www.england.nhs.uk

Using insight for

improvement

Insight & Feedback Team

Clare Enston

www.england.nhs.uk

What does insight mean?

• “The capacity to gain an accurate and

deep understanding of someone or

something” - OED

• 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

and the patient voice

• Everyone’s business

“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

www.england.nhs.uk

Why is insight and feedback

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 Kahneman

Thinking, Fast and

Slow

www.england.nhs.ukMatrix of insight methods from Measuring patient experience: evidence scan Health Foundation, June 2013

Insight &

Feedback

Less descriptive Less g

enera

lisable

More

genera

lisable

More descriptive

In depth interviews

Experience Based

Co-Design

Focus groups

& patient forums

NHS Trusts

CCGs

Healthwatch

Patient organisations

Surveys

GP Patient Survey

Bereaved Voices

Cancer Patient Experience Survey

NHS Staff Survey

PROMs

Online reviews

& ratings

NHS Choices

Patient Opinion

IWantGreatCare

Care Connect

Patient stories

HealthTalkOnline

Patient Voices

Feedback tools

(kiosks, SMS, apps)

Examples include:

Hospedia

Synapta

Feedback apps

Social media

listening

Salesforce

Polecat

Healthberry

Public

Meetings

NHS Trusts

CCGs

Friends & Family Test

Complaints

www.england.nhs.uk

The Insight and Feedback Team at

NHS England• We run:

• GP Patient Survey

• NHS Staff Survey

• National Cancer Patient Experience Survey (CPES)

• VOICES survey of Bereaved People

• PROMs (Patient-Reported Outcome Measures)

• The Friends and Family Test

• We also liaise with CQC and DH on the other national surveys (hospital surveys, adult social care survey, etc)

• We support the system in using insight to improve quality:

- Collecting data from patients, analysing it and learning from it

• We also support colleagues across NHS England with their insight needs

www.england.nhs.uk

What do

people

think?

7

GE 2017Vote for Brexit;

Cameron resigns Cameron becomes PM

Issues Facing Britain:

NHS / Hospitals / HealthcareWhat do you see as the most/other important issues facing Britain today?

0

10

20

30

40

50

60

70

80

May1997

May1998

May1999

May2000

May2001

May2002

May2003

May2004

May2005

May2006

May2007

May2008

May2009

May2010

May2011

May2012

May2013

May2014

May2015

May2016

May2017

Report says waiting lists have

doubled under Labour

Lowest score since

December 1985 (12%)

Highest score since April 2002

(61%)

Source: Ipsos MORI Issues IndexBase: representative sample of c.1,000 British adults age 18+ each month, interviewed face-to-face in home

www.england.nhs.uk

19%

Please tell me whether on the whole you agree or disagree with each of the following statements…

It is easy for people to feed back on the service they receive from the NHS

51%Agree

The public are divided about whether it is

easy to give feedback about the NHS

Source: Ipsos MORI/DH Perceptions of the NHS Tracker

Don’t know Disagree

Base: Adults aged 16+ in England, Winter 2016

30%

www.england.nhs.uk

Fewer than half think feedback is acted

upon – and a third don’t know

Base: Adults aged 16+ in England (c. 1000 per wave)

Source: Ipsos MORI / Department of Health Perceptions of the NHS Tracker

Please tell me whether on the whole you agree or disagree with each of the following statements…

The NHS acts on feedback it receives from patients

46%

44%

26%

26%

Different dimensions impact

on feeding back

Type of feedback – positive/negative/neutral

Topic

Moment feedback is given or asked for

Care setting

Authorship and anonymity

www.england.nhs.net

My state of health

NHS Empathy

11GPPS headline findings and CCG-level variance | July 2017 | Version 1 | Internal & Client Use Only |

Overall experience has declined slightly in the last year, continuing a

general downward trend seen since June 2012

86.7%

Overall, how would you describe your experience of your GP surgery?Q28

Source: GP Patient Survey, 2012 - 2017

85.8% 85.1% 85.7%

Base: All patients who answered question, 2017 (794,704), 2016 (407,497), 2015 (425,324), 2014 (445,762), 2013 (483,226), 2012 (491,027)

88.4% 84.8%

www.england.nhs.uk

Inpatient survey- 2016 results

www.england.nhs.uk

Inpatient survey 2016 – highest scores

www.england.nhs.uk

Inpatient survey 2016 – lowest scores

www.england.nhs.uk

What do

staff

think?

www.england.nhs.uk

Engaging staff

‘Employee engagement emerges as the best predictor of NHS trust outcomes. No combination of key scores or single scale is as effective in predicting trust performance on a range of outcomes measures as is the scale measure of employee engagement.’

