Quality Improvement Development for NHSScotland Organisational Development Leads

1. Quality Improvement Development for NHSScotland Organisational Development Leads Workshop 1 Patient-Centred Quality Improvement Stakeholder Analysis

2. Agenda • Welcome and introduction • Quality Improvement – aims and objectives • Participant introduction • Patient-centred quality improvement • Stakeholder engagement

3. Learnings • Understand the elements of patients’ experience • Define what is meant by patient-centred care • Understand the process for achieving patient-centred care • Find out ways to implement patient-centred care

4. Lord Darzi’s Vision An NHS that gives patients and the public more information and choice, works in partnership and has quality of care at its heart High Quality Care for All

6. “The balance is wrong between task-focused care and patient-focused care. […] We need to listen better and listen more to patient experiences” Ann Abraham, Ombudsman

7. How satisfied are patients? Q3. Overall, how would you rate your care and treatment during your stay in hospital? Q1. Overall, how would you rate your admission to hospital? Q4. How did you feel about being involved in decisions about your care and treatment? Q2. Overall, how would you rate your the hospital environment? Scottish Inpatient Patient Experience Survey 2010

8. Does it matter? • “Our patients aren’t complaining, so we must be meeting all their needs “ • “Providing patient-centred care is too costly” • “Patient-centred care is nice, but not important” • “Being patient-centred is too time consuming”

9. Why patient-centred care is a priority • Room for improvement regarding patient experience • Improved outcomes – evidence to show results in reduced mortality and morbidity1 • Reducing costs – less likely to develop complications or need readmission • Indicator of poor care 1 Feeling Better – Improving Patient Experience in Hospital, 2010

10. What is patient-centred care? ? ? ?

11. What patients want… • fast access to reliable health advice • effective treatment delivered by trusted professionals • participation in decisions and respect for preferences • clear, comprehensible information and support for self-care • attention to physical and environmental needs • emotional support, empathy and respect • involvement of, and support for family and carers • continuity of care and smooth transitions. Picker Institute, 2009

12. Case study – A&E handover • Aim – to provide timely, coordinated and seamless care to patients • Benefits • Improved patient experience • Greater accuracy • Safer • Faster turnaround times • Approach: • Patient walkaround “in your shoes” • Highlighted inefficiencies and poor patient experience • Outcome – improved experience for patients, faster turnaround for staff and new processes that improved safety.

13. Case study – Good hydration practice • Aim – review the actual level of intakes and increase water consumption on ward • Benefits: • improve the level of hydration of patients • improve the level of awareness of the need for good hydration among staff • improve the level of patients’ awareness of the health benefits of drinking more fluids • Approach: • review of good practice • audit of water intake • introduced new tools and good practice • Results: • evidence showed good hydration improved recovery • Improved feedback from patients

14. Your examples of patient-centred care? ? ? ?

15. Key steps for patient-centred approach • Understand what patient feedback is and how you obtain it • Understand findings from your surveys • Share feedback • Create action plan for improvement

16. Quantitative research(Numbers) • self-completion postal surveys • interviewer-administered face-to-face surveys • telephone surveys • automated telephone surveys (interactive voice response – IVR) • online surveys using web-based or email questionnaires • surveys using hand-held portable devices (PDAs or tablets on-site) • surveys on touch-screen kiosks (on-site) • surveys on bedside consoles (on-site) • administrative data/routine statistics

17. Qualitative research(Words) • focus groups • in-depth face-to-face interviews (may be audio- or video-taped) • patient stories

18. Gather user feedback • In pairs • Select one person to answer the questionnaire on travel to the venue (1 minute) • Same person tell story of journey • Role of the other person is to listen and prompt • 10 minutes

19. Qualitative research(Words) • focus groups • in-depth face-to-face interviews (may be audio- or video-taped) • patient stories • comment cards or suggestion boxes (on-site) • video boxes (on-site) • complaints and compliments • patient diaries • mystery shopping and observation • experience based design (EBD) • customer journey mapping.

20. The Experience Based Design Approach …about using experience to gain insights from which you can identify opportunities for improvement …about experiences not attitudes or opinions

21. EBD – Gathering the experience • Collect stories and thoughts from both patients and staff:- • Interviews • Story boards • Photography and film Intimidating Stressful Clean Impersonal Time-consuming

22. Gather user experience • In pairs • Think about your last visit to dentist • Use Product Reaction Cards • Find cards that describe the experience (first reaction) • Select top 5 • Explain why you selected these 5 • Take 15 minutes

23. Actions Responses Language Feelings Deep Emotions Deep understanding tool –Peeling the Onion Layer 1: Actions What people do? Why? What is driving them? Layer 2: Responses What people say? Why? – what’s behind the words? How honest do you think they are being? Layer 3: Language How people say things. What words do they use. Capture real quotes. What is body language Layer 4: Feelings what are they feeling? Trust? Comfort? Irritation? What is causing this? Layer 5: Deep Emotions: What are their real loves and hate? Where are the passion points?

