Improving Staff and Patient Experience

Richard Chester, deputy director of patient experience

15th March 2017

Me • Qualified nurse for 24 years

• Senior manager for 10 years

• Work at East Midlands Strategic Health Authority

• Leicester/ Leicestershire Primary Care Trust

• Department of Health

• Worked at my current trust for 2 ½ years

• Responsibilities include:

• Patient experience

• Patient advice & Liaison Service

• Complaints

• Equalities

• Strategic Dementia lead

• Chaplaincy

• Bereavement support and mortuaries

“What patients want is not rocket science, which is really unfortunate because if it were rocket science, we would be doing it. We are great at rocket science. We love rocket science. What we’re not good at are the things that are so simple and basic that we overlook them.”

Laura Gilpin, Planetree Pioneer

A starting thought

Person

Present

Past

Perspective:

3P of the Royal Free

Views of the trust

Yearly view through numbers:

• Treat 1.6 million patients

• Deliver 8,000 babies

• Over 1 million outpatient attendances

• 17 million laboratory tests

• Over 200,000 ED attendances

• Over 900,000 prescriptions dispensed

• Train 350 nurses and midwives and more than 600 Drs

View of where we came from

• Founded in 1828 as the London General Institution for the Gratuitous Cure of

Malignant Diseases

• The title ‘Royal’ was granted by Queen Victoria in 1837

• In 1877 the first hospital in London to

accept women as medical students

• The first hospital to appoint an almoner

(forerunner of a social worker)

• In 2014/15 the high level isolation unit successfully treated Ebola victims from Sierra

Leone

Birthday Parties

Nurses at Barnet Hospital helped a 104-year-old dialysis patient celebrate his

birthday on Monday 10 October. Sidney Benjamin, from Finchley, is thought to be

one of the oldest people in the country to be receiving

dialysis treatment. He has been on dialysis for the past eight

years after his kidney deteriorated at the age of 96.

The nurses in the renal unit bought balloons and a birthday

cake to help him celebrate.

11.28 seconds to sing

How do we capture the

experience of patients?

> 5900 responses

36

> 395 tweets

At least 4

120c complaints

1200 contacts

18 Active Surveys

115 staff inductions

Mystery Shoppers

Viewing things differently

Involvement or Experience“Learning from Blockbuster Video. . . ”

Experience of renting films

• More copies of films

• Better Choice

• Cheaper sweets by till

• Longer rental times

Involvement in renting films

• What I would really like is on a

Tuesday evening after a meal and

glass of wine to watch a film. . . .

Clarity – what is experience?

“The sum of all interactions, shaped by the culture of the Royal Free, that influence patient and carer perceptions across their pathway”

But what about staff?

“The sum of all interactions, shaped by the culture of the Royal Free, that influence staff perceptionsacross their career”

Connections – patient and staff experience correlate with outcomes

Patient experience correlates with

quality and outcomes •Hospitals with lower patient experience scores have

higher re-admission rates

•Dissatisfied patients are less likely to comply with

clinicians’ discharge instructions and treatments

•Good communication influences emotional health,

symptom resolution and reported pain; and effective self

management of long term conditions

•Patients with lower anxiety pre-surgery feel less pain

and wounds heal quicker

Hospitals with higher staff

engagement have:•Better patient experience / significantly higher patient

satisfaction

•Lower mortality rates, fewer HAIs, better, safer patient

outcomes and significantly fewer mistakes

•Better financial performance – on average £150k saving from

reduced absenteeism for each increase of standard deviation

in engagement in average DGH

•Better staff health and well-being and motivation to improve -

50% more people feeling they can impact service delivery

positively

Variation in patient satisfaction scores at different hospitals is

driven 91% by human factors

Where do we want to be?

3 INTEGRATED DIAGNOSTIC

PHASES

VisionExcellentexperienceforpa entsandstaff

Ourvalues

PATIENTANDCARERENGAGEMENT(clearcommunica onofvision,meaningfulinvolvementofpa entsandcarers;capturingandac ng

onfeedback;on-goinglisteningforimprovement;on-goingpa entexperienceimprovementcampaign–commsandrepor nge.g.“yousaidwedid”)

2014/5Wherewe

arenow

• 1yearPa ent

ExperienceImprovement

Planinplace• Valuesand

commitmentstopa entswell

defin

e

d• Behaviour

frameworkindevelopment

• Culturediagnos c

undertaken2014–

experiencebaseline

established• Staff

EngagementImprovement

Plan(SEIP)being

developed• JointPa ent

andStaffExperience

Commi eeinplace

STAFFENGAGEMENT(embedandreinforcesharedvaluesandbehaviours;con nuousimprovementofexperienceatthefront-line;posi veandapprecia veleadershiptonefocusedonlivingourvalues;performance

coachingtonurtureandreinforcesharedbehavioursandexperienceimprovement)

MEASUREMENTANDGOVERNENCE(clearperformancemeasuresforpa entexperience–widerthansurveys/sa sfac on–BoardtoWard;alignedstaffandpa entexperiencemeasuresfocusedonourvalues;alignedapproachto

improvingpa entandstaffexperienceinlinewithourvaluesandbehaviours)

CONTINUOUSIMPROVEMENT-EMBEDBESTPRACTICEPATIENTEXPERIENCE(3yearprogrammeofhighprofiletargetedimprovementprojectstoembedconsistentbestprac ceacrossallsites,basedoncon nuouslearningapproachprojecttoprojectmovingfromestablishing

methodologies,developingskills,embeddingskills,evalua ngandsharelearning)World

ClassC

are,

LocalExperse

Strategicframeworkforimprovingpa entandcarerexperienceacrossRFL2015-2018

I’m finally on the staff meeting agenda. . .

