West Midlands Strategic Health Authority
The changing policy context around patient experience – What
do we really know?
Dr Lisa Bayliss-Pratt Assistant Director of Nursing
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
What do we think patients care about?
West Midlands Strategic Health Authority
Care and Compassion
Clean environments
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
What the research tells us…
West Midlands Strategic Health Authority
10 most important items
10 least important items
A clean ward
Being given help to eat my meals when I need it
Staff cleaning their hands before touching patients
Being given accurate information about ward routines
Being treated quickly in an emergency
Not having to wait around in hospital once I have been told I can go home
Getting the best treatment for my condition
Being given help to arrange transport home
Doctors knowing enough about my condition and treatment
Having a choice about which hospital to go
Clear expectations about what will happen during an operation or procedure
Not having to pay too much to make phone calls
Being told the risks and benefits of any treatment in a way that I can understand
My religious beliefs being respected
Clear expectations of my condition or treatment
Being able to watch television without having to pay for it
Being treated with dignity and respect
Being able to get an interpreter
Being told how my operation or procedure has gone in a way I can understand
Having access to food when I am hungry
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
What the research tells us….
West Midlands Strategic Health Authority
• Complaints data is not typically collated or analysed at national or
local levels
• ‘Relational’ aspects of care (dignity, empathy, emotional support)
are very significant alongside functional aspects (access, waiting
times)
• Current data collection, analysis and reporting have evolved – not a
science…
Ref: Robert et al (2011) What matters to patients? – Developing the evidence base for measuring and
improving patient experience. National Nursing Research Unit, King’s College London
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
The national picture – patient experience:
West Midlands Strategic Health Authority
 Focus on acute care
 Relevant to services rather than patient
journeys
 Not timely
 Not representative
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
What is happening across the NHS
West Midlands Strategic Health Authority
•
Maintaining quality and safety during transition
•
The quality architecture – still to be determined
•
Develop a single quality operating model for the SHA Clusters
•
Develop a standardised set of quality metrics
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
How are organisations using the information?
West Midlands Strategic Health Authority
Wide range of
capabilities
Clinical
effectiveness,
patient safety and
experience do not
have the same
status
Poor links between
dedicated to measuring and
improving patient
experience
‘Real time’ approaches are
common but focus on ‘snapshots’
CQUINS not seen to be a significant
leverage
Organisations do not know their
costs to the NHS of collecting
patient experience data
Innovative work not always
recognised by commissioners
Six universal challenges: structural, political,
cultural, educational, emotional and technical
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
Emerging architecture…
West Midlands Strategic Health Authority
Harm Free
Care
Dashboards
Triangulation
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NHS Safety
Thermometer
Thoughts about
capturing Primary
Care
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
The Hypothesis…
West Midlands Strategic Health Authority
If the system is performing well at the
highest level of aggregation it will perform
well at lower levels too
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
BIG Dot
West Midlands Strategic Health Authority
•
-
Big dot criteria
NHS-wide
Outcome driven (not a process indicator
Connect to other ‘little’ dots or processes
(multifaceted)
Triangulation????
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
Timelines of measurement
West Midlands Strategic Health Authority
Metrics that are captured
frequently
No less frequently than
quarterly (excludes
annual surveys)
Preferably monthly
Move towards more
regular closer real time
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
The Selected Big Dots
West Midlands Strategic Health Authority
Outcome Framework
Big Dots
Preventing people from dying
prematurely
Avoidable mortality
Enhancing quality of life for people
with long-term conditions
Right Care First Time – Emergency
admissions
Help people to recover from episodes
of ill health
Readmissions
Ensuring that people have a positive
experience of care
Patient Experience
Timely Care
Harm Free Care
• Infection Free
• Severe Harm
• Never Events
• Harm Free Care
• Safeguarding
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
Alternatively….
West Midlands Strategic Health Authority
Is perception
Net Promoter Initiative: would you recommend this to your family and friends?
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
The Patient Revolution
West Midlands Strategic Health Authority
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
What is a Patient Revolution?
West Midlands Strategic Health Authority
• Co-production between
patients & professionals
• Community participation
between the public & the
Service
• Customer experience
of patients & carers
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
We know what needs to done, e.g.
West Midlands Strategic Health Authority
•
•
•
•
Appointments and access
Physical comfort
Attitudes of staff
Organisation and
communication
• Knowledge of the patient
• Cleanliness
• Privacy and dignity
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
Putting the ‘S’ back in the NHS
West Midlands Strategic Health Authority
• The Problem
– Customer Service & patient
experience is not a Board
level priority
– Little real time monitoring
– No incentives to improve
– No learning from other
industries, e.g. First Direct
– Just a nursing issue
• Best practice to build on
– Real time feedback – used
by almost all acute trusts in
West Midlands, and was
being used routinely by
commissioners
– Ipsos Mori ‘Attitude to
Health Surveys’ – including
Net Promoter scores
– East Midlands Patient
Experience Service
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
West Midlands Strategic Health Authority
“I have seen other hospitals asking
more immediate questions, with more
relevant and particular questions, like,
“when you pressed the call button, was
the response what you expected, better
than you expected or worse than you
expected?”. Such questions, done
frequently and disaggregated to wardlevel where possible, give a
management focus on what is
happening in a hospital.”
Andrew Lansley’s first speech as
Secretary of State, 8th June 2010
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
A national and local priority
West Midlands Strategic Health Authority
• Operating Framework, e.g.
- Diffusion of innovation
- Summary Care records
- Patient feedback and patient surveys
• Commissioning Framework, e.g.
- Standardised ‘Net Promoter’ question
and methodology is asked in all existing
patient surveys from 1 April 2012
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
What will be different by April 2013 West Midlands Strategic Health Authority
• A paradigm shift in the attitudes of
NHS Boards, clinicians and patients
• NHS Boards across the NHS Midlands
and East using the simple metric of
the ‘net promoter’ score
• Year on year improvements in the ‘net
promoter’ score
• Sustainable mechanisms in place
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
Programme
Governance
West Midlands Strategic Health Authority
• System-wide Creating and
Patient and Customer
Services Revolution Steering
Group
• Executive Sponsorship
providing assurance and
strategic leadership
• System change through task
and finish work streams
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
The Steering Group
• New approach to an
age old problem
• Being ambitious in the
ambition!
• External challenge
and leadership
• System & Leaders
• 3:1 ratio
• From bog-standard to
West Midlands Strategic Health Authority
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
Task and Finish Groups
West Midlands Strategic Health Authority
Customer
Services
Culture
Communit
y and
Citizen
Participati
on
Patient &
Customer
Services
Revolutio
n
Coproduction
between
Clinician
and
Patients
• System Led
• Clinical Sponsorship
• SHA Management &
Secretariat support
• Defining what good
looks like
• Share good practice
• Upscale and adoption
• Innovative solutions to
age old problems
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
Task and Finish –
Being Part of the Revolution
West Midlands Strategic Health Authority
Customer Services
Culture
• Net Promoter
• Assurance &
Reporting
Framework
• Leadership
Development
• Customer Services
Recognition
• Patient Revolution
Alliance
Community &
Citizen Participation
• PPE Framework
• Statutory Duties
• Health watch and
HWB Development
Co-production
• Shared Decision
Making Tools
• Patient Education
• Clinical Education
Information and Knowledge Management
e.g. Web Portal, NHS Local
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB
Thank you for
Listening
West Midlands Strategic Health Authority
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton
Chief Executive: Sir Neil McKay CB