Presentation on theme: "Patient and public involvement in clinical audit"— Presentation transcript:
1Patient and public involvement in clinical audit Kim Rezel – PPI lead, HQIP
2PPI at HQIPRepresentatives from National Voices and the Royal collegesFound members from local organisationsWord of mouthSocial mediaI’d like to start with telling you a little about the PPI at HQIP.We asked our parent organisations firstly and found members that way, we also asked local organisations through our connections and e-bulletins, but over the years this has now spread and we have found other members by the Network talking about it in their local areas and also through our social media pages including our PPI blog
3The Service User Network Meet four times a yearAdvisory groupInitiate ideas in PPI and clinical auditEg – How to develop a patient friendly clinical audit reportMonitor the development of HQIP resourcesEg – Involved in working group for online learning toolsParticipate in HQIP managed programmesEg – Active steering group members of CORP, COP, NJRSUN’s influence has increased and developed over the years as they have become more experienced. Some of our members are lay auditors within their own Trusts, we have CQC inspectors, members who were involved in the Keogh review and some have key roles at national levels for example – NHS England’s clinical advisory group specialising on commissioning policy.SUN are an advisory group to HQIP, for example with the development of the How to....guide, which I will look at more later.We consult SUN with much of our new work, recently Sam from the national team came to a SUN meeting to discuss the new quality assessment tool and which they then had a chance to take away and comment on. They have sat on product development working groups eg the online learning and most recently the COP – style guide. Workshop, etc.Members of steering groups....
4Logo and pictureGraphs and images here Is your graph readable to your audience? Would summary lines of text work better?
5PPI pagesOur pages, that are both for patients and public and for professionals working with patients.
6How to – patient friendly clinical audit report The SUN wanted HQIP to help the national audit teams present their results in a less complicated and more engaging wayA working group developed the short guide, benefitting from SUN consultation throughout the whole process. Two case studies were used:National Joint Registry who had recently completed their first public and patient guideDiabetes UK who were about to embark on the development of their first patient-friendly report.We were recently shortlisted for a Patient Experience Network National Award for the Access to information category based on this product.This is an example of SUN’s influence which led to this guide.
7Why is it important to patients? The reports allow patients access to data and information about the treatment they may receiveIt empowers patients to ask questions about the care they should receive, the benefits and risksPatients can use the reports to make comparisons between standards of careThe reports can provide patients with greater knowledge and give them more control over their own care
8How to – patient friendly clinical audit report The results provide vital data, information and analysis relating to how care meets current standards and identifies areas for improvement. For example:THE RESULTS54% of patients had received all nine checksSTANDARD All people living with diabetes should receive nine healthcare checks each yearTHE CLINICAL AUDIT2.15 million diabetes patients records were examined in 83% of GP practices in EnglandPPI involvement can help us identify areas that need change, in the case of clinical audit reports the SUN has helped us formulate accessible ways to feedback clinical audit results.
9Group discussion Do you have examples of PPI in clinical audit? What are the benefits to having patients and public involved in clinical audit?What does effective PPI look like?What do you need to do to achieve this in your own organisation?Does your organisation have the aspiration and resources to support PPI? To what level?What are the barriers?How can you overcome these?Ask the first question to the group.If they will work better in tables ask them to discuss these questions for 15 minutes and prepare to feedback to the wider group.
10Benefits Patient perspective Improved outcomes Responsive to local needsProject continuationData collectingOrganisational buy-inOther benefits are:Patient perspective – It’s always great to be able to talk to patients about their ideas on what needs an audit. Junior doctors on rotation or other temporary staff may have little knowledge about the hospital or the area they’re assigned to. Through asking patients you’ll see what is important to them. If you choose an area based on their input, they’re support could be very useful throughout your project.R to local needs – Your clinical audit will be of more use to the hospital if it is responsive to local needs, an area that requires improvement. It is more likely to be followed through even after you’ve left.O. Buy-in – Do you need funding for your project? Do you need Board sign-off? Getting backing for your project can be made easier when a patient supports you. Patient stories can be more impactful and can validate your proposal.Data collecting – Working with a group of volunteers, eg a patient panel, can also mean that they can interview patients. Patients respond better to lay people rather than doctors, giving more honest responses and it helps you with your workload. Numbers don’t often present the whole story. Interviews can strengthen the results and give a different perspective. Experience measures versus outcome measures PROM/PREM.- A paper in BMJ about qualitative research and evidence based medicine describing howQualitative methods can help bridge the gap between scientific evidence and clinical practiceQualitative research findings provide rigorous accounts of treatment regimens in everyday contextsThis can help us understand the barriers to using evidence based medicine, and its limitations in informing decisions about treatmentRecognising the limits of evidence based medicine does not imply a rejection of research evidence but awareness that different research questions require different kinds of researchProg Cont –Volunteers can help see the project through. They can ensure the recommendations from your report are put into an action plan and are implemented.Imp outcomes – By involving patients in disseminating the report, it can raise the projects profile. Patients can present the results to internal and external stakeholders that may help with funding and support to see the recommendations implemented and improve overall outcomes.
