Transcript Powerpoint template - blue swirl

Patient Experience: Why does it
matter?
Sarah Dickie
Nurse Consultant
What is Patient Experience?
• How the patient journey (and the dynamic,
associated human interactions and emotional
response) is experienced and interpreted by an
individual
• A subjective measure of a patient's experiences. It
looks at a care provider's offering from the
standpoint of the patient's holistic experience
Why it matters?
Better Health Better Care -Mutuality and
Patient Centeredness
‘We are determined to put the needs of patients
at the centre of our health service…and learn
from patient experience, good and bad, in
improving how we design and deliver services’
Shared ownership and partnership working
with patients
What do Patients want?
•
•
•
•
Fast access to a reliable health service
Effective treatment delivered by professionals
Participation in decisions & respect
Clear, comprehensive information and
support for self care
• Continuity of care
Picker Survey 2007
Quality Strategy
The three Quality Ambitions
• Person- centred
• Safe
• Effective
Better Together
• Consistent
information regularly
collected across NHS
Scotland
• Focused on detailed
patient experience
• Useful at both local
and the national
level
Better Together
• Year 1 and 2:
• Acute Care (Inpatient)
• Primary Care (GP
Services)
• Disease specific (Longterm conditions,
including Cancer)
Better Together
Areas which received the lowest levels of
positive feedback included:• Being told how long you would have to wait in
A&E and knowing who was in charge of the
ward
• Emergency or urgent patients were less likely
to score their overall admission to hospital
positively (77%) when compared to those who
were admitted from a waiting list or planned
(86%)
Quality Patient
Care
Safe & Effective
External ‘process’/journey
Patient Experience
Rights
Based
Approach
Admission/
Referral
Expectations
Assessment/
Treatment
Human ‘internal’/experience
Clarity about
purpose
“what happens
to me”
Anxiety
Empathy
/Engagement
Intervention/
Treatment
Explanation of
procedure/risks
involved
Choices offered/
patient/carer
engagement
Discharge Plan/
Exit System
Role
of
the
healthcare
professional
- Understanding
aftercare/self care
- Compliance assured
- Lifestyle change
- Where to get help
Clinical
Outcome
What has been done to
patient
Impact on patient
Crosshouse Hospital Front Door – Patient Experience Map
Positive Responses
“It wasn’t that long [wait for the doctor] but it felt longer
because I was worried about what was going on. But it
wasn’t that long at all, and then the doctor came in and
examined me and he answered every question that I had
for him which was quite good.”
42.9% sought advice from their
family or friends
25.0% sought advice from their
GP
3.6% sought advice from
NHS24
92.9% found the receptionist to be
friendly and welcoming
3.6% sought advice from a
general website
We felt that the nurse practitioner did an
exceptionally careful and good job on my leg
which had a deep cut and torn skin after a fall.
Also, there were 2 medical students who were
observing the procedure, and she was
excellent in the way she explained everything
to them.
75% felt treated with dignity and
respect
14.3% sought advice from
elsewhere (first aider etc)
75% were able to speak without any
interruptions
25.0% didn’t seek any advice
67.9% felt their hospital record was
accessed without any problem
71.4% made the decision
themselves to present at A&E
I was seen very quickly and the nurse and
doctor explained everything to me, and put
me at ease with my minor injury, as I felt I
was taking up precious time that could have
went on somebody else, at a very busy time of
day. Thank you very much for your help.
I was brought in by ambulance and I
was seen straight away.
14.3% had the decision made by
a family member or friend
10.7% were advised to attend
by their GP
3.6% were advised by someone
else (not listed).
“I think I was lucky downstairs at A&E
because they weren’t busy. They were
busy in the cubicles but actually sitting
waiting wisnae busy.”
Pre-Arrival
Arrival @ A&E
“They [NHS24] go
through the same
routine – she
wanted somebody
to talk to – you just
give them the same
information time
after time after
time.”
“I had an
appointment with a
specialist in May
and they sent me a
letter saying that it
was cancelled,
erm, fair enough.
They said they’d
send me another
appointment.
However, they
hadn’t and I
phoned up about it
and they said I was
on a list of people
that had fell behind
and I still haven’t
heard.”
“I had been
waiting for an
outpatient
appointment but I
was progressively
getting worse and
he [GP] wanted me
to come in.”
Reception
Not Ignored
Confident
Pleased
Calming
Lucky
Fortunate
Triage by Nurse
The nurse practitioner who stitched my wound and her student could not have been
more efficient and helpful - they were very nice indeed - excellent. If I had any small
problem it was going into reception and checking in - I didn't really know the
procedure and just sussed it out - maybe someone not so able would be confused. All
in all I would say thank you to the nurses.
32.1% were told how long
they should expect to wait
53.6% felt they had enough
privacy when giving their
details
Negative Responses
“They were very
interested in you, in
me, which made you
feel confident in
what they were
saying.”
