Implementing the recommendations from Putting Patients Back in the Picture

Wednesday 26 February 2014, London

Follow this conference on Twitter #NHSComplaintsFeb14 This conference focuses on implementing the recommendations from the National Review into Complaints Handling in the NHS including developing board level responsibility, improving complaints standards and complaints handling, improving communications and information on the wards, responding to patient concerns, giving the complaints process independence and implementing the statutory duty of candour. The conference will also update delegates on national developments including how the Care Quality Commission will be using complaints information in the new inspection plans and new requirements for trusts such as the annual complaints report.

For further information and to book your place visit or email

A £250 +VAT discounted rate* is available to PEN members quote: HCUK250PEN when booking.
(This rate applies to new bookings only* and cannot be used in conjunction with any other offer. Full T&Cs available upon request)

Experience-based Toolkit

The revised Experience-based co-design (EBCD) toolkit, which was launched this week by The King’s Fund at

The toolkit outlines a powerful and proven way of improving patients’ experience of services. It captures the experiences of patients, carers and staff through discussion, observation and filmed interviews, then brings them together to explore the findings and to work in small groups to feed this into direct service improvement. By enabling patients and service users to tell their own stories in this way, the EBCD approach often reveals unexpected areas for improvement that can be surprisingly simple to overcome.

The original toolkit was launched in August 2011 and there is evidence that services have improved for patients as a result. Surveys also show very high levels of positive feedback on engagement. A 2013 global survey found that EBCD projects had either been implemented, or were being planned, in more than 60 health care organisations in the NHS and in other countries.

The Kings Fund have updated the toolkit in response to suggestions made by people using it. The main additions are:

  • Four case studies to help bring to life the successes and rewards of running this type of project, including in mental health
  • More on costs and how to adapt the approach to a limited budget (‘accelerated EBCD’)
  • More on the role of the facilitator
  • More links to peer-reviewed evidence on the effectiveness of EBCD

NHS Institute for Innovation & Improvement – Children and Young People

AhHa Publications was developed by Helen Sadler and Audrey Fletcher-Price, creating photographic storybooks for children featuring “Monkey”, a loveable character with a mission to support, inform and reassure children and their families before and throughout an unfamiliar hospital stay or frightening medical procedure.

In response, the NHS Institute for Innovation and Improvement, together with the Association of Chief Children’s Nurses (ACCN), with a small grant, worked with parents, and Helen and Audrey to develop a suite of resources for use in primary schools to educate and engage 5-11 year olds about emergency and urgent care services “fronted” by a friendly character called Monkey.

This creative and educational project is interactive and fun it encourages healthcare professionals to work with teachers in schools. It has the opportunity to include the wider community and is accessible to all through the addition of British Sign Language, Audio Description and subtitling. The impact is potentially enormous if just one child from each school does not head straight to ED and considered alternatives, pressure on Emergency departments could be relieved. Even in just 5 schools the impact has been amazing and encouraging e.g. if Harry’s Grandma now knows about Walk in centres after sharing the guidebook at home, then how many other families will access the appropriate facility rather than heading straight to ED?WHAT’S IN THE PACK?

Teacher’s Lesson Plan

DVD Resources Disc, featuring NHS Explorer’s Film, Monkey’s NHS Song and ample resources supporting the teaching (in line with the National Curriculum and Early Years Foundation Stage Curriculum)

35 Children’s Guidebooks for children to take home

NHS Explorer Sticker Sheets

NHS Services A2 poster

Monkey Puppet for role play that encourages discussion and interaction to aid enthusiasm of the message objective

In an evaluation by Nick Medforth and Dr. Daz Greenop of the Faculty of Health and Applied Sciences, Liverpool JMU they commented:

“Monkey’s cultural neutrality and cheeky demeanour gives him universal appeal.”

“An invaluable resource tool.”

The Hillingdon Hospitals NHS Foundation Trust – Refresh of our values

The Hillingdon Hospitals NHS Foundation Trust took the exciting journey to review our values in November 2010 when it became apparent that there was the need to refresh and build on the existing culture and values. To capture learning from others a small working group visited other organisations to understand their culture and values and how they engaged staff. The learning from these organisations was used locally to make use of tried and tested methods.

