Yorkshire Patient Experience Toolkit
Coaches’ Network Celebration: 1 year on
NHS Horizons, Leeds
Friday 6th December 2019
[email protected] / 01274 383966 www.improvementacademy.org
Welcome and introductions
Beverley Slater Director
Yorkshire & Humber Improvement Academy
Housekeeping
Tweet whilst you’re here!
#PatientExperienceToolkit
How was your journey today?
Programme
A year of the coaches network
Laura Proctor
Project Manager
Improvement Academy
The PET coaches network a year on….
1.Opportunities to connect with other coaches
2.Opportunities for training & support
3.Access to online resources
Q. What do you want from the Coaches Network?
The PET coaches network a year on….
Navigating the website
• https://www.improvementacademy.org/tools
-and-resources/the-yorkshire-patient-
experience-toolkit.html
• https://www.improvementacademy.org/our-
networks/patient-experience-coaches-
network.html
There is one page about PET and its development:
There is another page about the coaches network and resources:
The PET coaches network a year on….. • Linking to Trust broader QI initiatives in some instances (e.g. Mid Yorks,
LCHT). (Involvement of senior managers, benefits)
• Newsletter
• Development of PET leaflet
• Development of toolkit - staff experiences
Q.1 What has been your experience of working on this ward?
Q.2 Is there anything that is not quite as you would like?
Q.3 Is there anything that would make your role better?
Q.4 Any other comments?
• Supporting volunteers
The facilitator is key to the entire PET process
and the success of making changes
As a result one-to-one support developing
Developing the coaches role
Patient Experience:
a changing policy landscape
Claire Marsh
Patient & Public Engagement Lead
Improvement Academy
Latest research
A Sheard, L. ‘Understanding and enhancing how hospital staff learn from and act on patient
experience data’ (estimated publication Sept 2019)
B Weich, S. ‘Evaluating the Use of Patient Experience Data to Improve the Quality of Inpatient
Mental Health Care’ (estimated publication March 2020)
C Donetto, S. ‘ This study identified five key themes that helped explain how patient
experience data work could lead to quality improvements in acute hospital trusts’(published
October 2019)
D Locock, L. ‘Understanding how frontline staff use patient experience data for service
improvement – an exploratory case study evaluation and national survey’ (estimated
publicatione 2019)
E Powell, J. ‘Improving NHS Quality Using Internet Ratings and Experiences (INQUIRE)’
(estimated publication January 2020)
F Sanders, M. ‘Enhancing the credibility, usefulness and relevance of patient experience data
in services for people with long-term physical and mental health conditions using digital
data capture and improved analysis of narrative data’ (estimated publication January 2020)
G Rivas, C. PRESENT: Patient Reported Experience Survey Engineering of Natural Text:
developing practical automated analysis and dashboard representations of cancer survey
free text answers (published July 2019)
H Burt, J. Improving patient experience in primary care: a multimethod programme of
research on the measurement and improvement of patient experience (published May 2017)
I Graham An evaluation of a near real-time survey for improving patients’ experiences of the
relational aspects of care: a mixed-methods evaluation (published March 2018)
Preview • Embrace all forms of feedback
• Not all data for improvement needs to be ‘hard’, valid, representative
– narrative feedback inspires improvement
• Should not try to triangulate all different types - they are different
• Draw learning from positive feedback
• Presenting some data to staff (on relational experience) is complex.
• Leaders need to give staff the authority and resources to act
• Facilitators can help decide what action to take
• Engaging staff and patients in co design helps sustainability
• Online feedback is a growing field, but staff often don’t have the
systems or know-how to respond
Published evidence for facilitation & skills development
Health Expect. 2019 Feb;22(1):46-53. doi: 10.1111/hex.12829. Epub 2018 Sep 22.
Putting evidence into practice
• A partnership approach
• Reviewing & developing the coaches network for
continued support in Yorkshire & Humber
+
Reflections from coaches – part 1
Heather Thrippleton
Tamsyn Wright
Leeds Community Healthcare
Children’s Nursing Service
• Context – With which teams/services have you used PET
and how did this come about?
