Kath Evans

There are approximately 12.3millon Children and Young People in England, that’s 22% of the population and their experiences of care matter.

We cannot address experiences of care unless we take a moment to ask, how is for you? What’s working, what could be better? The challenging element of working with Children and Young People is tailoring our communication to their developmental stage so we get the best outcome for all.  As a Children’s Nurse I’ve worked in the NHS for nearly 26 years and fully appreciate the busyness of day to day clinical practice and the demands made on staff, for health care professionals juggling is a critical component of our job description! Yet it’s the combination of science, art and humanism that create moments that matter to the Children, Young People and Families/Carers we have the privilege of serving, whether that be on a one to one, in a group situation, or on issues such as configuration of services.

Kath Evans

Children, Young People and Families/Carers constantly inspire me, children like Rhys who had a renal transplant at 18months of age and showed us what he didn’t like by breath holding – a pretty scary communication strategy which was very effective! Daniel, 14 who when I visited his school having spent a week in hospital asked me to take a note back to the NHS reminding us how scared patients are (attached). Thines who has Brittle Bones shared ‘in my 19 year of using NHS Services no one has ever once asked how is it for you?’ and parents including Jane Raca who writes eloquently of her experiences of ‘Standing up for James’ her son with complex disabilities and having to constantly challenge the system about her son’s and family’s experiences of care.

Kath EvansI am a bit of fan of Social Media, it’s a great way to make connections with users of services, including the wonderful Adam who tweets as @Adsthepoet he shares his experiences of care by blinking and blogging, and parents such as Rick, tweeting as @38lineblog dad to Isaac challenges how we are delivering on the 6Cs, Compassion, Care, Competence, Commitment, Communication and Courage. Social Media also offers professional connections with wonderful colleagues such as Cath Battrick in Southampton tweeting as @wooffa and Jerusha MurdochKelly tweeting as @jerushaMK and Walter Tan who tweets from @RMCHosp and Emily Roberts tweeting as @emily_melville – they all share how they are working to improve experiences of care across the country in real time, creating conversations that challenges current practices.

Of course I also have a remit for Maternity experiences of care, and inspirational now retired Consultant Midwife Sheena Byrom @SafefemmeSB is a twitter mentor! If we create great maternity experiences that the best foundation for that child and family that we could wish for. Sadly things don’t always go well and recent mapping of care offered to women experiencing miscarriage http://www.nhsiq.nhs.uk/resource-search/publications/pregnancy-loss.aspx highlighted there’s lots of good practice across the country we could be sharing to improve experiences in often incredibly sad situations.

My current role at NHS England as Head of Patient Experience, brings together my previous clinical, academic, managerial and service improvement roles, it’s a privilege to be part of a social movement that is amplifying experiences of care, including the 22% of population, our Children and Young People  who have a right to the best health care possible (UNCRC 1989)

http://www.unicef.org.uk/UNICEFs-Work/Our-mission/UN-Convention/

I am delighted to be recognised by the Patient Experience Network, it’s a team I have the utmost respect for, however we are all outstanding contributors patient experience and all make a contribution by the attitudes we choose each day.  

Kindest regards

Kath

Kath Evans
Head of Patient Experience – Maternity, Newborn, Children and Young People
Nursing Directorate
NHS England
Mobile: 0782 4545954
Email: kath.evans3@nhs.net  Twitter: @kathevans2
‘High quality care for all, now and for future generations’

Dorset County Hospital

Title of Project
The Side Rooms Project – Dorset County Hospital uses crowd sourcing to engage frontline staff in improving the patient experience of hospital side rooms.

Organisation
Dorset County Hospital

1.Introduction
Dorset County Hospital (DCH) is a modern, 333-bed hospital, with 7 main theatres and 2 day theatres and 50 side rooms. It provides the full range of general, acute hospital services including an emergency department and links with satellite units in five community hospitals and has 3,114 members of staff. The hospital serves a population of approximately 215,000 people.
Dorset is a medium-sized county with a smaller than average, sparsely distributed and mainly rural population. Over a quarter of the population is of retirement age (in the whole of England, this figure is less than a fifth). The population of Dorset has been growing faster than the national average, particularly in the older age groups in which long-term illness is more common.

