Patient Experience Report
“Developing a better understanding of what matters most to patients, families
and carers.”
Quarter 2
July – September 2015
Author:
Sarah Balchin
Head of Patient Experience
October 2015
1
Contents
Page
Patient, Relative and Carer Feedback
3
Friends and Family Test
3
National Surveys
11
Patient Experience Feedback Project
13
Patient and Public Engagement
13
Improving the Experience of Carers
14
Improving the Experience of Discharge
15
Improving the Experience of People at the End of Life
16
Improving the Care of Adults with Specialist Mental Health Needs
16
Voluntary Services
18
Conclusion
19
Recommendations
19
2
1. Patient, relative and carer feedback
Friends and Family Test (FFT) – partially achieved
Targets:

Early implementation of FFT into outpatient and day case departments in line with national
guidance.

Increased or maintained response rates in in-patient areas and ED.

Improving positive responses to the FFT question in ED, in-patient areas and maternity.
The Friends and Family Test provides patients with the opportunity to provide feedback about their
recent hospital experience, the aim being to better understand what matters most to them. During
2015 the programme has been extended to include people who have had a day case procedure
and out-patients. This has increased the number of patients who have the opportunity to provide
feedback which they may do by post card, the Trust web site or directly to the survey provider.
Every month about 5000 patients now tell the Trust how satisfied they were with their care and
treatment, and many provide written comments which are used to identify areas for improvement
and areas of best practice to share.
Early implementation of FFT into outpatient (OPD) and day case departments
Over 2000 Out-patients have taken the opportunity to provide feedback in Q2. The overall
satisfaction was 94.1% with consistently positive feedback about the attitude of staff and the
management of the waiting times.
Out-patient
areas
Response rates
Responses
Out-patient
areas
Response rates
Month
–
Responses
Apr-15
716
Jul-15
810
May-15
753
Aug-15
737
Jun-15
620
Sep-15
827
Total
2,089
Total
2374
Quarter 2
Quarter 1
Month
–
People who have undergone day case procedures are now eligible to participate in the in- patient
FFT survey. This has been successfully implemented with a significant associated increase in the
number of respondents in quarter 2.
3
Increased or maintained response rates in in-patient areas and Emergency Department (ED)
In-patient areas
A 26.5% response rate was achieved in quarter 2, an increase from 22.6%% in quarter 1
Total
response
rate
Responses
/ eligible
pts.
Apr-15
21.00%
1410 / 6714
May-15
24.80%
1782 / 7194
Jun-15
22.00%
1725 / 7843
Total
22.60%
n/a
Month
Quarter 1
In-patient areas – Response rates
Total
response
rate
Responses
/ eligible
pts.
Jul-15
27.70%
2232 / 8068
Aug-15
27.80%
1971 / 7095
Sep-15
24.1%
1963 / 8161
Total
26.5%
n/a
Month
Quarter 2
In-patient areas – Response rates
During analysis of July data, Information Services identified an error in the calculation of the
number of patients eligible to complete the survey. The error was caused by a failure of the system
to access all of the base data due to the significant increase in number of patients (day case)
eligible to participate. This affected the number of patients since April 2015, when the inclusion of
day case patients was introduced by NHS England.
It should be noted that overall there has been an increase in the total number of responses
provided by patients. The response rate does not reflect this increase as the number of patients
eligible to participate in the feedback opportunity has also increased.
There is recognition that there is variation in response rates from wards and departments. A review
of those areas who consistently achieve a higher response rate was undertaken to identify what
enabled them to do so. It was identified that successful ward and departmental teams benefited
from very timely feedback. This enabled teams to have an up to date understanding of how
patients and their families were reporting their experience.
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To share this learning the following actions have been taken:

Training for ward teams and leaders in the use of the information system which provides
real time feedback, both satisfaction scores and narrative.

Weekly and monthly reports from the Patient Experience Team.

