Patients First: Supporting Nurse-Led Innovation in Practice

A partnership between the Foundation of Nursing Studies and the Burdett Trust for Nursing

November 2016 - June 2018

End of Programme Evaluation

Author: Jo Odell, Practice Development Facilitator, Patients First Date: October 2018

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Acknowledgements To the Burdett Trust for Nursing for their forward thinking in supporting this programme. To the participants, who demonstrated such motivation to improve their patients’ experience, and through that were able to advance and improve aspects of nursing practice. Executive Summary The FoNS Patients First Programme, supported by the Burdett Trust for Nursing, is a programme of support for clinical frontline teams. It aims to support them to innovate in practice, working in collaboration with their wider teams and people who use services and their families and carers. It is a competitive entry programme which recruits 10 teams. The main elements of the programme are six workshops of support in London, workplace visits from the FoNS Practice Development Facilitator and a bursary to support the programme and the practice innovation. The progamme is evaluated after each workshop and these evaluations are published on the FoNS website. This report is based on findings and evidence generated through a participatory evaluation process at the 6th workshop day; a collaboration between the participants and the FoNS Practice Development Facilitator. It seeks to answer the following questions:

• What has the impact of the Patients First Programme been? • How have the elements of Patients First enabled the participants and practice change? • What are the outcomes of the projects and participants’ involvement in Patients First? • How have/ will participants use and share what has been achieved with Patients First? • What would participants say to colleagues and FoNS about Patients First?

The key findings are:

• The participants highlighted that that they as individuals have gained new skills and confidence, have improved team working within the project team and have used and introduced creativity within their projects.

• The outcome of the projects resulted in improved safety and referrals, cost savings and a better patients experience. Although participants also highlighted that some projects were still a work in progress beyond the time scale of the programme.

• The participants highlighted that all elements of the programme ( workshops, support from the Practice Development Facilitator and bursary) had been useful in different ways and perhaps more important at different times within the project.

• Participants highlighted that they have already or have plans to share their projects and new ways of working at internal and external events locally, nationally and internationally.

• Participants highlighted that the Patients First programme was inspiring, motivating, supportive and provided protected time out for participants to work on their projects. They would recommend it to others.

“It has been a great project that offers support and learning to help deliver service improvements in practice. I would highly recommend it to colleagues. A unique opportunity to meet other teams across the UK who are highly motivated, which is inspirational and informative. Great opportunity to share ideas, experience and knowledge”

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1. Introduction and background 1.1 About FoNS: The Foundation of Nursing Studies (FoNS) exists to help nurses transform how they work, use innovative, knowledge based approaches to improve the practice of caring and ultimately provide the standard of person-centred nursing that ensures patients feel respected and safe. 1.2 About the Burdett Trust: The Burdett Trust for Nursing is an independent charitable trust which targets its grants at programmes and projects that are nurse-led, using its funds to empower nurses and make significant improvements to the patient care environment. FoNS has been a partner of the Burdett Trust since 2009 for this programme. For further information visit: http://www.burdettnursingtrust.org.uk/ 1.3 About the Patients First Programme: The Patients First Programme provides support and facilitation to clinically based, nurse-led teams to help them to develop, implement and evaluate locally focused innovations that improve patient care in any health or social care setting across the UK. Over a period of 18 months, the Patients First Programme provides:

• A six-day workshop programme of support and development. The workshops bring the teams together to explore and enable effective strategies, practice development tools and resources for developing and changing practice and to provide opportunities for networking and sharing

• Regular workplace visits by the FoNS Practice Development Facilitator to enable the development and consolidation of knowledge and skills in leading and facilitating sustainable changes in practice and improvements in care

• Advice and support to develop effective project plans/proposals which have a central focus on the patient and/or service user’s experience and the issues that matter to them most

• Support to identify and make links with people who may be able to offer support locally

• Peer mentorship linking up team leaders with those who have completed similar initiatives

• Support with publishing and active dissemination • Bursary funding of up to £5000

Within the workshop programme there are a number of themes as described in Table 1 below. Table 1: Themes of the workshop days

Themes: 1. Person-centredness What is person-centredness, how is it experienced in practice, how

can practice development support greater person-centredness 2. Practice Development What is practice development, what sort of activities support

improvements in quality, how can stakeholders participate? 3. Facilitation

The benefits of facilitation as a leadership style, how to become a better facilitator

4. Context and Culture What is an effective workplace culture, how does culture influence practice, how can culture be changed and improved?

5. Collaboration, Inclusion and Participation

What are collaboration, inclusion and participation of patients and other stakeholders, what are the barriers and enablers?

6. Gathering and Using Evidence

What evidence can be used to inform practice, how can it be gathered and how can staff become involved in evidence gathering and critique of evidence?

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7. Action Planning How to develop and use an action plan 8. Evaluation What different approaches to evaluation are there and how can

they be used? 9. Reporting and

Disseminating Support to develop some form of report or publishable evaluation

2. Previous Evaluations During years 1 to 7 of the Patients First Programme, 80 teams were supported. Each year of the programme was evaluated internally and an additional independent external evaluation was conducted by the University of Worcester covering years 1 to 3 of the programme. Details of evaluations can be found on the FoNS website: (https://www.fons.org/programmes/patients-first/Evaluations). Each evaluation has sought to highlight the difference that the programme has made to participants, patients, the service and the organisation as well as highlight how the elements of the programme have enabled the participants to put their projects into practice. In an effort to make the continued annual evaluation meaningful, more novel approaches have been taken over the years. This end of programme evaluation report will focus on year 8 of the programme, which commenced in December 2016. As, after each workshop day an evaluation was produced https://www.fons.org/programmes/patients-first/Evaluations, this work will not be repeated and this end of programme evaluation will focus on the participatory evaluation undertaken on the last day of the programme and highlight some case studies that exemplify the work of the participants. This evaluation seeks to promote and celebrate the work that FoNS and the Burdett Trust does through its partnership working. 3. Overview of the Year 8 Programme 3.1. Recruitment and selection The Patients First Programme was advertised widely in FoNS’ and other nursing/healthcare publications, via direct marketing and via social media. The recruitment process for the programme is illustrated in Table 2 below. Table 2: Recruitment process to year 8 of the programme

