Presentation on theme: "Patient Experience Network Conference – 19 January 2011"— Presentation transcript:
1Patient Experience Network Conference – 19 January 2011 Joan SaddlerNational Director of Patient and Public Affairs, Department of Health
2What do we mean by Patient Experience? Patient experience = direct experience of specific aspects of treatment or carePatient satisfaction = an evaluation of what happened, reporting the patient’s feelings about the experience of care, usually requiring patients to give an overall rating based on their whole service experiencePatient-reported outcome = patient’s perspective on whether a procedure improved quality of lifePatient-defined outcome = patients are involved in the definition and design of measures of the outcome of particular procedures or services‘Patient Experience’, ‘Patient satisfaction’, ‘patient-reported outcomes’ and‘patient-defined outcomes’ are all different concepts.
3Factors contributing to patient-centred care at organisational level: Leadership at Chief Executive and Board levelStrategic visionInvolvement of patients and familiesSupportive work environment for staffSystematic measurement and feedbackQuality of the built environmentSupportive technology(Source: Shaller 2007)Based on interviews with leaders of patient-centred organisations and initiatives in the US, Dale Shaller’s report identified seven key factors for achieving patient-centred care at the organisational level:Leadership at CEO and Board level: sufficiently committed and engaged to unify and sustain the organization in a common mission.2. Strategic vision: clearly and constantly communicated to every member of the organisation.3. Involvement of patients and families: at multiple levels, not only in the care process but as full participants in ‘key committees’ throughout the organisation.4. Supportive work environment for staff: which engages them in process design and treats them with the same dignity and respect that they are expected to show patients and families.5. Systematic measurement and feedback: to continuously monitor the impact of specific interventions and change strategies.6. Quality of the built environment: that provides a supportive and nurturing physical space and design for patients, families, and employees alike.7. Supportive technology: facilitating information access for patients and communication with their caregivers.
4Providing a good patient experience involves providing patient-centred care A multitude of frameworks list ‘key domains of patient experience’ e.g. Institute of Medicine:Compassion, empathy and responsiveness to needs, values and expressed preferencesCoordination and integrationInformation, communication and educationPhysical comfortEmotional support, relieving fear and anxietyInvolvement of family and friends(Institute of Medicine 2001)
5Patient experience is also related to productivity and efficiency Whilst not all improvement in patient experience saves money, evidence shows a link:poor patient experience can be costlypoor doctor-patient communication and poor performance on patient surveys associated with higher litigation costs (US)evidence of an association with excellent patient experience and market performance and financial health of providers (US)
6Patient experience is closely related to and influences clinical effectiveness and safety For example, research evidence tells us that:Patient experienceClinical effectivenessSafetyOrganisations that are more patient-centred have better clinical outcomesImproved doctor-patient communication leads to greater compliance in taking medication and can enable greater self-management for people with long-term conditionsIndividuals’ anxiety and fear can delay healingIn the quality triangle, Patient Experience is the ‘new kid on the block’ in terms of NHS focus. That said it has much further to go compared to clinical effectiveness and safety.Understanding and improving patient experience is central to a more effective NHS. It does not exist in splendid isolation, we know that good patient experience can lead to better clinical outcomes.Therefore it is a welcome development that we are here today to celebrate successes in Patient Experience.
7Local Involvement Networks (LINks) Healthwatch Feedback can be captured in a variety of ways, at different times, for different purposesKey is getting the right balance - national, regional, local activityAppropriately informing different decisionsCapturing views at the right point in the patient journeyPostal surveysQuantitativeTelephone surveysFace-to-face surveysHand-held technologyRegulationOn-line surveysComment cardsContractManagementComplaintsOn-line communitiesComplimentsServiceimprovementBedside terminalsCitizens juriesPay andincentivesServiceimprovementPALs feedbackFeedback websitesCommissioningKiosksThere are a variety of ways in which patient experience feedback is gathered and how it influences different parts of the system.Absolutely key is for patient experience feedback to be utilised for local service improvement, which in turn will improve the patient experience.Methods for gathering this feedback range from qualitative methods such as patient stories, through to quantitative methods such as postal surveys.Patient storiesFocus groupsLocalAccountabilityMystery shoppersPublic meetingsLocal Involvement Networks (LINks) HealthwatchPerformanceBenchmarkingWalking the floorNew servicedevelopmentQualitativeFor illustrative purposes only
8Improving patient experience is a long haul, not a quick fix As much about cultural change as is it is about availability of data:“Sustaining more substantial change is likely to requireorganisational strategies, engaged leadership, cultural change, regular measurement and performance feedback, and experience of interpreting and using survey data.”“Small measurable improvements in patient experience may be achieved over short projects.”But we know that placing Patient Experience centre stages so it is part of the DNA of the NHS and to effect cultural change , it is going to take time.Davies et al 2008
9England has some of the most comprehensive patient survey programmes in the world – but further refinement and development is neededYearSurvey2007/08Users of maternity servicesAdult inpatientsPCT residents registered with GPUsers of community mental health services (CPA)A&E/Emergency servicesPersonal Social Services Survey of Adults Receiving Community Equipment & Minor AdaptationsGP Patient Survey2008/09Ambulance (category C)Mental health inpatientsPersonal Social Services: Home Care Users Aged 65 or over, England2009/10Outpatient servicesGP Patient Survey (now running as a quarterly survey)We have extensive data on patient experience through:national patient survey programmeGP Patient surveyInformation on patient experience is much more limited in other areasThe main gaps are:along whole pathways of carein community services & social carein services for specific clinical conditionsFor national surveys, whilst we have some of the largest and most comprehensive survey programme in the world, we know there are significant gaps in how it supports improving patient experience. For example it tends to be setting specific, but patients experience is along the pathways of care.
