25th June 2014

Best Practice Principles in presenting Cancer Patient Experience Survey Data

for Improvement

Catherine Thompson

Head of Patient Experience, Acute Care, NHS England

Welcome and Introduction to the day

www.england.nhs.uk

Learning for Change

Best practice principles in presenting Cancer Patient Experience Survey data for improvement

25 June 2014

www.england.nhs.uk

• Explore how CPES results can be best presented to:• Meet the needs of patients.• Meet the needs of trust leaders, clinicians and

patient experience teams• Drive improvements in services.

• Increase understanding of how Trusts use and cascade CPES data.

• NOT to change the questions or methodology of CPES

To inform and develop CPES reporting

www.england.nhs.uk

• Shared with Quality Health (current CPES provider), CPEAG

• Develop a Quality Improvement Resource that will help people to put the CPES data to greatest use

• Your contributions are essential to the process.

The outputs from today

www.england.nhs.uk

• If you would like to participate in a follow up telephone interview to share innovative practice in using the CPES data make contact with a member of NHS Improving Quality

• Live Tweet the event using #Insight2Improve

Throughout the day

Dan Wellings

Head of Insight and Feedback

NHS England

@danwellings

An update from NHS England Patients and Information Directorate

Building choice of high quality support for commissioners

FFT and beyond – Insight and Feedback in the NHS

Dan WellingsHead of Insight and

Feedback – NHS England

Our vision for insight & feedback

“Our ambition is for the NHS to become a world class customer service. Above all this means always listening to what our patients & service users tell us.

By routinely gathering people’s comments, feedback, complaints & suggestions, we can construct a rich database of information & evidence that will enable us to commission the services people want. This is what we mean by insight”

Transforming participation in health & care Sept 2013

Insight in practice…

• Using qualitative and quantitative data to inform what we do

• Using whatever data sources we have - not just surveys but a whole range of market and social research techniques

• Always asking the question, what don’t we know?

• As much an art as science

• Answering the question, “So what?”

“The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end”

A promise to learn – a commitment to act

The Berwick Report

Why is it important? “The confidence that individuals have in

their beliefs depends mostly on the quality of the story they can tell about what they see, even if they see little. We often fail to allow for the possibility that evidence that should be critical to our judgement is missing – what we see is all there is”

Daniel KahnemanThinking, Fast and

Slow

The Insight Strategy

Insight &Feedback

Less descriptive Le

ss g

ener

alis

able

Mor

e ge

nera

lisab

leMore descriptive

In depth interviewsExperience Based Co-Design

Focus groups& patient forumsNHS TrustsCCGsHealthwatchPatient organisations

SurveysGP Patient SurveyBereaved VoicesCancer Patient Experience SurveyNHS Staff SurveyPROMs

Online reviews & ratingsNHS ChoicesPatient OpinionIWantGreatCareCare Connect

Patient storiesHealthTalkOnlinePatient Voices

Feedback tools (kiosks, SMS, apps)Examples include:HospediaSynaptaFeedback apps

Social medialisteningSalesforcePolecatHealthberry

Public MeetingsNHS TrustsCCGs

Matrix of insight methods from Measuring patient experience: evidence scan Health Foundation, June 2013

Friends & Family Test

Complaints

Objective of Insight Strategy

To establish a clear strategic vision for how the different elements of insight & feedback can complement each other most effectively, to be greater than the sum of their individual parts in giving us a clear picture about what patients and the public think of their NHS services

FFT and other data– Review raised a question mark over perceived purpose

– It has different characteristics from other surveys

15

FFT • Real-time

• Ward-level

• Effective for service improvement

• Can be used as early-warning system

• Not representative

National surveys

• Robust, comparable data at Trust level

• Data on a range of issues

• Suitable for relative scores

• Not meaningful to front-line staff

• Has not historically changed behaviours

• FFT and the national survey programme offer 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

Means nothing if nothing is done

dan.wellings@nhs.net

Thank you

The CPES – how can patients and public use it to drive change?

