PATIENT EXPERIENCE REPORT · 2012. 10. 22. · Page 3 11stst January 2012 – 31January 2012 – 31stst March 2012March 2012 File Edit View Tools Help Key highlights from the Patient

Improving Patient Experience

PATIENT EXPERIENCE REPORT

1st January 2012 – 31st March 2012

Care Group & Directorate Breakdown

Feedback Overview

Service Improvement

Patient Survey Feedback

National Surveys

Focus on A&E

Visits

Reporting Framework

Page 2

1st January 2012 – 31st March 20121st January 2012 – 31st March 2012

File Edit View Tools Help Executive Summary

IntroductionThe Patient Experience Report aims to present a rounded picture of patient experience and, as such, provides informationon all aspects of experience, good and less positive. Where poor experience is reported, actions are then taken to ensure improvements are made and featured in future reports.

The reports present a wide range of information from different sources. Including the following:

- National Surveys- Frequent Feedback- Website Feedback- Comments Cards- Complaints- Clinical Assurance Toolkit (CAT)- Service Improvement Projects- Governor and LINk Visits

It is understood that each method of feedback has its strengths and weaknesses. Using all methods of information available enables the Trust to better understand the patient’s experience of the services offered and delivered, and is beneficial to helpprioritise where to focus efforts on action planning.

Executive Summary

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Key highlights from the Patient Experience Report are as follows:

Feedback Overview shows the top 5 themes raised in unsolicited feedback where patients and families are able to freely comment on any aspect of services.

The top 5 positive and negative themes show similar results to the previous quarters. Staff attitude continues to be the top positive and top negative issue. Nutrition, and in particular the quality of food has returned to the top 5 negative themes.

Emergency Care, Head and Neck and SYRS continue to be the 3 care groups that received the most feedback during this quarter. The report explains the commitment to increasing the number of comments received from patients across the Trust.

In relation to comments cards, results are similar to previous quarters. The number of people who gave the highest possible rating of their experience as ‘excellent’ this quarter was 75% (compared to 72% over the past 12 months). The number this quarter who rated their experience with the lowest possible score, ‘poor’ has dropped to 6% (compared to 13% over the past 12 months). Excellent and Poor ratings account for 85% of all comment cards received in the past year. This suggests that those having either a very good or very bad experience are motivated to comment.

The Trust has received a similar number of new complaints to the previous quarter. The chart linking the numbers of

complaints received to weighted clinical activity indicates thatthe directorates receiving higher numbers of complaints than might be expected over the past 12 months are; General Surgery, Ophthalmology and ENT.

Complaints performance data for the past 3 months indicates that the number of complaints have dropped to within the expected range for both Ophthalmology and ENT. This suggests that the problems, including contacting the departments by telephone, have been addressed effectively through their action plans.

The reasons for higher levels of complaints in General Surgery are being investigated and analysed. A full review of the complaints received by this Directorate over the past 12 months will be reported to the next full meeting of the Patient Experience Committee.

The Trusts performance for replying to complaints within 25 working days was 89% against a target of 85% reflecting a substantial improvement on previous months. The improved performance is primarily related to the 32% improvement in response times within the surgical services care group. Having cleared a substantial backlog of complaints, the challenge for the surgical services team is now to sustain this improvement.

Care Group and Directorate Breakdown tables aim to show performance in relation to key indicators by care group and where information is available, by directorate from a number

Executive Summary, cont’d…

Executive Summary

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Executive Summary

of different sources. Results in this report show findings fromthe Inpatients Frequent Feedback survey.

The inpatients survey captures feedback from every inpatient ward across the Trust on a range of topics. A minimum of 20 surveys are carried out for each ward. They suggest excellent performance for patients having confidence in the doctors and nurses treating them, pain management and providing help getting to the bathroom and toilet. Improvements or reductions are needed in the number of respondents who report that doctors and nurses talk in front of patients as if they aren’t there.

Following good progress made over the last year to reduce the number of patient information leaflets which are beyond their review dates, performance at directorate level is presented in this quarters report. A number of future developments are planned to further improve aspects of information provision including the introduction of a new system to automate the publication of leaflets.

Service Improvements - An update on the renal outpatients’ project which featured in last quarters report is presented. Patient waiting times in the clinic have been significantly reduced as a result of the improvement project from an average of 31 minutes to 7 minutes.

Patient Reported Outcome Measures (PROMs) -2011/12 PROMs scores are not yet available. The Patient Partnership Department is reviewing how to prepare for the introduction of additional national PROMs and how clinical

directorates can be kept informed of progress with existing proms within their areas.

National Surveys - Results from the 2011 National Outpatient and Inpatient Surveys were published by the Care Quality Commission (CQC) during this quarter.

STH performed well in the 2011 outpatient survey compared to other Trusts. Key areas for further improvement have been identified and priorities for improvement action will be reviewed and agreed as part of the Outpatients Service Improvement Project.

The Trust also scored well in the Inpatient survey. Over 95% ofpatients rated their care as either excellent, very good or good. Just under 3 % said their care was fair and 2% reported that they had received poor care.

The key area for improvement identified in the Inpatient Survey Report for Trust-wide improvement relates to Improving the quality of information included in letters sent between the hospital and family doctors so that they are written in ways that patients can understand. This improvement target is reflected in one of the Trust’s Quality Priorities for 12/13.

