Patients as Partners: at the Forefront of Service Redesign An Introduction to Patient Focus Public Involvement

Policy context Designed to Care: Renewing the National Health Service in Scotland (1997) Our National Health: A Plan for Action, a Plan for Change (2000) Patient Focus & Public Involvement (2002) Partnership for Care (2003)

Independent Advice and Support Service for Users of Local Health and Community Care Services A National Service Framework March 2006 Provide: advice and support services to patients wishing to make a complaint or raise concerns about NHS services information and advice to patients on a variety of issues that impact on their health and well-being in order to maintain or improve these

Duty to encourage public involvement It is the duty of everybody….to take action with a view to securing, as respect to health services for which it is responsible, that person to whom those services are being, or may be provided, are involved in, and consulted on- –the planning and development, and –decisions to be made by the body significantly affecting the operation, of those services. National Health Service Reform (Scotland) Act 2004

Building a Health Service FIT FOR THE FUTURE (2005) Moving public consultation to the front end of service change rather than as a last step: involving the public in the planning and delivery of services involvement of individual patients in decisions about their own care

What are patients and the public telling us about their experience?

‘Satisfaction is clearly linked to a number of factors, notably waiting times – the shorter the wait (for any kind of consultation or appointment or admission), the higher the level of satisfaction, both with the individual service and with the NHS as a whole’. Public Attitudes to the NHS in Scotland 2004 Survey

Patients prioritise improvements for A&E as follows: Low Priority Medium Priority High Priority Televisions Reducing waiting times to see receptionist/triage nurse Drinks machines/ refreshments Doctors/nurses will not rush patients Waiting area will be a clean and pleasant environment Children’s play areas Staff will be friendly and caring Privacy (most feel that this is already adequate) Explanations in layman's terms, of relevance to their situation Reducing waiting times to see doctor/ get treatment Plenty of information available in waiting areas (on screens/and from staff) Staff will all be polite and sensitive to patients’ situation

Mrs Foley Consider the journey **

‘Every system is perfectly designed to get the results that it gets If we want to change the patient experience, we must change the system To change the system, we must think in fundamentally different ways’ Donald Berwick Institute of Health Care Improvement

A Patient Focus in Public Involvement Questionnaire Focus Groups Patient Mapping Patient Tracking Patient Shadowing Patient Diaries Discovery Interviews

Patient journey analysis Improving the experience Increasing detail of analysis Questionnaire/ Patient Satisfaction Survey Focus Group Patient Flow Analysis Patient Mapping Individual Patient Patient Tracking Patient shadowing Patient Diaries

Questionnaires Can target a wide audience or sample Critical mass for service reconfiguration and redesign of provision Includes benchmark scores and/or written comments Un-ambiguous and easy to count

Picker Institute Picker Institute Europe works with patients, professionals and policy makers to promote understanding of the patient's perspective at all levels of healthcare policy and practice. We undertake a unique combination of research, development and policy activities which together work to make patients' views count.

Expert patients/ focus groups Focus groups of patients Delegates from focus groups meet with staff to discuss improvements to service A plan is agreed and staff select actions to take forward

Flow mapping Views the system from the patient perspective following their journey across organisational boundaries Helps staff understand how complex and confusing processes appear to the patient Organisation specific Diagnostic, and used as a basis for redesign, actively involving frontline staff in the process

Patient tracking Validate or challenge process and flow map Identifies patterns in presentation of patients Identifies frequent ‘Hand-offs’ of patients or paper Identifies periods of waiting

Patient shadowing Patient, member of staff or volunteer accompanies patient Provides objective observational feedback Builds up comprehensive picture of patient and staff perception of service.

Flow Analysis Tool

Patient diaries A patient record of events throughout their healthcare Offers a personal account Can be in any format - written, visual or audio – patient’s choice Diaries are confidential and agreement must be made before any material is shared

Discovery interviews Semi-structured interviews of patient and/or carer Follows a framework to interview Allows local teams to gain insight and identify needs Patient consent, confidentiality and anonymity are essential Ethical approval may be required

In groups discuss the statement… ‘ I am going in completely blind – I have no idea what is expected of me, if anything for that matter. Am I just a token gesture or am I there as somebody who has some impact?’ Patient