I’ll get the buy-in for. . .

• Improvement plans

• Symbiotic relationship

• Benchmarks

• FFT2

Engaging through NHS Choices

18

"There comes a point

you have to stop pulling

people out of the river,

get upstream and find

out why they're falling in."

[Desmond Tutu]

Getting the agenda out there. . .

• Present to/at the following:

•Nursing Students

•Preceptorship Nurses

•Medical Students

•FY2 Drs (this pm 3 hour session)

•All leadership courses

•Nursing Sister/ Charge Nurse conferences

•Clinical Practice Events

•Divisional Quality Safety Board

•Committee of the Trust Board

•Recent LGTB event

•Quality Improvement initiatives

All the above have to link patient and staff experience

Linking our values

Map Performance to Values

1. Patients found member of staff to talk to about concerns

2. Staff did everything they could to help control pain

3. Patients did not wait a long time to get a bed on the ward

4. Staff asked patient what name they preferred to be called by

5. Appraisals 6. Staff FFT 7. Care is top priority 8. Staff experience

1. Patients always treated with dignity and respect

2. Patients involved in decisions about care and treatment

3. Patient did not feel treated as a set of cancer symptoms

4. Patients given enough privacy when discussing condition or treatment

5. Appraisals 6. Punishes or blames

individuals involved in errors

7. Staff FFT 8. Feel pressured to attend

work

1. Enough information about condition or treatment given to patient

2. Patient did not feel staff contradicted each other

3. Patients always received clear and answers from doctors

4. Patients always received clear and answers from nurses

5. Appraisals 6. Communication between

senior managers and staff 7. Staff FFT 8. Staff experience

1. Patients had confidence and trust in doctors (cancer)

2. Patients had confidence and trust in nurses (cancer)

3. Toilets and bathrooms used in the hospital were clean

4. Percentage of actions resulting from complaints delivered

5. Appraisals 6. Sickness absence 7. Staff FFT 8. Bullying and Harassment

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Section

Number

of pages

Overview

‘Values Dashboard’

1

Single front page

showing overview

of Performance

KPIs, ‘mapped

against the World

Class Care values.

’Friends & Families

Test

1

Detailed page

showing the Friends

and Families scores

for both patients and

staff.

Outpatient results

are uploaded onto

the trust website..

‘KPI Dashboard’

2

Presents trust

performance

against quality and

performance KPIs.

Highlights specific

areas for

escalation..

‘Key experience

data'

Single page showing

overview of key

experience data; to

include,

opportunities for

improvement,

reasons for staff

leaving the trust.

Details number of

hours and financial

value of the Royal

Free Charity

volunteers

‘Escalation'

As necessary

Detailed pages to

explore where

performance is

outside acceptable

tolerance and

warrants

Committee

discussion.

Details root

cause(s) of poor

performance and

identifies corrective

actions.

1 2 3 4 5

IPSEpR structure – navigating the report

The new IPSEpR is divided into five sections…

23

1

Leadership helps. . . not just minePatient and Staff Experience Committee

• Two non-execs

• chief executive

• chief operating officer

• director of nursing

• director of workforce and od

• chief information officer

• Three divisional nurse

directors

• associate medical director for

patient experience

• Three governors from staff and

public

• assistant director - hr strategy

and business partnering

• head of internal communications

• me

Going Forward. . .

• We are one of only four FTs to be

accredited by NHS Improvement

to lead groups or chains of NHS

providers.

• Patient experience will feature at

both group and hospital level.

• Framework for standardisation

across all hospitals.

Change can happen any time

Sometimes the best plans fail

Our principles sum it up. . .

1. We won’t expect results overnight

2. We know there are lots of ways to do something right and a few ways to do

something wrong.

3. Whilst are lots of enthusiastic staff who want to be involved in enhancing experience,

we need to find qualified talent to help or train people

4. We will experience failures but will have no regrets as we tried something and leaders

won’t berate us for it

5. We will take care of our staff we move forward

6. We will take risks, be vulnerable and have some courage in our approach

7. We will do things that people say won’t work

8. We recognise that we may make some staff mad/ annoyed/ frustrated

9. We are in the acute medicine business; the ‘patient’ is not always right

10. We will never forget our journey to here and who helped us get here

Richard Chester

deputy director of patient experience

richardchester@nhs.net

Tel: 020 7794 0500 ext. 34405

Bleep: 1137