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FEEDBACK MATTERS EVENT FRIDAY 15 TH MARCH, 10:00 – 15:30

FEEDBACK MATTERS EVENT FRIDAY 15 TH MARCH, 10:00 – 15:30 Duncan Macmillan House, Nottingham, NG3 6AA. PATIENT AND CARER EXPERIENCE: WHAT MATTERS TO THE CQC?. SURRINDER KAUR Inspection Manager - Mental Health Care Quality Commission. #NottsPCX. Our purpose and role.

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FEEDBACK MATTERS EVENT FRIDAY 15 TH MARCH, 10:00 – 15:30

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  1. FEEDBACK MATTERS EVENT FRIDAY 15TH MARCH, 10:00 – 15:30 Duncan Macmillan House, Nottingham, NG3 6AA

  2. PATIENT AND CARER EXPERIENCE: WHAT MATTERS TO THE CQC? SURRINDER KAUR Inspection Manager - Mental Health Care Quality Commission #NottsPCX

  3. Our purpose and role • We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve • Register • Monitor and inspect • Use legal powers • Speak independently • Encourage improvement • People have a right to expect safe, good care from their health and social care services

  4. Core services in Mental Health What we do: • Acute wards for adults of working age psychiatric intensive care units • Long stay/rehabilitation MH wards for working age adults • Forensic inpatient/secure wards • Child and adolescent MH wards • Wards for older people with MH patients • Wards for people with LD or autism • Community-based MH services for adults of working age • MH crisis services and health-based places of safety • Specialist community MH services for children and young people • Community-based MH services for older people • Community MH services for people with LD or autism CQC can also access any other service during an inspection

  5. Our 5 key questions

  6. Our questions By safe, we mean that people are protected from abuse and avoidable harm By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect By responsive, we mean that services are organised so that they meet people’s needs By well-led, we mean that the leadership, management and governance of the organisation assure the delivery of high-quality care, supports learning and innovation, and promotes an open and fair culture #NottsPCX 7

  7. PATIENT AND CARER EXPERIENCE: WHAT MATTERS On the CQC website you will find the • Key lines of enquiry, prompts and ratings characteristics for healthcare services #NottsPCX

  8. PATIENT AND CARER EXPERIENCE: WHAT MATTERS • Your experience form cqc web site • Experts by experience • Focus groups and interviews • Observations #NottsPCX

  9. The involvement of people in the care they receive • Admission process informs and orients the patient to the ward and the service. (C2p1, W3p8) • Active involvement and participation in care planning and risk assessment (evidence in care plans, participation in MDT reviews, access to a copy of their care plan etc) and encouragement to maintain independence. (C2p1/p3/p4, C3p4, W4p2) • Access to advocacy. (C2p2) • Appropriate involvement of families and carers. (C2p3, C2p4, W4p2, W3p8) • People able to give feedback on the service they receive i.e. surveys or community meetings. (C2p4 W4p1, W3p8) • People are able to get involved in decisions about their service e.g. able to help recruit staff. (C2p4, W3p8) • Patients have advance decisions in place. (C2p2) #NottsPCX

  10. The facilities promote recovery, comfort and dignity and confidentiality • Full range of rooms and equipment to support treatment and care (clinic room to examine patients, activity and therapy rooms). • Quiet areas on the ward and a room where patients can meet visitors. • People can make a phone call in private. • People have access to outside space. • The food is of a good quality. • PLACE survey score for ward food. • People can make hot drinks and snacks 24/7. • People are able to personalise bedrooms. • People have somewhere secure to store their possessions. • There is access to activities; including at weekends. #NottsPCX

  11. Meeting the needs of all people who use the service • Adjustments for people requiring disabled access. (R2p4) • Information leaflets available in languages spoken by people who use the service. (R2p1/p2, C2p2) • Oversight of s117 aftercare • There is provision of accessible information on treatments, local services, patients’ rights, how to complain etc. (C2p4) • Easy access to interpreters and/or signers. (R2p1/p2, C2p2) • Choice of food to meet dietary requirements of religious and ethnic groups. (R2p1, R4 p5) • Access to appropriate spiritual support. (R2p1/p2) #NottsPCX