System of escalation of areas who have nil returns (noting that in the main these are areas
with very limited discharges) to allow for early follow up.
Emergency Department (ED)
The Trust achieved a 17.4% response rate for quarter 2, in comparison to 18.5% at the end of Q1.
Department
Response
Total
response
rate
Responses
/
eligible
pts.
Apr-15
17.50%
1228 / 7032
May-15
14.60%
1066 / 7288
Jun-15
22.70%
1676 / 7391
Total
18.20%
n/a
Month
Quarter 1
–
Emergency Department – Response rates
Total
response
rate
Responses
/
eligible
pts.
Jul-15
17.50%
1383 / 7898
Aug-15
13.60%
1283 / 9444
Sep-15
21%
1956 / 9329
Total
17.4%
n/a
Month
Quarter 2
Emergency
rates
There continues to be a challenge to achieving a sustained adequate response rate which has
been compounded by the major operational challenges facing the department. Support continues
to be provided to the ED team to develop and implement sustainable changes in practice to ensure
that patients are afforded the opportunity to provide feedback.
There was a significant
improvement in September since the implementation of a new local recovery plan. Daily monitoring
and support is now in place.
Trust wide satisfaction
There has been a small decrease in overall satisfaction rate from 95.6% to 95.1% in quarter 2. It is
a recognised phenomenon that with a significant increase in responses the satisfaction rate often
reduces but this does ensure a robust indicator of experience.
Trust wide actions
 The role and activity of the FFT Project group have been reviewed in response to feedback
from staff using the feedback method. The emphasis will be on reducing variation by the
sharing of best practice and review of the comments provided by patients.
5

Weekly and monthly monitoring reports continue to
ensure teams are aware of the number of responses
received against the target.

Greater transparency for patients, relatives and carers
with the clinical area satisfaction scores now displayed on
the Clinical Dashboard alongside ‘You said / we did’
changes made as a direct result from the feedback
received

New Patient Experience FFT page internet which enables
public access to all FFT results, including a live feed of
three most recent comments.
Improving positive responses to the FFT question in ED, in-patient areas
Emergency Department
Total no.
Likely
very
likely
&
Compliance
Month
Likely
&
very likely
Total no.
responses
Compliance
Apr-15
1184
1288
96.40%
Jul-15
1298
1383
93.90%
May15
1011
1066
94.80%
Aug-15
1196
1283
93.20%
Jun-15
1532
1676
91.40%
Sep-15
1829
1963
93.5%
Total compliance average
Quarter 2
Quarter 1
Month
Total no.
Total no.
responses
94.20%
Total compliance average
93.5%
There has been a small variation of satisfaction over Q2 with the average satisfaction 93.5%
against a national average of 88% (August figures). This is a positive indication of the quality of
experience patients at times of exceptional demand on the service.
6
In-patient areas
Total
no.
Likely &
very
likely
Total
no.
responses*
Compliance
Month
Likely
very
likely
&
Total
no.
responses*
Compliance
April ‘15
989
1020
97%
Jul-15
2153
2232
96.50%
May ‘15
1735
1782
97.40%
Aug-15
1903
1971
96.50%
June ‘15
1666
1725
96.60%
Sep-15
1881
1963
95.8%
Total compliance average
Quarter 2
Quarter 1
Month
Total no.
97%
Total compliance average
96.3%
The average percentage of patients who were satisfied with the services they received while an
inpatient has remained consistently high. The national average reported in August was 96%.
Patient Narratives
With about 5000 responses a month the challenge is to analyse and understand the written
feedback provided by patients. To do this and to communicate effectively and in a timely way the
system allows for the development of a “Wordle”. This visual representation reports the most
frequently used words in responses, both positive and negative. It is now widely accessed by
managers and staff and used in public areas to showcase what the patients’ experiences of care
are.
Response themes from the Friends and Family Test (FFT)
In-patient and ED
Key themes identified:
Waiting
Waiting continues to be a key theme from FFT feedback. This is however a multifaceted issue.

Waiting for medications at night makes it difficult to settle
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
Waiting for hospital transport to and from out patient appointments extends the appointment
considerably.

Waiting for medication for discharge.
Communication
Communication is reported as a key theme for improvement, reflecting other sources of feedback
and the national trend. Specific issues raised include:

Poor communication between medical and nursing staff leading to patients being unsure as to
what is happening.

Poor communication between other staff such as porters and pharmacy means an increase in
delays.