• Bonnie Green• Service User and Carer• June 2014

What I’m covering

– Why am I here– Working with Macmillan– Working with my local commissioner– Working with my local provider

My story

My husband’s story

Why am I here

Working with Macmillan

• Worked with Macmillan last summer to produce a guide to create more patient/public awareness of the CPES and how the data can be utilised to improve the patient experience http://be.macmillan.org.uk/be/p-21015-driving-cha

nge-in-local-cancer-care.aspx

• To support people affected by cancer to navigate the National Cancer Patient Experience Survey (CPES)

• To outline the key themes covered in the CPES that patients have said are important to them

• To enable them to find CPES data they feel is most relevant• To empower them to use relevant CPES data, e.g. local or tumour specific and

use it in their roles as patient/carer representatives in a range of settings such as CCGs, Healthwatch, hospital groups/committees, to influence service improvement

Aims and objectives of the guide:

What we considered important to highlight:

– Explaining what the CPES is

– What the data indicates

– How it can be used

– That it represents the experiences of 70,000 cancer patients

Who was involved

How has the guide been distributed• Copies sent to 80 cancer patient representatives on

Healthwatch• Disseminated via Macmillan’s Service Development

Team to PPI leads in SCNs, CCGs and Health & Wellbeing Boards

• Handed out at events e.g. Macmillan Parliamentary Question Time, Pan London Cancer User Partnership

• Over 200 copies ordered from be.macmillanWhat’s still to do• Refreshed distribution in September alongside CPES,

e.g. circulation to all Healthwatches, Macmillan information centres, Macmillan involvement coordinators

How have I utilised the CPES results locally

1. My local CCG

2. My local provider

Questions and Discussion

Dr Sean Duffy, National Clinical Director, Cancer

NHS England

An overview from NHS England

Activity 1.

Turning insight into improvements and solutions

www.england.nhs.uk

Model for

Improvement

Ben Page, Chief Executive

Ipsos MORI

@benatipsosmori

Data and what works well

Bringing data to life, tailoring CPES data to the right audience

Activity 2

Gill Starkey

Northumbria NHS Trust

Case Study

Northumbria Healthcare NHS Foundation Trust Experience

One of the largest geographical trusts in England.

Provides acute and community health services and adult social care to a population of over half a million people in the North East. The trust has nine hospitals (three general hospitals plus six community hospitals) and employs about 10,000 staff.

Northumbria Healthcare NHS Foundation Trust

Director of Patient Experience

Patient Experience Team

Executive management team support

Ensure patients & families are always included

Transparency

Quality Council

The Northumbria Way

Quality Council

Shared Purpose

Patient Perspective

2 minutes of your time

Friends and family

Inpatients – best in North East region and within top 20%.

Outpatient survey 2011/12 – 5th best in the country.

King’s Fund 2013 - study identifying Northumbria as one of 30 Trusts who provide consistently good patient experience in acute, outpatient and A&E.

Quarterly monitoring of A&E across 3 sites – within top 20%.

General patient experience

Cancer patient experience

In top 10 for first 3 surveys :-

What happens with results?

CNS meeting

Lead Clinicians / MDT’s

Cancer locality group

Trust board

Safety and quality panel

Patient/ Carers

Strong membership :-

Communication

Peer review

Lung cancer project

Orthotics

Publicity – business cards

Detailed analysis of CPES

Patient / Carer User Group

Mainly from patient comments

Communication :- Sage and Thyme

Advanced Communications

Written assessment / care plan

Financial support

Detailed lung patient survey

Research

Actions

24 hour chemotherapy helpline

CNS’s at ODU report

Acute Oncology service

Survivorship programmes

Clinical Psychology

Teamwork

Primary Care links

PATIENT/ CARERS

Good practice

Staying in top 10!!

Environment

Capacity

Cumbria

New Emergency Care Hospital

Challenges ahead

Thank you for listening– any

questions?

Julie WellsDirector

Transforming Health Ltd&

Kristin GustafsenProgramme Manager

Imperial College Healthcare NHS Trust

The Macmillan Values Based Standard

Macmillan Values Based Standard®

What we have achieved and learnt to date

Julie Wells

Macmillan Values-Based Standard™• Naming – “I am the expert on me”. • Private communication – “My business is my business”. • Communicating with more sensitivity – “ I’m more than my

condition” • Clinical treatment and decision-making – “I’d like to

understand what will happen to me”. • Acknowledge me if I’m in urgent need of support – “I’d like

not to be ignored”. • Control over my personal space and environment – “I’d like to

feel comfortable”. • Managing on my own – “I don’t want to feel alone in this”. • Getting care right – “My concerns can be acted upon”.

Trumps!