• Your role – What has your main role been and who have you
worked with?
• Added value – What benefits have you seen through using
PET e.g. patients, staff, trust, team, you?
• Lessons learnt – How has PET added to your understanding
of patient experience and its relation to staff?
• What next – How would you like to develop this work?
Children Community Nursing Service: Supportive, professional, lovely, communicative,
valued, lifeline
The service is a lifeline because..... Of the relentless nature of caring within the family
Carers/parents often puts themselves in the position of protector/defender due to
high anxiety
Parents and families view the service as a lifeline and are really appreciative of the
service and staff - fabulous, listening, professional, kind, supportive
It "Keeps our family intact” The staff are appreciated and valued, they are a God
send
The families' homes can therefore be highly emotive, high-stress environments, presenting very complex needs for support from the service including psychological as well practical.
Families seek clarity on service provision.... Care plan isn’t always used to enable a consistent approach to the child's care and
this can therefore undermine confidence
More clarity about service provision would be helpful to patients/carers; What can
staff do when visiting? Can they take my child out? Who gives medical care? Can
they play with my child?
Continuity and consistency in approach is very important to parents and to
children who respond well to particular people/approaches, -but inconsistency can
lead to lack of confidence in the service
Positive relationships built on trust & openness are
fundamental The way in which families are informed of changes to service provision (e.g.
reductions in care input) is important and can cause upset if there is no warning or chance to discuss implications
Trusting relationships are evident and are really valued
Feeling involved and listened to is so important to families and can allay the fears
that families have and build their confidence in the service.
Enhancing flexibility in communication approaches (understanding children's
needs, e.g. Makaton) could be helpful
Point of contact for addressing queries not always clear to families but makes a
massive difference when it's working well
The limitations of resources & funding cause
anxieties….
Worries about the future and the changing needs of the child (especially post 18
yrs.) Who to ask about this? How to cope with implications?
Flexibility in care rotas that respond to family’s needs is really appreciated; not
losing rota'd care hours when they clash with other family commitments.
Information and signposting really appreciated; e.g. Peer support groups and
Direct Payments/PHBs are often poorly understood.
The service is a lifeline because.....
Of the relentless nature of caring within the family
Carers/parents often puts themselves in the position of protector/defender
due to high anxiety
Parents and families view the service as a lifeline and are really appreciative of
the service and staff - fabulous, listening, professional, kind, supportive
It "Keeps our family intact” The staff are appreciated and valued, they are a
God send
The families' homes can therefore be highly emotive, high-stress environments, presenting very complex needs for support from the service including psychological as well practical.
Families seek clarity on service provision....
Care plan isn’t always used to enable a consistent approach to the child's
care and this can therefore undermine confidence
More clarity about service provision would be helpful to patients/carers;
What can staff do when visiting? Can they take my child out? Who gives
medical care? Can they play with my child?
Continuity and consistency in approach is very important to parents and to
children who respond well to particular people/approaches, -but
inconsistency can lead to lack of confidence in the service
Positive relationships built on trust & openness are fundamental
The way in which families are informed of changes to service provision (e.g.
reductions in care input) is important and can cause upset if there is no warning or chance to discuss implications.
Trusting relationships are evident and are really valued
Feeling involved and listened to is so important to families and can allay the fears
that families have and build their confidence in the service.
Enhancing flexibility in communication approaches (understanding children's
needs, e.g. Makaton) could be helpful
Point of contact for addressing queries not always clear to families but makes a
massive difference when it's working well
The limitations of resources & funding cause anxieties….
Worries about the future and the changing needs of the child (especially
post 18 yrs.) Who to ask about this? How to cope with implications?
Flexibility in care rotas that respond to family’s needs is really appreciated;
not losing rota'd care hours when they clash with other family
commitments.