Process Dates Response received

Call for applications via e-news alerts and other advertising

June - Sept 2016

Number of potential applicant enquiries August - Sept 2016 41 Closing dates for applications Sept 2016 Applications received Sept 20 Applications reviewed for key criteria and then offered a telephone interview

Sept-Oct 2016 16

Successful teams notified Oct 2016 10 teams Programme starts with visit from Patients First facilitator

Oct 2016 - November 2016

Start of workshop programme Dec 2016 10 teams

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All potential applicants were encouraged to telephone and discuss their ideas with a member of the FoNS team to enable them to meet the criteria of the programme. Once the applications were received, they were reviewed by the FoNS team against the programme criteria. Sixteen applicants/teams were interviewed by telephone and 10 teams were selected. Successful applicants were contacted by email with information regarding the programme terms and conditions, which have to be signed by the project team and the appropriate Director of Nursing (or equivalent). 3.2 Summary of year 8 projects Table 3: Summary of projects Name of lead applicant Title of project Tom Stamp, Community Therapy Service, Oxford Health

A worry shared – social inclusion to promote anxiety management for older adults in the community

Claire Matata, Northumbria Specialist Emergency Care Hospital, Northumberland

Improving the experience of low risk patients with febrile neutropenia following chemotherapy

Rebakah Denny, Chestnut Tree House Children’s Hospice, Arundel, West Sussex

The hard to reach families project

Lisa Kieh, Gwalia Care and Support, Newport, Wales

Assuring the nursing care that matters most to you

Carol Morrison, Ashley Court Nursing Home, Randolph Hill Care, Edinburg

Co-designing required care plan documentation to embed person centred care in day to day practice

Claire Adams, Addenbrookes Hospital, Cambridge

Developing a workshop to support and empower patients with negative body image due to the cosmetic effect of lipodystrophy

Elizabeth Green, Basingstoke and North Hampshire Hospital, Hants

Putting patients and carers first. A project to improve patient experience on an acute elderly care ward

Dawn Hart, Sussex Community NHS Foundation Trust

Patient safety project

Lisa Hacker, Royal Bournemouth and Christchurch NHS Trust, Bournemouth

Embedded retention of information for people being cared for in the orthopaedic outpatient department

Julie White, Leeds General Infirmary, Leeds Developing nursing practice and nurse led services to improve the patient journey through the children and teenage haematology and oncology day unit

4. Aims of this evaluation The aim of this evaluation is to answer the following questions:

• What has the impact of the Patients First Programme been? • How have the elements of Patients First enabled the participants and practice

change? • What are the outcomes of the projects and participants’ involvement in Patients

First? • How have/ will participants use and share what has been achieved with Patients

First? • What would participants say to colleagues and FoNS about Patients First?

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5. Participatory evaluation The morning of the 6th workshop day (6th June 2018) was given over to the end of programme evaluation. Participants were both ‘subjects’ of the evaluation and evaluators. The rationale behind this was firstly as a way of gaining ‘external’ evaluation data for the Patients First Programme and it was also driven by a desire to work in a more participatory and collaborative way with participants. It was hoped this would also provide a learning experience of a collaborative evaluation process that participants could use in future ventures. Initially participants were asked to answer 10 ‘first level’ questions individually prior to the workshop. These were recorded on sticky notes and attached to 10 separate flip chart sheets at the start of the workshop (see Appendix 1). Participants were then asked to randomly put themselves into ten groups of three or four people. Each group worked with one question and themed the responses which were fedback to the main group. The ten questions were then reduced to five ‘second level’ questions by combining related questions (see Table 4 below). Participants randomly re-formed into five new groups and each group used the themes and data produced from the first round of analysis to answer these ‘second level’ questions. Each group was given time to discuss the data and find a creative way to feed this back to the larger group and the FoNS Practice Development Facilitator. Above are a selection of photos showing the participants taking part in the participatory evaluation.

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Table 4: First and second level questions First level questions - answered individually then themed in small groups

Second level questions - themed and summarised

1. Please describe the impact of being involved in the Patients First Programme on you and your learning. Think about this individually and then as a team.

What has the impact of Patients First been?

2. Please describe the impact of being involved in the Patients First Programme on how you involved and engaged with patients and the people you care for in your service.

3. Please describe the impact of being involved in the Patients First Programme on your project or change in practice.

4. Tell us why the different elements of the programme namely • Bursary • Workshops • Practice Development Facilitator • The FoNS website

were important to you and why and how they enabled your project to come to fruition.

How have the elements of Patients First enabled you and your project change?

5. What methods and approaches did you use in your project? What are the outcomes of the projects and your involvement in Patients First? 6. What were the outcomes of your project in relation to patient

experience, patient safety and clinical effectiveness (Include any cost or time savings?)

7. Tell us about any conferences/ celebrations events/ or events where you have or plan to share your work however informal.

How will you use and share what has been achieved with Patients First?

