1. Patient Experience the focus at the Royal Devon and Exeter
Angela Pedder
Chief Executive

2. Background £350 million Acute Teaching Hospital
One of first 10 FTs authorised
Consistent good performance on national performance indicators including patient survey, star ratings and Health Care Commission
Large membership base, reflective of local population and patient/care involvement with services provide
History of patient engagement in service improvement projects.

3. Drivers for change
Making FT public benefit real - influencing strategy
Lots of data on process of care activities but how could they be meaningfully triangulated?
Annual national survey provides aggregate data single snap shot
National survey patients saying views on care not asked for when in hospital
No regular systematic way of asking about patient experience
Board concern about aggregate data and risks of good performance in some areas masking poor performance elsewhere
No decision about me without me

4. Three practical examples
Embed patient experience within the overarching Trust Governance and Performance Framework
Patient experience pre-eminent measure in Nursing Quality Assessment Tool (NQAT) scoring
Real time patient involvement in safety briefings

5. Governance, Operations & Performance System
Board of Directors
The Executive Directors
Audit Committee
Governance Committee
Trust Management
Committee
Integrated
Safeguarding
Committee
Clinical
Effectiveness
Committee
Workforce
& Diversity
Committee
Safety &
Risk
Committee
Engagement
& Experience
Committee
Senior
Operations
Group (SOG)
Directorate
Quarterly
Reviews
Executive
Line Management
and 1:1s
Directorate Representation
Directorate Business & Governance Meetings
Service Line Reporting – Balanced Scorecard Approach

6. NQAT Organisational / clinical / area / unit Team Individual
A calm, clean, safe
environment
Good team working
And good
relationships
A positive friendly
culture
Patients have confidence in care
Organisational / clinical / area / unit
Team
Individual
Skills and will
Ways
Means
Well managed
Care with efficient
delivery
Personalised care
for and about
Every patient
Staff are caring with confidence

8. What Does NQAT Include? Department of Health Essence of Care
PRESSURE ULCER
SAFE
ENVIRONMENT
PAIN MANAGEMENT
PRIVACY &
DIGNITY
Department of Health
Essence of Care
Nursing Standards
INFECTION
CONTROL
MENTAL HEALTH
ELIMINATION
SELF CARE
FOOD &
NUTRITION
RECORD KEEPING
COMMUNICATION

9. Approach Utilises handheld tablet computers
Incorporates RCN observations of care
Includes real time patient survey
Undertaken by clinical staff from another clinical area and non clinical non uniformed staff volunteers for patient discussion

10. METHOD + + = NQAT DOCUMENTATION 20% (staff) OBSERVATION 40% (staff)
Documentation carried out by
Patient Experience interview’s carried out by staff member in non uniform, cross division cover +
PATIENT FEEDBACK
40% (volunteer) =
NQAT

11. FOR EXAMPLE….. DOCUMENTATION547 Elements Records of staff training.
Patients assessments complete and up to date.
Evidence of care.
OBSERVATION
103 Elements
Clear signage.
Communication.
Cleanliness.
Caring.
Culture.
PATIENT FEEDBACK
28 Elements
Have you felt safe?
Have you felt cared for?
Would you recommend us?
Mention Patient feedback used to give full picture on the data gathered from the audit.

12. RESULTS – within 48 hours All results in every element RAG rated
Aggregate ward score
Fail ≤74%
Bronze 75 – 84%
Silver %
Gold ≥ 95%
Re-audit and rapid improvement cycle action plans
Results published at ward level and to Board on quarterly basis

13. Coverage and next steps
All ward areas
Modified tools for: Theatres, Recovery, ITU, Paediatrics, NNU, Maternity, Emergency Dept
Move to CQAT during 2012 to include medical care
Get patients to remember the conversations they had when completing national survey!!

14. Involving patients in safety briefings
Context
2009/10 difficult winter, capacity issues
Recent ward closure and major service redesign
Poor staff survey result – low staff morale
Increasing number of complaints
No visible safety culture
Concerning NQAT scores
Time to resolve complaints high
Low staff morale

15. Our Vision – Real time feedback
The most honest response possible
Immediately… while the patient is still in our care
To resolve issues promptly
Help us to understand the complex & challenging causes of safety incidents
To learn about what really matters to patients

16. Fostering a visible safety culture
Safety Briefing
Visible, priority, cultural shift
Measurement
Metrics, themes, outcomes, actions
Capture Patient Experience
Critical language, real-time
Communication of feedback
Open, transparent, accountable
De-Briefing
Listening, learning, real-time, action

17. Inter-professional Safety Briefings

18. Capture patient experience
We encourage patients and relatives to tell us how we are doing. If you are able, please can you tell us what went well for you today?
We would like to learn from your experiences. Please tell us how we might improve care on this ward. Today would have been even better if…
If you would like to discuss your feedback with the Matron, please leave your name.
Thank you Matron
“What went well…? Even better if…”

19. De-briefing
What did we learn from our patients today?

20. “What went well?” “ Great team, lovely nurses.”
“ This ward is fantastic, they all work so hard and they have such kindness.”
“ I managed the stairs today, I’m excited about going home.”
“ Nothing is too much trouble for them. A lovely ward.”

21. “Even better if . . .”
“You can’t reach the call bell or toilet roll holder from the toilet in the bathroom...this was really difficult for me, I thought I would fall.”
“Sometimes it takes too long for call bells to be answered, particularly at night.”
“The last time I had my hip replaced I had a shower by now, it’s day four and I feel dirty.”
“Why do I still have a catheter in? They said it would come out this morning?”

22. Communication
It would have been even better If there was . .

23. Outcomes Improved team working - staff survey
Improved staff sickness – 9.7% (2009) to 2.7% (2010)
Outstanding NQAT results (gold)
Number and type of safety incidents reduced

24. Outcomes Identification of learning needs
Themes for service improvement
Introduction of patient stories, ward to board
Cannulation prompt card – patients driving change
Falls/slippers leaflet

25. Summary Costs = minimal Patient involvement in safety briefings
Rich “real time” narrative describing patient experience
Transferability
Improves morale and reduces complaints
Raises standards
Open, honest patient safety culture
Costs = minimal

27. QUESTIONS?