2.Aims of the Initiative
This project used the experience based design approach (NHS Institute for Innovation & Improvement, 2009) to understand the experience of healthcare in side rooms from the patients’, carers’ and staff perspective in a deeper way. Working in partnership with the Local Involvement Network (LINks) in Dorset, DCH discovered that patients in side rooms often felt isolated, at times disorientated and didn’t always understand why they were in the rooms. DCH wanted to address these issues and make significant improvements by engaging the frontline staff who service the side-rooms in making improvements to the patient experience.

3.What was done?
DCH used a ground-breaking way of collecting and using ideas from their staff to improve how patients experience their services and is now implementing the ideas put forward.

Using innovative ‘crowdsourcing’ methods, the project empowered staff of all levels to act as patient ambassadors. Using a private social-media style website called ‘Patient & Family Echo’ they anonymously submitted ideas for improvement, and voted the best to the top.

The campaign asked cleaners, porters, doctors and nurses to submit their ideas on how to improve the patient experience in the side rooms. All ideas were treated equally, which can be a problem for more traditional engagement technique such as focus groups.

The campaign was promoted to 175 doctors, nurses and support staff who work with patients in side-rooms, who were asked:
What can we do to improve communication with our patients about their stay in the side-rooms?
What can we do to make our patients feel less lonely and isolated during their stay in the side-rooms?

The campaign ran for three weeks and during this time:
17 representatives from all clinical groups came together to suggest improvements based on their interactions with patients,
They collectively made over 150 contributions, around 19 specific, actionable ideas.
This campaign was delivered without any meetings or workshops, allowing the whole consultation process to be completed in a little over a month.

Having implemented the improvements, DCH has engaged a volunteer to monitor them and the patient experience. The campaign enabled the Patient and Public Experience Team together with the Infection Control Team and Dorset LINks to work with their colleagues across the hospital to make improvements.

4.What impact has the initiative made?
The ebd approach enables healthcare providers to ensure that what might have been seen as ‘little things’ in the past are an important part of the delivery of high quality care, and involves understanding the experience from the staff, patient and carers perspective.

During the project, all contributions were mapped against the QIPP objectives of Quality, Productivity and Prevention, showing how these objectives are being met. Specific improvements include:

Clocks with day, date and time are being put in every room.
The League of Friends deliver a free newspaper for every side room patient.
Estates and Facilities plan more imaginative colour schemes when they next redecorate.
In partnership with Hospedia, a communication was sent to staff on how to request free television for patients, based on clinical need.
The Infection Control Team reassessed and restructured the communications given to patients and carers to help them understand the reasons for their stay in the side rooms.
Piloted Intentional Ward Rounding
Engaged a volunteer to monitor the changes and impact upon patient experience.

The campaign also saw the submission of a number of smaller ideas which constitute best practice in daily activities (e.g. ways of speaking with patients). These ideas were not made into formal action plans, as we used the website to encourage participants to put them into action themselves.

5.What next and where can we find more information?
We are systematically using this process to engage staff in service improvement and decision making. Our second campaign engaged staff to share ideas for patient experience improvement around themes from the National Inpatient Survey. The Patient & Family Echo team worked closely with us during the first project to help us build a capability we can use on our own. As we continue we will seek to identify groups of staff that have not engaged, understand the reasons why and try to encourage them to do so.
This campaign was widely publicized through CEO and Trust briefings, Sisters and Matrons meetings and the local press. The project was written up in full and available on the Trust intranet site. Reports were made to the Learning from Patients Committee, Trust Board, PEAT Committee and Infection Control Team meetings. Individual frontline staff were invited to participate in the campaign via their Trust email addresses. The campaign was publicized through the Dorset Echo, HSJ, Patient Feedback Challenge Website and Patient & Family Echo/Clever Together Website.