8. Tell us how you are or plan to use new skills, tools, learning or confidence in other aspects of your practice.

9. What would you say about being involved in the Patients First Programme to colleagues?

What would you say to colleagues and FoNS about Patients First? 10. Finally - The Patients First programme would be better if

5.1 Summary of theming of the individual feedback to the ‘first level’ questions As described above, participants initially answered each first level question individually using sticky notes which were themed by small groups of participants and then fedback to the main group (see Appendix 1 for full results). Below (in Table 5, left hand column) are the themes of the findings. 5.2 Summary of findings from the ‘second level’ questions Working in five groups, participants took a second level question and using data and feedback from the first level questions and set out to analyse and feedback the findings in a creative manner. These are summarised below in Table 5, right hand column.

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Table 5: Summary of themes from level 1 and 2 questions. First Level questions Second level questions

1) Please describe the impact of being involved in the Patients First Programme on you and your learning. Think about this individually and then as a team.

• Confidence • Developing new skills • Creativity • Team work

1) What’s has been the impact of Patients First

2) Please describe the impact of being involved in the Patients First Programme on how you involved and engaged with patients and the people you care for in your service.

• Engagement • Communication • Awareness • Diversity • Asking questions

3) Please describe the impact of being involved in the Patients First Programme on your project or change in practice.

• Positive changes and improvements • Increase awareness, engagement and

sharing • Confidence • Person centred care

4) Tell us why the different elements of the programme were important to you and why and how they enabled your project to come to fruition a) Bursary

• Time out of practice • Opportunity and enabling us to be

creative with resources • Breaking barriers with senior managers -

enabled management signup b) Workshops

• New ideas • Protected time away from the workplace • Sharing enthusiasm • Informal and put us at ease • Gained confidence

c) Practice Development Facilitator • Enabling • Always there • Supportive • Keeping you on track • Encouraging

2) How have the elements of Patients First enabled you and your project change?

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• Inspirational d) The FoNS website

• Lots of resources • Could have used more

5) What methods and approaches did you use in your project?

• Facilitating group work • Evaluations • Golden moments and challenges

3) What are the outcomes of the projects and your involvement in Patients First?

6) What were the outcomes of your project in relation to patient experience, patient safety and clinical effectiveness (Include any cost or time savings?)

• Increased referrals/improved safety • Work in progress • Cost savings • Better patience experience

7) Tell us about any conferences, celebrations or events where you have or plan to share your work however informal.

• Presentations outside of organisation • Shortlisted for national award • Presentations and posters within

organisations • Organisation website and FoNS website • Open days to celebrate achievements • Media coverage

4) How will you use and share what has been achieved with Patients First?

8) Tell us how you are or plan to use new skills, tools, learning or confidence in other aspects of your practice.

• Awareness of new skills • Using new skills and learning

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9) What would you say about being involved in the Patients First Programme to colleagues?

• Great • Recommend • Inspiring • Supportive • Motivating • Time out/ protected time from practice

5) What would you say to colleagues and FoNS about Patients First?

10. Finally - The Patients First programme would be better if

• Closer to home-regional events • Meeting as a group every three months -

perhaps have a follow up post programme

• More theory of service development

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Celebration event 2018 After the participatory evaluation, the teams were able to present both oral and poster presentations. It was an opportunity to showcase the achievements of the Patients First teams to a wide variety of invited guests including Shirley Baines, Chief Executive, Burdett Trust for Nursing. Pictures (below) The year 8 Teams and examples of oral and poster presentations.

6. Examples of projects completed Below in Table 6 are three examples of completed projects and what they achieved.

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Table 6: Examples of projects and what has been achieved Hard to Reach Families Project - Chestnut Tree House Children’s Hospice (Poster presented at the celebration event in June 2018) Chestnut Tree House (CTH) is a children’s hospice situated in West Sussex, that accepts referrals for children and young people with life-limiting/ shortening conditions or who are not expected to reach their adult years from across Sussex and Hampshire. As part of the strategic review for CTH from 2015-2020 an area of focus was the vast diversities of families within the geographical catchment area, in particular how few of these diverse communities or “hard to reach families” currently access end of life care and support. A project group was formed to focus on a small geographical area as a ‘pilot’ and the group set about engaging local communities through a variety of communication channels. They were successful in raising the awareness of Chestnut Tree House amongst healthcare professionals, social care and educational agencies as well as established more substantial community engagement within the area of Hastings (including St Leonards) evidenced by an increase in community support and referrals to the hospice. Hampshire Hospitals - Putting patients and carers first. A project to improve patient experience on an acute elderly care ward (Poster presented at the celebration event in June 2018) When the project lead was appointed staff appeared to be broken, demoralised and really in need of some TLC. She set about creating a whole new senior team was which gave the team an initial boost but as time went on old habits came back. The main project team and steering group were invited to an away day to discuss and analyse the findings from the questionnaires and culture tool. The following changes were introduced: open visiting, bay nursing to enable a nurse to be visible and accessible to patients and families and a whole team away day was held to enable the team to unite under a common vision and to develop an action plan of improvements.

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A worry shared – social inclusion to promote anxiety management for older adults in the community The Community Therapy Service (CTS) is a rehabilitation service for people over 65yrs of age, dedicated to enabling and maximising patients’ independence in the community. CTS pride themselves in being able to provide holistic support, inclusive of physical and mental health issues, mobility and accessibility and social situation. The aim of the project was to reduce social isolation for older people and reduce their anxiety using innovative approaches. The full report (presented as a PowerPoint) can be found here: https://www.fons.org/library/report-details/73985

7. Discussion The aim of this evaluation is to answer the following questions:

• What has the impact of the Patients First Programme been? • How have the elements of Patients First enabled the participants and practice

change? • What are the outcomes of the projects and participants’ involvement in Patients

First? • How have/ will participants use and share what has been achieved with Patients

First? • What would participants say to colleagues and FoNS about Patients First?