The Trust’s performance for both the Inpatient and Outpatient Surveys compared to other Trust’s in our region is illustrated in the quadrant charts in this report. STH is identified as one of the Trusts with high scores compared to other providers and higher levels of improvement compared to previous survey results.

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Executive Summary

Focus on A&E - A programme to capture patient experience has been running in A&E since April 2011, as part of the national A&E quality indicators framework. A patient focus group took place in November with 15 patients taking part. Comments from the focus group are presented under the 4 key headings identified by participants. In addition complaints activity for A&E during this period is also presented.

Patient Experience Reporting Framework 2012/13 - In quarter 4 Patient Experience reporting activities have been additionally focussed on providing Care Group, Directorate and where available, ward and department level data to teams across the Trust in the form of Annual Patient Experience Summaries.

The Patient Partnership Department aims to coordinate the patient experience reporting activity and further support improvements in Patient Experience in the coming year by:

• Integrating the reports due to be produced in 12/13 into a Patient Experience Reporting Framework.

• Providing information on the feedback received that is targeted to the staff best placed to respond through Care Group and Directorate level reports.

• Making better use of the feedback mechanisms we have in place through increasing the level of unsolicited feedback information received through comments cards and website feedback. This is outlined as a Trust Quality Priority for 12/13.

• Encouraging Improvements in the quality of actions taken in response to complaints and feedback received though better information, guidance and training on action planning.

• Continuing to obtain a wide range of patient feedback through different mechanisms to further inform improvement activity.

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1. Feedback Overview 7

2. Care Group and Directorate Breakdown 12

3. Service Improvement 16

4. Patient Survey Feedback 17

5. National Surveys 18

6. Focus on… 19

7. Visits 22

8. Patient Experience Reporting Framework 23

a) Website Feedback and Comment Cards 7b) Word Clouds 9c) Complaints 10

a) Complaints by Outcome 12b) Inpatient Survey 13c) Patient Information Status 15

a) Service Improvement in Renal Outpatients Project Update 16

a) Patient Reported Outcome Measures (PROMs) 17

a) National Inpatient and Outpatient Surveys 18

a) Focus on Accident and Emergency 19

a) Huntsman 6, Northern General Hospital 22

ContentsContents

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2%6%10%6%Comms – Communication w/ Patient5

9%

10%

14%

35%

Jan-Mar 2012

15%10%10%Nursing Care – General nursing care2

31%49%37%Staff Attitude1

11%

11%

Oct-Dec 2011

14%

10%

Apr-Jun 2011

6%Medical Care – Competence of Staff4

13%Environment - Cleanliness3

Jul-Sep 2011

-8%-5%Nutrition – Quality of Food5

3%6%2%5%Comms – Communication w/ Patient4

6%6%5%6%Environment - Cleanliness3

18%10%12%14%Waiting Times2

15%

Jan-Mar 2012

14%

Oct-Dec 2011

11%

Apr-Jun 2011

4%Staff Attitude1

Jul-Sep 2011

I must have been a pain at some time to

several staff members but they did not complain at all

I depend on friends for transport and it can be

difficult for them, waiting for medication on discharge is

too long (5 hours)

I was treated with dignity and respect but above

all as an individual

Staff talking to other members of staff

about nothing to do with work in front of

patients!!!

The graphs and tables show all feedback received through website feedback and comments cards broken down by care group. Each comment can cover a range of themes and the analysis below is based on the themes covered in the individual comments. During the period January to March 2012, 221 comments were received, an increase of 6% on the previous quarter (208 comments).

Feedback Overview – Website Feedback and Comment CardsFeedback Overview – Website Feedback and Comment Cards

Top 5 Positive ThemesTop 5 Positive Themes

Top 5 Negative ThemesTop 5 Negative Themes

Feedback Overview

Website Feedback and Comment Cards

I physically was unable to wait any longer to be seen and had to leave after sitting in waiting room for 80

mins

If finding a lump in my breast was a little worrying; the

subsequent diagnosis and treatment should have been terrifying…however, thanks

to the excellent staff involved in my care, the experience

has been entirely manageable

Great rapport with me that gave me confidence that I

was in good hands

All comments have been fed back to the relevant ward or department through the annual Patient Experience Summary Reports

The attitude of the nurse was unsympathetic,

dismissive of the severity of my symptoms, and lacking in diligence.

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Comments Card Ratings165 completed comments cards were received between January and March 2012. Of these, 160 gave their experience a rating. Between April 2011 and March 2012 524 ratings have been received. The % split of these ratings is displayed here.

Feedback Overview

Website Feedback and Comment Cards Cont’d…

No.

of c

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Website and Patient Comment Card Responses1st April 2011 to 31st March 2012

Total ResponsesPositve CommentsNegative Comments

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Excellent Very Good Good Fair Poor

Comments Cards - Breakdown of experience rating April 2011 - March 2012

1. Excellent – 72%2. Poor – 13%3. Very Good – 11%4. Good – 2%5. Fair – 2%

Ratings in order of %

STH performed well in the latest National Inpatient Survey. However as in many other Trusts, over 90% of respondents said they were not asked to give their views on the overall quality of their care. The overwhelmingly positive feedback we receive through comments cards should encourage staff to have confidence in explaining to patients that we are interested in their views and value their opinions. Thoughts and suggestions from patients can be helpful in enabling us to reflect on key aspects of patients experience because people usually leave comments about what matters most to them. We report back to people on comments received and actions taken through our ward posters so that patients, visitors and staff can reflect on the impact and value of patients’ comments.

