Peninsula Community Health (PCH) is a Community Interest Company (CIC) providing NHS community health services to people in Cornwall and the Isles of Scilly. PCH employs just over two thousand staff, serving a local population of 532,000 and an additional five million visitors per year. PCH services include 14 community hospitals providing inpatient care and rehabilitation to patients discharged from acute hospitals or admitted by GPs.
As a participant in the NHS Institute Patient Feedback Challenge, Peninsula sought to:
- spread the ‘Kinda Magic’ principles of the PCH process of collecting real time, face to face patient feedback, to other NHS organisations. The process not only provides metrics data for monitoring purposes, but also gets to the heart of the reasons behind the results, giving staff something immediate to work with. There are 5 basic principles:
- Face to face conversations (guided interviews)
- Responses to questions recorded, probed, comments captured
- Using non-clinical managers or other non-clinical staff ‘with influence’ (e.g. trainers) to visit wards and talk to patients
- Real time verbal feedback to clinical staff
- Production of quantitative RAG-rated data supported by qualitative information to ‘make it real’.
This truly ‘ward to board’ reporting engages and empowers staff, resulting in improvement actions being taken whilst the patient is still in our care rather than later actions responding to retrospective (and poorly understood) metrics data. In other words, the Kinda Magic process is about ‘putting quality into metrics’
- spread the Kinda Magic process to patients ‘excluded’ because they have cognitive and/or communicative impairment e.g. dementia, aphasia, learning disability. Although we included relatives and carers when possible, the tool, process, and the skills of those who collect the data, neither equipped nor enabled us to be fully inclusive. We knew that we were not fully meeting our obligations under the NHS Constitution, and that morally we were not meeting our obligations to our most vulnerable patients, as we were not capturing their feedback. A year of searching widely for tools and methods to do this had proved fruitless, so, ambitiously, we decided to develop our own.
The Dementia Lead and the Patient Experience Manager did the initial planning. We sought likeminded and committed individuals with rich and varied expertise in local health and third sector organisations. We tapped into a common will to find ways to gather feedback and ‘measure patient experience’ of patients with cognitive/communicative impairment. We formed an initial working group and subsequently, after we submitted a winning bid to the NHS Institute’s Patient Feedback Challenge (PFC) we recruited further ‘spread partners’ (see Appendix 1)
Spread partners signed up by committing to two objectives, or 2 phases:
Phase 1 implementing their own processes to collect patient experience metrics based on Kinda Magic principles.
Phase 2 work with us to develop accessible tools to collect feedback from patients so far excluded.
We recruited a Project Officer and Impact Innovation in a coaching and facilitating role. We formed the core team but actual delivery of the project was a bigger, broader effort involving the leads of all spread partner organisations.
We involved patients and their representatives throughout via third sector organisations.
We produced a ‘call to action’ film to engage interest. Shown at numerous forums and events locally and nationally, and included in all publications, it is available on YouTube.
We communicated via the PFC web channel making information visible and available
We devised an ‘event driven’ project programme to maintain momentum; working towards each workshop meant key milestones were met. Each event re-invigorated the will and motivation and promoted further spread.
We promoted the core principles rather than a prescriptive tool; these principles became central to implementation in different forms and allowed local interpretation of tools.
We measured spread of Phase 1.
We produced tools to use with different groups of patients. Phase 2 consisted of workstreams in dementia, learning disability and stroke. However, almost immediately, unplanned but spontaneous spread of Phase 1 occurred in our spread partners’ mental health services and children’s services, highlighting the need for Phase 2 in those areas. Royal Cornwall Hospitals Trust (RCHT) led on learning disability and children’s services, PCH led on dementia and aphasia, and Coventry and Warwickshire Partnership Trust (CSPT) led on mental health.
We tested the tools with target patient groups and identified further improvements. Each workstream has been self-organised, and reports back to the wider project in workshops and meetings.
A more in-depth promotional film was commissioned by the Institute
Impacts We’ve achieved wide spread of a process that makes patient experience metrics do more than simply provide a dashboard for reporting and retrospective actions against trend data. We’ve spread a process that does that, but also makes it meaningful, engages staff, results in quick actions and improved outcomes.
We have numerous examples of outcomes in terms of:
- improvements made in response to feedback
- interventions when other issues have been elicited (e.g. safeguarding)
- anecdotal evidence that staff who undertake the process value their contact with patients and reflect on what they hear when operating in their own roles
- ward staff value, trust and respect the feedback they receive and value seeing senior non clinical managers/trainers/directors on the frontline
We’ve demonstrated that Kinda Magic principles are widely replicable across different care settings. Participants saw connections and application in areas not originally planned. Consequently, spontaneous spread into mental health units and children’s services occurred. Spontaneous spread also occurred in the Care Home sector. Brought about by the call to action and general ‘buzz’ the project created, Cornwall Council’s Adult Care and Support became spread partners and piloted the process in care homes.
We’ve given a voice to our most vulnerable patients! We’ve developed a range of tools to collect feedback from patients who previously were not being asked their views.
Measurement We measured ‘spread’ of the Kinda Magic principles. Until embedded, we regularly measured number of organisations/teams participating, and number of patients interviewed. Spread occurred into:
PCH District Nursing Service and Bladder and Bowel Service, RCHT in Eldercare, HPFT in mental health inpatient units, CWPT in mental health inpatient units. At CWPT they also used their learning from this to design a set of metrics for community mental health patients.
Spread is ongoing with new organisations asking for guidance to implement our Phase 1 process.
Key Learning Points
- Success depends on strong leadership and organisational commitment therefore it is crucial to ensure the Board is signed up.
- Recruiting senior non-clinical staff is challenging due to the time commitment required, however, using senior staff rather than junior staff, is one of the most powerful aspects of this process.
- Try and recruit some who will be champions, but in our experience, some of the biggest advocates have turned out to be those who were not initially keen.
- Support and role preparation are key.