7.1 What has the impact of the Patients First Programme been? The participants highlighted that that they as individuals had gained new skills and confidence, had improved team working within the project team and had used and introduced creativity within their projects.

“I’m new to the programme but I can see a real impact it has made to my colleague. The programme has helped her with confidence building and she has been able to deliver activities in many different projects within our company as a result”

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They highlighted that they had engaged with patients and staff and increased communication and awareness of diversity.

“It has been an amazing experience and will now shape my future leadership. It has made me think how I engage with patients and their loved ones and how important that is”

Lastly, they identified that the Patients First Programme had resulted in positive changes and improvements with a focus on person centred care. This had resulted in an increased awareness and engagement and sharing with patients and staff alike which in turn had resulted in an increase in confidence on the part of the project teams to keep working with the new methods, approaches and skills.

“The impact has been massive. It’s provided confidence to present myself and beliefs and back up/gain evidence to what I thought could be done better” “Realising the true meaning of person centred care, becoming more open minded and embracing change as a good thing” “Without the project I do not think I would have been able to sustain the momentum of the project due to service delivery challenges or gained the same quality of evidence to inform its direction”

7.2 How have the elements of Patients First enabled the participants and practice change? The participants highlighted that all elements of the programme had been useful in different ways and perhaps more important at different times within the project. Bursary

“Encouraged senior management signage. Allowed activities/events that may not have been allowed. Encouraged thinking out of the box and what would be most helpful”

Workshops

“Inspiring to see so much enthusiasm across the UK to make services the best they can be. Head space to evaluate and look at next steps. Learning about techniques and experiencing these. Time frame” “Good to get away from workplace - always left the workshops full of ideas and a buzz!”

Practice Development Facilitator

“Key in starting the project, keeping on track, evaluating progress to date and reviewing next steps. Helping to think of different ideas to try in practice. Support in undertaking facilitating events” “Jo has provided answers. Actually she has prized the answers out of us! Have done this with others since (Thank you- self developed me!!)” “Inspiration and calming, makes you feel that anything you do is of great importance”

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The FoNS website “Very helpful and informative, but perhaps I should have used this more”

7.3 What are the outcomes of the projects and participants’ involvement in Patients First? Participants highlighted that they had used a variety of methods and approaches as a result of being involved in the Patients First Programme, this included facilitating group work and gathering evidence and evaluating the process and outcomes of their project work.

“We held workshops, provided crafts and asked our team and clients to help work out how we should collect feedback. Used attendees’ feedback to plan the next workshop”

The outcomes of the projects included improved safety and referrals, cost savings and a better patient experience, although participants also highlighted that some projects were still a work in progress beyond the time scale of the programme.

“Patient experience in seeing resident listened to and able to make important choices/positive comments to CQC re their care (and staff survey shared a good understanding of PCC). Clinical effectiveness - 2 CQC grades have gone up since we have been doing the project. Safety - ensuring residents happy with what we plan to put in place and not appropriate for everyone” “Not quite there yet but hoping to demonstrate increased quality of service experienced by families. Reduced journey times for patients through the day unit. Robust process to increase Patient safety with GA lists. Reduced costs for home maintenance service by utilising IT systems”

7.3 How have/ will participants use and share what has been achieved with Patients First? Participants highlighted that they had an awareness of the new skills they had developed as part of the programme but they were also using these new skills in other areas of their practice.

“To continue to engage staff. Team building was a really good experience and something that is still talked about and has a lasting impact” “Utilise skills to nurture team working through different methods. Time out for facilitation and meetings. Ongoing patient engagement”

Participants highlighted that they have already or have plans to share their projects and new ways of working at internal, external events locally, nationally and internationally.

“Poster: MRC/Wellcome trust meeting, Cambridge Nov 2017. Presentation: European Consortium of Lipodystohphies meeting, Minster, Germany- April 2018. Planned a conference in Orlando, USA”

7.5 What would participants say to colleagues and FoNS about Patients First? Participants highlighted that the Patients First Programme was inspiring, motivating, supportive and provided protected time out for participants to work on their projects. They would recommend it to others to apply to take part in. There were some small suggestions

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about providing meeting up points post the end of the programme and to consider hosting regional workshops in the future.

“It has been a great project that offers support and learning to help deliver service improvements in practice. I would highly recommend it to colleagues. A unique opportunity to meet other teams across the UK who are highly motivated, which is inspirational and informative. Great opportunity to share ideas, experience and knowledge” “Interesting/thought provoking/inspiring/challenging/ rewarding- has helped to make our workplace better. Happier residents/staff”

8. Conclusion At the time of writing this evaluation the funding for this programme has come to an end. The Patients First Programme has run for 8 years and supported over 90 clinical nursing teams across the UK to develop and improve care using a project based approach but using methods and approaches which promote collaboration, inclusion and participation and embrace the voice of patients and staff alike. This evaluation has highlighted (as have previous years’ evaluations) that the participants have developed new skills and approaches through working on their projects with the support of FoNS at the workshops and through working with the practice development facilitator. The project teams have achieved very patient focused outcomes in terms of safety, effectiveness and experience and have shared and promoted their work through a number of events and conferences. Although not part of this evaluation, it is worthy of note that participants record their projects via a project report that is stored in the FoNS library to inspire nurses worldwide https://www.fons.org/library/project-reports.