One of the Trust’s priorities in the Quality Strategy for 12/13 is to ‘make it easier for people to communicate with our organisation’ through increasing the number of website feedback postings and comments cards received by 20% and 50% respectively.

It is important that all inpatient areas make use of the comments cards and website feedback processes that we have in order to increase the level of general feedback received about all areas. The patient partnership department would be pleased to hear from any wards or departments who would like to discuss how to make better use of the processes in place and further encourage patients to give us their views. Please contact Alan Smith for further information.

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Website Feedback and Comment Cards – Word Clouds


Feedback Overview

The ‘word clouds’ below present the qualitative data collected from website feedback and comments cards between January and March 2012. The clouds give greater prominence to words from the feedback received this quarter that appear more frequently. For example, the words ‘staff’‘ and ‘helpful’ appeared most frequently in positive comments and ‘waiting’ and ‘staff’ in the negative feedback appeared more than other words.

Positive FeedbackPositive Feedback Negative FeedbackNegative Feedback

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Feedback Overview - ComplaintsFeedback Overview - Complaints

Feedback Overview

Complaints

338 new complaints were received between January and March 2012, this was consistent with the average numbers received over the past year.

No specific inpatient areas showed peaks in the number of complaints received during Quarter 4, however, Cardiology, Neurology and Orthopaedic outpatients did report higher numbers of complaints. Cardiology complaints were linked to individual issues regarding medical care and treatment rather than specific inpatient or outpatient services. 4 of the neurology complaints related to concerns regarding the attitude of medical staff and differences of opinion from the patients perspective regarding diagnosis and treatment, the other complaints were about waiting times and delays. In orthopaedics, half of the 10 complaints received related to waiting times for surgery.

The Trusts performance for replying to complaints within 25 working days was 89% at the end of Quarter 4 reflecting a substantial improvement on previous months. The improved performance is primarily related to the 32% improvement in response times within the surgical services care group. Having cleared a substantial backlog of complaints, the challenge for the surgical services team is now to sustain this improvement.

Complaints activity – January 2012 to March 2012Complaints activity – January 2012 to March 2012Concern: A complaint was received regarding building work on a ward at RHH which was disturbing patients on the ward above. The complainant contacted their local MP’s offices and the press regarding their concerns.

Outcome: The noise disruption was acknowledged and apologies were given for the impact that the building work had on the patient and his family.

An explanation was given detailing; why the building work was being carried out, how facilities for patients would be improved as a result and that significant refurbishments always present a challenge to the hospital in balancing the need to improve facilities alongside the need to continue delivering patient care.

The efforts taken by staff to minimise the disruption to patients as a result of the work including; arranging for the temporary relocation of the ward during the most disruptive part of the building scheme, ensuring that the observation of a patient rest period was written into the contract with the builder, the establishment and use of a standard procedure for staff to request temporary cessation of work in the event that noise disruption had a significant impact on hospital activities and, regular liaison meetings between staff to discuss the impact that the building work was having on patients, were also explained in the response to the complaint.

Action Taken: An offer was made to the complainant to have the patient moved to a different ward however the patient was well enough to be discharged home. Having investigated and upheld the complaint, it was felt no further action could have been taken other than to offer apologies and provide a thorough and detailed explanation of reasons behind the disruption.

Complaints received by activity – April 2011 to March 2012Complaints received by activity – April 2011 to March 2012

Complaints received for the year are reported against the overall activity for that directorate for comparison and where indicated further investigations can be undertaken. In April, the Patient Experience Committee agreed to review complaints in General Surgery.

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Feedback Overview - ComplaintsFeedback Overview - Complaints

Feedback Overview

Complaints Cont’d…

Sub-subjects raised in complaints closed -Jan to Mar 2012Sub-subjects raised in complaints closed -Jan to Mar 2012

0

5

10

15

20

25

30

35

Attit

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Top 5 Issues through Complaints – Apr 2011-Mar 2012Top 5 Issues through Complaints – Apr 2011-Mar 2012

0

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30

40

50

60

70

80

90

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Lack of Care Medicine Communication andInformation

Lack of Nursing Care Bedside Manner* Delay

Apr - Jun 2011Jul - Sep 2011Oct - Dec 2011Jan - Mar 2012

* Attitude is now a sub-subject of the Bedside Manner subject. Where Attitude was listed in previous months, this is now presented within Bedside Manner.

The issues raised by complainants in Quarter 4 were similar to those in the previous reporting period. The chart showing the top 5 issues most frequently raised reflects the changes that have been made to the subjects used to classify and group issues. The issue of bedside manner has been introduced to identify complaints about communication with staff involved in delivering care to inpatients. Previously these issues would have been recorded in the more general communication and information group and therefore could not be identified separately to complaints regarding all aspects of communication.

