Improving Patient & Client Experience Measuring the Impact Mary Hinds Director Nursing, Allied Health Professions

Why? Negative reports in the press and inquiries Feedback from patients, carers and nurses Targets which focused to date on numbers Pace and complexity of change The need to put humanity back in the health service.

Quality Issues There are serious problems in quality – Between the health care we have and the care we could have, lies not just a gap but a chasm. The problems come from poor systems…not bad people – The question is why have we not sorted it to date? – What is each of our responsibilities? What difference have we made since last year?

Patient Client Experience Standards Respect – Being valued as a unique individual Attitude - Feeling cared for as an individual Behaviour – Feeling valued and safe Communication - Understanding and feeling understood Privacy & Dignity - Protected and treated with due respect and consideration

Measurement Approach Obtaining User Feedback Patient Survey Patient Stories Review of compliments & complaints Observing the ImpactObservations of practice Staff Feedback Staff survey Focus Groups Organisations Organisational audit

Priorities for Action Target By September 2009 Trusts should adopt Patient and Client Experience Standards in relation to Respect, Attitude, Behaviour, Communication, and Privacy and Dignity, and have put in place arrangements to monitor and report performance against these standards on a quarterly basis

Process Approach Survey tool – Acute Medicine Survey Tool - Acute and non medicine, acute psychiatry, learning disability Organisational Audit Trust Wide Observations of Practice Patient Stories Staff feedback

Engagement Approach Standard Development Membership of development group Consultation Focus Groups Pilot Tool Development PCC membership HSC Trust PPI structures Targeting specific groups

Progress to date Design of satisfaction survey for pilot Completion of pilot testing December quarter Evaluation, reshaping and rolling programme

Pilot Standard 30 questions Acute medical wards Quarter ending Dec

Pilot What worked well Regionally agreed questions to measure standards with some flexibility for local targeting Positive feedback from patients Easy to complete Engagement from all 6 Trusts What we needed to change? Response rate 19% to 52% Improved involvement of carers Better options for return of survey

Pilot Messages Communications Information Mixed sex wards Pilot Actions Trust action plans Performance Monitoring

What Next Comprehensive Action Plan with key milestones – Roll out revised pilot to acute mental health and non acute medicine – Working group for learning disability clients – Organisational audits – Observations of practice – protocol, training – Compliments & Complaints

Five Forces for Change Respect Attitude Behaviour Communication Privacy & Dignity

The Sixth Force.. You

The Gap What we came in to achieve? What patients and their families tell us we deliver? Value Gap What we do? What we do about it? Empowerment Gap

Why is it important? Powerless nurses are: – Ineffective nurses – Less satisfied with their jobs – More susceptible to burn out – More likely to depersonalization – More likely to contribute to poor patient outcomes.

Independent inquiry into care provided by Mid Staffordshire NHS Foundation Trust – Attitudes of patients and staff – Bullying – Target driven priorities – Disengagement from management – Low staff morale – Isolation – Lack of openness – Acceptance of poor standards of care – Reliance on external assessment – Denial

Independent inquiry into care provided by Mid Staffordshire NHS Foundation Trust Privacy and Dignity – Incontinent patients left in degrading conditions – Patients left inadequately dressed in full view of passers by – Patients moved and handled in unsympathetic and unskilled ways, causing pain and distress – Failures to refer to patients by name or their preferred name – Rudeness and hostility

Myths The perfection myth – if we all try hard enough we will not make any mistakes The punishment myth – if we punish people when they make mistakes they will make fewer.

Reality It is in your hands…