‘From Good to Great’ Improving the patient experience at the University Dental Hospital

University Dental Hospital Project Team Ellie Maher – Dental Matron Sara Nowell – Dental Nurse Manager Sharon Potts – Senior Dental Nurse Anne Stanton – Divisional Lead Nurse

Service Overview The University Dental Hospital is located on the Oxford Road Campus of the University of Manchester. A variety of consultants, specialist dentists, specialist dental nurses and dental therapists Support the care of over patients per year. The service provision is mainly out-patient based with specialist services including: Restorative Dentistry Prosthodontics Oral medicine & Oral surgery Orthodontics Emergency Dental care Staff from the hospital also support Children’s Dental Services at the Royal Manchester Children’s Hospital and In-patient Dental Services at the Manchester Royal Infirmary

Project Overview Advancing Quality Alliance (AQuA) Advanced Team Training Programme in Healthcare Improvement (ATTPH) Project submission ‘invite’ (December 2012) Original project title ‘Utilising Patient Stories to Support Multidisciplinary Training’ Course Attendance (March – July 2013) Variety of modules: Quality Improvement in Context, Improvement Theory and Application, Measurement Theory, Features of Effective Teams, Storyboarding & story Telling and Leadership for QI Coaching and Webex support sessions Access to AQuA web portal

Initial Plan / Project Statement We will ensure that the patient’s voice is heard throughout all levels of the Division; we will gather and utilise patient feedback to influence and improve the patient experience.

The Art & Science One of the arts of nursing is the ability to truly listen to our patients. The science of nursing is the ability to translate what we ‘hear’ into action to create continuous Improvements.

Brain Storming - Project Ideas

Aims Statement The project team were aware that clinics were overrunning and patients were waiting longer than expected, each member of the team had their own thoughts and ideas regarding the cause and effect of the overruns. There was however a recognition that one perspective and opinion was missing from the discussion; that of the patients themselves. Prior to January 2013 UDH did not have systems in place to collect and utilise patient feedback. Therefore we will utilise data collection process to gather information from our patients; and use the data we collect to focus our improvement work. We will: Increase levels of patient feedback to 5% of total number of patients seen per month (June – Dec 2013). We will increase this to 10% by December Ensure that the overall reported patient experience score (as per the trust patient experience tracker dashboard) is consistently above the lower threshold of 85%

Driver Diagram Aim: Ensure that the patients’ voice is heard throughout all levels of the Division Gather and utilise patient feedback to influence and improve the patient experience. Patient Experience and Expectations Coordination of Care Staff Involvement Quality and availability of patient procedural information Understand patient’s expectations of:  Environment/facilities/signage  Waiting times  Access  Customer service Patient feedback (improve mechanisms to collect data). Dental nurse staffing allocation (appropriate number / skills) Utilization of appointment slots (appropriate time allocation). Improve and standardise surgery layout to improve productivity and efficiency. Timely availability of dental notes (understanding current issues). Review process of communication between admin desk and clinics. Availability and distribution of dental equipment Support staff to develop an understanding of the way in which patient’s feedback is used to improve services. Educate staff in improvement and change methodologies.

Driver Diagram: Identified Measures Aim: Ensure that the patients’ voice is heard throughout all levels of the Division Gather and utilise patient feedback to influence and improve the patient experience. Patient Experience and Expectations Coordination of Care Staff Involvement Understand staffs’ & patient’s expectations of:  Information (verbal & written)  Waiting time  Customer service Patient feedback (improve mechanisms to collect data). Utilization of appointment slots (appropriate time allocation). Gather data to inform Net Promoter Question % of patients who provide feedback (written & electronic) % of patients who are seen on time. Allocated v. actual treatment time

Data Collection

Staff Feedback

New DSD tracking / non-conformance system implemented New equipment (equating to £255K) purchased in April 2013 Dental Nurse Away Day held in May 2013 (follow up planned for October Staffing restructure completed March 2013 ‘Celebration Day’ held in May 2013 ‘We’re Listening – We’re Improving (biannual staff engagement sessions) implemented January ‘Change One Thing’ – quality initiative launched July 2013 Monthly senior management team drop in sessions commenced March 2013

Net Promoter Question 1.How likely are you to recommend our service to your family or friends 2. Tally Responses Extremely Unlikely Extremely Likely NPS= /total x /total x 100 UDH NPS = Calculate

Patient Experience Data

Statement of Plan PlanDoStudyAct Next Steps Increase levels of patient feedback to 5% of total number of patients seen per month by Dec 2013), with an increase to 10% by June Agree departmental targets for electronic data collection (5% target =9 patients per day) Develop patient feedback cards (agree distribution, data collation and reporting) Reformat patient satisfaction questionnaire and redistribute. Distribute staff questionnaire to all staff Reformat data collection tool in collaboration with clinicians. Collect and analysis further process data to identify themes Agree work programme and interventions based on data analysis and themes from patient and staff feedback Agree departmental roll out plan Next Steps Increase levels of patient feedback to 5% of total number of patients seen per month by Dec 2013), with an increase to 10% by June Agree departmental targets for electronic data collection (5% target =9 patients per day) Develop patient feedback cards (agree distribution, data collation and reporting) Reformat patient satisfaction questionnaire and redistribute. Distribute staff questionnaire to all staff Reformat data collection tool in collaboration with clinicians. Collect and analysis further process data to identify themes Agree work programme and interventions based on data analysis and themes from patient and staff feedback Agree departmental roll out plan

Lessons Learnt Think Big! Start Small! The need for appropriate time management & task allocation. Sustaining interest (via regular update / reporting). Ensuring clinician and management involvement. Setting and meeting deadlines. Identifying, supporting and training change champions.