Professor Michael West

www.england.nhs.uk

Overall staff engagement has shown gradual but

sustained improvement over the last five years

www.england.nhs.uk

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Care ofpatients /

service usersis my

organisation'stop priority

I wouldrecommend

myorganisationas a place to

work

If a friend orrelativeneeded

treatment, Iwould be

happy with thestandard of

care providedby this

organisation

I look forwardto going to

work

I amenthusiasticabout my job

Time passesquickly when I

am working

Makesuggestions to

improve ourwork

Opportunitiesfor me to show

initiative

Able to makeimprovements

21a 21c 21d 2a 2b 2c 4b 4a 4d

Minimum %

Maximum %

Range of scores – Staff Engagement

www.england.nhs.ukhttps://www.cqc.org.uk/publications/evaluation/driving-improvement-case-studies-eight-nhs-trusts

www.england.nhs.uk

Staff

experience

drives

patient

experience

www.england.nhs.uk

Staff

experience

drives

patient

experience

nhs.qii@nhs.net

www.england.nhs.uk

Creating a

context for

improvement

www.england.nhs.uk

Insight in the NHS

“We want the NHS to become the

world’s largest learning

organisation, with a culture that

uses all sources of insight,

including from complaints, to

improve services and quality of

care, particularly for the most

vulnerable” https://www.england.nhs.uk/publicatio

n/next-steps-on-the-nhs-five-year-

forward-view/ page 62

www.england.nhs.uk

https://www.kingsfund.org.uk/publications/organising-care-nhs-front-line

Clare Carter-Jones; cardiology matron, Royal Free

Mike Richards; Chief Inspector of Hospitals, CQC

www.england.nhs.uk

Range of scores - Your Safety At Work

www.england.nhs.uk

ALLSTAFF

AlliedHealth

Professionals,

HealthcareScientists

andScientific &Technical

staff

Ambulancestaff

(operational)

Medical /Dental staff

RegisteredNurses

andMidwives

Nursing orHealthcareAssistants

Social carestaff

PublicHealth /Health

Improvement

Commissioning

managers /support

staff

WiderHealthcare

Team

Generalmanagers

Disagree % 18 15 23 17 14 20 14 17 15 16 7

Agree % 56 62 48 60 62 46 60 59 67 60 82

0

10

20

30

40

50

60

70

80

90

% S

taff

Q4d) I am able to make improvements happen in

my area of work

www.england.nhs.uk

Patient feedback

www.england.nhs.uk

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Care of patients /service users is

my organisation'stop priority

My organisationacts on concerns

raised bypatients/service

users

I wouldrecommend my

organisation as aplace to work

If a friend orrelative needed

treatment, I wouldbe happy with thestandard of careprovided by this

organisation

Is patient / serviceuser experience

feedback collectedwithin yourdirectorate /

department? (e.g.Friends andFamily Test,

patient surveysetc.)

I receive regularupdates on patient

/ service userexperience

feedback in mydirectorate /

department (e.g.via line managersor communications

teams)

Feedback frompatients / serviceusers is used tomake informeddecisions withinmy directorate /

department

21a 21b 21c 21d 22a 22b 22c

Minimum %

Maximum %

Range of scores - Your Organisation

www.england.nhs.uk

ALL STAFF

AlliedHealth

Professionals,

HealthcareScientists

andScientific &Technical

staff

Ambulancestaff

(operational)

Medical /Dental staff

RegisteredNurses andMidwives

Nursing orHealthcareAssistants

Social carestaff

PublicHealth /Health

Improvement

Commissioning

managers /support

staff

WiderHealthcare

Team

Generalmanagers

Disagree % 5 5 7 5 5 5 7 6 4 4 4

Agree % 73 74 66 78 79 79 76 72 71 71 81

0

10

20

30

40

50

60

70

80

90

% S

taff

Q21b) My organisation acts on concerns raised

by patients / service users

www.england.nhs.uk

ALLSTAFF

AlliedHealth

Professionals,

HealthcareScientists

andScientific &Technical

staff

Ambulancestaff

(operational)

Medical /Dental staff

RegisteredNurses andMidwives

Nursing orHealthcareAssistants

Social carestaff

PublicHealth /Health

Improvement

Commissioning

managers /support

staff

WiderHealthcare

Team

Generalmanagers

Disagree % 13 12 12 15 12 11 10 12 13 12 9

Agree % 50 52 47 53 55 52 53 55 53 47 71

Don't know % 10 10 8 8 7 9 9 10 9 13 4

0

10

20

30

40

50

60

70

80

% S

taff

Q22c) Feedback from patients / service users is used to

make informed decisions within my directorate / department

Remembering

the person

www.england.nhs.uk

https://www.theguardian.com/healthcare-network/2017/jun/14/patient-

stories-online-feedback-nhs?CMP=ema-1700&CMP

www.england.nhs.uk

http://listen.health.org

.uk/all-stories/

http://listen.health.org.uk/

stories/peter-butler/

Michael Wise, patient & former specialist in oral surgery and restorative dental

www.england.nhs.uk

What kind of feedback is it, and what

do we want to use it for?It’s research data – it’s about

precisely measuring the

experience of my patients

• Am I using reliable, robust,

validated measures?

• How can I act if I only have data

from 10% of patients?

• Have I got a representative

sample?

• How are my data collection

methods introducing bias?

It’s management information – to help me

identify where there’s a problem and

prioritise what needs fixing

• Are my measures good enough? Do they have

the detail to know what needs fixing?

• 10%, wow! If they say it’s a problem, I at least

need to investigate

• Maybe it’s not representative – but better than

nothing. I’ll go and investigate

• Maybe there is some bias – but does it let me

compare different wards, and know where to act?15

www.england.nhs.uk

We know that while data on small or

large scale can move people from the

status quo to the new world, it is the

efforts of individuals – people like you

– who make this happen.

35

www.england.nhs.uk

To contact us with a question or to join

our NHS Insight Network:

england.insight-queries@nhs.net

Thank you