The relational aspects of care

trump the functional ones

How we work…….What is really going on here?Discover

• Use survey data, annual and real time• Work with staff – identify system failures• Interview patients, run focus groups• Observation• Identify front line improvement teams/leads

What interventions might help?Innovate• Staff and patients co-design interventions• Agree measurement systems• Small tests of change, evaluate and refine• Diffused leadership and permissions to respond to individual need• Workplace reflection, learning and support

Measure, sustain and spread improvementImprove• Develop measurement systems that ensure on-going improvement• Continually involve patients and staff in understanding ‘how we are doing’• Embed workplace reflection• Develop a plan for spreading good practice, including corporate processes such as , recruitment, induction and appraisal• Feedback results – Ward to Board

Triangulation

QualitativeQ

uant

itativ

e

Observations

Key achievements to date

• Our Collaborative Phase 1 and 2• Involvement of front-line staff• Involvement of patients• The power of data• Spread• National interest• The Learn Zone

The Learn Zone

http://learnzone.macmillan.org.uk

Imperial`s“Way Forward “

by Kristin Gustafsen

Aim

• Background• Demo of presenting results• Innovation challenges • Next step

Background

• Pilot started Oct 2012• 4 areas • Data collection• Privacy and ward round focus• Restructure in organisation • Programme manager November 2013• 11 areas

Discovery and Data Collection

• 1st and 2nd wave areas• Ward visits• Build relationships and promote projects• Data collection• Patient focus• Staff focus

The Evidence

• National Cancer Survey• In-Patient feedback survey• Patient feedback interviews and discussions• Staff feedback survey• Staff feedback interviews and group sessions

Staff survey resultsRAG: Red/Amber/Green

Do you feel that there is good team work in this unit? STF032 88.75

Are you proud of the quality of care that you and the team deliver within this unit? STF040 92.50

Do you encourage patients to raise their concerns? STF033 95.00

Are you able to provide confidentiality and privacy when this is needed, to discuss a mobile patient's condition or treatment in this unit?

STF029 94.29

When you have concerns do you feel they are actioned by the person you raised it with? STF041 63.75

At work, do you feel your opinions seem to count within the team on this unit? STF039 61.25

Does your manager or a senior member of staff at work, seem to care about you as a person?

STF037 62.50

Do you feel your role is valued within the organisation? STF020 45.00

Does your manager or team leader encourage your development? STF038 45.00

In this last year, have you had opportunities at work to learn and develop within your role? STF042 43.75

Do you receive recognition or praise for doing good work, from your manager or a senior member of staff at least weekly?

STF036 53.75

At work, do you feel you have the opportunity to deliver the best service you can every day? STF001 62.50

Do you think hospital staff did everything they could to help control your pain?

Did you feel the staff treated you as an individual person?

Were you happy with how staff spoke to you during your stay?

High Performing Questions

PERSy Example – Showing ImprovementDid staff pay attention to your levels of general comfort? (E.g. Did you have enough pillows?)

Way Forward Events;Who, when, where?

ThemesInformation and feedback

• Patients said; they feel informed about their treatment plan and care, although 3/10 said they had not received written information

• 3/10 felt that the ward welcome could be improved and they had experienced being left waiting without being informed about what was going on, making them very anxious.

• Staff said; they do not always get feedback, and that there is a lack of positive feedback and praise from senior leaders and managers. The ward manager do give staff praise sometimes.

Co-Design

Innovation challenges

• Engagement• Quick Wins• Longer term solutions• Patient involvement• Project leads• Resources• Measures

Our Next Step

Q&A

How best to present data

Activity 3

NHS Improving Quality Update

Purpose of NHS IQ

Improving health outcomes across England by providing improvement and change expertise

• Scanning the horizon, ensuring our work is cutting edge to help grow improvement science, knowledge and skills across the health and care system

• Develop and implement improvement programmes and building improvement capability and capacity within the NHS

• Support improvement across the wider NHS

Improvement programmes

Next Steps

1. Deliver regional learning events in 2014 in partnership with NHS England and Macmillan “Using CPES for commissioning for continual quality improvement”.

2. NHSIQ will develop a quality improvement programme aligned to the CPES, using recognised Quality Improvement methodologies based upon the Model for Improvement Framework. NHS IQ will evaluate the knowledge and insight accumulated from the collaborative programme and the validity of adapting and replicating the approach in other Patient Experience priority areas.

3. Commission qualitative research into the conditions for best practice/improvement, by visiting and discussing key characteristics of a purposive sample of top performing and “most improved” Trusts . 4. Develop a peer support and review model whereby high performing and most improved Trusts would “buddy” with low performing partner.5. Publish tools and resources for professionals using recognised Quality Improvement techniques for improved patient experience and engagement

Reflections on the day and next steps

@NHSIQ

enquiries@nhsiq.nhs.uk

www.nhsiq.nhs.uk

Improving health outcomes across England

by providing improvement and change expertise.