Transcript Neil Churchill`s Presentation
Neil Churchill
Director of Patient Experience - (Domain 4 Lead) Measuring, Understanding and Acting on Patient Experience Insight
Why is insight into patient experience important?
“ The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare
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A systematic review of evidence on the links between patient experience and clinical safety and effectiveness
British Medical Journal
Q
What does a “very good” experience mean?
Overall, how would you describe your experience of your GP surgery?
Very good 31% 32% 39% 43% 49% 60% 66% 65% Fairly good 49% 49% Neither Poor 13% 5% 12% 5% 18 to 24 25 to 34 All respondents who answered the question (948,758) 46% 44% 41% 33% 29% 29% 10% 4% 35 to 44 9% 3% 45 to 54 7% 2% 55 to 64 5% 65 to 74 4% 4% 75 to 84 85 + Source: GP Patient Survey 2012-2013
How do we take our love of doctors into account?
Q.
“For each, would you tell me whether you generally trust them to tell the truth or not?”
% Not trust % Trust Doctors Teachers Professors Judges Scientists Clergyman/Priests The Police Television News Readers Social workers The ordinary man/woman in Civil Servants Managers in the NHS Pollsters Trade Union officials Local councillors Business Leaders Bankers Managers in local Journalists Government Ministers Politicians generally
8 12 11110 34 17 17 20 27 26 25 25 45 57 55 37 46 62 74 57 70 80 19 17 14 40 39 34 31 29 29 26 47 63 62 60 55 74 72 71 68 88 81
Base: 1,026 United Kingdom adults aged 15+, 10-16 June 2011 Source: Ipsos MORI/BMA
80%
To what extent do we need to tackle “gratitude bias”?
Net satisfaction with the running of the NHS 60% 40% 20% 0% 1983 1984 1986 1987 1989 1990 1991 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 -20% -40%
Pre War (born before 1945) Generation X (born 1966-1979) Baby Boomers (born 1945-1965) Generation Y (born 1980 onwards)
Data: BSA 1983-2010. Each data point represents >100 respondents
So what impact will the changing demographic have on satisfaction? Proportion of UK population from each generational grouping
100%
% sample universe from pre war generation
90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1983: All adults 1983: All adults aged under 39
% Baby boomers % Generation x
83 84 85 86 87 89 90 91 93 94 95 96 97 98 99 00 01
% Generation Y
02 03 04 05 2010: All adults aged over 66 2010: All adults aged between 45 and 65 2010: All adults aged between 44 and 31 2010: All adults aged under 31 06 07 08 09 10 Source: Eurostat
How was your experience? (1)
Adult Inpatient Survey 2012 Overall…
30% 25% 20% 15% 10%
18% rated their overall experience lower than 7/10
5% 5% 1% 1% 1% 2% 0% 0 1 2 I had a very poor experience Base: 61399 (all respondents). Fieldwork: Sept 2012 – Jan 2013 3 2% 4 5 6% 6 12% 24% 20% 25% 7 8 9 10 I had a very good experience Source: CQC/Picker Institute
How was your experience? (2)
Adult Inpatient Survey 2012
BUT 62% reported at least one aspect of poor care
18% Poor overall experience 62% Experienced some form of poor care
Overall experience measures good for tracking satisfaction but not for rooting out problems?
Base: 61399 (all respondents). Fieldwork: Sept 2012 – Jan 2013 Source: CQC/Picker Institute
Sometimes an overall measure can mask poor experience Paste co brand logo here
Female, white, 65+, in hospital for several months
Her report… Her experience…
“… in [the hospital] they treated me well” “Oh yes I found it satisfactory”
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On third day she asked for a bedpan
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Nurse told her it wasn’t worth running back and forth, told her to do it in the bed
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Nurse complained to her in the morning that she was soaking wet
© Ipsos MORI
CASE STUDY
“I went to the dentist, reported to the receptionist and the receptionist forgot about me. I’m not used to my sight loss and lost my orientation and couldn't bring myself to ask anyone for help and just felt too nervous to shout out or anything. I ended up sitting there for hours and it was an extremely frightening experience .”