http://www.dorsetecho.co.uk/news/10456669.Hospital_staff_share_knowledge_to_improve_patient_experience/

http://clevertogether.com/public/case-studies/dorset-case-study/

http://www.hsj.co.uk/dorset-county-hospital-crowdsources-improvements/5060040.article

6.How might the initiative be relevant to other groups
Service improvement:
improve the experience of patients and their families in healthcare
drive efficiencies and increase quality
create more integrated and motivated workforce
more joined-up working with partners and suppliers

Robust, transparent strategies with buy-in from the off-set:
capture the collective wisdom of staff and stakeholders to inform strategic choices
use staff and stakeholders as a test bed for tactical ideas to drive action, fast

Patient & Family Echo was part of The Patient Feedback Challenge, and supported several NHS Trusts in running campaigns. The NHS Patient Feedback Challenge, created and managed by the NHS Institute and funded by the Department of Health, was a one year programme designed to find and spread great approaches which use feedback from patients to improve services.

http://pfchallenge.clearvale.com/pg/groups/27985/patient-and-family-echo/

http://pfchallenge.clearvale.com/

7.What do you feel makes this initiative special?
Service Quality: Turns patient feedback into service improvement, quickly and transparently.
 
Staff Motivation: Helps staff feel engaged and valued, by giving them a voice in service improvement.
 
Compliance: Embeds a systematic approach that empowers staff to share insight & concern with leadership, anonymously.

8.Learning points
Go for it! Until you try something out you don’t know how it’s going to work in your organisation. Some of our campaigns have been more successful than others. It is important to communicate and publicize the project, throughout the campaign, so when you start one be prepared to set aside time for this aspect.

9.Materials for Sharing
Tools and resources about the ebd approach are available at www.institute.nhs.uk

http://www.institute.nhs.uk/quality_and_value/experienced_based_design/the_ebd_approach_(experience_based_design).html

Tools and resources for the Patient & Family Echo are available at www.clevertogether.com

http://clevertogether.com/public/patient-family-echo/

Peninsula Community Health (PCH)

Peninsula Community Health (PCH)

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:

  1. 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’

  2. 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.
https://www.youtube.com/watch?v=1TRMzP7OWz4

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
http://www.youtube.com/watch?v=y4fhGgRRA5Q

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.

Using Technology to Improve Patient Feedback and Patient Experience

Using Technology to Improve Patient Feedback and Patient Experience

Nottinghamshire Healthcare provides integrated healthcare services, including mental health, learning disability and community health services. It employs over 8800 staff from over 100 sites. It has an income of £435 million.

The Trust aimed to be the most open and responsive organisation in the NHS and to help do this they wanted to develop their own publicly accessible patient experience website. They wanted to be the first NHS organisation to make all their feedback visible to the public and Trust staff whilst making it easier for staff to respond.

They successfully applied for funding from the £1m NHS Patient Feedback Challenge. They used some of the funding received from the Challenge to develop their own feedback website where people could leave and view feedback from the variety of sources they use.

With the enthusiastic support of the Board the Involvement Team launched their Feedback Challenge project in September 2012. The team led a transformational and ambitious programme to:

  1. Develop ten teams across the Trust’s three Divisions to become beacons of good practice for all aspects of patient feedback and to spread this to other teams.
  2. Create a patient experience website that is public, accessible, improves accountability and drives change

To develop the website two design workshops were run in November 2012 one for service users, carers and frontline staff and the other for managers. These were to gather what people wanted from a Patient Experience Website and to seek advice on its design.

The website was developed over five months, during which they tested versions with service users, carers and staff. It was refined into a site that meets the needs of both staff and the public, with five distinct sections:

  1. Home page – with the most recent survey results, latest Patient Opinion postings and changes teams have made in response to feedback
  2. Leave Feedback – where people complete the survey, tell their story via Patient Opinion or find contact details to speak to the organisation directly via PALS
  3. View Feedback – see reports with survey results and all the comments received for each team. A custom search with the ability to interrogate the data in many ways including looking at the experience of different communities.
  4. What we’ve done – where Nottinghamshire Healthcare teams post changes they have made in response to feedback
  5. Learn More – where people can see patient experience case studies, videos, resources and how to get involved.