In particular, a gap was identified around the underpinning behaviours expected of staff. We wanted to clearly define the minimum standard of behaviour that is expected across the Trust from our staff.

When consulting with staff it was reinforced that staff engagement in the refreshing of the culture and values was paramount to encourage ownership and buy in. The first stage of this engagement exercise was to gain staff input into the decision around which word would serve to remind staff what our values are. In view of this, and following further research, four acronyms (as below) were identified and put to staff vote.

  • PRIDE – People, Responsibility, Inspire, Deliver, Educate
  • ACT – Attitude, Communication, Teamwork
  • CARE – Communication, Attitude, Responsibility, Equity
  • PROUD – People, Responsibility, Outstanding, Understanding, Deliver

The acronym CARE received the highest votes and therefore represents our values. It was recognised that the word ‘Safety’ is a much needed addition to CARE, so it was added, thereby making the acronym ‘CARES’.

Associated behaviours

We then went on to develop a set of CARES behaviours that all Trust employees are responsible for demonstrating. To encourage full staff ownership of the behaviours small focus groups were arranged with staff from various areas and levels across the Trust. It is important that the behaviours whilst generic were meaningful and understood by all staff regardless of their role within the Trust or their area of work.

A total of seven events were held during June and July 2010 with a representative sample of staff from a variety of areas discussing the CARES acronym and the behaviours that they felt should underpin the acronym.

A session was also delivered to patients at the July 2010 Patients in Partnership forum to capture feedback, suggestions and thoughts from our service users. CARES was received positively and the feedback provided a more rounded set of behaviours that help incorporate the service user’s expectations.

Implementation of CARES and the expected behaviour

CARES has been and continues to be threaded through a number of initiatives, to ensure that our values embed the culture we want to create within the organisation and that it is at the heart of everything we do. We have been doing this through:

Developing our Experience and Engagement & Leadership strategies

CARES underpins the Trust Experience & Engagement and Leadership strategies. These two key strategies will provide a rounded approach to our commitment to embedding our culture through our values thus ensuring sustainability over time through developing supporting mechanisms. We wanted our commitment to improving staff and patient experience to expand into everything we develop so that it becomes ingrained as part of our transformational as well as transactional activities.

CARES will be incorporated into the development of the leadership framework and any leadership programmes. Existing leadership and management development programmes will be reviewed to incorporate CARES.

Retention and Recruitment

We have developed a set of generic questions incorporating the key behaviours within CARES for use at all interviews. The key behaviours will also be incorporated into our person specifications. We explore staff perceptions of how well CARES is embedded at Exit interviews, when leavers are more inclined to be open and honest with feedback.

Performance and Development Review (PDR) and Talent Management

We reviewed both our PDR and Talent Management processes and paperwork to incorporate the CARES behaviours in the format of a behavioural scale encouraging a more open discussion in a non-threatening manner about the individual’s demonstration of the values.

Reward and Recognition

Current reward and recognition initiatives are being reviewed and expanded to ensure they include assessment against the CARES framework so that staff who display the appropriate behaviours are recognised.

Customer Care Development Programme

The Trust has invested in an external provider to deliver a bespoke Customer Care programme which uses actor’s to present scenarios that have been taken from actual staff and patient feedback. These have been powerful as they bring emotion into the scenarios that bring feelings to life.

CARES Ambassador’s

We have appointed CARES Ambassador’s who have a responsibility for demonstrating the CARES values in practice, inspiring others to demonstrate the values and to want to be an Ambassador. They will reinforce the importance of our values and the commitment of the organization to making the embedding of them a success.

They will capture good practical examples of CARES in action and good news stories, communicating these so that we deliver positive messages about how we are making progress.

The Ambassadors will give feedback to others who demonstrate the CARES values and will challenge others whose attitude and behaviour is contrary to our values.

The road ahead…….

We recognize that we have made some progress but know that we still have a long way to go but through our multi targeted approach we are confident that we will see improvements over the coming years.

We will be asking staff about their understanding of the values through bespoke questions in the National Staff Survey and will continue to use it to measure the impact through the varying stages of implementation from understanding through to applying.