Patients and relatives being told conflicting information from staff
CSCs which have identified these issues as an area of concern have included in their local quality
improvement plan. These will be monitored and reported via quality reports to the Governance and
Quality Committee.
Improving positive responses in maternity
Target: Improve positive responses in maternity
Improving positive responses
MATERNITY
Month
Total number likely and very likely
Total number responses
Overall compliance
(including ‘don’t know’)
Sept 2015 680
692
98.2%
Aug 2015
538
556
96.7%
July 2015 556
562
98.9%
There has been an overall increase in the number of patients who are likely or very likely to
recommend the Trust to a friend or family member. There are a number of responses in
September which reflect increased activity. The Q2 average of 98% compares favourably with the
national average of 95% (August data).
Maternity services response rates and themes
Target: reporting only
Women are asked to complete an FFT form at four points of contact.
Question 1. During the 36th week of pregnancy.
8
Asking women’s experience to date about care received in their pregnancy. This question cannot
be asked by the named midwife who has provided care.
Question 2. Following birth.
Asking for feedback about the labour experience; again the question cannot be asked by the
midwife who has provided care in labour.
Question 3. Post birth experience.
Asking for feedback about care on the postnatal ward prior to discharge home.
Question 4. Community postnatal care experience.
Asking for feedback about care in the community setting. This care will have been received at
home or in a postnatal clinic (depending on individual needs) and is asked when care is transferred
to the health visiting team. This occurs between days 14-28 depending on individual needs.
Question July 2015 Aug 2015 Sept 2015
1.
9%
6.8%
6.3%
2.
36.3%
35.3%
39%
3.
43.6%
42.4%
54%
4.
33.8
32.3%
32.8%
Rate
29.3%
28.8%
34.3%
There continue to be challenges to improving response rates for question 1 as many antenatal
clinics are based in Children Centres and named midwives cannot ask the women to complete the
forms. There is no nationally available data against which to benchmark local response rates. The
trust is committed to securing benchmarking data in Q3 via the providers of the FFT surveys to
assist in the identification of Trusts who have a significantly better response rate, to learn from their
experiences.
Response themes
Overall, the responses from women in their feedback continue to remain very positive and staff
continually recognised individually on the feedback forms.
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Positive comments
The midwife who delivered my baby was professional and caring and made me feel safe
comfortable at all times.
and
Clean tidy environment, very helpful staff and responsive too. The care we received was excellent.
Midwives were attentive kind and supportive.
Very encouraging and always ready to support my breastfeeding issues.
All midwives Drs and maternity support workers were very understanding.
All the midwives students and doctors were friendly helpful and supportive explaining everything
that was happening and helped me feel relaxed.
Negative comments and examples of change
Times of home visits could have been more accurate as I felt I was hanging around
Action:
Women are now encouraged to attend postnatal clinic appointments if they are well, as home visit
times can not be guaranteed due to the needs of the wider service. The clinic appointments have
been very successful.
Improvement being able to sleep as noisy.
Action:
The staff have all been made aware of issues about noise particularly at night. Staff have been
made aware of how noise travels which can disturb sleep and to ensure patient confidentiality.
Wearing appropriate footwear. Keeping doors closed etc. to minimise noise.
Staff seem to be struggling with broken resources
Action:
All staff have been informed that all clinical equipment can be replaced if broken. There is also an
Assistant Technical Officer in post who regularly checks and ensures that equipment is maintained
and functioning.
10
Staff FFT
Target: Provide response rates and outcomes
During August 2015, staff were asked to complete the quarter 2 friends and family test alongside
other key questions. This quarter saw an increase in response rate. There was however, a slight
decline in staff recommendation of the place to work and receive treatment as well as staff feeling
able to put forward ideas for improvement. Further analysis will take place to understand the cause
of this decline. The full results and associated actions are reported in the Integrated Performance
Report: Workforce and Organisational Development.
2. National Surveys – achieved
Target: 6 monthly update
Emergency Department
All actions from plan reported to Board in March 2015 have been completed and on time. The
department has continued to face significant operational challenges with a sustained increase in
the number for people attending the department. Work is in progress to improve the FFT response
rates to ensure a contemporary understanding of the patient experience in ED (See section 1).
Cancer
11
The Cancer Service Team has made significant improvements based on the key themes identified
from the survey. These improvements are detailed in an accessible report written for patients –
“You said – we did”.
Key changes include:

1 to 1 appointments for patients starting chemotherapy who are unable to attend the
scheduled “Demystifying Chemo” Programme

Improved information about the services provided by the MacMillan Centre for financial
advice.

