Patient Experience the focus at the Royal Devon and Exeter Angela Pedder Chief Executive

Background £350 million Acute Teaching Hospital One of first 10 FTs authorised Consistent good performance on national performance indicators including patient survey, star ratings and Health Care Commission Large membership base, reflective of local population and patient/care involvement with services provide History of patient engagement in service improvement projects.

Drivers for change Making FT public benefit real - influencing strategy Lots of data on process of care activities but how could they be meaningfully triangulated? Annual national survey provides aggregate data single snap shot National survey patients saying views on care not asked for when in hospital No regular systematic way of asking about patient experience Board concern about aggregate data and risks of good performance in some areas masking poor performance elsewhere No decision about me without me

Three practical examples Embed patient experience within the overarching Trust Governance and Performance Framework Patient experience pre-eminent measure in Nursing Quality Assessment Tool (NQAT) scoring Real time patient involvement in safety briefings

Governance, Operations & Performance System Board of Directors The Executive Directors Audit Committee Governance Committee Trust Management Committee Integrated Safeguarding Committee Clinical Effectiveness Committee Workforce & Diversity Committee Safety & Risk Committee Engagement & Experience Committee Senior Operations Group (SOG) Directorate Quarterly Reviews Executive Line Management and 1:1s Directorate Representation Directorate Business & Governance Meetings Service Line Reporting – Balanced Scorecard Approach

NQAT Organisational / clinical / area / unit Team Individual A calm, clean, safe environment Good team working And good relationships A positive friendly culture Patients have confidence in care Organisational / clinical / area / unit Team Individual Skills and will Ways Means Well managed Care with efficient delivery Personalised care for and about Every patient Staff are caring with confidence

What Does NQAT Include? Department of Health Essence of Care PRESSURE ULCER SAFE ENVIRONMENT PAIN MANAGEMENT PRIVACY & DIGNITY Department of Health Essence of Care Nursing Standards INFECTION CONTROL MENTAL HEALTH ELIMINATION SELF CARE FOOD & NUTRITION RECORD KEEPING COMMUNICATION

Approach Utilises handheld tablet computers Incorporates RCN observations of care Includes real time patient survey Undertaken by clinical staff from another clinical area and non clinical non uniformed staff volunteers for patient discussion

METHOD + + = NQAT DOCUMENTATION 20% (staff) OBSERVATION 40% (staff) Documentation carried out by Patient Experience interview’s carried out by staff member in non uniform, cross division cover + PATIENT FEEDBACK 40% (volunteer) = NQAT

FOR EXAMPLE….. DOCUMENTATION547 Elements Records of staff training. Patients assessments complete and up to date. Evidence of care. OBSERVATION 103 Elements Clear signage. Communication. Cleanliness. Caring. Culture. PATIENT FEEDBACK 28 Elements Have you felt safe? Have you felt cared for? Would you recommend us? Mention Patient feedback used to give full picture on the data gathered from the audit.

RESULTS – within 48 hours All results in every element RAG rated Aggregate ward score Fail ≤74% Bronze 75 – 84% Silver 85 - 94% Gold ≥ 95% Re-audit and rapid improvement cycle action plans Results published at ward level and to Board on quarterly basis

Coverage and next steps All ward areas Modified tools for: Theatres, Recovery, ITU, Paediatrics, NNU, Maternity, Emergency Dept Move to CQAT during 2012 to include medical care Get patients to remember the conversations they had when completing national survey!!

Involving patients in safety briefings Context 2009/10 difficult winter, capacity issues Recent ward closure and major service redesign Poor staff survey result – low staff morale Increasing number of complaints No visible safety culture Concerning NQAT scores Time to resolve complaints high Low staff morale

Our Vision – Real time feedback The most honest response possible Immediately… while the patient is still in our care To resolve issues promptly Help us to understand the complex & challenging causes of safety incidents To learn about what really matters to patients

Fostering a visible safety culture Safety Briefing Visible, priority, cultural shift Measurement Metrics, themes, outcomes, actions Capture Patient Experience Critical language, real-time Communication of feedback Open, transparent, accountable De-Briefing Listening, learning, real-time, action

Inter-professional Safety Briefings

Capture patient experience We encourage patients and relatives to tell us how we are doing. If you are able, please can you tell us what went well for you today? We would like to learn from your experiences. Please tell us how we might improve care on this ward. Today would have been even better if… If you would like to discuss your feedback with the Matron, please leave your name. Thank you Matron “What went well…? Even better if…”

De-briefing What did we learn from our patients today?

“What went well?” “ Great team, lovely nurses.” “ This ward is fantastic, they all work so hard and they have such kindness.” “ I managed the stairs today, I’m excited about going home.” “ Nothing is too much trouble for them. A lovely ward.”

“Even better if . . .” “You can’t reach the call bell or toilet roll holder from the toilet in the bathroom...this was really difficult for me, I thought I would fall.” “Sometimes it takes too long for call bells to be answered, particularly at night.” “The last time I had my hip replaced I had a shower by now, it’s day four and I feel dirty.” “Why do I still have a catheter in? They said it would come out this morning?”

Communication It would have been even better If there was . .

Outcomes Improved team working - staff survey Improved staff sickness – 9.7% (2009) to 2.7% (2010) Outstanding NQAT results (gold) Number and type of safety incidents reduced

Outcomes Identification of learning needs Themes for service improvement Introduction of patient stories, ward to board Cannulation prompt card – patients driving change Falls/slippers leaflet

Summary Costs = minimal Patient involvement in safety briefings Rich “real time” narrative describing patient experience Transferability Improves morale and reduces complaints Raises standards Open, honest patient safety culture Costs = minimal

QUESTIONS?