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How Patients and Carers can Influence Service Improvement

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Presentation on theme: "How Patients and Carers can Influence Service Improvement"— Presentation transcript:

1 How Patients and Carers can Influence Service Improvement
Discovery Interviews Dr Jeffrey Phillips Consultant in Intensive Care Medicine Princess Alexandra Hospital, Harlow

2 NHS Modernisation Agency Critical Care Programme
Improve access, experience and outcomes for patients with potential or actual need for critical care

3 Why? The New NHS (1997) Critical to Success (1997)
Comprehensive Critical Care (2000) NHS Plan (2000) Shifting the Balance of Power (2001) NHS Reform Act (2002) The Kennedy Report (2001) Commission for Health Improvement

4 Patients are our raison d’être
Why? Patients are our raison d’être

5 Aim Patients and Carers to influence change
To understand what patients and carers perceive as important New ways of working Inclusive approach

6 “Change has become a constant; managing it has become an expanding discipline. The way we embrace it defines our future.”

7 Audit or Research? Audit or qualitative research
Informing about previous experience New information sought Approval for project LREC MREC

8 Patient and Carer Participation
Questionnaires Low response rate Questions set by professionals Cover limited aspects of service Results seldom improve care Groups Inhibition of introverts Clash of opinion Directed by professionals

9 Discovery Interviews Provide opportunities for patients and their carers to directly tell the story of their illness or condition using a framework that guides them through the key stages of their experience We cannot just ask people what their needs are, we do not think this way. And so the idea of Discovery Interviews was born. Describe the two main points above, emphasise the focus on experience of illness not care. They weave stories of their care into their accounts but in their own way using their own language.

10 Using Narratives Reflection Listeners must ask: Action
“What is learned from the narrative?” “What needs to change?” Action “How can change happen?”

11 Discovery Interviews Semi-structured No formal direct questions
Interview spine derived from process mapping Process map simplified

12 Discovery Interview Spine
First realising something was wrong Getting to the Critical Care Unit Being in the Critical Care Unit Leaving the Critical Care Unit Being on the Ward Going Home At Home

13 Discovery Interviews Subject encouraged to talk about experiences at each stage Interviewer avoids direct questioning Audio-recorded Transcribed

14 Analysis Process initiated by the team in order to learn about the patient and carers experience Non-confrontational process Teams listen to uninterrupted narratives Stories and narratives are a great leveller

15 Action Identify areas requiring improvement Immediate Change
Process Mapping & PDSA Service commissioning Testament v Anecdote Other areas for further inquiry

16 Improvements Orientation of patients when waking from a period of sedation Strengthen pre-assessment phase of a patient’s journey Communication and information Noise

17 Those in power to learn from our experiences
The Future Continue improving! Roll out to all 29 Critical Care Networks Different subject groups The bereaved Cascade throughout Trust Those in power to learn from our experiences

18 Summary Learning from Patient and Carer stories
Powerful tool to understand from the Patients’ and Carers’ perspective Patients and Carers able to provide a comprehensive picture of both recollections and experiences Strengthened partnerships

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