“If you asked
questions they
answered you, they
told you, what they
did, they kept you
informed as they
went along.”
“I was kept up-to-date and I
was checked regularly.”
82.1% were completely or
very satisfied with their
length of wait
82.1% were completely or very
satisfied overall with the service
they received from A&E
64.3% felt the reason for their tests
or treatment had been fully explained
“I can say that the nurses on this ward
last night were exceptional, I mean, they
couldnae do enough for you.”
67.9% felt they had been treated with
dignity, respect, care and
compassion
“If you ask questions they
answer them. Everybody is
that friendly.”
92.3% understood what they had to
do when they got home
Staff were very courteous and
understanding.
80.8% felt that their condition,
illness or injury had been fully
explained
76.9% were confident that they
could manage at home
You are very helpful.
Was told to attend Ayr Hospital Eye
Clinic once discharged from
Crosshouse where they were able to
diagnose the problem with my eye.
“If I had any questions they
always answered it as best
they could, you know what I
mean, so it was quite good.”
Decision to
Refer/
Discharge/
Admit
Testing/
Treatment
The average length
of wait from the
Triage Nurse to
seeing a doctor
was
24 minutes.
Waiting Room
“When you go into reception and my husband
had to give my name and that, and you sit for
the triage nurse, well there was a wee bit of a
wait so I had to go back out because I
couldnae breathe, so I had to go out and get
fresh air and wait till they came for me . . . I
couldnae breathe, I was just desperate for
somebody to let me breathe.”
“They took me
through to where the
doctors and nurses
see you and they
couldnae have been
nicer. Everything
was done quite quick
except there was a
wee wait to get up to
the ward, but that
was all really, I
mean, I had my x-ray
done in, in fact, a
minute – it was hard
to believe.”
“They talked me through what
would happen.”
Transfer/
Discharge
“I was left waiting downstairs from probably,
from what I can recall, and I wasnae happy
about it, probably before 6 in the morning,
maybe even earlier than that, probably 5 in
the morning. Nobody asked me, came and
asked me, and I shouted for somebody, and I
shouted and I shouted and eventually I got a
wee toty lassie and she says I’ll fix you up.”
Put up with it
“You can understand, I mean, I’ve been
through A&E before and it’s never took that
long. I think they did say, the nurses did
explain that Ayr Hospital is shut and
everything is coming here, so, we’re taking
everything, there was even folk sitting in
corridors on chairs and whit no, it was just
like something out of casualty it was [laugh].”
“I was at the renal clinic yesterday and they sent me from there to get a
heart trace done, they told me to go home and get some clothes and come
back, and she gave me a letter to by-pass A&E. So I went to A&E and I
spent from quarter to 2, maybe 2 o’clock till quarter to 8 when I got
brought here [3E] last night. They say there was no record of a doctor
saying I was being transferred but I gave them the letter and I still spent
6 hours there [at A&E]. But they did say it was a busy day because Ayr
Hospital was shutting.”
“I came in at 3 o’clock and
the first doctor I seen was at
half past 4 . . . they just
leave you until the doctor
has time to see you.”
Over your head
“The nurses did try
and said they’re
just waiting on
beds, there’s no
beds, and that was
the biggest
problem.”
“When we arrived I gave the letter to A&E downstairs and, er,
sat for a little while and then we were conveyed to a little side
room downstairs, I’d say in about 20 minutes and that’s not too
bad is it. And, it just took off from there. I had to wait for a
while in the little side room for a bed.”
The receptionist, nurse and maxillofacial doctor were
all helpful, caring and patient however the initial
doctor I spoke to did not seem to think that my pain
was as bad as I was saying and was condescending
towards me which was annoying and upsetting.
After seeing the nurse practitioner I
had to wait a further 50 minutes
before being seen by the doctor.
After that my treatment was prompt
and efficient.
Just the distance, to walk to a vacant room, because I
had a foot injury. Thank you once again for your
service, very much appreciated.
32.1% found it easy to find where
they had to go for tests or treatment
Ward 3E
“When you get your breakfast and
they say ‘do you want tea’, you get
your tea before you start your
breakfast, lunch is the same and
probably the evening. . . you get your
tea cold when you’re ready to take it
and if you ask for another cup they
don’t have time.”
Cubicle/Trolley
Not happy
“Then the doctor came and went through
all the procedure again, actually similar
to what I got in A&E, and just told me all
that was wrong, what he thought was
wrong with me. All this time my
daughter was in the waiting room and I
asked him would he explain it all to my
daughter cause sometimes it goes over
your head when you’re not feeling too
good, so eh, he did, he came in and my
daughter had came in by that time, and he
came back and explained it all to her, so,
she was very pleased with that. It lets her
know as well as me what’s really
wrong.”
