1. ‘Your healthcare, Your way’
A review of year two in delivering our Patient and Public Empowerment Strategy
Matthew Areskog, Bristol Community Health

2. Our vision
Patients and carers should not be talked about as ‘demand on the system’ or seen as ‘passive recipients of healthcare’.
Patients, carers and the public are empowered to:
Become equal partners in their care, confident in managing their health
Share their experiences, knowing it makes a difference
Motivate their community
Be active participants in shaping services
Why does involvement matter? Talk about knowing our communities, understanding their needs, providing services that meet needs reduces inefficiencies etc

3. Our objectives
Your Healthcare, Your Way, PPE Strategy developed with patients, carers, VCS in June 2014.
Will give overview of some of our key achievements in delivering the strategy and the impact
Place what is important to patients at the centre of every decision.
2. Make it simple for patients and carers to share their experiences.
3. Make it simple to inform patients and carers how their feedback is leading to improved services .
4. Work together with patients, carers and the wider public to develop services around their needs.
5. Work alongside volunteers to strengthen the care we provide and our bonds with the community.
6. Working collaboratively with the voluntary and community sector to improve outcomes for patients and carers.

4. Shared Decision Making
Shared Decision Making (SDM) is a person centred approach that empowers patients to work as equal partners with health professionals. In the past year we have:
Continued to train our staff in the principles of shared decision making
Trained volunteer ‘Care Plan Buddies’ to support patients with goal setting
Rolled out an Accessible Care Plan in Offender Health services
Training increase staff skills and confidence

5. What is Patient Experience
“...what actually happens to patients as people in the process of receiving care & treatment “
Picker Institute
Key dimension of quality, alongside clinical effectiveness and patient safety

6. Principles of Person Centred Care
Based on international research with thousands of patients

7. Making it simple to give feedback
Continued the roll-out of our real-time patient feedback approach
Designed a new, integrated patient experience approach in our Offender Health Services
Provided ongoing support to our teams to interpret feedback and produce meaningful plans to improve patient experience
Trained patient feedback volunteers to meet patients and hear their story
Translated our complaints leaflet into different languages
Real-time feedback is in place in almost all of our services (42 compared to 34 last year)
Offender Health services – created real-time feedback across GP, Dentistry, Mental Health and Substance Misuse, Nursing, Optometry and Audiology
Action plans are in place to ensure our staff make the best use of all of the feedback we receive
Stories provide us with a rich insight into how people experience health services, how did it feel, what did we miss, what did we get right for you?
Complaints leaflet in Punjabi, Urdu, Romanian, Somali and Polish

8. Listening to more patients than ever!
We have increased patient feedback by 171% since 2013

9. What do patients tell us?
96% of patients seen at home or in clinic based services would recommend our services
87% of patients seen at the Urgent Care Centre or Walk in Centre would recommend our services
Overall patient experience score up 90.2 out of 100 (+0.6)
Patient and carer experience improved in End of Life Care services, Offender Health services, small decrease in Musculoskeletal services
Increase in complaints by 58% to 126 in the past year
265 compliments

10. What do patients tell us?
Blue =
Sep 14 to Aug 15
Yellow =
Sep 15 to Aug 16

11. Areas for improvement
We will trial morning and afternoon appointment times for appropriate patients (planned care) on the Community Nursing Service caseload. We will do this in two teams and then evaluate the approach before making a decision on how best to roll-out further.
We received a number of comments about unsatisfactory waiting times for some services and communication that could be improved. Many of our services are commissioned to see 95% of patients within 18 weeks of referral. Whilst we maintain good performance in this area and see the majority of patients before 18 weeks, we do understand that for some patients who wait longer this can be difficult. We will be working over the next year to improve our communication with patients who are waiting to be seen.

12. Areas for improvement
3. We are rolling out the Accessible Information Standard in our services for adults, ensuring that we ask, record, highlight, share and – most importantly - meet the needs of all patients. The Accessible Information Standard will make sure that people who have a disability or sensory loss get information that they can access and understand, and any communication support that they need. We intend to roll out this approach to offender health and children’s services later in the year.
4. We need to look in more detail at the differences between how our services perform, with a focus on clinical competency in the shared decision making approach. We will look at the services in which patients report improved understanding of their condition and increased confidence in managing their health having seen a clinician. We will then use an ‘action learning set’ approach to pair up those services who perform well with those who need to improve. We will use appreciative enquiry to improve patient experience and promote shared decision making further.

13. Learning and improving
We are focusing more than ever on taking action that makes a difference to the experience of patients
We now include information on expected waiting times for treatment on letters sent to patients of our Community Therapy Service
Our Bladder and Bowel Service is increasing the range of time slots available and reviewing its clinic locations
The patient-led Heart Failure Support Group has doubled in size following a request to promote the group via a leaflet given out by our Heart Failure Service
Here are just a few examples of learning and improving from patient feedback, focus groups and complaints. More examples can be found in our annual PPE report.

14. You Said, We Did Dermatology
Podiatry
You said, “We are not completely sure when to use the diabetes risk cards ”
We did, “Updated staff on how the cards are presented to you to ensure you have a full understanding of when and where to use it.”
Dermatology
You said, “Wish we had been referred earlier by my GP”
We did, “We are in the process of re advertising our service to all the GP’s in Bristol, and using social media to advertise the team and what we do”
Learning Disabilities
You said, I found the psychology group really helpful, and I think more people should be offered groups
We did, We have arranged more groups, and more people have been able to attend

15. Carers Experience
We worked with the Carers Support Centre to improve the way in which we engage with carers and understand how well we are supported them
Two focus groups with 20 carers
A new cross-organisation working group with carer representatives
A action plan to improve carer experience
Created an information pack for carers, co-produced with carers
A new carer experience survey

16. Engaging and Involving
Grew our ‘Participation Community’ to 142 members and held our first event here last year
Involved our participation community in deciding on our Quality Account priorities for 2016/17
Held focus groups and encouraged peer support
Developing patients as leaders
Kings Fund programme ‘Collaborative Pairs’
Healthcare Change Maker programme
Further grown our volunteer programme
Focus groups in UCC, Community Nursing and Diabetic Foot Care

17. Collaboration
Focus groups in UCC, Community Nursing and Diebetic Foot Care

18. The Year Ahead
Taking forward our Patient and Community Leadership programme
Working with volunteers to embed our patient stories in training and to inform opportunities for improvement
Implementing the Accessible Information Standard
Taking forward our empowerment work in Offender Health services
Working alongside the participation partner for Childrens Community Health Services to engage and involve children and young people

19. The Year Ahead
Do you have ideas for how we can engage and involve patients, carers and our communities?
Please take the opportunity to speak to our staff here today and share your ideas