Improving processes of care and staff-patient interactions.

Annie Laverty

The King’s Fund Conference6 December 2010.

Contents

1. Our approach

2. Patient perspective programme

3. Understanding what matters most – in real time

4. Driving improvements at team level

5. The King’s Fund Hospital Pathways Programme

6. Summary

Northumbria Healthcare NHS Foundation Trust :

•large provider

•vast geography

•10 hospitals sites

•6500 staff caring for over 355,000 people each year

•history of diverse and complex delivery needs

Our approachReal-time data collection

Two minutes of your time

Patient perspective

National survey programme

Individual

+

Wards

+

Business units

+

Trust Board

Ward by Ward performance to date

Patient and family free text comments

Outpatient data

• views of 11,500 outpatients

• same approach at individual consultant level

• 8 domains that matter most to outpatients

• generating single score for appraisal

Ward-based real-time surveys

• consistency and co-ordination of care

• treatment with respect and dignity

• involvement

• doctors

• nurses

• cleanliness

• pain control

What matters most to inpatients?

Monitoring performance month-on-month

Driving improvements at team level

Working assumptions

• The bottom line is the bottom line

• Patient experience isn’t just an end point of care, it should be the start of improving care

• We work with different types of people these days

• Patient experience and staff experience are more similar than different

• Best care demands the best ways of improving care

21/06/2010 29/06/2010

09/07/2010 25/08/2010

The likelihood of recommendation based on the care on this ward 8.71The likelihood of recommendation based on the care on this ward 7.88

The likelihood of recommendation based on the care on this ward 7.87The likelihood of recommendation based on the care on this ward 7.23

Resultsby visit

Ward 16Wansbeck

Reported in real time & accessible to staff

Ward 3 Hexham Haltwhistle

Exit surveys : 2 minutes of your time

From ward to board

• Metrics based on what matters most to patients

• Measurement for improvement: tracking + reporting monthly performance

• Appreciative enquiry: sharing best practice + celebrating success

Our share point

Our gains

• Results are transparent and owned

• Individual teams delivering front-line led solutions

• Improved performance and reputation for all pilot teams

• Improved communication and collaboration

• Patients and families engaged at every level of service delivery, planning and improvement

• Important person-centred and staff-focused changes

Some things we’ve learnt• The benefits of real-time reporting at team level

• Focusing on things that matter most has made sense

• Investing in improvement rather than measurement has helped

• Qualitative feedback appears particularly important to our teams

• The transparency of reporting is important

• Executive management team support is crucial

• Ensure patients and families are part of your improvement team

• Collaborative 18 month project designed to transform patient

experience• Part of The Point of Care

Programme• 5 participating hospitals• 2 selected pathways each –

elective and emergency

Hospital PathwaysProgramme

Participating hospitalsGeorge Elliot Respiratory Support and Abdominal Pain Pathway

Royal FreeLiver Surgery and Elderly Care

SalisburyCardiology and Trauma Pathway with Focus on Elderly Care

Taunton and SomersetStroke and Elective Hip and Knee Replacements

Northumbria Dementia and Hip Fracture Care

Programme aims

• Improve patients’ experiences of care in hospital so that all patients receive a consistent and reliable quality of care.

• Improve relatives’ experiences so they can have confidence in the quality of care their loved ones’ receive.

• Demonstrate that the well-being of staff is important, not just for its own sake but for the sake of patients.

• Keep patient experience of care as high on the quality agenda as safety, clinical effectiveness and finance.

Themes

1) Leadership and values

2) Staff effectiveness and well-being

3) Patient and family-centred care

4) Reliable care processes (and environment)

5) Co-ordinated, collaborative, evidence-based care

All ways of knowing

• Process maps• Emotion mapping• Shadowing/patient walkthroughs• Patient surveys• Focus groups• Discovery interviews• Stories• Executive safety walk-rounds

Many opportunities

• Faculty support − special thanks to Annette Bartley

• Understanding the integration between staff engagement and patient involvement processes

• Ensuring continued investment in the internal family

• Creating structured processes for quality improvement• Developing involvement tools that focus on co-production

• Celebrating achievements and acknowledging contributions

• Focus and challenge

• Sharing the learning

In summary

‘People must always come before numbers. Individual patients and their treatment are what really matters. Statistics, benchmarks and action plans are tools not ends in themselves. They should not come before patients and their experiences.’

Robert Francis QC, The Mid Staffordshire NHSFoundation Trust Inquiry

Thanks for listening

Any Questions ?