11Recruiting lay memberss Patient informationPosters, fliers, leafletsOpen dayPresentationsI went to a poster competition in a London hospital a few months ago. The junior doctors had conducted extensive clinical audit projects and had produced posters summarising their methodology and results. Some of these projects were amazing in their achievements, one doctor, through their project, had reduced the number of deaths from cardiac arrests in A & E by 50%! It seems to me that that kind of accomplishment should be boasted about. Just like a shop might shout about how amazing and competitive their store is to their customers, as should hospitals boast about their success stories to their patients!
12How? Clinical audit patient panels Volunteers Local groups National charitiesYou can find patients that want to be involved through some of these ways. If you want more diversity in your patient groups go out to the communities, you have to be proactive.
13Action plan to create a patient panel A copy of the How to develop a patient panel guide is available for you today and includes an action plan template to help you follow the steps needed to create an effective group.
14Training for patientsWith SUN we developed some online training, available free on our website which is broken down into two parts.1 – for patients to understand clinical audit at a basic level, what it is and how to understand (patient friendly) reports.2 – 4 sessions following the CA cycle, each session ends with a quiz where you have to answer all questions correctly in order to get a certificate.
15Barriers Culture Resources Clinical leadership Board support -NED & ED FinanceStaffExpertiseClinical leadershipBoard support -NED & EDSome of the barriers which you have raised today.
16Fighting off barriers with... SticksCarrotsLegal obligationsIdentify clinical champion(s)Strategy and policyPatient storiesNew NHS structureClinicians storiesCCGsCase studiesHWBsHealthWatchNEDsHow can we persuade management to sign off on increasing the amount of resources available for PPI?The Board – legislationLack of time – adding it to clinical audit policy to ensure that it has to be part of your work, action plans etc. Working groups and clinical audit committeesResources – minimum funding required to start off – expenses obviously but your group will be local people not travelling far, and should be a trust priority to budget for it.Can’t find volunteers – use examples found online, posters, newsletters, flyers add to in waiting rooms, community centres, public libraries etc....don’t use the term clinical audit – Would you like to help improve your services?Training – you have to commit to doing the training in order to make the involvement effective and meaningful, don’t need to reinvent the wheel, use our resources....other websites.Takes time – yes it does, it doesn’t have to happen overnight, start small, representation on the clinical audit committee, leading up to small involvement on an audit project, to perhaps increased involvement, until representative might like to run their own audit, find volunteers to join them etc.How to start – “open day” – QI day – recruitment using brief application forms. Interview led my patients or keep it smallInformation governance – Worked out with HR, examples of contract and confidentiality agreements online. Can vary for each project. Your trust should already have a volunteer contract in place, use same thing. Certain policies/guidelines set in place from the beginning.Patient time – rolling recruitment, bi-annual open days, regular slot on the Trust bulletin etc.
17Does it make a difference? Staley (2009) conducted review of 89 published research studies that actively involved the public in health and social care research internationally and identified a number of impacts:improving the research design and relevancy of research questionshelping researchers develop ethically acceptable researchimproving recruitment and response ratesenhancing the collection and analysis of dataenhancing dissemination of findings in an accessible way to the general publicAlan SimpsonProfessor of Collaborative Mental Health NursingSchool of Health Sciences, City University LondonI saw this slide in a presentation from Prof Alan Simpson, although he is talking about research there are similarities when looking at questionnaire design, qualitative data collection and dissemination of results
18Case studiesWe have also provided you with two case studies from COL and WWL as great examples of user-led audit.COL – an organisation who trains service users to go into their local organisations and conduct clinical audits.
19Changing Our Lives - quote “When services have such a profound influence on the way people experience significant periods of their lives it is only right they have a real influence in shaping how these services are run.”Black Country Partnership Foundation NHS TrustQuote from a trust who worked with COL.Other notes from COLPatients involved to contribute to what change is requiredPatients can help in the development of the action plans and ensuring that change is supported throughout the organisation. This may be done through patient stories which can have more of an impact on commissioners and managers than a list of numbers.Patients could either present their stories, write down their stories or attend meetings to support the change that could affect their lives.“At the heart of this work is real ‘co-production’: a way of working which enables people who use services to be equal partners in the development, delivery and evaluation of services”This work ‘shifts the balance of power’ between managers/clinicians to people who use servicesThis ‘Transparency’ provides a window into the Trust from a service user perspectiveThis approach has buy in from ‘Board to Floor’
20WWL - quote“When I attended my first audit meeting and learned that at my hospital they couldn’t reach the standards of a national audit as we didn’t have a piece of equipment and the board wouldn’t agree to purchase it, I became involved in the project and the Board had some explaining to do. We now have the correct equipment and re-audit shows that we meet the national standards. Patient Power Rules.”Wrightington, Wigan and Leigh NHS Foundation Trust – Lay audit memberI want to end on two quotes from an organisation and a lay audit member.A lay member who’s influence ensured the board spent the funding required to buy equipment that would help the trust meet national standards.
21Thank you www.hqip.org.uk Kim Rezel – 020 7469 2511 Please contact me if you have best practice examples that we could write up as cast studies and promote on our website, or if you have ideas around PPI that you would like to discuss.