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