We are looking in greater detail at issues raised by recording more specific information on our complaints database. The sub-subjects used to categorise issues were updated and agreed in September 2011, however, the list is kept under review. This enables us to track any trends around specific issues more easily. The top 15 sub-subjects recorded for complaints closed in Quarter 4 are shown in the chart below.

Issues raised in complaints – Jan 2012 to Mar 2012Issues raised in complaints – Jan 2012 to Mar 2012

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Complaints by OutcomeComplaints by Outcome

Since April 2010 all complaints on completion have been assessed and reported as Well Founded, Partially Founded or Unfounded. This is an assessment made by the Patient Partnership Co-ordinator and, as such, is subjective. An independent audit is to be undertaken by lay members of the Patient Experience Committee, including governors, to check the accuracy of these assessments. The criteria for this assessment was agreed by the Patient Experience Committee and is as follows:

Care Group and Directorate BreakdownCare Group and Directorate Breakdown


The Care Group and Directorate Breakdown aims to compare key indicators by care group and, where information is available by directorate. Complaints by outcome, findings from the Frequent Feedback Inpatients survey and patient information status results are presented.

Complaints in which the concerns were not found to be correct on investigation.Unfounded

Complaints in which, on investigation, the main concerns were not found to be correct, however some of the concerns or issues raised by the complainant were found to be correct.

Partially Founded

Complaints in which the concerns were found to be correct on investigation.Well Founded

Care Group and Directorate Breakdown

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Well Founded Complaints (%) 29% 0% 29% 100% 100% 100% 100% 0% 33% 56% 50% 60% 22% 0% 14% 15% 12% 26% 26% 0% 22% 0% 25% 0% 13% 0% 0% 33% 0% 38% 40% 38% 33% 25% 0% 0% 40%

Partially Founded Complaints (%) 57% 0% 57% 0% 0% 0% 0% 0% 31% 11% 50% 40% 39% 0% 38% 40% 35% 42% 42% 0% 50% 100% 44% 100% 75% 67% 100% 67% 0% 38% 34% 38% 67% 0% 0% 0% 0%

Unfounded Complaints (%) 14% 0% 14% 0% 0% 0% 0% 0% 36% 33% 0% 0% 39% 100% 49% 45% 53% 32% 32% 0% 28% 0% 31% 0% 13% 33% 0% 0% 0% 23% 26% 25% 0% 75% 100% 100% 60%

TOTAL COMPLAINTS (QTY) 7 0 7 9 4 3 2 0 42 9 2 5 23 3 37 20 17 19 19 0 18 1 16 1 8 3 2 3 0 73 35 32 6 8 2 1 5

Com

plai

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File Edit View Tools Help Care Group & Directorate Breakdown


Care Group and Directorate Breakdown Cont’d…

Frequent Feedback Inpatient SurveyFrequent Feedback Inpatient Survey

The Inpatient survey was designed to capture patient feedback from across the Trust on a range of topics. The Trust previously ran an inpatient survey from June 2009 to May 2010; this was revised in June 2011 to include questions on issues which are of importance to patients as demonstrated in Picker research and based on the Trust’s scores in the National Inpatient survey 2010. In addition, the questions from the Mixed Sex survey and five new Commissioning for Quality and Innovation (CQUIN) questions have been incorporated. The questionnaire covers topics such as: same sex accommodation, communication from doctors and nurses, getting help when needed and provision of information.

This survey started in July 2011 and to the end of March 2012, 2426 interviews have been carried out.

Results for the directorates that have been surveyed so far are presented on the following page. Other directorates will be reported on in the future.

On the following page, each score from the survey’s is colour coded to give a guide to highlight those areas performing well and those performing not so well. The colour coding is as follows:

A score of 85% or above is excellent – green

A score of 75- 84% is good – yellow

A score of 65% -74% is average – orange

A score of 64% or below is poor – red

ScoringScoring

Frequent Feedback Developments 2012/13Frequent Feedback Developments 2012/13

The questions asked in the frequent feedback inpatient survey are being reviewed to ensure that we are capturing the information about what matters most to patients and which will be most helpful to us in monitoring performance and encouraging improvement across a range of key aspects of patient experience.

A new set of questions will be introduced in July 2012. The frequent feedback survey will be aligned directly with the patient survey that forms part of the Clinical Assurance Toolkit (CAT) Patient Questionnaire. This means that we will be asking a greater number of patients the same set of questions and will therefore have a higher number of responses from which to draw trends, make comparisons and set priorities for quality improvement. This approach also means there will be options for completing the survey in either real time using the electronic handsets or in paper based format with the responses being scanned centrally to collate the results.

The aim in 2012/13 is to further increase the number of patients asked to give us their views through structured frequent feedback and to provide survey reports targeted specifically to the areas from which the feedback was gathered. The Patient Partnership Department are also looking at introducing a frequent feedback survey tailored to outpatient areas.

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File Edit View Tools Help Care Group & Directorate Breakdown



Frequent Feedback Inpatient Survey ScoresFrequent Feedback Inpatient Survey Scores

Percentages show the results for all ‘positive’ responses to the areas surveyed to date.

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Thinking just about your stay on THIS WARD, have you shared a sleeping area, for example a room or bay, with patients of the opposite sex?