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Appendix 1: Answers from First level questions

1. Please describe the impact of being involved in the Patients First Programme on you and your learning - Think about this individually and then as a team

• Individually-Different way of thinking to normal. Usually very fact based, not thinking out of the box, never been creative. As a team-Lovely to have time together away from the office. Amazing to have funds to back the project up and to let us finish something

• It’s totally supported my enthusiasm. Its provided theories and introduced processes to problem solve and find solutions (both as an individual and as a team)

• More confident, more collaborative, think outside the box, confidence, more creative, consideration of environment, self promoting (team)

• I’m new to the programme but I can see a real impact it has made to my colleague. The programme has helped her with confidence building and she has been able to deliver activities in many different projects within our company as a result

• Raised thoughts and ideas about the project, may not have thought about before • Being involved in the Patients First programme has enabled me to further my skills and

carry out further training within my role. As a team we have achieved so much for our department and the trust itself. As well as our patients’ journey

• FoNS has enabled us to promote bespoke training for our team. It has offered us protected time away from clinical duties to reflect on the vision of our team and how our service can develop. It has really helped to promote communication with the team

• I have developed my self confidence, sharing ideas and working in teams with people I didn’t know

• It has got me started with a different way of thinking-Collaboration means more now! • Given creative ideas of how to facilitate. Enabled team to have some time together • It has made me look at my personal practice and has given me a way to drive my team

forward! The main thing that I learnt is that “education” can be creative and how you can facilitate people to engage in progress

• It has helped me to improve/gain confidence in what I do, regarding patient care. Now able to delegate and share duties whereas before also try to do everything myself

• Being involved in the Patients First programme has developed my confidence to Lead service improvement by having increased awareness of the process involved and increased interventions to utilise and facilitate staff and user involvement in more creative ways

• Individually- used for revalidation! Something different- got me thinking! Fresh ideas. Found out how to properly do a project in sequence. Team- Make people feel easier about suggestions and bring ideas forward and feel more valued

• It has helped me to think about things in more depth and to be more expressive with ideas that can then be shared with each other in the team

• Individually-Reinforced my views on best practice and reminded me of priorities. Tam gained knowledge and support from fellow workers

2. Please describe the impact of being involved in the Patients First Programme on how you involved and engaged with patients and the people you care for in your service

• Much more holistic. Less structure if needed- feel more able to use other techniques that would never have- creative, cards and direct learning

• Its directed me to be more focused when talking to patients. To consider their issues and see them holistically. I engage more enthusiastically

• We are mailing our model to ask specific questions generated by the various departments • My colleague was able to get an operational perspective in her work with clients and use

her experience and lessons learnt through the programme to help her re engage with

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clients. My colleague currently works in an office environment, so being on this programme has helped her to revisit old skills to engage with clients

• I have been able to have more patient contact now than before the patients First programme. We have involved and engaged with patients by calling and inviting them to classes gaining feedback

• It has enabled us to have more time to support our patients in listening and devising support plans. The best is yet to come as we are about to launch our pilot group

• We were able to better understand the diversity and needs of the area we targeted • I am much more aware of engaging with patients now and how to do it and the benefits • Gave time out to focus on project in order to focus on patients • It has been an amazing experience and will now shape my future leadership. It has made

me think how I engage with patients and their loved ones and how important that is • It has helped me to be aware and treat people differently. Being organised from the day

the patient is admitted to the ward • The project encouraged me to use very different methods to engage with children/Young

people and their families using social media, joint staff and family engagement eb=vents and patients’ stories

• Improved communication between staff and residents/ relatives/staff. Surveys/feedback improved resident care

• This has made me feel much closer to our staff and residents and it encourages more engagement

• Reminded of the importance of listening and of working with what was said not what I thought was needed

3. Please describe the impact of being involved in the Patients First Programme on your project or change in practice

• Allowed us to actually do the project we wanted to. Helped us to keep to time and follow through.

• The impact has been massive. Its provided confidence to present myself and beliefs and back up/gain evidence to what I thought could be done better

• In team meetings, reviews, audits we now use icebreaker activities if appropriate, prompt cards and work collaboratively to build plans of action

• My colleague has been very vocal in championing the project within our organisation and has lined up her model to the care conversations we practice in some of the care homes. Being involved in the Patients First programme has given her the voice she needed

• Increased awareness and referrals. Working and engaging with other teams to achieve the same goal

• We have made changes in practice which have now been implemented as a daily routine. These changes have proved very positive

• FoNS has helped us to raise the profile of Mental Health within our service. I feel I have had the freedom to lead and develop part of our service

• We have had an increase in referrals from our target area • The project is much stronger because of the way we have been working with patients- this

is because of the Patients First programme • Gave time to think and implement and involve the whole team (away day) • Sometimes you lose sight of our patients in the missed red tape on the ward. It has helped

at times to evaluate this • Helped me to be confident in my role • Without the project I do not think I would have been able to sustain the momentum of

the project due to service delivery challenges or gained the same quality of evidence to inform its direction

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• Person centred care is now becoming more “every day” in the workplace. Now ask what a candidate knows about person centred care at interview

• It has changed the way we collate our information and share it with staff and residents and it has made our home more homely and familiar

• Realising the true meaning of person centred care, becoming more open minded and embracing change as a good thing

4. Tell us why the different elements of the programme as below, were important to you and why and how they enabled your project to come to fruition Bursary

• Enabled us to attend the workshops, pay for outside support, run workshops and get materials required

• Enabled us to be independent with buying things, which could benefit our knowledge. Enabled funding for visits which wouldn’t have happened otherwise

