Post on 27-Mar-2015
Discovery Interviews
Dr Jeffrey Phillips
Consultant in Intensive Care Medicine
Princess Alexandra Hospital, Harlow
How Patients and Carers can Influence Service Improvement
NHS Modernisation Agency Critical Care Programme
Improve access, experience and outcomes for patients with potential or actual need for critical care
Why?
• The New NHS (1997)• Critical to Success (1997)• Comprehensive Critical Care (2000)• NHS Plan (2000)• Shifting the Balance of Power (2001)• NHS Reform Act (2002)• The Kennedy Report (2001)• Commission for Health Improvement
Why?
Patients are our raison d’être
Aim
• Patients and Carers to influence change
• To understand what patients and carers perceive as important
• New ways of working
• Inclusive approach
“Change has become a constant; managing it has become an
expanding discipline. The way we embrace it defines our future.”
Audit or Research?
• Audit or qualitative research
• Informing about previous experience
• New information sought
• Approval for project– LREC– MREC
Patient and Carer Participation• Questionnaires
– Low response rate– Questions set by professionals– Cover limited aspects of service– Results seldom improve care
• Groups– Inhibition of introverts– Clash of opinion– Directed by professionals
Provide opportunities for patients and their carers to directly tell the story of their illness or condition using a framework that guides them through the key stages of their experience
Discovery Interviews
Using Narratives
Reflection
• Listeners must ask:– “What is learned from the narrative?”– “What needs to change?”
Action
• Listeners must ask:– “How can change happen?”
Discovery Interviews
• Semi-structured
• No formal direct questions
• Interview spine derived from process mapping
• Process map simplified
Discovery Interview Spine
First realising something was wrong
Getting to the Critical Care Unit
Being in the Critical Care Unit
Leaving the Critical Care Unit
Being on the Ward
Going Home
At Home
Discovery Interviews
• Subject encouraged to talk about experiences at each stage
• Interviewer avoids direct questioning
• Audio-recorded
• Transcribed
Analysis
• Process initiated by the team in order to learn about the patient and carers experience
• Non-confrontational process
• Teams listen to uninterrupted narratives
• Stories and narratives are a great leveller
Action
• Identify areas requiring improvement
• Immediate Change
• Process Mapping & PDSA
• Service commissioning– Testament v Anecdote
• Other areas for further inquiry
Improvements
• Orientation of patients when waking from a period of sedation
• Strengthen pre-assessment phase of a patient’s journey
• Communication and information
• Noise
The Future
• Continue improving!
• Roll out to all 29 Critical Care Networks
• Different subject groups– The bereaved
• Cascade throughout Trust
• Those in power to learn from our experiences
Summary
• Learning from Patient and Carer stories• Powerful tool to understand from the Patients’ and Carers’ perspective• Patients and Carers able to provide a comprehensive picture of both recollections and experiences• Strengthened partnerships