Comfortable
Consultation
Desperate
“ADOC had phoned down
but when we got down there
nobody had got the phone
call, well, so they said, so
my husband had to go
through it all again and then
we had to go through it all
again [at triage].
“It was done very nicely and quickly with the
minimum of fuss, and that was good wasn’t it –
no hovering.”
“No sooner was I in when the nurse came
and checked my heart and then the doctor
came and done his bit and asked all his
questions . . . I was quite pleased with the
doctor, he was very nice, very calming,
as I was a bit excited about coming in.”
Understood
The average
length of wait
from arrival to
seeing the Triage
Nurse was
11 minutes.
Excited
“Everything was just flowing actually,
everything was just fine, there were no
problems.”
Everyone was very professional
with an understanding and caring
approach.
Worried
Not sure
Confused
“After my x-ray I had to wait for a
wee while because they were very,
very busy downstairs, just to come to
the ward, and then once a bed
became free I came up here [3E].”
“The only thing I have against it [A&E] was
that it was that long to wait to come up to the
ward. 7 o’clock I came up here and it was
twenty past 10 before I got a bed . . . fair
enough, they’re busy, you cannae help that.”
“I was sitting myself for my x-ray so
it seemed a bit long.”
“I got seen really quickly, erm, but it was
quite busy in the period from being seen until
I got moved up here [to 3E].”
“There is really nothing you can do about it [the wait for a bed]. You’ve just got
to put up with it. Erm, I know that sometimes people come in that are in a worse
state than you, you’ve got to wait, but I just felt it was a long, long time to sit
there. I mean, she told me they’d be happy for me to come in and get admitted
straight to 3E and I didnae – I spent 6 hours down in A&E. If I had knew that I
wouldnae have done it, I’d have stayed at home.”
“The meal I got today was atrocious
. . . no options at all. It’s take it or
more or less leave it.”
“If you ask they tell you and I’m one
of those folk that asks. I got a whole
lot of pills this morning and I
thought no way that I’m taking them
– I want to know whit they’re for.
So I managed to reject 2 of them.”
Map Key
Patient Identified Touchpoints
Although I am quite happy about the care and attention I received at A&E, I had
to ask what my injury consisted of. When I got home I had to ask my daughter
what the nurse had told me to do i.e. seeing the practice nurse which made me
feel that written details about this should have been given to me.
Expressed Emotion
A&E Survey Results (Interim)
A&E Survey – Comments
X-ray waiting times could be
better or indication of priority
cases e.g. head injury.
35.7% were told how and when
they would receive their results
Service was pretty good but waiting
to see Doctor was too long.
Patient Interview Quotes
Transforming Relationships
• Supporting Patients and Carers to engage in
improving services at local level
• Surveys, Focus groups and patient stories
• Clinical supervision to promote reflection as
an everyday part of work
• Creating opportunities to support staff in
driving improvement in patient care
• Patient experience embedded into CPD and
staff feedback
Patient experience: Trauma Review Clinics
• Data collated Feb 2010 – Feb 2011
• All patients (new & return) attending the
Tuesday morning Trauma Review clinic are
offered a patient experience questionnaire to
complete
Patient experience: Trauma Review Clinics
• 86% of respondents rated the Trauma Review clinic
as either excellent or very good
– Patients valued not waiting
– Patients valued staff who were professional, polite and
caring
• Areas where patients thought we could do better
– Information: “provide information updates when clinic’s
running late”
– “Make sure their was enough time to ask questions”
Patient Experience: ENP Service
• Data Collection: May 2010
• All patients presenting to Emergency
Department and seen by an ENP
• N= 734 surveys completed
• Overall patients experience with the ENP
service was rated excellent across all aspects
of the service
Patient Experience: ENP Service
Excellent Care.
I was very impressed
Fast and efficient.
Thank you
Thanks for good
advice. Everything
was explained clearly
to me
First class care from the
ENP, a credit to the
Hospital
I was very pleased with
the way I was treated
You said – We did
• Short survey offered to patients and relatives
each month
• Collated information displayed on white
board
You said – We did
YOU SAID
WE DID
• Staff kind and caring,
excellent care
provided
• Thank you for this feedback.
Passed on to staff and congratulated
on their good work
• Staff have been asked to ensure
• Waiting times seemed that patients and relatives are kept
too long
informed and up to date with
potential delays to flow
• Lack of
communication after
being left in a room
• Relatives should be encouraged to
accompany the patient. Staff asked
to provide more communication
Next steps: Over to You
• What does the patient experience programme
mean for me and my organisation ?
• Are we delivering the Services we would want
to receive ?
• What are you going to do that will really make
the difference to patient experience ?
Useful links
• Patient Experience Coordination Centre
Email: [email protected]
• NHS Education for Scotland
– A framework to support staff development in Patient
Focus Public involvement www.scot.nhs.uk/pfpi