• Allowed us to attend workshops, provide refreshments and craft material at our own workshops

• To travel to London and experience the programme first hand • Enabled the team to attend workshops, travel to and carry out meetings, have protected

time and use resources • Enabled us to carry out certain tasks, like invite patients to classes etc, more resources to

help with providing information to patients • This has been crucial in organising bespoke training and resources. In view of the current

financial environment, this would not have been possible without the bursary • Enabled us to send a lot of information. Printing/postage etc for travel/ accommodation

as we’re are a charity, we didn’t use their resources • We could pay for time and training from changing faces (Charity) • Travel and away days • It helped to give us time off the ward to regroup and take forward ideas and drive the

ward forward • Manged to arrange away day with the whole team at work • Encouraged senior management signage. Allowed activities/events that may not have

been allowed. Encouraged thinking out of the box and what would be most helpful • Mostly used for travel to workshops and accommodation • To be able to travel from Scotland and stay • Enabled team to travel to workshops to participate in programme

Workshops

• Time away to focus on project • These supported our confidence to present at public events eg conferences, public

education sessions for our patients. I wouldn’t have done this otherwise • Provided new ideas, made me think outside the box, challenged me personally to develop

and take on board innovative ideas • New skills were learnt, and workshops are a meaningful way of learning • Helped the team to focus on the objectives of the project • Given us many ideas from other projects and allowing us time to discuss and plan the next

steps • Sharing of ideas, shared vision of developing nursing practice. More theory would be

welcomed • Really enjoyed the creative aspects and by participating and creating it made me

remember the learning • We learnt techniques and ways to engage and facilitate groups

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• Time to focus and be creative • Facilitated us to go back and put our ideas back into the ward environment

- Helped to gather ideas from other teams • Inspiring to see so much enthusiasm across the UK to make services the best they can be.

Head space to evaluate and look at next steps. Learning about techniques and experiencing these. Time frame

• Good to get away from workplace- always left the workshops full of ideas and a buzz! • Promote inspiration and enthusiasm, to move on/carry on with our going project • Enjoyed the interaction, information and knowledge gained from others

Practice Development Facilitator

• Always available • Jo has provided answers. Actually, she has prized the answers out of us! Have done this

with other since (Thank you- self developed me!!) • Jo made us confident to facilitate our communication model. A fantastic support. Gave us

a push when stalled. • Jo helped the team to develop their ideas and gave lots of reassurance and guidance to

them • Support • Given us the confidence when we felt we were failing. Pointing us in the right direction for

positivity • We would not have been able to stay on track without the support of Jo-Fabulous! • Lots of support and ideas at workshops, email and visits to the office • Got us thinking outside the box and trying different things • Talk things through /Coaching • It was good to have a point of call to access help and assistance • Key in starting the project, keeping on track, evaluating progress to date and reviewing

next steps. Helping to think of different ideas to try in practice. Support in undertaking facilitating events

• There to question, advise and support • Inspiring and calming, makes you feel that anything you do is of great importance • To benefit from her knowledge, skills and encouragement

The FoNS website • Great for seeing challenges others have overcome • Great resource • Resources are excellent • Help with evaluation • Very helpful and informative, but perhaps I should have used this more • A very useful, informative resource • Inspiration from other groups • Read reports and get inspired • To have additional support when needed • Able to view what other groups are doing • Must admit not really utilised - sorry • Could have used this more - not good with technology! • A great source of information but difficult to navigate • To gain information and advice

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5.What methods and approaches did you use in your project? • Facilitated groups, claims concerns and issues, blue sky thinking • Mainly PDSA cycles - Plan, Do, Study, Act. I love this as so quick and easy. Patient

evaluation - graphs, colleague feedback, team building evaluations and audit • We held workshops, provided crafts and asked our team and clients to help work out how

we should collect feedback. Used attendees feedback to plan the next workshop • Workshops, icebreaker activities to collate feedback from clients • Golden moments and challenges • PDSA, Graphs, Evaluations/feedback from patients • Claims, concerns and issues. Looking at both qualitative and quantitative data.

Stakeholder meetings and focus groups • Facing challenges and changing the direction of the project where necessary ie. narrowing

the geographical area • Facilitated focus groups. Claims, concerns and Issues/Blue sky thinking • Facilitation, evoke cards, team involvement • Team building days, questionnaires pre and post intervention, meetings and away days • Away days- discussing issues and how to deal with them. Team building to achieve goals,

meetings, questionnaires to staff and families • Values clarification exercise, Claims, concerns and issues, Round the world café,

Creativity, social media, patient stories and diaries • Surveys, get togethers, progress ladder in the foyer at front door, change of language • Think cards • Surveys, get togethers, progress ladder, daily use of language referring to person centred

care 6. What were the outcomes of your project in relation to patient experience, patient safety and clinical effectiveness (Include any cost or time savings?)

• Nice to be able to have something to now offer to patients rather than no service ( no cost savings)

• Outcomes were great. Patient experience was positive as saved lots patients being cancelled on the day of surgery (after admission). Been clinically effective as saved huge theatre time/space and money. We’ve improved the patient journey from foot point of view. Better pre-op/recovery experience

• -In progress but people we support engaged in our workshops and valuable insights into how they felt about care. Some good some negative

• Staff cultural awareness and more referrals • Saving a huge amount of money from wasted theatre time. Allowing more patients to

have surgery. Improved the patient journey and outcomes and recovery. Implemented positive changes within the department

• This is still in progress. It is hoped that we will be seeing more patients in a group setting and this will be more cost effective

• More referrals • We are still working on our project but we believe we will improve the patient experience • Improved safety measure, improved patient and relative experience, better team work • It is still a work in progress as things change all the time. Staff engagement is improving.

