1. www.england.nhs.uk Dan Wellings, Head of Insight and Feedback Neil Churchill, Director for Patient Experience Patient Experience Insight 7 th October 2014

2. www.england.nhs.uk What does insight mean? 2 Using qualitative and quantitative data to inform what we do Using whatever data sources we have - not just surveys but a whole range of market and social research techniques Always asking the question, what don’t we know? As much an art as science “The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end” A promise to learn – a commitment to act The Berwick Report

3. www.england.nhs.uk The Friends and Family Test Review Positive findings: FFT is making an impact 78% of Trusts reported that FFT had increased the emphasis placed on patient experience at their Trust FFT is being used mainly as a service improvement tool Provides feedback to frontline staff, often boosting morale Feedback is real-time and granular: it tells staff about what is happening in their ward Identifies problems and encourages action to be taken Not used widely for performance management Concerns over robustness of data, including comparability between trusts

4. www.england.nhs.uk Comparability of data FFT data is not comparable between Trusts Collection mode effects have been established through analysis Many more biases exist, having a different effect in each Trust: Non-response bias, selection bias, framing and priming biases, social desirability bias, timing effects Data will not be comparable unless we move to a centrally administrated system i.e. a methodology similar to that of a National Survey Standardisation of mode would not make data comparable Data do show promise for intra-trust comparability Changing FFT so that data is comparable would remove its key features: Data would not be available in real-time Potentially lower local engagement in data due to lack of responsibility for collection Census approach might not be viable

5. www.england.nhs.uk Better quality FFT data BUT we have been able to make the data more accurate and useful: We have mandated the follow-up question We have prohibited the “token” collection system Encouraged local collection of demographic data (age, gender, ethnicity) Provided best practice guidance on data collection materials to reduce framing and priming Reduced motivation to “game” the system by using a simpler score and emphasising FFT’s use as a service improvement tool Payments are not to be attached to inter-trust comparisons

6. www.england.nhs.uk Encouraging better models of data usage Services have been given guidance on best practice Advice on how best to use the data within the Trust: Discussing feedback in weekly staff meetings in wards/departments Monitoring all negative comments across the Trust NHS England exploring the role of Healthwatch, CQC and other relevant bodies to hold the system to account on the provision and quality of FFT Continued work in NHS England and with partners to understand what we can and cannot say about the data, and how best to extract insight from it

7. www.england.nhs.uk What is FFT? FFT is a real-time local feedback tool It has different characteristics from national surveys FFT Real-time Ward-level Effective for service improvement Can be used as early-warning system Not representative, not comparable National surveys Robust, comparable data at Trust level Data on a range of issues Suitable for performance management Not meaningful to front-line staff Has not historically changed behaviours FFT and National surveys are complementary sources of Insight FFT is a formative measure: it provides data to improve services National surveys are summative measures: they provide an accurate picture of relative performance

8. www.england.nhs.uk Methodology – pros and cons Robustness Usability

9. www.england.nhs.uk A measure and an intervention

10. www.england.nhs.uk Friend and Family Test - outcomes Soft closing bins have been purchased for inpatient areas as a response to patients feeding back that noisy bins kept them awake at night Comments regarding disturbed nights led to Introducing the ‘Quiet Protocol’ to help patients sleep well at night Environmental issues Mid Staffs NHS Foundation Trust Sandwell and West Birmingham Hospitals NHS Trust

11. www.england.nhs.uk The A&E department’s self-check in service had no disinfectant hand gel. This has now been provided Feedback from a patient with a stoma bag that it would be useful to have a shelf in the patient toilets in the surgical ward has led to the Trust fitting shelves in the toilets so people have somewhere to place their belongings Hygiene related issues Hull & East Yorkshire Hospitals NHS Trust East and North Herts NHS Trust – Lister Hospital Friend and Family Test - outcomes

12. www.england.nhs.uk After negative feedback, the Trust has introduced medication cards for patients who are off the ward during drug rounds to alert them that their medication is waiting to be dispensed "Was in pain on previous admission, felt ignored by staff" – comment led to self- medication programme - patients manage their own analgesic medication when they are in pain Medication issues The Royal Wolverhampton NHS Trust Friend and Family Test - outcomes

13. www.england.nhs.uk Conclusions and next steps for FFT Ambitions: Primarily a real-time feedback tool for service improvement May be used to inform patient choice Not suitable for relative performance management, especially with financials attached FFT score: NPS to be replaced with % who would recommend FFT question: Steps taken to ensure accessibility for all Data quality: Methods have been tightened up to make the data more useful But system not to be fully standardised at this time Data usage: Mandatory use of the follow-up question Patient choice: Work done to increase awareness and understanding on NHS Choices Communications: Clearer messages within the service about what FFT is for

14. www.england.nhs.uk Beyond FFT “An Insight Strategy will be developed in 2014 providing commissioners with practical approaches in how to gain insight from their patients”

15. Insight & Feedback Less descriptive Less generalisable More generalisable More descriptive In depth interviews Experience Based Co-Design Focus groups & patient forums NHS Trusts CCGs Healthwatch Patient organisations Surveys GP Patient Survey Bereaved Voices Cancer Patient Experience Survey NHS Staff Survey PROMs Online reviews & ratings NHS Choices Patient Opinion IWantGreatCare Care Connect Patient stories HealthTalkOnline Patient Voices Feedback tools (kiosks, SMS, apps) Examples include: Hospedia Synapta Feedback apps Social media listening Salesforce Polecat Healthberry Public Meetings NHS Trusts CCGs Matrix of insight methods from Measuring patient experience: evidence scan Health Foundation, June 2013 Friends & Family Test Complaints

