neil churchill
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Neil Churchill. Director of Patient Experience - ( Domain 4 Lead). Measuring, Understanding and Acting on Patient Experience Insight. - PowerPoint PPT PresentationTRANSCRIPT
Neil Churchill Director of Patient Experience - (Domain 4 Lead)
Measuring, Understanding and Acting on Patient Experience Insight
Why is insight into patient experience important?
“The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare”
A systematic review of evidence on the links
between patient experience and clinical
safety and effectivenessBritish Medical Journal
What does a “very good” experience mean?
Source: GP Patient Survey 2012-2013
Very good
Fairly good
Neither
Poor
All respondents who answered the question (948,758)
Q Overall, how would you describe your experience of your GP surgery?
18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85 +
5% 5% 4% 3% 2%
13% 12%10% 9% 7%
5% 4% 4%
49% 49%46%
44%41%
33%29% 29%
31% 32%39% 43%
49%
60% 66% 65%
812
171720
27262525
344537
465755
6257
7074
8881
74727168
636260
5547
4039
3431292926
19171480
11110
DoctorsTeachers
ProfessorsJudges
ScientistsClergyman/Priests
The PoliceTelevision News Readers
Social workersThe ordinary man/woman in
Civil ServantsManagers in the NHS
PollstersTrade Union officials
Local councillorsBusiness Leaders
BankersManagers in local
JournalistsGovernment Ministers
Politicians generally
% Not trust % Trust
How do we take our love of doctors into account?Q. “For each, would you tell me whether you generally trust them to tell the truth or
not?”
Base: 1,026 United Kingdom adults aged 15+, 10-16 June 2011 Source: Ipsos MORI/BMA
To what extent do we need to tackle “gratitude bias”?
1983 1984 1986 1987 1989 1990 1991 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
-40%
-20%
0%
20%
40%
60%
80%
Pre War (born before 1945) Baby Boomers (born 1945-1965)Generation X (born 1966-1979) Generation Y (born 1980 onwards)
Data: BSA 1983-2010. Each data point represents >100 respondents
Net satisfaction with the running of the NHS
So what impact will the changing demographic have on satisfaction?
83 84 85 86 87 89 90 91 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 100%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%% sample universe from pre war generation
% Generation Y
% Generation x
% Baby boomers1983: All adults aged 39 and over
Proportion of UK population from each generational grouping
Source: Eurostat
2010: All adults aged over 66
1983: All adults aged under 39
2010: All adults aged between 45
and 65
2010: All adults aged between 44
and 31
2010: All adults aged under 31
How was your experience? (1)Adult Inpatient Survey 2012
0 1 2 3 4 5 6 7 8 9 100%
5%
10%
15%
20%
25%
30%
1% 1% 1% 2% 2%5% 6%
12%
24%20%
25%
Overall…
I had a very good experienceBase: 61399 (all respondents). Fieldwork: Sept 2012 – Jan 2013
Source: CQC/Picker Institute
18% rated their overall experience lower than
7/10
I had a very poor experience
How was your experience? (2)Adult Inpatient Survey 2012
Base: 61399 (all respondents). Fieldwork: Sept 2012 – Jan 2013
Source: CQC/Picker Institute
BUT 62% reported at least one aspect of poor care
18% 62%Poor overall experience Experienced some form of
poor care
Overall experience measures good for tracking satisfaction but not for rooting out problems?
© Ipsos MORI
Paste co-brand logo
here
Sometimes an overall measure can mask poor experience
• On third day she asked for a bedpan• Nurse told her it wasn’t worth running back and forth, told her to do it in the bed• Nurse complained to her in the morning that she was soaking wet
“… in [the hospital] they treated me well”
“Oh yes I found it satisfactory”
Female, white, 65+, in hospital for several monthsHer report… Her experience…
CASE STUDY “I went to the dentist, reported to the receptionist and the receptionist forgot about me. I’m not used to my sight loss and lost my orientation and couldn't bring myself to ask anyone for help and just felt too nervous to shout out or anything. I ended up sitting there for hours and it was an extremely frightening experience.”
Patient experience is closely linked to patient involvement and engagement
Experience Involvement
Being involved is part of having a good experience
Involving patients is one means to understanding and improving experiences
Individual
Individual and collective
UNCLASSIFIED
Means nothing if nothing is done
www.institute.nhs.uk/theguide
http://www.kingsfund.org.uk/projects/ebcd/experience-based-co-design-description
The priorities for patients with breast and lung cancer were differentLung cancer Breast cancer
Communication of diagnosis Functioning of day surgery unit
Information about treatment Appointments system and conduct of OP clinics
Continuity and coordination of care Communication
Information about symptoms
Everyone Counts: Planning for Patients 2014/15 to 2018/19
– Plans are expected to demonstrate measurable improvement in patient experience as well as continued investment in generating feedback;
• enhance feedback and insight from vulnerable patient groups; • measure and improve the experience of carers; • easier access to proven techniques and support for their
implementation; • strengthen forms of staff engagement which can support
improvements in patient experience through better staff experience; • learn from complaints and improve the experience of making a
complaint.
Putting Patients First: NHS England business plan 2014/2015
• NHS England’s Commitments to Carers published April 2014• Introduction of Staff FFT April 2014 and support to engage staff on patient
experience;• All NHS services provide real-time feedback through FFT by March 2015;• Insight strategy 2014;• Plans for ‘Always Events’ and a system-wide approach to improving patient
experience by Sept 2014;• Patient Rights programme November 2014 and strategy to embed NHS Constitution;• Patient Centred Outcome Measures (PCOMs) by March 2015; • Accessible Information Standard and extension of PLACE to cover disability issues by
March 2015;• Strategy for nutrition and hydration by March 2015• Support for patient leaders.
Friends and Family Test OverviewSimple test based on Net Promoter Score methodology
‘How likely are you to recommend our <ward / A&E department> to friends and family if they needed similar care or treatment?’
1 Extremely Likely2 Likely3 Neither Likely nor Unlikely4 Unlikely5 Extremely Unlikely6 Don’t know
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
• 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
3 million people in the UK are malnourished or at risk of...
Of those:• A third are over the age of 65 - more than 1
million older people are malnourished• 93% are in the community, 5% in care
homes, 2% in hospital• Public Sector expenditure is estimated to be
billions of pounds a year.• NICE identifies better nutritional care as the
sixth largest potential source of cost savings to the NHS
Nutrition and Hydration
Nutrition and Hydration
23
Building on success and promoting what works
Improving understanding of malnutrition and
dehydration
Involving all staff and building
collaboration between teams
Embedding responsiveness to patient
voices
Making every contact with patients and carers count
Strengthening commissioning
Building on Compassion in Practice to connect values with behaviours and make nutritional care an agenda that resonates
within and beyond nursing
‘If you’d asked me the most important quality of a doctor, I would have said competence. When I became a patient I soon realised how important compassionate attributes in the people looking after me were’
Kate Granger
17 April 2013Derbyshire Healthcare NHS Foundation Trust
Opening Ceremony
@GrangerKate
Ensuring we listen and act on feedback from vulnerable patients
Accessible Information Standard
• There is a formal process to develop an Information Standard.
• We are asking people for their views to inform the details of the standard, which we will start to write in spring 2014.
• There will be a formal consultation on the draft standard in summer 2014.
• We are expecting to have a final version of the standard approved in autumn 2014 – organisations will then have up to 12 months to comply.
PLACE assessments
Point of Care 2014
Staff Satisfaction = Improved Patient Satisfaction and Care