However, we continue to strive forward • Received lots of feedback from the families and the trust. Reduced length of stay in the

hospital • Not quite there yet but hoping to demonstrate increased quality of service experienced by

families. Reduced journey times for patients through the day unit. Robust process to

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increase Patient safety with GA lists. Reduced costs for home maintenance service by utilising IT systems

• Patient experience in seeing resident listened to and able to make important choices/positive comments to CQC re their care (and staff survey shared a good understanding of PCC). Clinical effectiveness- 2 CQC grades have gone up since we have been doing the project. Safety- ensuring residents happy with what we plan to put in place and not appropriate for everyone

• This has changed the whole approach and ethos in our care towards our residents and our staff- although we already cared its created a stronger bond or feeling towards everyone involved. Which helps towards safety of everyone in care and in practice

• Patient experience- Surveys, shared information. Safety- encouraging choice to enable independence whilst offering support. Clinical effectiveness-Increase in grades from care inspectorate

7. Tell us about any conferences, celebrations or events where you have or plan to share your work however informal.

• Diabetes UK, MRC welcome trust meeting locally, European lipodystrophy consortium • We presented at a local conference and are doing again in September 2018. Lots of media

coverage, internal with organisation and local papers. Future comms dept featuring our savings

• We will be presenting to our various forums our company has. I will be making a presentation to our board of directors

• Sharing communication on the project on the central intranet site within the company. Staff meetings to present the project

• Display poster at work on education boards. Share presentation with others and share in company via monthly bulletin

• Sept 2017-Nursing and Midwifery and Allied Health professionals conference-Presented the project and how positive it had been so far. Again Sept 2018- to present poster and update on how the project is progressing

• We shared at a poster event with the Head of Allied Health Services for England. I would like to share my work at the development event later on in the year, held within the Trust.

• Display poster at work and share our presentation for educating others who may be involved in replicating the project in other areas

• Poster: MRC/Wellcome trust meeting, Cambridge Nov 2017. Presentation: European Consortium of Lipodystohphies meeting, Minster, Germany- April 2018. Planned a conference in Orlando, USA

• QI HHFT- Poster and presentation. Shortlisted for HSJ Patient safety awards • We are the exemplary ward for the Trust • Presented at the LTHT Nursing and AHP conference in 2017. Due to present at the Quality

Improvement showcase event at Leeds Children’s hospital. Plan to present at CCLG winter meeting in Jan 2019

• Open afternoon at start of project. Regular resident/ relative/staff get together where we inform everyone of progress and next planned steps and for feedback

• We plan another presentation to be given to our residents and staff at Ashley Court • Open afternoon to start project. Continued meetings, get togethers, social occasions

8. Tell us how you are or plan to use new skills, tools, learning or confidence in other aspects of your practice?

• Patient consultations and group work/team meetings • We would willingly now present at any conference. Use skills learnt to problem solve • I am hoping to roll our model out across all of the care and support to obtain a snapshot

of how both ……

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• Carry on with project and duplicate in other areas • This will enable me to further my education and I will be able to use parts for my college

work (current learning) • If successful we hope to launch our patient group workshop, countrywide. My confidence

has grown at management and leadership • Generally, a better understanding of the different cultures and diversities of families who

come into our care • Much more aware of working with patients collaboratively • Using facilitation to bring out people’s ideas • To continue to engage staff. Team building was a really good experience and something

that is still talked about and has a lasting impact • Utilise skills to nurture team working through different methods. Time out for facilitation

and meetings. Ongoing patient engagement • Now have a much better idea of how to run a project, still have things to do on the project

and already have ideas for future projects • We will continue with the things we have changed and continue to share our ideas and

feelings and make time to use shared time and think cards • To actively use, be mindful of new learning and pass it onto fellow workers

9.What would you say about being involved in the Patients First Programme to colleagues? • Great opportunity • Thoroughly recommended • I have been very vocal about this within our organisation and will encourage our clinician

leads to apply to your conferences • Good team building experience • I would highly recommend them to be involved in the programme • It gives nurse practitioners a unique platform to develop services • It has been a good learning experience with valuable “time out” from the normal working

day to focus on our project • Do It! • It has been a roller coaster but have learnt loads to take though to further be proactive

and roles • Go for it and have a good experience which I had • It has been a great project that offers support and learning to help deliver service

improvements in practice. I would highly recommend it to colleagues. A unique opportunity to meet other teams across the UK who are highly motivated, which is inspirational and informative. Great opportunity to share ideas, experience and knowledge

• Interesting/thought provoking/inspiring/challenging/ rewarding- has helped to make our workplace better. Happier residents/staff

• Very worthwhile, enlightening, encouraging, motivating 10. Finally - The Patients First programme would be better if …?

• Future meets 1yr follow up, 2yr follow up • Regional events • Perhaps more theory/learning about service development, management, leading teams.

Perhaps more of a balance with academic work and the creative exercises • We meet more often • You could maybe practice some of the facilitation skills in the workshops ie. round the

world café. Facilitating at a table • Regional events

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Appendix 2: Themes from first level questions

1.Please describe the impact of being involved in the Patients First Programme on you and your learning - Think about this individually and then as a team

Confidence New ideas and confidence Improved self confidence, sharing ideas and working in teams with people I didn’t know Confidence in sharing and listening Gained confidence in what I do and be creative to make the job interesting Developed confidence to lead service improvement Increase confidence, more collaborative, think outside the box

Developing new skills Enabling, promotes communication, leadership skills provided theories for problem solving Developed skills and a toolkit to facilitate staff and user involvement in creative ways Learned how to properly do a project

Creativity Just how much of a creative person I am Creative thinking Different ways of thinking Given creative ideas on how to facilitate A different way of thinking. Collaboration and facilitation mean more now!