16. www.england.nhs.uk Objective of Insight Strategy To establish a clear strategic vision for how the different elements of insight & feedback can complement each other most effectively, to be greater than the sum of their individual parts in giving us a clear picture about what patients and the public think of their NHS services

17. www.england.nhs.uk Progress on the Strategy 17 NHS England survey programme and other channels of feedback are being reviewed in the round Are all patient groups and service types being covered? Steering group meeting quarterly to discuss priorities for data collection and criteria for assessing the programme Includes stakeholders from: NHS England, DH & CQC; CCGs & NHS Trusts; Third sector organisations, patient groups & clinical groups Insight team conducting engagement interviews with patient experience data leads in CCGs and CSUs

18. www.england.nhs.uk Means nothing if nothing is done

19. www.england.nhs.uk What is patient experience?

20. www.england.nhs.uk What makes a good experience?

21. www.england.nhs.uk Moving beyond marginal improvements in experience Improving faster for the most vulnerable Improving consistency Engaging staff and influencing work climate Achieving right balance between local and national. The challenge

22. www.england.nhs.uk Improvement priorities

23. www.england.nhs.uk The approach Vulnerable Patients Service Excellence

24. www.england.nhs.uk Accessible Information: ‘Making health and social care information accessible’ The project will make an Information Standard around accessible information and communication support. This is a set of rules that health and adult social care bodies must follow.

25. www.england.nhs.uk The vision Our vision for the accessible information standard is that: “Patients and service users, and where appropriate carers and parents, with information or communication support needs relating to a disability, impairment or sensory loss have those needs met by health and social care services and organisations.”

26. www.england.nhs.uk The Standard includes: Patients or service users of publicly-funded health or adult social care, or their parents or carers. Publicly-funded means that the service is paid for by the Government through money from tax payers. This includes all NHS services. Information or communication support needs because of a disability, impairment or sensory loss. This includes support for people who are blind, d/Deaf, deafblind, have had a stroke, or have a learning disability. Providing information, such as patient leaflets and letters in different formats such as large print, braille, via email, in an audio format or in easy read. Supporting people to communicate through using a hearing aid, lipreading, or using a communication tool. Arranging a professional to provide communication support or to be an interpreter. For example a British Sign Language interpreter, deafblind manual interpreter or an advocate. Support for appointments, for overnight stays in hospital, and for long-term care such as at a care home.

27. www.england.nhs.uk Have your say - consultation Following engagement activity last winter, a consultation is now live. Read the consultation document and complete an online survey at www.england.nhs.uk/accessibleinfowww.england.nhs.uk/accessibleinfo The consultation document is available in Word, PDF, easy read, braille, audio and British Sign Language. The consultation closes on 9 th November. Queries to england.nhs.participation@nhs.netengland.nhs.participation@nhs.net

28. www.england.nhs.uk Making sure everyone has a voice…

29. www.england.nhs.uk Easy Read forms

30. www.england.nhs.uk PLACE assessments

31. www.england.nhs.uk Different ways of working

32. www.england.nhs.uk Patients as partners Centralised system to support learning disability service user led quality assessments 4 Phases approach, starting October 2014; 1 – Research, existing user led measures 2 – Use, the research to design a tool base on best practice 3 – Establish, a register of trained quality assessors 4 – Establish, a network of social enterprises for facilitating the commissioning & delivery Supporting work around Winterbourne & Confidential Inquiry into Premature Deaths of People with LD (CIPOLD)

33. www.england.nhs.uk Service excellence ‘Put emotional experience at heart of the healing process, not as an add-on’ Fred Lee ‘If Disney Ran Your Hospital’ (2005)

34. www.england.nhs.uk Kindness – a virtuous circle KINSHIPKINDNESS ATTENTIVENESS ATTUNEMNETTRUST THERAPEUTIC ALLIANCE BETTER OUTCOMES J. Ballatt & P. Campling – Intelligent Kindness (2011)

35. www.england.nhs.uk 17 April 2013 Derbyshire Healthcare NHS Foundation Trust Opening Ceremony @GrangerKate

36. www.england.nhs.uk The skills that every clinician needs How to connect with other human beings How to listen without controlling the conversation How to recognise, identify and respond to emotion How to respond constructively to difference, disagreement and conflict How to communicate in such a way that the listener understands and remembers @ClevelandClinic

37. www.england.nhs.uk

39. Levels of Motivation HABIT IMAGINATION WILLPOWER COMPLIANCE

40. www.england.nhs.uk Staff Engagement QI - How likely are you to recommend to friends and family if they needed care of treatment? Q2 - How likely are you to recommend to friends and family as a place of work?

41. www.england.nhs.uk Staff FFT is a tool for local improvement work, 2 questions with free text feedback Allows a voice of concern and recommendation Minimum of yearly involvement Open to NHS Trust organisations currently and can be linked to staff surveys, although needs to be inline with the guidance ( http://www.england.nhs.uk/ourwork/pe/fft/staff-fft/) Quarter 1 results published late September Staff Friends & Family Test

42. www.england.nhs.uk Why are you the Patient Experience?

43. www.england.nhs.uk