98% 98% 96% 100% 98% 99% 97% 100% 100% 99% 100% 98% 98% 96% 95%

Has someone explained to you the reason why you shared a sleeping area, for example a room or bay, with patients of the opposite sex?

36% 7% 57% - 50% 100% 40% - - 100% - - 25% 58% -

During your stay on THIS WARD, have you used the same bathroom or shower area as patients of the opposite sex? 90% 92% 91% 83% 90% 97% 82% 93% 88% 93% 90% 77% 85% 96% 87%

Before moving to your CURRENT ward did you ever have to share a sleeping area, for example a room or bay, with patients of the opposite sex?

92% 94% 83% 100% 100% 92% 82% 86% 94% 88% 100% 100% 91% 93% 95%

Before moving to your CURRENT ward did you ever have to use the same bathroom or shower area as patients of the opposite sex?

92% 96% 91% 100% 90% 96% 75% 91% 82% 83% 95% 87% 93% 100% 93%

Do you have confidence and trust in the DOCTORS treating you? 99% 99% 98% 98% 97% 97% 100% 100% 100% 98% 100% 100% 99% 97% 100%

Do DOCTORS talk in front of you as if you aren't there? 73% 74% 64% 60% 86% 63% 72% 68% 88% 77% 76% 72% 74% 78% 57%

If you ever need to talk to a DOCTOR, do you get the opportunity to do so? 95% 94% 94% 92% 94% 99% 97% 94% 98% 98% 91% 97% 95% 94% 97%

Do you have confidence and trust in the NURSES treating you? 99% 99% 99% 98% 100% 98% 100% 92% 98% 97% 99% 99% 99% 100% 100%

Do NURSES talk in front of you as if you aren't there? 82% 82% 75% 67% 87% 75% 83% 76% 92% 87% 79% 79% 90% 87% 72%

In your opinion, are there enough nurses on duty to care for you in hospital? 51% 51% 46% 48% 74% 65% 64% 40% 63% 34% 62% 55% 52% 40% 40%

Do you get enough help to eat your meals? 74% 69% 91% 88% 93% 88% 77% 92% 50% 69% 86% 81% 81% 54% 77%

If you need help from staff getting to the bathroom or toilet, do you get it in time? 90% 89% 98% 90% 100% 94% 91% 96% 90% 80% 87% 94% 92% 79% 100%

Do you think the hospital staff do everything they can to help control your pain? 98% 97% 99% 98% 99% 100% 99% 98% 100% 97% 99% 99% 97% 98% 100%

Are you involved as much as you want to be in decisions about your care and treatment? 94% 94% 94% 98% 98% 93% 94% 87% 98% 95% 99% 98% 92% 93% 98%

While in hospital, have you ever seen any posters or leaflets explaining how to complain about the care you received? 22% 17% 25% 28% 31% 18% 23% 17% 20% 28% 39% 26% 21% 18% 29%

Overall, do you feel you have been treated with respect and dignity during your stay in hospital? 99% 98% 99% 100% 100% 99% 100% 100% 98% 96% 100% 100% 98% 100% 99%

Overall, how would you rate the care you have received? 98% 98% 98% 100% 100% 95% 99% 100% 100% 96% 100% 99% 97% 97% 100%

Would you recommend this hospital to your family and friends? 97% 96% 97% 100% 97% 97% 98% 98% 100% 97% 97% 98% 96% 94% 97%

Inpa

tient

Sur

vey

Questions asked

Page 15






Patient Information StatusPatient Information Status

To meet Trust standards all leaflets need to be reviewed on a 2 yearly basis. Since January 2012 any un-reviewed leaflets reaching 3 years old are now automatically archived. The status of leaflets is monitored on a monthly basis by the Patient Information Manager.

Click here to access ‘live’ data

Crit

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O

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Serv

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Crit

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Ana

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Total Information Resources 50 48 2 82 16 27 8 31 281 192 9 2 73 5 180 85 95 82 81 1 92 18 45 29 214 68 43 90 13 82 44 30 8 29

Information Leaflets within review date 98% 98% 100% 90% 100% 81% 100% 90% 70% 58% 89% 100% 97% 100% 93% 98% 89% 90% 90% 100% 93% 94% 93% 93% 93% 96% 95% 90% 92% 87% 93% 87% 50% 100%

Information Leaflets less than 12 months beyond review date 2% 2% 0% 9% 0% 19% 0% 6% 28% 40% 11% 0% 3% 0% 7% 2% 11% 7% 7% 0% 7% 6% 7% 7% 7% 4% 5% 10% 8% 12% 7% 10% 50% 0%

Information Leaflets more than 12 months beyond review date 0% 0% 0% 1% 0% 0% 0% 4% 1% 1% 0% 0% 0% 0% 0% 0% 0% 2% 2% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 3% 0% 0%

Info

rmat

ion

Stat

us

Following good progress made over the last year to update patient information we are now looking to improve other aspects of information provision. These initiatives will be detailed in a future report but will include:

• Developing a new system to automate the publication of leaflets• Supporting information provision across community services • Encouraging the uptake of Information Prescriptions for patients

with a long term condition• Improving the information used as part of the consent process• Improving access to patient information via the internet• Improving access to information for patients with specific needs

Patient Information - Monthly Progress (Status by Total Resources)

0

200

400

600

800

1000

1200

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11

Jul-11

Aug-11

Sep-11

Oct-11

Nov-11

Dec-11

Jan-12

Feb-12

Mar-12

Apr-12

Tota

l num

ber o

f res

ourc

es

Within Date(up to 2yrs)

ExceedingReview Date(2 to 3yrs)

ExceedingReview Date(3yrs+)

http://nww.sth.nhs.uk/STH/ControlledDocumentsAdmin/PIMadmin/PatientInformationReport.asp

Page 16


File Edit View Tools Help Service Improvement

Service ImprovementService Improvement

BackgroundBackground

In the last Patient Experience Report, it was reported that the Trust’s Service Improvement Team have developed a Trust Wide service improvement strategy for Outpatients (OP) Services to define key areas for driving system wide improvement of OP services.