Provision of mobile phones for Clinical Nurse Specialists to improve patients’ ability to
contact them in a timely way.
Adult In-patient
The 2015 Adult In-patient Survey has commenced. Data will be requested from 1250 patients, an
increase from a sample size of 850 in 2014. The initial results will be made available in February
2016.
Children and young people
The Children and Young Peoples (C&YP) Survey asked children, young people and parents for
feedback about their inpatient or day case experience. People reported a positive experience of
care and said that they felt safe whilst in hospital. Key issues for improvement identified included:
Young people adolescents said there were not enough activities for them
Actions in Q2 :
A landscaper is looking at improving our outside area and there will be a separate area for young
people with appropriate age related facilities
Young people also fed back out with the survey that they wanted bigger Gym and someone to
support them with exercise for better respiratory health. The team created more useable gym
space, are looking at better gym kit and are about to advertise for a physio tech whose role will
include improving respiratory health through fitness
Food quality, timing and nutritional value
Action in Q2:
Children and young people gave feedback that they were unhappy with food choices. In
September we invited parents to taste food. They had food from the adult menu and provided
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positive feedback. C&YP will now also be offered food from adult menu in addition to the child
menu.
The implementation of the action plan will continue to be monitored via the Paediatric Standards
Committee.
3. Patient Experience Feedback Project
Target: Nil- for information only
Working in partnership with the University of Portsmouth a 6 week project was commissioned to
review all available sources of feedback from patients and their families during a 3 month period
May – July 2015. The objectives of the project were to:
1. Identify the feedback opportunities that patients and their families used to tell us about their
experience
2. Establish which methods were most frequently used and to consider why
3. Triangulate the feedback themes from the identified sources
4. Make recommendations to improve the accessibility of feedback opportunities to the broader
community.
All of the objectives were met and the full report provided to the Patient Experience Steering Group
members.
4. Patient Engagement - achieved
Target: review the current arrangements for engaging with service users, their families and carers
and develop a patient engagement strategy.
The Trust Patient Engagement Strategy – Participation for Improvement has been developed with
the local community, patients, families and carers and ratified by the Trust Board. The strategy is
based on the principles of:
Outreach – that is working with already established patient and community groups to consult,
advise and communicate key issues to and from the Trust.
Inclusivity: promoting equal access to all involvement and engagement opportunities including
meetings, workshops and feedback methods.
Solution development: the process for working with patients and community representatives to
design solutions to area identified as requiring improvement.
To help us achieve this we have started some new projects:
13

A patient/student buddy system is being piloted for pre-nursing students. This helps people
wanting to go on to nurse training understand what is important to patients and their families.

We are recruiting new Patient Engagement Volunteers to help us secure more feedback in a
variety of ways from patients, families and carers.
Implementation of the strategy is being led by patients and carers, and monitored by the Patient
Experience Steering Group. The trust is sharing this development with Solent NHS Trust to reflect
the fact that our local community are often patients of both trusts and we should endeavour to
make their journey as simple as possible.
A patient commented in the local press about his experience of involvement.
The week’s highlight, though, was being invited to consult on plans to modify the alternate (nonrotating) doors at the southern main reception at Queen Alexandra Hospital.
Shocking, because as a disabled person I was treated as a professional, and I’d not even
complained about the doors! Eighteen months ago, I decided to be the first, and to that point, only
person to complain about how badly disabled visitors and patients are treated even before they
enter the hospital, ranging from long distances, poor signage and other concerns……..
I was most pleased to join a forum of user group reps earlier this year which met to prioritise which,
of 10 high-level groups of problems found, should be fixed first.
This is a major leap forwards, at least on a larger scale, because the NHS, and major hospitals,
have a somewhat mixed track record in treating disabled people…….To be invited to consult, and
be treated as a peer, not a patient, is a huge leap forwards. It is one thing being a professional
trained architect, but nothing beats experience.
5. Improving the experience of carers - achieved
Target: Improve communication between staff, carers and those cared for
In Q1 it was noted that carers advised they are unable to commit providing feedback using surveys
due to time constraints. As requested by carers, the Trust has sought feedback from a) local group
meetings and b) via the Portsmouth City Executive Board. Key areas for improvement have been
identified as:

Early identification of carers – both those new to the role and experienced carers

Recognition of the expertise of carers, and active involvement in communication and decisions
related to care and treatment of the person they care for.

