The changing policy context around patient experience – What do we really know?

1. The changing policy context around patient experience – What do we really know? Dr Lisa Bayliss-Pratt Assistant Director of Nursing

2. What do we think patients care about? Care and Compassion Clean environments

3. What the research tells us…

4. What the research tells us…. • Complaints data is not typically collated or analysed at national or local levels • ‘Relational’ aspects of care (dignity, empathy, emotional support) are very significant alongside functional aspects (access, waiting times) • Current data collection, analysis and reporting have evolved – not a science… Ref: Robert et al (2011) What matters to patients? – Developing the evidence base for measuring and improving patient experience. National Nursing Research Unit, King’s College London

5. The national picture – patient experience: • Focus on acute care • Relevant to services rather than patient journeys • Not timely • Not representative

6. What is happening across the NHS • Maintaining quality and safety during transition • The quality architecture – still to be determined • Develop a single quality operating model for the SHA Clusters • Develop a standardised set of quality metrics

7. How are organisations using the information? Clinical effectiveness, patient safety and experience do not have the same status Poor links between dedicated to measuring and improving patient experience Wide range of capabilities ‘Real time’ approaches are common but focus on ‘snapshots’ CQUINS not seen to be a significant leverage Organisations do not know their costs to the NHS of collecting patient experience data Innovative work not always recognised by commissioners Six universal challenges: structural, political, cultural, educational, emotional and technical

8. Emerging architecture… Triangulation???????????????????????????????????????????? Dashboards Harm Free Care NHS Safety Thermometer Thoughts about capturing Primary Care

9. The Hypothesis… If the system is performing well at the highest level of aggregation it will perform well at lower levels too

10. BIG Dot • Big dot criteria • NHS-wide • Outcome driven (not a process indicator • Connect to other ‘little’ dots or processes (multifaceted) Triangulation????

11. Timelines of measurement Metrics that are captured frequently • No less frequently than quarterly (excludes annual surveys) • Preferably monthly • Move towards more regular closer real time

12. The Selected Big Dots

13. Alternatively…. Is perception Net Promoter Initiative: would you recommend this to your family and friends?

14. The Patient Revolution

15. What is a Patient Revolution? • Co-production between patients & professionals • Community participation between the public & the Service • Customer experience of patients & carers

16. We know what needs to done, e.g. • Appointments and access • Physical comfort • Attitudes of staff • Organisation and communication • Knowledge of the patient • Cleanliness • Privacy and dignity

17. Putting the ‘S’ back in the NHS • The Problem • Customer Service & patient experience is not a Board level priority • Little real time monitoring • No incentives to improve • No learning from other industries, e.g. First Direct • Just a nursing issue • Best practice to build on • Real time feedback – used by almost all acute trusts in West Midlands, and was being used routinely by commissioners • Ipsos Mori ‘Attitude to Health Surveys’ – including Net Promoter scores • East Midlands Patient Experience Service

18. “I have seen other hospitals asking more immediate questions, with more relevant and particular questions, like, “when you pressed the call button, was the response what you expected, better than you expected or worse than you expected?”. Such questions, done frequently and disaggregated to ward-level where possible, give a management focus on what is happening in a hospital.” Andrew Lansley’s first speech as Secretary of State, 8th June 2010

19. A national and local priority • Operating Framework, e.g. - Diffusion of innovation - Summary Care records - Patient feedback and patient surveys • Commissioning Framework, e.g. - Standardised ‘Net Promoter’ question and methodology is asked in all existing patient surveys from 1 April 2012

20. What will be different by April 2013 • A paradigm shift in the attitudes of NHS Boards, clinicians and patients • NHS Boards across the NHS Midlands and East using the simple metric of the ‘net promoter’ score • Year on year improvements in the ‘net promoter’ score • Sustainable mechanisms in place

21. Programme Governance • System-wide Creating and Patient and Customer Services Revolution Steering Group • Executive Sponsorship providing assurance and strategic leadership • System change through task and finish work streams

22. The Steering Group • New approach to an age old problem • Being ambitious in the ambition! • External challenge and leadership • System & Leaders • 3:1 ratio • From bog-standard to

23. Task and Finish Groups • System Led • Clinical Sponsorship • SHA Management & Secretariat support • Defining what good looks like • Share good practice • Upscale and adoption • Innovative solutions to age old problems

24. Task and Finish – Being Part of the Revolution Information and Knowledge Management e.g. Web Portal, NHS Local

25. Thank you for Listening