Patient experience is closely linked to patient involvement and engagement Experience Being involved is part of having a good experience
Individual
Involvement Involving patients is one means to understanding and improving experiences
Individual and collective
Means nothing if nothing is done
UNCLASSIFIED
www.institute.nhs.uk/theguide
http://www.kingsfund.org.uk
/projects/ebcd/experience based-co-design-description
The priorities for patients with breast and lung cancer were different
Lung cancer
Communication of diagnosis
Breast cancer
Functioning of day surgery unit Information about treatment Continuity and coordination of care Appointments system and conduct of OP clinics Communication Information about symptoms
Everyone Counts: Planning for Patients 2014/15 to 2018/19
– Plans are expected to demonstrate measurable improvement in patient experience as well as continued investment in generating feedback; • enhance feedback and insight from vulnerable patient groups; • measure and improve the experience of carers; • easier access to proven techniques and support for their implementation; • strengthen forms of staff engagement which can support improvements in patient experience through better staff experience; • learn from complaints and improve the experience of making a complaint .
Putting Patients First: NHS England business plan 2014/2015
• NHS England’s Commitments to Carers published April 2014 • Introduction of Staff FFT April 2014 and support to engage staff on patient experience; • All NHS services provide real-time feedback through FFT by March 2015; • Insight strategy 2014; • Plans for ‘Always Events’ and a system-wide approach to improving patient experience by Sept 2014; • Patient Rights programme November 2014 and strategy to embed NHS Constitution; • Patient Centred Outcome Measures (PCOMs) by March 2015; • Accessible Information Standard and extension of PLACE to cover disability issues by March 2015; • Strategy for nutrition and hydration by March 2015 • Support for patient leaders .
Friends and Family Test Overview
Simple test based on Net Promoter Score methodology ‘How likely are you to recommend our
Friend and Family Test - outcomes
Environmental issues • • Soft closing bins have been purchased for inpatient areas as a response to patients feeding back that noisy bins kept them awake at night Mid Staffs NHS Foundation Trust Comments regarding disturbed nights led to Introducing the ‘Quiet Protocol’ to help patients sleep well at night Sandwell and West Birmingham Hospitals NHS Trust
Friend and Family Test - outcomes
Medication issues • 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 The Royal Wolverhampton NHS Trust • "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 The Royal Wolverhampton NHS Trust
Nutrition and Hydration
3 million people in the UK are malnourished or at risk of...
• • • • Of those: A third are over the age of 65 - more than 1 million older people are malnourished 93% are in the community, 5% in care homes, 2% in hospital Public Sector expenditure is estimated to be billions of pounds a year.
NICE identifies better nutritional care as the sixth largest potential source of cost savings to the NHS
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Nutrition and Hydration
Building on success and promoting what works Improving understanding of malnutrition and dehydration Involving all staff and building collaboration between teams Embedding responsivene ss to patient voices Making every contact with patients and carers count Strengthening commissioning Building on Compassion in Practice to connect values with behaviours and make nutritional care an agenda that resonates within and beyond nursing
‘If you’d asked me the most important quality of a doctor, I would have said competence. When I became a patient I soon realised how important compassionate attributes in the people looking after me were’
Kate Granger
17 April 2013 Derbyshire Healthcare NHS Foundation Trust Opening Ceremony
@GrangerKate
Ensuring we listen and act on feedback from vulnerable patients
Accessible Information Standard
• • • • There is a formal process to develop an Information Standard. We are asking people for their views to inform the details of the standard, which we will start to write in spring 2014. There will be a formal consultation on the draft standard in summer 2014.
We are expecting to have a final version of the standard approved in autumn 2014 – organisations will then have up to 12 months to comply.