is awarded, according to the national benchmark. Further analysis of the PET results is supplied in Appendix 2. Patient Survey Action Plan As previously reported, the questions that formed the 2008 Inpatient survey were themed into 5 broad areas: Activity Quality of Care Environment and Cleanliness Privacy and Dignity Communication A team leader and deputy were appointed for each area and they were tasked with leading the development and implementation of action plans to address the shortcomings identified by the respondents to the 2008 survey. A further sub group to address dissatisfaction with discharge arrangements, additionally supported through the PET responses, (see Appendix 2) has been formed and will be reporting back through the Patient Survey Leads Group. The team leaders meet monthly and update the corporate Action Plan which is then reviewed on a monthly basis along with the PET results. Examples of findings and responses/actions reported by the team leaders are as follows: Activity Perceptions of waiting times in A&E are often skewed, i.e. a patient complained of waiting for more than 5 hours whilst booking in records showed that the wait was in fact only 1½ hours. There will be posters in the area advising patients of the <4 hour wait target and that patients will be seen in order of clinical priority. Extra clocks have already been put in place. Quality of Care Competencies for Band 5 nurses do not include customer care. This is being addressed by the Practice Development team. Environment and Cleanliness Patients identified the lack of safe storage for their personal belongings as being an issue. The team have identified arrangements for long stay patients of being of particular concern and are investigating the provision of safes. Another major concern relates to the food served to patients the team have identified the need to serve food promptly and ensure that patients are aware of the choices available. Privacy and Dignity Laminated signs reminding staff of the patients rights to privacy and dignity during treatment and/or consultations have been provided to all wards. There has been a lot of interest in this initiative and some out patient areas and A&E will also utilise them. Good practice within this area is being reinforced to all staff and analysis of PET results demonstrate significant improvements in the areas covered within this theme. Communication Trauma and Orthopaedics are trialling a scheme whereby patients and/or carers are invited to make appointments to meet with the Matron to discuss any issues or concerns. The groups are moving forward with the implementation of the recommended activities and audits are being put into place to monitor the effectiveness of individual actions. Page 3 of 10
Patient Experience Month During September 2009 Directorates will be focussing on Patient Experience Month. This initiative incorporates a presentation to enable staff to identify and deliver the highest standards of care and communication, thus enhancing the patient experience. The presentation draws on patient feedback and the aim is to equip members of staff at all levels within the organisation with the skill set needed to deliver a good patient experience. The presentation will be delivered by a combination of CDs, DMs, Head Nurses/Matrons and members of the Executive team using a range of venues local to individual Directorates. Each Directorate has been responsible for drawing up its own schedule of presentation delivery. As an example, Child Health decided that they will focus on one week named Positive Patient Experience Week. The DM, CD and Head Nurse will be hosting a week with daily seminars incorporating the patient experience presentation together with data that supplies feedback on the patient experience, e.g. letters of complaint, audits and questionnaires. NHS Choices Website We have identified the fact that valuable information concerning the patient experience contained on NHS Choices is often overlooked. A process is being developed whereby the site will be checked on a weekly basis and any comments downloaded. Currently 71% of the 35 patients who have rated the Trust on NHS Choices would recommend our hospital to a friend. Much of the data cannot be allocated to any particular ward or area however the feedback is, in general, useful and is broadly in line with the feedback received from PET and the patient survey. Nursing Quality Indicators We are in the process of developing a Head Nurses Dashboard to look at 7 quality indicators and measure compliance and performance against them. The quality areas are: Documentation Falls Assessment Nutritional Assessment Pain Management Pressure Prevention Assessment Medication Assessment Patient Observations Certain specialist areas have had questions revised to reflect the nature of the specialty, e.g. Paediatrics, ITU/HDU, Theatres and Maternity. Performance will be assessed on a monthly basis at challenge meetings to be held with the Deputy Directors of Nursing to ensure accountability and ownership, thus improving clinical care and enhancing the patient experience. Recommendations It is essential that the Trust acts on the feedback received to improve the patient experience. The necessary levels of improvement will, in some areas, require changes in cultural and behavioural attitudes, however, without such change we will not see the level of improvement that we wish. The Board is asked to discuss the contents of this report and support the proposals to develop and implement the required actions and cultural changes. Sue Hardy Director of Nursing, Midwifery and Patient Services Page 4 of 10
PET Questions Appendix 1 The questions detailed on this page are those questions currently in use across the Trust (effective from 7 th September 2009) Question Ans 1 Ans 2 Ans 3 Ans 4 From the time you arrived at the hospital, did you feel that you had to wait a long time to get a bed on a ward? Sometimes, a member of staff will say one thing and another will say something quite different. Did this happen to you? Were you involved as much as you wanted to be in decisions made about your care and treatment? When you had important questions to ask a member of staff, did you get answers that you could understand? Would you be willing to be treated in this hospital again? To some extent Often Sometimes To some extent Always Sometimes Did not ask any questions Question Ans 1 Ans 2 Ans 3 Ans 4 In your opinion, how clean was t very t at all the hospital room or ward that Very clean Fairly clean clean clean you were in? Were the attitude and friendliness of the staff of a high standard during your stay? Overall, did you feel you were treated with respect and dignity while you were in the hospital? Did you ever have to use the same bathroom or shower area as patients of the opposite sex? Would you recommend this hospital to family and friends? Always Most of the time Sometimes Always Sometimes Never Page 5 of 10
PET Results 13 th May 19 th September 2009 Appendix 2 Are you satisfied with the care you have received on Ward/Unit 5% 95% Did the staff answer your questions in a way you could understand? 2% 10% 20% 68% Always Sometimes Seldom Most of the Time Would you be willing to be treated in this hospital again? 5% 95% I feel the cleanliness of the Ward is.. 5% Excellent Satisfactory 95% Page 6 of 10
Were you involved as much as you wanted to be in decisions about your care and treatment? 26% 7% To Some Extent 67% When you had important questions to ask,did you get the answers you could understand? 3% 17% Always Sometimes Seldom 22% 58% Most of the Time If you needed assistance with eating did you receive the help you required? 6% 42% 52% Help Required Are staff friendly and approachable when you need help? 0% 100% Page 7 of 10
Do you feel you were kept informed of your/your child's care? 0% 100% Would you recommend this hospital to family and friends? 11% 89% Did you ever have to use the same bathroom or shower area as patients of the opposite sex? 19% 81% Do you feel you have been kept informed of the discharge arrangements throughout your stay in hospital? 30% 70% Page 8 of 10
Do you feel staff have actively tried to promote your privacy, dignity and protect your modesty? 3% 97% Page 9 of 10
Page 10 of 10