www.england.nhs.uk

Paul Jebb Experience of Care Professional Lead

Its all an Experience

www.england.nhs.uk

Experience of Care• improving patient experience on your ward: practical steps• Always Events: setting out the events that should happen on your ward for every patient• developing a responsive ward culture

www.england.nhs.uk

Where we want to be!

Where we are!

How do you bridge the gap?

www.england.nhs.uk

What is patient experience?

www.england.nhs.uk

• I am involved as an active partner in my care.

• I am treated as an individual – my needs, values and preferences are respected.

• There is a recognition that I am the expert on me.

• I am able to access services when I need them, and my care is coordinated.

• I am asked about my communication preferences so that communication is tailored to me.

• I have access to the information I need, which is presented in a way that is right for me.

• I have access to the support I need and is right for me, including emotional and practical support, and I am able to involve my loved ones in decisions about me.

• The environment in which I receive my care is clean and comfortable and makes me feel dignified.

• Abridged from: http://www2.warwick.ac.uk/fac/med/research/hscience/sssh/publications/warwick.pdf

What makes a good experience?

www.england.nhs.uk

The skills that every clinician needs

• How to connect with other human beings

• How to listen without controlling the conversation

• How to recognise, identify and respond to emotion

• How to respond constructively to difference, disagreement and conflict

• How to communicate in such a way that the listener understands and remembers

@ClevelandClinic

www.england.nhs.uk

Service excellence

‘Put emotional experience at heart of the healing

process, not as an add-on’

Fred Lee ‘If Disney Ran Your Hospital’ (2005)

www.england.nhs.uk 8

www.england.nhs.uk

www.england.nhs.uk

What is FFT?

• FFT is a real-time local feedback tool

• It has different characteristics from national surveys

FFT • Real-time

• Ward-level

• Effective for service improvement

• Can be used as early-warning system

• Not representative, not comparable

National surveys

• Robust, comparable data at Trust level

• Data on a range of issues

• Suitable for performance management

• Not meaningful to front-line staff

• Has not historically changed behaviours

• FFT and National surveys are complementary sources of Insight

• FFT is a formative measure: it provides data to improve services

• National surveys are summative measures: they provide an accurate picture of relative performance

www.england.nhs.uk

The Friends and Family Test

• Positive findings: FFT is making an impact

• 78% of Trusts reported that FFT had increased the emphasis placed on patient experience at their Trust

• FFT is being used mainly as a service improvement tool• Provides feedback to frontline staff, often boosting morale• Feedback is real-time and granular: it tells staff about what

is happening in their ward• Identifies problems and encourages action to be taken

• Not used widely for performance management• Concerns over robustness of data, including comparability

between trusts

www.england.nhs.uk

Means nothing if nothing is done

www.england.nhs.uk

Friend and Family Test - outcomes

• Soft closing bins have been purchased for inpatient areas as a response to patients feeding back that noisy bins kept them awake at night

• Comments regarding disturbed nights led to Introducing the ‘Quiet Protocol’ to help patients sleep well at night

      

Environmental issues

Mid Staffs NHS Foundation

Trust

Sandwell and West Birmingham

Hospitals NHS Trust

www.england.nhs.uk

• After negative feedback, the Trust has introduced medication cards for patients who are off the ward during drug rounds to alert them that their medication is waiting to be dispensed

• "Was in pain on previous admission, felt ignored by staff" – comment led to self-medication programme - patients manage their own analgesic medication when they are in pain

      

Medication issues

The Royal Wolverhampton

NHS Trust

The Royal Wolverhampton

NHS Trust

Friend and Family Test - outcomes

www.england.nhs.uk

Improvement priorities

www.england.nhs.uk

Priorities

16

www.england.nhs.uk

Making sure everyone has a voice…

www.england.nhs.uk

www.england.nhs.uk

Through the Patients’ Eyes

“Patient-centered care focuses on the patient’s needs and concerns as the patient define them.”

Picker/CommonwealthPatient-Centered Care Program

www.england.nhs.uk

Always Events®

Always Events® are defined as

“those aspects of the patient and family experience that should always occur when patients interact with healthcare professionals and the delivery system.”• Institute of Health Care Improvement

www.england.nhs.uk

The Five Aims of Always Events® 1. Raise the bar on both provider and patient

expectations

2. Introduce a new organizing principle to help galvanize action and accountability

3. Demonstrate how the Always Events ® concepts can be implemented in practice

4. Widely disseminate Always Events ® strategies for national replication

5. Energize and expand the movement toward a more patient- and family-centered health care system

www.england.nhs.uk

Criteria for Always Events® • Important: Patients and families have identified the

event as fundamental to their care

• Evidence-based: The event is known to be related to the optimal care of and respect for patients and families

• Measurable: The event is specific enough that it is possible to accurately and reliably determine whether or not it occurs

• Affordable: The event can be achieved without substantial capital expense

www.england.nhs.uk

How might Always Events work in the NHS?

Goal: • “a consistent culture of compassionate care

with patients’ interests at its very heart”

Sir Robert Francis• In a NATIONAL Health Service, what can

patients expect always and everywhere in interactions with staff?

• And also staff with each other!

www.england.nhs.uk

National core set + local

Recognition (local decision) -

transparent local feedback/ measurement

National tools– with patients & professionals

Local always events –

with patients & professionals

www.england.nhs.uk

What you said

“Is there anything

else I can do for

you, or get for you,

while I’m here?” and

“Do you have

everything you want

to hand?”

“Always gain better

understanding of the person

as the individual that

they were before they became the ‘patient.’ “

“I will always explain my role in a way that is understandable to the person and take steps to be sure they

understand”

“Always use the person’s preferred

name”

www.england.nhs.uk

What will we be doing nationally?

• Identify tools to support you developing a core set of Always Events - with patients & professionals

• Identify pilot sites to test implementation and impact on improved experience of care

• Develop a strategy for spread and scale-up

www.england.nhs.uk

17 April 2013Derbyshire Healthcare NHS Foundation Trust

Opening Ceremony

@GrangerKate

www.england.nhs.uk 28

Its in our gift….. https://www.youtube.com/watch?v=vqOICgtJhDQ

www.england.nhs.uk

Questions

p.jebb@nhs.net

@pauljebb1

29