Provision of information about support service available to them and the person they care for.
To address these concerns the Trust continues to work in partnership with Portsmouth City Council
to deliver the on-site carers service. A total of 181 Carers were identified in QA Hospital between
14
1st July - 30th September. 128 of these were new Portsmouth Carers. 14 of these were Hampshire
Carers who received information/advice and signposting to services in the local area. 39 of these
were known Portsmouth carers who went onto receive further information/advice, accessed the
break fund or had a new Sitting Service put in place. Only 13 carers identified declined all carers
support evidencing the need for this valuable support service.
6. Improving patient and carer experience of the discharge process - achieved
Target: Outline of outcomes of experience and changes made - Reporting only
The results of the Q1 volunteer led survey were reported to the Discharge Team and the key
themes included in the Discharge Planning Road Show held in September 2015.
In Q2 a further sample of 50 patients who had been discharged over a one week period were
contacted by volunteers and invited to participate; all responded. There were significant
improvements in patients being involved in decisions about their discharge, a reduction in delays at
the point of discharge and improvement in the services provided to support discharge. There was
an increase in the number of patients who reported a delay, in medication provision being the
cause of the delay.
An opportunity for additional comments with an open ended question was provided to allow for a
broader feedback opportunity. The full results have been reported to the Discharge Team and will
be used to inform further service changes.
Question
Did you feel involved in decisions about your
discharge from hospital?
Were you given enough notice about when you were
going to be discharged
Response
Yes definitely
Yes to some extent
No
Did not want to be
involved
Yes definitely
Q1
48%
28%
18%
Q2
58%
22%
20%
6%
0%
Yes, to some extent
24% 20%
No
20% 22%
56% 58%
On the day you left hospital, was your discharge Yes
delayed for any reason?
No
42% 32%
What was the main reason for the delay?
Medicines
29% 50%
How long was the delay?
19% 6.25%
Waiting to see Dr
Waiting
for 19% 12.5%
ambulance
33% 31.25%
Something else
27% 27%
Up to 1 hour
58% 68%
Between 1 and 2 13% 18.75%
hours
15
Question
Response
Q1
Between 2 and 4 20%
hours
Longer than 4 hours 40%
Were other services required to support your Yes
62%
discharge?
38%
No
Were there any problems with these services?
16%
Yes
Q2
25%
18.75%
36%
64%
8%
48% 34%
No
I did not need any 36% 46%
services
To supplement this feedback a review of FFT data during this period which referred to admissions,
discharge and transfers was completed. This identified 97 examples of feedback which included
reference to discharge. Whilst there were no negative reviews there was reference to some delays
in receiving medication and waiting for transport to go home.
7. Improving care for end of life patients and their relatives – partially achieved
Target: Evaluation of 2nd pilot and finalisation of required amendments, undertake relatives survey reporting only
The second phase of the launch of the Adult Priorities of Care (APOC) document included all
wards in the Medicine for Older People, Rehabilitation and Stroke and the Renal
Department. Education training and awareness events were provided for staff to prepare them for
the implementation.
Changes were made to the documentation in response to feedback.
Members of a local community engagement committee provided advice on the development of a
letter which is to be provided to families of patients at the end of life.
On the 14th September the PoC documentation was launched across all clinical inpatient areas.
Data will emerge regarding use, over the coming months. The Hospital Palliative Care Team
continues to support and promote the use of this important plan of care for patients who may be at
the end of life.
There has been a delay in the planned testing and implementation of the survey. A remedial plan is
being developed to ensure delivery in Q3.
8. Improving quality of care for adults with specialist mental health needs - achieved
Target: Assurance report on progress of 2 priority issues, staff training and KPIs- reporting only
Training
Sixty-two (62) members of staff have attended mental health awareness training provided by
specialist mental health practitioners. The programme aimed to improve staff understanding of the
issues facing and needs of people with specialist mental health needs. The programme was
16
developed based on areas identified as requiring improvement during the quality review 2014/15.
The evaluation was very positive with participants reporting significant progress and improved
capability in working with people with specialist mental health needs.
“It was a very informative snap shot of mental health, it has improved my understanding greatly”.
“Good to explore opportunities for joint working”.
“I learned a lot from this course which I was unsure of”.
“Excellent course content, enjoyable day, everybody got involved”.
Further training has been commissioned from an external provider commencing December 2015. A
total of 11 sessions are scheduled and evaluation will inform the development of a programme for