The Renal Directorate operates a stand-alone outpatient service based in the Sorby OP building at the Northern General site. In 2010-11 the Renal Directorate saw 1676 new and completed 11,737 follow-up patient consultations in its general nephrology, low clearance and dialysis clinics as well as 4,189 outpatient transplant reviews. The OP department also operates a busy emergency clinic providing urgent nephrology opinions during office hours.

Feedback from patients and staff has highlighted many positive aspects of the service particularly the quality and dedication of our staff. However, concerns regarding the delays in being seen, clinics overrunning and inadequately responsive scheduling prompted us to fully review the service (Service improvement in Renal Outpatients Project, SIROP).

The discrete geography of the unit, the dedicated staff and medium size make it an ideal candidate for piloting and developing the Trusts strategy.

The last report featured the planned workstreams, patient feedback and results from the patient survey.

Service Improvement – Service Improvement in Renal Outpatients Project (SIROP) Update

UpdateUpdate

Feedback from the Patient and Staff surveys conducted recently as part of the 5Ps (Purpose, Patterns, Professionals, Processes, Patients) data collection exercise indicated that long waiting times for patients was a major concern. In order to reduce this waiting time and improve the clinic experience the SIROP patient flow work stream has worked initially on the Thursday morning general Nephrology clinic. The redesign work culminated in the first new clinic being tested onThursday 16th February.

What did the work stream group do?What did the work stream group do?

• Collected baseline data which showed how long patients spent on each step of the clinic process.

• Redesigned the clinic based on actual timings identified in the baseline data. Doctors would see the patients in time sequence taking the next patient present. Slots were built in for the Dietician too.

• Communicated with the patients informing them of the changes and what we were trying to achieve. It also asked patients to try to arrive on their appointment time.

• Created a new outcome form which aids the booking of patients into the appropriate clinician at their next appointment.

• Set up a Transport work stream to try to improve the reliability of arrival and pick up times by collecting data and liaising with our transport providers.

Next StepsNext Steps

• Continue the test and sustain the new clinic model. Patients will be timing the waiting at clinics over the coming weeks.

• Move on to work in other clinics. Low clearance and the Transplant clinics have both collected data and are looking to start new clinic schedules in the near future.

• Use these innovations as the model for running all clinics in Renal OPD, reducing waiting and improving the experience for both staff and patients

Overall an astounding success,

no delays

Would prefer to see my doctor next time

Excellent. However it is a shame that I now have to wait

hours for my transport

The time planned for my consultations was about right

Page 17



Patient Survey Feedback – Patient Reported Outcome MeasuresPatient Survey Feedback – Patient Reported Outcome Measures

Patient Survey Feedback

Patient Reported Outcome Measures (PROMs)

STH continues to participate in the national PROMs programme and collects patients’ views of the outcomes of four surgical procedures; groin hernia repair, varicose vein surgery, hip replacements and knee replacements.

A pilot project commenced in November 2011 within South Yorkshire Services looking at Coronary Bypass Graft surgery and Coronary Angioplasty. There is not a defined end point to the pilot, but it is envisaged that once this has been evaluated it will be rolled out nationally.

The Department of Health are currently exploring using the PROM methodology for assessing outcomes in a number of long term conditions.

The Trust needs to be prepared for the introduction of new PROMs and a piece of work is underway to agree an implementation process and associated guidance for Clinical Directorates. This is being led by the Patient Partnership Department.

Additional work is also underway to identify how Clinical Directorates are kept informed of progress and issues within their areas regarding existing PROMs and what information is shared and with whom.

There are a number of national and local service evaluation projects emerging that use patient reported outcome measures methodology. Discussions are underway between the Chief Nurse Office, Patient Partnership and Clinical Effectiveness Departments to determine the process for approving and monitoring any future non Department of Health ‘PROMs work.

PROMs updatePROMs update

Participation RatesSTH participation rates for March 2012 are as follows:

- Groin Hernia repair = 116%- Hip Replacement = 56%- Knee Replacement = 80%

This reflects a decline in pre-operative participation for patients undergoing hip replacement and work is underway to understand the reasons and to take any corrective actions identified.

Response Rates:

The response rates for 2011/12 are not yet available.

Outcome Results:

The health gain scores for hip replacement procedures continue to be below the expected level for our Trust when compared to the national average as was reported in previous Patient Experience Reports. Work continues with the Orthopaedic Directorate and the Health Observatory to try and understand the reasons for this.

