Discovery Interviews

Dr Jeffrey Phillips

Consultant in Intensive Care Medicine

Princess Alexandra Hospital, Harlow

How Patients and Carers can Influence Service Improvement

NHS Modernisation Agency Critical Care Programme

Improve access, experience and outcomes for patients with potential or actual need for critical care

Why?

• The New NHS (1997)• Critical to Success (1997)• Comprehensive Critical Care (2000)• NHS Plan (2000)• Shifting the Balance of Power (2001)• NHS Reform Act (2002)• The Kennedy Report (2001)• Commission for Health Improvement

Why?

Patients are our raison d’être

Aim

• Patients and Carers to influence change

• To understand what patients and carers perceive as important

• New ways of working

• Inclusive approach

“Change has become a constant; managing it has become an

expanding discipline. The way we embrace it defines our future.”

Audit or Research?

• Audit or qualitative research

• Informing about previous experience

• New information sought

• Approval for project– LREC– MREC

Patient and Carer Participation• Questionnaires

– Low response rate– Questions set by professionals– Cover limited aspects of service– Results seldom improve care

• Groups– Inhibition of introverts– Clash of opinion– Directed by professionals

Provide opportunities for patients and their carers to directly tell the story of their illness or condition using a framework that guides them through the key stages of their experience

Discovery Interviews

Using Narratives

Reflection

• Listeners must ask:– “What is learned from the narrative?”– “What needs to change?”

Action

• Listeners must ask:– “How can change happen?”

Discovery Interviews

• Semi-structured

• No formal direct questions

• Interview spine derived from process mapping

• Process map simplified

Discovery Interview Spine

First realising something was wrong

Getting to the Critical Care Unit

Being in the Critical Care Unit

Leaving the Critical Care Unit

Being on the Ward

Going Home

At Home

Discovery Interviews

• Subject encouraged to talk about experiences at each stage

• Interviewer avoids direct questioning

• Audio-recorded

• Transcribed

Analysis

• Process initiated by the team in order to learn about the patient and carers experience

• Non-confrontational process

• Teams listen to uninterrupted narratives

• Stories and narratives are a great leveller

Action

• Identify areas requiring improvement

• Immediate Change

• Process Mapping & PDSA

• Service commissioning– Testament v Anecdote

• Other areas for further inquiry

Improvements

• Orientation of patients when waking from a period of sedation

• Strengthen pre-assessment phase of a patient’s journey

• Communication and information

• Noise

The Future

• Continue improving!

• Roll out to all 29 Critical Care Networks

• Different subject groups– The bereaved

• Cascade throughout Trust

• Those in power to learn from our experiences

Summary

• Learning from Patient and Carer stories• Powerful tool to understand from the Patients’ and Carers’ perspective• Patients and Carers able to provide a comprehensive picture of both recollections and experiences• Strengthened partnerships