  12. PATIENT AND CARER EXPERIENCE: WHAT MATTERS • Sexual safety on wards • Dormitories • Rehabilitation – repatriation • Equality and Diversity • Restrictive practice #NottsPCX #NottsPCX

  13. Thank you for all that you do everyday in the health service ……………..and for listening

  14. OUR APPROACH TO PATIENT AND CARER FEEDBACK AND THE PATIENT AND CARER EXPERIENCE REVIEW PAUL SANGUINAZZI Head of Involvement and Experience AMY GASKIN-WILLIAMS Involvement and Experience Manager #NottsPCX

  15. A brief history of listening 15 Mar 2019 Paul Sanguinazzi, Head of Involvement & Experience

  16. 10 Years Ago … • A Trust wide Survey • Care Opinion • Service User and Carer Experience Group • A very long paper report

  17. 2012 • National Patient Feedback Challenge Winners • Team Challenge and Your Feedback Matters Website Capturing feedback Sharing feedback Sharing changes Taking action

  18. 2014 • Would you recommend – the FFT

  19. 2018 • The survey – 180 062 responses, 25 859 comments on what we could do better and 67 919 comments on what we do well • Care Opinion: • Monthly Patient Voice report to Board: each directorate identifies key actions + action proposed , then updated after 3 months and a year. Link to Staff Voice report.

  20. 2018 • Service user/care volunteers collecting feedback • Link to staff experience • Developing Your Feedback Matters website

  21. Our Approach & Getting them both right

  22. Openness, honesty and accountability

  23. Curiosity, compassion and communication

  24. Culture

  25. Listen, understand AND Respond

  26. All Ears?

  27. Connecting and understanding - focus on stories, conversations and comments During my treatment I had to move from one psychiatrist to another on as I was not in the correct area after a re-structure of the service. To have to move from psychiatrist who has been with me from the start was extremely unsettling and caused me a lot of anxiety. Patients are in a bad situation and to put this on top of their mental health conditions very poor. (City North LMHT) OR

  28. What on earth is all this saying?

  29. Let’s work together

  30. Love Action – at the Board

  31. Love Action – from the Directorates DIRECTORATE/LOCALITY INVOLVEMENT AND EXPERIENCE REPORT Six-monthly report ARNOLD LODGE

  32. Love Action – from Care Opinion

  33. Future Challenges • The balance between a rich understanding and a wide assurance • Feedback in the community • Resources and focus – where do we focus to make the most significant difference to people’s lives? • Using patient/carer experience in service changes and improvement projects

  34. THE TRUSTWIDE PATIENT AND CARER EXPERIENCE REVIEW • AIM: • Increase our understanding of patient and carer experience and make sure this understanding leads to a bigger impact on services and care • ELEMENTS: • Understand what key people think and want • Critique our approaches - what’s working, what’s not • Adapt existing (or design new) ways to capture patient and carer feedback , analyse the information, respond to it, act on it and share what we’ve done as a result • Evolve the Trustwide approach, paying attention to what works for different contexts/services/patient groups into account • Collaborate with, support and learn from neighbouring/peer • organisations with similar issues to tackle #NottsPCX

  35. PHASE ONE (OCT 18 – MAR 19)… • Interviews with every area of service at Notts Healthcare • Interviews with patients • Half day with our experience-focussed volunteers • Met with local organisations to compare and discuss, find common ground/objectives • Patient and carer experience data analysis • Started some conversations: Openlab, staff experience, Learning and Organisational Development • Research and literature review #NottsPCX

  36. WHAT’S THE RESEARCH AND LITERATURE SAYING… • National Patient Experience Improvement Framework (NHSI, 2018) • Improving experience of care through people who use services report (NHS England, 2015) • What Matters to Patients: Developing the Evidence Base for Measuring and Improving Patient Experience (The Kings Fund, Kings College London – 2010) • EURIPIDES study (University of Warwick, University of Birmingham, Queen Mary University London, The Mental Health Foundation - 2017) • The Patient Experience Book (NHSI, 2013) • Can we use patient-reported feedback to drive change? The challenges of using patient-reported feedback and how they might be addressed.(Flott, K. M., Graham, C., Darzi, A., & Mayer, E. - 2017) • In their words: What patients think about our NHS (Care Opinion, 2011) #NottsPCX