It can be seen at: http://feedback.nottinghamshirehealthcare.nhs.uk and can be viewed on PC, iPAD, Smartphones and there is a QR code for the site.

The Feedback Matters website has already had a significant impact and made a difference to how people use and respond to feedback. The usage of the website is increasingly rapidly from 17 unique visitors in April to 601 in October 2013 and now 1608 unique visitors to the site with over 13,000 page views.

The site has already made a difference to staff enabling them to see all the feedback about their team or service at any time online. They can see graphs and trends from the survey, all the comments received (analysed by theme) and all Patient Opinion stories about the Trust. This has opened up feedback to all staff through the ‘View Reports’ section.
http://feedback.nottinghamshirehealthcare.nhs.uk/reports

The initiative has had a wider impact, increasing the number of survey responses by 43% to 13 671 in the last year. Over 14 500 comments have been received, analysed by theme, and are visible to staff and public on the website.

The number of Patient Opinion postings has increased by 48% to 401 stories in the last year, as well as increasing the number of service changes from 20 to 31 on the site. In addition, the Trust’s Service Quality Rating has increased from 88% over the year to September 2012 to 90% in the year to September 2013.

The increased focus on responding to feedback has meant teams have taken action on a whole range of issues. Over 35 changes are recorded on the site these can be seen on the ‘What we’ve Done’ Section of the Nottinghamshire Healthcare website: (http://feedback.nottinghamshirehealthcare.nhs.uk/service/what-weve-done) Many more changes can be seen in the Annual Involvement Report 2012/13 (http://feedback.nottinghamshirehealthcare.nhs.uk/learn-more/resources/annual-involvement-report-2012-13).

New online seminar: The Power of Co-Production

I’m writing to invite you to a new online seminar we are holding on Friday 7 March at 10.30am. The one hour seminar reflects on how Hywel Dda University Health Board involved service users in a quality improvement project and the real difference it made.

The Power of Co-Production’ focuses on the NHS Wales award-winning project which involved improving way finding and signage at Withybush Hospital.
During the seminar, you will:

  • Find out how you can apply a citizen-centred approach to your work and develop wider partnership working.
  • Discover how service users and staff worked together to develop a solution to a problem.
  • Understand the importance of continued engagement to test and improve the solution.

Members of the team will share their whole hospital approach. The work was shaped and delivered by a group of adults with learning disabilities, Siarad Iechyd/Talking Health members, the Community Health Council, outpatients’ user group, hospital staff and the hospital estates department.

Martin Semple, a member of the judging panel, said: “The project put citizens at the very centre of redesigning signage to ensure when they visit the hospital they can get to the department and service they need. It shows that citizens can make a huge contribution in designing services in the NHS.”

I hope you’re able to attend and perhaps encourage other members of your organisation to join you on Friday 7 March, from 10.30 to 11.30am.

And because it’s a free online seminar, there’s no need to travel – you just need a phone and a computer.

Further details can be found in the attached leaflet and you can book your place on the seminar at www.1000livesplus.wales.nhs.uk/co-production.

Should you have any queries, please don’t hesitate to contact me.

Regards

Karen

 

P.S. You may also want to arrange for a ‘hub’ in your organisation so a group of colleagues can attend the seminar together.

 

*You may receive this email more than once if you are a member of more than one of the networks supported by 1000 Lives Improvement service.

Karen Field

Rheolwr Labordy Dysgu a Rheolwr Gwobrau GIG Cymru, 1000 o Fywydau – Gwasanaeth Gwella, Iechyd Cyhoeddus Cymru, Ty Arloesi, Ffordd Pen-y-bont, Llanharan CF72 9RP

Learning Laboratory Manager & NHS Wales Awards Manager, 1000 Lives Improvement Service, Public Health Wales, Innovation House, Bridgend Road, Llanharan CF72 9RP

 

Ffôn/Tel:01443 233347   WHTN: 1754 4847

Ebost/Email:karen.field@wales.nhs.uk

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