PROMs resultsPROMs results

Page 18



National SurveysNational Surveys

National Surveys

National Surveys

STH performed well in the 2011 outpatient survey. A number of issues highlighted by respondents were similar to those identified in the previous survey carried out in 2009.

The number of patients who reported that they did not receive copies of all letters sent between hospital and their family doctors has improved from the previous survey.

The key areas for improvement identified in the Outpatient Survey Report are:

Priorities for improvement action will be reviewed and agreed as part of the Outpatients Service Improvement Project.

• informing patients when they would find out test results • clearly explaining test results • informing patients of waiting times in clinic • availability of suitable food or drink • car parking

National Outpatient SurveyNational Outpatient Survey

National Inpatient SurveyNational Inpatient Survey

STH also scored well in the 2011 inpatient survey with results similar to other Trusts.

Over 95% of patients rated their care as either excellent, very good or good. Just under 3 % said their care was fair and 2% reported that they had received poor care.

The key area for improvement identified in the Inpatient Survey Report for Trust-wide improvement is:

Improving the quality of discharge notes is a Trust Quality Priority for 2012/13.

• Improving the quality of information included in letters sent between the hospital and family doctors so that they are written in ways that patients can understand.

The Trust’s performance for both the Inpatient and Outpatient National Surveys is shown in the quadrant charts provided by the Yorkshire Health Quality Observatory. STH is in the quadrant highlighting those Trusts with both high scores and higher levels of

improvement compared to previous survey results.

Page 19



A&E clinical quality indicators have been designed to present a comprehensive and balanced view of the care delivered by A&E departments, and accurately reflect the experience and safety of patients and the effectiveness of the care they receive. The indicators support patient and public expectations of high quality A&E services and allow A&E departments to demonstrate their ambition to deliver consistently excellent services which continuously improve.

Sheffield Teaching Hospitals NHS Foundation Trust has carried out a planned programme of patient experience evaluation each quarter throughout 2011/12 to capture patients’ views, these consisted of:

• Qtr 1 (April – June 2011) - Snap Patient Survey (featured in the last report)• Qtr 2 (July – September 2011) - Mystery Shopping• Qtr 3 (October – December 2011) – Patient Focus Group• Qtr 4 (January – March 2012) - Frequent Feedback Survey

This quarter’s Patient Experience Report presents comments made during the Patient Focus Group, along with complaints activity during October - December 2011 and website comments regarding A&E during this period.

Next quarters Patient Experience Report will feature the final initiative for 2011/2012, Frequent Feedback Surveys.

Quality Indicators 2011/2012Quality Indicators 2011/2012

Focus on Accident and EmergencyFocus on Accident and Emergency

Focus

Focus on Accident & Emergency, October to December 2011

The focus group was attended by 15 people selected from the Trust’s central patient and public involvement (PPI) database, who had either had an experience themselves at A&E recently or who had accompanied a relative or friend at a recent visit to the A&E department.

Participants at the group identified 4 key areas for discussion. These included:

•The purpose of A&E•Location•Waiting Times•Care and Treatment

Discussions took place around each topic, comments made under each heading are presented on the following page.

Quarter 3 - Patient Focus Group (Oct-Dec 2011)Quarter 3 - Patient Focus Group (Oct-Dec 2011)

Methods to capture patient experience for the quality indicators during 2012/13 have been agreed by the directorate and will be as follows:

Consideration will be given as to whether the patient experience report is the best forum to report the findings from each quarter in the future.

Quality Indicators 2012/2013Quality Indicators 2012/2013

• Quarter 1. National A&E survey – report analysis• Quarter 2. Local Staff Survey• Quarter 3. Local Patient Survey • Quarter 4. Participants in the staff survey from quarter 2 and patient survey

from quarter 3 will be invited to take part in an experience based design exercise during quarter 4 to review the patient experience of the care pathway in A&E and identify where improvements can be made.

Page 20




Focus

Focus on Accident & Emergency, October to December 2011, cont’d…

1. The Purpose of A&E

• It is there for services GPs can’t provide.• A&E is what it says it is for, Accidents and Emergencies, but it’s not

currently used as that. Anyone and everyone use it as a doctor’s surgery and that causes unnecessary delays for those of us who use it properly.

• GPs should direct patients to the correct places, if they had more flexible opening times it would reduce the number of people going to A&E.

• I don’t think people know who they should go to, when their GP is closed and often panic and come to A&E.

2. Location

• Without a car, it is difficult to get to, there are no decent transport routes• Why couldn’t we have drop in centres across the City, there is nothing

at the south side of the city, and this could stop a lot of people going to A&E unnecessarily.

• I think the A&E department is very easy to find and it is signposted well across the city.

3. Waiting Times

• It would be helpful to have reassurance that you have not been forgotten about sometimes, and an explanation of what the next stage may be would be useful.

• It would be useful to have an indication of how long we might have to wait.

• I went to A&E recently and didn’t have to wait long at all, I was very impressed.

4. Care and Treatment

• I have nothing but praise for the staff.• The staff are hardworking, professional, introduce themselves and the

treatment is excellent.• There is more of a human approach now, as opposed to just being

professional, I have noticed big improvement in the last few years.