  37. Ask in varied ways, to suit the patient group and the point in careBe available and take time to capture feedback and to understand itAll staff have a role in receiving, listening and responding to feedback (need for local ownership and resolution - EURIPIDES, 2017, tied as closely as possible to clinical services - What Matters to Patients). Seek quantitative (assurance from the many) and qualitative (detail from the few)Analyse well (weakest area across all Trusts - PEIF, 2018) WHAT’S THE RESEARCH AND LITERATURE SAYING… #NottsPCX

  38. Informal feedback is every bit as important as formal (Patient Experience Leads concerned about ‘weighting given to feedback in different forms’ - EURIPIDES, 2017) Triangulate/contextualise patient feedback against other informationService improvement should not be lead by negative feedback alonePatient feedback leads to environmental changes far more often than cultural changes WHAT’S THE RESEARCH AND LITERATURE SAYING… #NottsPCX

  39. WHAT ARE OUR PATIENTS SAYING … Need to see what has changed as a result- where patients were able to give examples of what had changed due to feedback, they were most highly motivated to give feedback again, and the opposite was also true. Full spectrum of perceptions of whether staff genuinely wanted their views – from being encouraged warmly and enthusiastically, to feeling as though giving their views lead to punishment. Feedback most freely given when relationships were good. This sometimes referred to relationships with staff, sometimes with volunteers. Survey fatigue- specific to surveys, no one said they were sick of sharing their views, but many were tired of the mechanism of surveys, particularly where questions remain the same. There is a stand alone desire to be heard – quite apart from whether anything is done. People don’t forgive feeling dismissed or being given no answer/explanation. #NottsPCX

  40. WHAT ARE OUR STAFF SAYING … We’re making some mistakes… • Over-surveying (LTC, inpatient services particularly) • Still focussing too much on quantity • Not flexible enough in our methods for some groups/demographics • Being humble is a virtue and a hindrance • Home/outpatient appointments – already squeezed • Survey may not be specific, or general enough #NottsPCX

  41. WHAT ARE OUR STAFF SAYING … Some of the ways we’re winning… • Volunteers are hugely valuable • Asking on discharge or as evaluation of an intervention • Making patient and carer/family feedback a standard agenda item • Constant ‘Is this working for you’ dialogue • Some exemplary patient forums • Pockets of defensiveness, but this isn’t our general attitude • Experience leads in each directorate • Patient Voice reports #NottsPCX

  42. WHERE ARE WE HEADED NEXT (Phase 2)… • Feedback from people seen in the community/in their own homes • Showing people we’re listening • Better quality conversations with patients and families • Support for staff • Bringing together staff/safety/outcome/experience data • Tracking experiences of care over time • Tackling survey fatigue • Learn more from the positives • Supporting the eager beavers! #NottsPCX

  43. UNDERSTANDING PATIENT EXPERIENCE DATA DR CHRIS BEELEY SENIOR ANALYST #NottsPCX

  44. NHSI • Systematic way of analysing patient feedback including complaints • Dedicated analytical support • Reports that demonstrate correlation between patient outcomes, patient safety, and patient experience #NottsPCX

  45. NHSI • Triangulate with staff survey • Understand the causes of variation and provide an early warning system • Patient experience data is received quickly and in a useful format by frontline teams, and is used to improve care. Learning is shared #NottsPCX

  46. Volume • This was a technological fix • Began software development • Bespoke database • Dedicated feedback dashboard #NottsPCX

  47. Response rate • Response rate for the FFT is about 1% • We have no idea what the 99% of people who don’t respond think • Managing response rate takes time, care, and money • Easier in a hospital #NottsPCX

  48. Representativeness and equity • We should have been more engaged with this at the beginning • We are currently investigating both • Developing a reporting system #NottsPCX

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