SBAR Report
Using Patient Stories at Grampian NHS Board
Situation
Grampian NHS Board has been “hearing” patient stories for approximately
two years. Whilst there is general acceptance that this is a good thing, the
purpose, influence and value of hearing these stories has not been clearly
identified. In order to inform the future use of patient and possibly staff stories
at NHS Grampian Board meetings, Board members were asked to complete
an on-line evaluation of the usefulness of stories heard to date.
Background
The NHS Confederation and the then National Patient Safety Agency
produced a fact sheet in June 2010 entitled “Questions are the answer:
putting patients and the public back into patient safety”. The fact sheet poses,
amongst others, the following questions to Board members:




Are our Board meetings held largely in public?
Do we regularly hear patients’ stories?
Do our directors meet with patients?
Do we receive regular feedback from patients about the standard of
care we are delivering?
The fact sheet goes on to explain the purpose of board members hearing
stories:
The Francis Inquiry Report (2010) stated, “Perhaps most importantly
representative stories hardly ever reached directors.”
Patient stories have now been heard at Grampian NHS Board meetings for
approximately 2 years, but how are they being used?
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The literature in this area makes reference to using stories of poor care and to
how hearing stories provides the opportunity to relate these stories to how an
organisation:




Undertakes Root Cause Analysis
Manages incidents and complaints
Applies “Being Open” policy
Approaches and develops an open and fair culture.
This can only be achieved through listening to stories of what happens when
things go wrong in healthcare. When we ask patients to tell us about their
experiences important quality, safety and effectiveness issues are also
revealed.
A recent press release from the Medical Protection Society declared that:
“Patient experience is the smoke detector of patient safety”
2012
Assessment
Fifteen Board members responded to a Survey Monkey questionnaire about
how we use patent stories at Grampian NHS Board meetings. The results
were as follows:
1. How many patient stories have you listened to at board
meetings?
60%
55%
50%
45%
40%
35%
% 30%
25%
20%
15%
10%
5%
0%
None
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2
3
4
more than 4
More than 50% of respondents have heard at least four stories.
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2. Hearing patient stories at board meetings helps
me to carry out my role as a board member
50%
45%
40%
35%
30%
% 25%
20%
15%
10%
5%
0%
Strongly agree
Agree
Not sure
Disagree
Strongly
disagree
Over 70% of respondents think that hearing patient stories helps them to carry
out their roles.
3. Hearing patient stories at board meetings
connects me to the organization's purpose
60%
50%
40%
% 30%
20%
10%
0%
Strongly agree
Agree
Not sure
Disagree
Strongly disagree
Over 80% of respondents feel that hearing stories helps them stay connected
to the organisation’s purpose.
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4. Patient stories should feature at every board meeting
50%
45%
40%
35%
30%
% 25%
20%
15%
10%
5%
0%
Strongly agree
Agree
Not sure
Disagree
Strongly
disagree
80% of respondents think that stories should be heard at every Board meeting.
5. I would like real patients and carers to
present their stores at board meetings
30%
25%
20%
% 15%
10%
5%
0%
Strongly agree
Agree
Not sure
Disagree
Strongly disagree
There is uncertainty as to whether or not real patients and carers should
attend Board meetings to tell their stories.
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6. Patient stories should be used at board meetings
to provide assurance of high quality care
60%
55%
50%
45%
40%
35%
% 30%
25%
20%
15%
10%
5%
0%
Strongly agree
Agree
Not sure
Disagree
Strongly disagree
The majority of respondents agreed that stories should be used to provide
assurance of high quality care.
7. Patient stories should be used at board meetings
to alert members to poor standards of care
50%
45%
40%
35%
30%
% 25%
20%
15%
10%
5%
0%
Strongly agree
Agree
Not sure
Disagree
Strongly disagree
The majority of respondents also agreed that stories should act as an alert to
poor standards of care.
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8. I think we should continue to hear patient stories at
board meetings
50%
45%
40%
35%
30%
% 25%
20%
15%
10%
5%
0%
Strongly agree
Agree
Not sure
Disagree
Strongly
disagree
There was an overwhelming majority in favour of continuing to hear patient
stories at Board meetings.
10. It would be helpful to hear about staff experiences
of delivering care at board meetings
70%
60%
50%
40%
%
30%
20%
10%
0%
Strongly agree
Agree
Not sure
Disagree
Strongly disagree
85% of respondents were in favour of hearing staff stories at Board meetings.
Question 9 asked:
What do you think the Board should do with the information contained
in patient stories?
The responses were:
They should be used in formal meetings and at development sessions, both to
demonstrate our willingness to be honest about good and bad practice and to
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enable learning to take place leading to change where change is seen to be
necessary. For this to happen we - Board members and the public - need to
see what impact the story had on NHS Grampian as a caring and listening
organisation. I would like to hear more stories from the young and the old,
arguably the most vulnerable and the age groups sadly at the centre of the
worst healthcare news stories of recent times. Also, it would be good to hear
more stories about how people's health and well-being changed for the better;
how it came about ; what role NHS Grampian played or did not play; what was
their own contribution and how they felt afterwards. I believe we need to find
ways of encouraging people to take charge of their own health and whether it
is smoking cessation, alcohol cessation/moderation or other health
improvement stories someone else's true story might be the encouragement
they need.
Link them to agenda items, either at the formal Board meetings or at Board
seminars.
Collect and keep for reference.
In every case feedback should be given to those services involved and
feedback to the patient as to the outcome of the Board discussion. The
information is and should be used for training purposes. There should be an
action plan agreed when there is an opportunity for continuous improvement
and outcomes should be reported and monitored. The Board should know
what difference is being made as a result of the presentation of the story.
The patient story should allow to understand from a patient perspective their
experience under our care. What would also be helpful would be to
understand what learning their is for us and how we are taking that forward
both positive and negative. My own view is that the patient story should not be
designed to focus on any particular aspect or provide assurance it should
simply be their story of their experience - there is nothing more powerful than
hearing from the ultimate user of our service - we should not seek to guide
how they tell their story
Make available to as many staff, the third sector and public as is reasonably
practical. In addition, build up a library of stories which can be accessed by
the above including prospective patients (viz. those involved in planned
care/chronic conditions.
Use as an educational tool more broadly.
Use these across the Board to help staff learn about patient perceptions of
good and bad care.
Consideration about use in relation to team brief.
Board should use the information as a means of supporting our "Listening,
Caring and Improving” strapline. Need to ensure there is follow up and
learning. Sharing of good practice is as important as learning from mistakes.
Ask for assurance that learning has been gained from the story (positive and
negative)
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I think that Board members should seek assurance through clinical
governance and staff governance arrangements that issues are being
addressed.
The only use of patient stories is if they highlight shortcomings or good
practice and that these have been acted upon by the executive to improve
overall standards.
Publicise
Recommendations
1. Continue to develop the use of “stories” at Board meetings.
2. Consider inviting patients to deliver their stories to the Board.
3. Request the Director of Nursing and Nurse Consultant Patient Safety
and Experience to develop an Action Plan to address the responses of
the survey.
4. Request the Director of Nursing and Nurse Consultant Patient Safety
and Experience to report other patient, carer and staff activity to the
Board eg Better Together results.
Linda E. Oldroyd
Nurse Consultant Patient Safety and Experience
Quality Governance and Risk Unit
NHS Grampian
16th May 2013
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