2016/17.
Key Performance Indicators (KPIs)
The Trust continues to work with the commissioners to develop of a set of KPIs which will help
determine how effective our internal improvement initiatives are.
Mental Health Service User Engagement
The Patient Engagement Strategy – Participation for Improvement is based on a principle of
inclusivity and a key aim is to further develop opportunities for people to provide feedback about
their hospital experience. It is recognised that the current feedback processes can make some
people feel vulnerable and therefore using outreach to well established community based groups
of mental health service users has been agreed. Commencing November 2015, the trust will be
working with the SHIFT group in Portsmouth. Using a workshop approach the aim is to identify the
key issues that matter most too mental service users when accessing general hospital services
locally.
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9. Mixed Sex Accommodation (National target and Contract) – Achieved
There were no mixed sex breaches in this quarter.
10. Voluntary Services
Target: Nil – for information only
From helping our patients navigating our hospital buildings, to delivering information leaflets and
helping feed patients, our volunteers provide support to patients, families and carers and visitors to
the Trust. Currently we have 800 active volunteers and are recruiting 35 – 40 people each month,
of all ages and backgrounds. We are actively seeking volunteers who represent the whole local
community and will ensure that any reasonable adjustment be made to support a person with a
disability join the team.
Dementia Volunteers
Being in hospital can be disorientating, confusing
and distressing for any patient. For those with
dementia
who
may
not
remember
or
fully
understand where they are, or why, it can have a
devastating effect. With demographic changes we
are seeing an ever increasing number of patients
with dementia and more of these will be living alone
at a distance from family support.
The Trust is establishing a group of Dementia
Volunteers after a successful pilot led by one of our volunteers, John. Dementia volunteers are
trained and supported to provide the person with dementia with individual attention purely focussed
on meeting their social needs. Taking the time to get to know each patient the volunteers will be
focussed on providing companionship and conversation, joining in with and encouraging activities
and providing assistance at mealtimes to make them pleasant and sociable.
Dementia volunteers will undertake specific dementia related training in addition to the standard
training provided to all trust volunteers. This will clarify the nature and boundaries of the role and
will include information about Dementia and delirium, communication skills, managing behaviour
that challenges and supporting patients to eat and drink.
We are aiming high, with a hope to have up to 300 dementia volunteers in the future. The first
group of 15 will start training this month.
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11. Conclusion
Over 10,000 patients gave us valuable feedback using the Friends and Family Test (FFT) between
July and September. About 95% told us that they were happy with their care and would
recommend the Trust to others. We acknowledge that we need to continue to improve the number
of people who respond to our request for feedback and have plans in place to do this. We have
looked at those responses that said they would not recommend the hospital to try and understand
why. Communication and waiting are the key things people have told us we need to improve. We
now have a better understanding of what matter most to our patients, their families and carers and
are working to make small but significant changes to improve their experience.
We have actively involved people in service changes and developments, including the new way
finding system, the design of ward information boards and the development of an event to raise
staff awareness of the needs of carers. New and innovative approaches to patient and public
involvement support our aim of ensuring patients and their families are at the centre of everything
we do.
Our work with partners from mental health services will enable us to provide a more positive
experience of care for people with specialist mental health needs. We will continue to explore how
we can encourage people to feed back about their experience.
As a Trust we have faced major challenges in the both the number of patients requiring care and
treatment and the seriousness of their illnesses. It is increasingly important that at these times, we
understand the experience of the people using our services. The following recommendations will
ensure that there continues to be a focus on the collection of feedback and prompt action to
improve aspects of care and treatment that matter most to patients, their families and carers.
12. Recommendations
1. Clinical Service Centers will develop and implement plans to deliver an improved response rate
for Friends and Family Test to ensure that there is a robust measurement of patient
experience.
2. The Patient Experience Steering Group will use the outcomes of the review, FFT and
complaints and PALS to identify priorities for the remainder of 2015/16.
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