Team work As a team we have come together and created a lot of positive outcomes Enabled team to have time together Lovely to have time as team 2. Please describe the impact of being involved in the Patients First Programme on how you involved and engaged with patients and the people you care for in your service

Engagement Enabled time out to focus on projects and engage patients A closeness and more engagement between everyone Much more aware of ensuring we engage with patients Made me think about how I engage when with patients/ relatives Use different methods to engage with children/YP think more creatively

Communication Being organised and pro-active in patient care from the day of admission Improved communication. Importance of listening- hearing what is said Improved communication between residents/relatives/staff. Improved resident care

Awareness Much more holistic, less structured Became more aware of our actions on others The best is yet to come. Offering something unique to our patients

Diversity Better understand the diversity and needs of the are we targeted More insight into cultural/ religious needs

Asking questions Asking questions generated by our various departments

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Made me more focused to information I need 3.Please describe the impact of being involved in the Patients First Programme on your project or change in practice

Positive changes and improvements Change in practice, sharing information, friendly and familiar Gave directions, support and information Sometimes you loose sight of what’s important…….. our patients and has made me re evaluate my practice Able to obtain quality of evidence to inform service improvement Enabled time out to think and implement Time to focus on the project An increase in referrals from our target area Person centred Care (PCC) is now the “everyday” in the workplace. Now include a PCC question for interviewing for new staff

Increase awareness, engagement and sharing In team meetings, reviews, audits, using more icebreaker activities and working more collaboratively Involved whole day and enabled away day Raising awareness and profile of mental health within our team and wider service Made positive changes which have now been implemented as daily routine for everyone Increased awareness, increased referral, engaging with other teams

Confidence Confidence in my role Increased confidence to express beliefs Help sustain momentum of project

Person centred care True meaning of person centred Project much stronger because of Patient Collaboration (Learnt from Patients First) 4.Tell us why the different elements of the programme as below, were important to you and why and how they enabled your project to come to fruition Bursary

• Time out of practice • Opportunity and enabling us to be creative with resources • Breaking barriers with senior managers- enabled management signup • Travel and accommodation for workshop days

Workshops • New ideas • Protected time away from the workplace • Sharing enthusiasm • Informal and put us at ease • Gained confidence

Practice Development Facilitator • Enabling • Always there • Supportive • Keeping you on track • Encouraging

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• Inspirational FoNS Website

• Lots of resources • Could have been used more

5.What methods and approaches did you use in your project?

Facilitating group work Surveys, get-togethers, progress ladder Get togethers, open day, think cards Held workshops, used arts and crafts, held icebreakers, used client feedback to plan next workshop Away days, team building, questionnaires to staff and families Claims, concerns and issues Regular stakeholder meetings focus groups Facilitated focus groups Facilitated group work Team building days Meetings away from the ward Facilitation, evoke cards

Evaluations Colleague evaluations Used patient evaluations Used PDSA cycles Evaluations and feedback

Golden Moments and challenges Facing challenges and changing the direction of the project where necessary ie narrowing the area Challenges and Golden Moments Challenges and golden moments, problem solving

6.What were the outcomes of your project in relation to patient experience, patient safety and clinical effectiveness (Include any cost or time savings?)

Increased referrals /improved safety More referrals and cultural awareness Staff more culturally aware, increase in appropriate referrals, families getting the support they need Good feedback from family, staff and trust Robust process to increase patient safety in relation to GA list

Work in progress Developed a model in obtaining feedback and its currently in progress Still a work in progress as things change and still the need for staff engagement to continue to move project forward and sustain it Still in progress. Hopefully seeing more patients at once, time efficient and cost effective We are still working on the project No cost saving but better service for team Change in practice. Approach, stronger and more caring

Cost savings Reduce costs for home management service Cost savings, improved patient journey, outcomes and recovery Increased trust budget

Better patient experience

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Quality service experienced by families Reduce journey times for patients throughout the unit 7.Tell us about any conferences/ celebrations events/ or events where you have or plan to share your work however informal.

• Presentations outside of organisation, European conference, national groups, etc • Shortlisted for national award • Presentations and posters within organisation • Organisation website and FoNS website • Open days to celebrate achievements with families • Media coverage

8.Tell us how you are or plan to use new skills, tools, learning or confidence in other aspects of your practice ?

Awareness of new skills Still have some aspects of project to do, and already have ideas for further project To actively use and be mindful of new learning to pass on to fellow workers New skills- Confidence, belief in self Leadership skills. New approaches to service development Much more aware of working with patients collaboratively To continue to engage staff. Team building was a really good experience and something that is still talked about. To always evaluate my practice in order to improve it! I have a better understanding of the different cultures and diversities of families who come into our care Enabling me to further my education and make patient journeys better

Using new skills and learning Using facilitation to involve and engage team to bring out ideas We are hoping to roll out our model in other parts of the business Duplicate project in other areas. More confidence in presenting and study days Carry on with project and duplicate in other areas We will continue with the changes we have made and share our ideas, feelings and make time to use the think cards 9.What would you say about being involved in the Patients First Programme to colleagues?

• Great • Recommend • Inspiring • Supportive • Motivating • Time out/protected time from practice

10. Finally- The Patients First programme would be better if …?

• Closer to home- regional events • Meeting as group every three months- perhaps have a follow up post programme • More theory of service development