24. Gathering user experience – observation • Observation of patients and staff delivering and receiving care • People do not always do what they say they do • People do not always do what they think they do • People do not always do what you think they do • People cannot always tell you what they need • Observation lets you find out what people really do and need IDEO 2006 73% of doctors say they wash hands before patient contact 9% actually do so Bill Kirkup 2006

25. Case study – EBD in Brighton • Aim • to better understand the real patient experience, including the issues and challenges faced by patients with digestive conditions • Benefits • Improve service for patients • Approach: • Patient diary/camera/dictaphone • Feedback to team • Process mapping with selected patients and develop new pathway • Outcome: • Identified barriers and delays in system • Improved staff understanding • Process re-designed to eliminate delays and poor experiences

26. Choosing the right research method

27. Gathering patient feedback – summary • set clear goals • identify relevant stakeholders • decide who you want to gather feedback from • secure adequate resources • choose the most appropriate methods • consider how you will act on the feedback gathered

28. Key steps for patient-centred approach • Understand what patient feedback is and how you obtain it • Understand findings from your surveys • Share feedback • Create action plan for improvement

29. Understanding findings from your surveys Careful examination of patient feedback will highlight the areas that need improvement to provide a better service for patients, and supply the evidence for change.

30. 22,799 21,898 20,310 6,347 6,303 7,126 100% 96% 89% 31% 28% 28% All referrals to OP Appointments given Appointments attended Decisions to admit Offers of admission Admissions Review patient journey Hip and Knee Replacement – activity figures for Q1-Q4

31. Compare results over time

32. Compare results with other organisations 5 Boroughs Partnership Patient Survey

33. Compare results internally Overall satisfaction by specialty

34. Identify areas for improvement

35. Understanding patient’s perspective - personas • Develop your personas as a team • Identify the traits that are common among that type of patient - key demographics, habits and personality • Add a photo, name, age, gender, location, family ties, profession and lifestyle • Include personality traits, goals, behaviour or motivations in relation to life • Validate your personas with your customer advisory group • Communicate your personas widely

36. Example personas

37. Develop your own persona • Work in groups • Develop a persona for a new day surgery unit • Come up with name, demographics, traits • Likes and dislikes about hospital • 15 minutes

38. Key steps for patient-centred approach • Understand what patient feedback is and how you obtain it • Understand findings from your surveys • Share feedback • Create action plan for improvement

39. Sharing feedback Raising awareness is an essential part of involving patients and the public in improving healthcare services. Communicating the results of your enquiries – and what you plan to do with them – will help to ensure that they are used effectively and not forgotten.

40. Sharing feedback • Internal audiences include: • board members • senior managers • staff at all levels, in both clinical and support roles • volunteers. • External audiences include: • patients • public • local community and voluntary groups • commissioners • other healthcare organisations • local authorities • the media.

41. Communications strategy • Who you want to reach • What you want to share • Why you want to share the information • When and where you are going to communicate • How you will share your information

42. Make the information more interesting • Graphs are often a better way of presenting data than tables • Include anonymous patient quotes • Photos and other visuals help make a document more engaging • Highlight how people can get involved so that they feel a sense of ownership.

43. Key steps for patient-centred approach • Understand what patient feedback is and how you obtain it • Understand findings from your surveys • Share feedback • Create action plan for improvement

44. Create an action plan • SMART Objectives (Specific, Measurable, Achievable, Realistic and Time) • Continue to involve patients • Senior management sponsor • Gather a supporting team • Make a plan • Communicate, communicate, communicate Picker Institute

45. Agenda • Welcome and introduction • Quality Improvement – aims and objectives • Participant introduction • Patient-centred quality improvement • Stakeholder engagement

46. Learnings from the stakeholders session • Find out how to improve the outcomes and sustainability of your service improvement by working effectively with your stakeholders. • Learn about the categories of stakeholders • How to manage effective communications

47. Who are your stakeholders? • Anyone in or around your project who affects or can be affected by your project • Identify your stakeholders • Select one project • Brainstorm all stakeholders • Write each on a Post-It note • 15 minutes

48. 9C Model • Commissioners: those that pay the organisation to do things • Customers: those that acquire and use the organisation’s products • Collaborators: those with whom the organisation works to develop and deliver products • Contributors: those from whom the organisation acquires content for products • Channels: those who provide the organisation with a route to a market or customer • Commentators: those whose opinions of the organisation are heard by customers and others • Consumers: those who are served by our customers: ie patients, families, users • Champions: those who believe in and will actively promote the project • Competitors: those working in the same area who offer similar or alternative services

49. Stakeholder classification • Patient (consumer, commentator, customer) • Healthcare workers (commentator, collaborator, channel, champion) • Healthcare charities (commentator, collaborator, channel) • Private healthcare providers (commentator, competitor) • Department of health (collaborator, consumer) • Media (commentator, collaborator) • Local authorities (commentators) • Government (commentator, consumer)

50. Populate your stakeholders? • Place your stakeholders in the 9C framework • How many more can you identify? • 10 minutes