Patient Focus Group - areas for discussion and comments

Page 21




Focus

Accident and Emergency Mystery Shopping – Patient Feedback Activity, October to December 2011

A&E – Subjects raised in Complaints ReceivedA&E – Subjects raised in Complaints Received

There were 21 complaints received regarding A&E between October - December 2011. On analysis there were no obvious trends however the following 3 subjects received the most complaints.

Website Feedback and Comment Cards

A&E Complaints Received – March 2010 to March 2012A&E Complaints Received – March 2010 to March 2012

This graph shows complaints are within a consistent range for the level of clinical care delivered and indicates that the number of complaints are reducing:

I obviously hope I won't be back, but if I am I

know I'll be in safe hands

The paramedics were very friendly, diligent and smiled at

my bad jokes!The level of care and

attention I received was truly excellent

I would like to extend my thanks to the doctor and

nurses for their expertise and efficiency in "patching me up"

They kept checking on me and making sure I was ok

which in the distressed state I was at the time I

appreciatedComplaints received regarding A&E

October - December 2011

9

5

2

0

1

2

3

4

5

6

7

8

9

10

Unhappy with aspects of medical care Unhappy with aspects of nursing care Waiting times

Page 22



As highlighted in previous reports, one of the key roles of the Sheffield LINk is to monitor and scrutinise local services. Members keep a ‘watching brief’ on all the main service providers and organisations across Sheffield and the LINk’s authorised representatives carry out ‘enter and view’ visits.

The recommendations from the 20th February 2012 visit to Huntsman 6, Northern General Hospital, are outlined below along with examples of the key actions taken following the visit .

Sheffield LINkSheffield LINk

LINk Visits – Huntsman 6LINk Visits – Huntsman 6

Visits

LINk Visit – Huntsman 6, Northern General Hospital

Following an Enter and View Visit to Huntsman 6, representatives of Link made a series of recommendations which included:

• Early introduction of the Productive Ward and intentional rounding schemes

• A review of patients bathing needs on the ward. • Support for protected mealtimes and queries about the

organisation of meal times and a review of the trolley meals service.

• Prioritising the setting up the ward quiet room and nursing office.

• Procurement of a more suitable linen trolley to keep linen clean

A detailed action plan has been completed by the Matron and Senior Sister for Huntsman 6 that will be returned to Link in response to their report.

Examples of the key actions taken following the visit include:

• The introduction of the ‘well organised ward’ module of Productive Ward. Intentional Rounding is scheduled to be introduced in June 2012.

• A hoist has been loaned to support patients with bathing and thesuitability of other products is being reviewed.

• The matron explained on the day of their visit, that there were operational difficulties, which meant that assistance with feeding on this day was not representative of the usual standard. Protecting mealtimes on such a busy ward is challenging however the meal service has been reviewed and patients will now receive a light lunch and warm evening meal. The introduction of light lunches means that patients can have a meal reserved and stored in the fridge if they have to leave the ward for tests etc over lunchtime.

• A bid has also been made for funding to introduce high tea onto this ward to further improve patient nutrition.

• Furniture has been delivered for the quiet / relatives room and request for redecoration has been submitted. The nursing office has also been equipped.

• A covered linen trolley has been ordered as recommended by infection control.

Sheffield LINk visited Huntsman 6, Northern General Hospital on the 20th February 2012

Page 23



Patient Experience Reporting FrameworkPatient Experience Reporting Framework

Patient Experience Reporting Framework – 2012/13

1. Trust Patient Experience Report 2. Complaints and Feedback Report

4. Ward and Department Patient Experience Annual Summary

Purpose: to present a rounded picture of patient experience and information on all aspects of the experience, good and bad. Presents a wide range of information from different sources suchas: National Surveys; Frequent Feedback; Website Feedback; Comments Cards, etc.

Target Audience: Trust Executive Group; Patient Experience Committee; Healthcare Governance Committee; Governors; Public; Board of Directors

Frequency: Quarterly

Purpose: to provide an overview complaints and feedback activity on a monthly basis. To highlight peaks or trends relating to the numbers of complaints and themes that need further investigation.

Target Audience: Patient Experience Committee; Healthcare Governance Committee; Trust Executive Group; Board of Directors

Frequency: Monthly

3. Group and Directorate Patient Experience Reports

Purpose: to present a summary of care group and directorate complaint activity and general feedback such as website and comment card feedback, and actions completed following complaints that were upheld, to highlight areas of improvement required and achieved.

Target Audience: Care Group and Directorate Management Teams; Central departments working on the improvement agenda (such as Service Improvement, Healthcare Governance, and Patient Partnership).

Frequency: Quarterly

Purpose: to present a detailed picture of patient experience at department and ward level. Presents a wide range of informationfrom different sources such as: Complaints, Compliments, Website Feedback, Comment Cards, Frequent Feedback, Clinical Assurance Toolkit, etc. To provide staff at department and wardlevel with the patient feedback information that is relevant to them to support the action planning process.

Target Audience: All members of multidisciplinary teams working in specific wards or departments; Patient Experience and Governance Leads for these areas; Senior staff with responsibility for these areas.

Frequency: Annually

This report and other reports that are regularly produced by the Patient Partnership Department and focus on patient experience have been integrated into a single Patient Experience Reporting Framework. Details of each report are illustrated below:

Reporting Framework