10Patient Experience Online Network Learning from others:Patient Experience Online NetworkVisionTo share ideas and practice to drive improvement in patient experience.To continually develop a network which connects and supports its members to exchange experience and knowledgeMembership300+ patient experience professionals across NHS, UK and abroad.ContentPolicy and contextTools and approachesConnecting patient experience networks and professionals30+ case studies from across NHS with links to othersMaterials from National Patient Experience Learning ProgrammeWe can learn from each other, as we are doing today, and I’d like to make a plug for the NHS Institute Patient Experience Learning Network which has a library of case studies. You will find the case studies for many of those which were considered for PEN awards on this site – it is a very rich resource to help disseminate examples of practice across the NHS10
11Outcomes Framework (domain 4 - ensuring people have a positive experience of care ) The NHS Outcomes framework, which was published on the 20th December 2010 following extensive consultation, reflects the importance of patient experience. Domain 4 of the O/F covers patient experience.1.Preventing people from dying prematurely2 Enhancing quality of life for people with long-term conditions3.Helping people to recover from episodes of ill health or following injury4.Ensuring that people have a positive experience of care5.Treating and caring for people in a safe environment and protecting them from avoidable harm page 30The indicators which follow the structure shown here will be used by the SoS to hold the NHS Commissioning Board to account:An overarching outcome indicator will measure the overall progress of the NHS across the breadth of activity covered by the domainA small number of specific improvement areas where the evidence suggests better outcomes are possible or areas that are identified as being particularly important to patientsSupporting Quality Standards developed by the National Institute for Health and Clinical Excellence (NICE) to help patients, clinicians and commissioners understand how to deliver better care.
12Consultation feedback – some headline comments and views Local measurement and ownership is keyA balance is required – local and national activityMust avoid domain 4 becoming a ‘research’ and ‘tick-box’ industryStaff will need support to assist them in their work to improve patient experienceIs different to other more clinically-orientated indicators - success on one may not always mean success in the othersFocus on general public, not just recent service usersNeed to make sure vulnerable patients and those who are excluded, hard to reach or seldom heard are fully includedThe approach adopted needs to be evidence based, well designed, be simple and easy for the NHS to implement and people to take part in.The Outcomes Framework consultation yielded a whole range of issues and concerns, which the published framework aims to address.
13Framework for 2011-12 Indicator to be developed Available The framework details a range of specific indicators and future development requirements to take forward patient experience. I wont cover these in detail, but it covers a comprehensive range of services and settings, for which much development work is required.Where it says 'indicator to be developed' - this means the survey instrument to gather the data is available but that we need to decide what the actual indicator will comprise of ( i.e. the numerator and denominator ) .Where it says 'survey to be developed' - this means that it will take longer to achieve since the fundamental survey itself needs to be developed.Survey to be developedIndicator to be developedSurvey to be developed
14The role of NICE Quality Standards? A bridge between outcomes and the structures and processes of care needed to deliver those outcomesNHS Commissioning Board will be able to commission Quality Standards from NICE – used to help commissioners achieve better outcomes for patientsWill also be used to inform the development of payment mechanisms and incentive schemesQuality Standards are not targets / mandatory or subject to regulationA quality standard is a set of specific, concise statements and associated measures that:act as markers of high-quality, cost-effective patient care across a pathway or clinical area;are derived from the best available evidence; andare produced collaboratively with the NHS and social care, along with their partners and service usersNICE quality standardsGuidance and related productsThe purpose of Quality Standards are to bring clarity as to what high quality care looks like.A quality standard is a set concise statements that:- Act as markers of high-quality, cost-effective patient care across a pathway or clinical area.- Derived from existing guidance, accredited sources of research and audit evidence as explained in the diagram. It is not intended to be a new product.Produced collaboratively with the NHS and social care, along with their partners and service users For Patient Experience NICE will produce:A generic standard for patient experienceA specific standard for adult mental healthAll other Quality Standards should have a patient experience dimension built in to themResearch and audit evidence
15Real-time Patient Feedback - Primary Care The Best Practice Guide to using Real-time Patient Feedback is an appendix to and sits alongside Improving access, responding to Patients: A ‘how-to’ guide for GP Practices.Using case studies, the Best Practice Guide demonstrates the positive impact on practices’ performance and patient engagement. It provides practical advice and a step-by-step guide for GP practices interested in carrying out real-time patient feedback. It summarises the approaches taken by pilot practices, providing:Examples of issues they tackledLearning from experienceImprovements achievedAvailable at
16NHS Bradford and Airedale NHS North Lincolnshire Other approaches in primary careNHS Leicester CityImprovements to services for adults with diabetesEngaging patients & public to review diabetes pathwayProcurement of new community diabetes service better suited to patients' needsCost savings £100,000+ per year.NHS Bradford and AiredaleBuilding Engagement & Experience into ContractsAddressing patient experience at local level.Contract monitoring - providers receive qualitative feedback.Provider reports back on issues including:Approaches to engagement undertakenPatient-identified issuesActions taken by the trust.How action has improved patient experienceEvidence of feedback to patientsNHS North LincolnshirePatient Stories - Making A DifferenceCare pathways, service specifications & new services commissioned as a result of patient stories.