Information and signposting really appreciated; e.g. Peer support groups
and Direct Payments/PHBs are often poorly understood.
Any Questions?
Thank you
Tamsyn Wright , The Mid Yorkshire Hospitals NHS Trust
Began a project using the YPET with support from the Improvement Academy after the unit had been agreed to carry out a staff culture survey project.
Conversations with staff and Improvement Academy re. value of speaking to staff about how they find working on the Unit.
Wide range of staff: Nursing staff – Nurses, Healthcare Assistants
Therapists – OT and Physio
Medical Staff
Pharmacists
Volunteers
Domestic support
Patient admission purpose:
Reviewed FFT feedback
Interviewed patients using YPET structure:
IA developed questions to frame conversations with staff
Supported in carrying out staff interviews – Liaison with Nurse Unit Manager
Challenges – time/availability
Patients and staff were grateful to have the time to ‘offload’ and express how they were feeling
Linking themes and topics show similar and additional themes
Potential added value of early engagement of staff in looking at potential improvements – even if bigger problems can’t be resolved
*Waiting*
*Busy Staff*
*Therapy time*
*Not enough staff*
*Emotional impact*
*Sitting out/TV/dining room*
*Nursing staff listen*
*Hard working*
*Volunteers*
*Caring*
*Kind*
STAFF QUESTIONS:
• What has been your experience
of working on this ward?
• Is there anything that is not
quite as you would like?
• Is there anything that would
make your role better?
• Any other comments?
*Busier*
*Less Staff*
*Low morale*
*Patient safety *
*External factors*
*Senior management*
*Moving wards*
*Team work*
*Prioritise patient care*
*Loyalty*
WHAT’S NEXT? • Continue with YPET steps– merging themes and topics into delivery of feedback
to interested staff identify improvements/issues to escalate…
• ?Opportunity to involve patients in further stages co-production….
• Gain stronger support from Senior Corporate Nursing Team re. value of YPET.
“Despite the volumes of data being collected, most of it does not scratch the surface of telling the patient story or capturing the experience of the teams that are at the front lines of patient care.” IHI Multimedia Team (2019).
“…Very quickly, it became apparent that the care team, patients, and family shared similar values and
reported similar struggles” IHI Multimedia Team (2019).
“…Without safe staffing levels in place, nursing staff are struggling to provide patients with the safe
and effective care they would like to, and which patients deserve. In England there is no law related to
nurse staffing. The RCN is campaigning for legislation to guarantee nurse staffing levels in England across all
sectors and settings” Royal College of Nursing (2019).
“There is evidence that the quality of patients’ experience is closely related to staff experience – happy staff
make happy patients” Raleigh et al (2009).
“…effective managerial support, good working conditions and positive staff morale are essential steps
towards providing a good-quality experience for patients. Monitoring patients’ experience via regular
surveys is also necessary, but not sufficient, to ensure that services are truly patient-centred. This needs to be
supplemented by other ways of ensuring that staff focus on patients’ needs. The ability to view services
through patients’ eyes should be the starting point for any quality improvement programme” Coulter, A. (2012) .
“Feeling low, anxious or angry, or not being able to control your emotions are all very common after a
stroke, especially in the first few months” Stroke Association (2018).
Coulter, A. (2012) Leadership for Patient Engagement. The King’s Fund, London
IHI Multimedia Team. (2019) Co-Designing an Environment Where Patients and Staff Thrive. http://www.ihi.org/communities/blogs/co-designing-an-environment-where-patients-and-staff-thrive
Raleigh VS, Hussey D, Seccombe I, Qi R (2009). ‘Do associations between staff and inpatient feedback have the potential for improving patient experience? An analysis of surveys in NHS acute trusts in England’. Qual Saf Health Care, vol 18, pp 347–54
Royal College of Nursing (2019) Safe staffing campaign. https://www.rcn.org.uk/employment-and-pay/safe-staffing
Stroke Association (2018) A complete guide to emotional changes after a stroke [online] https://www.stroke.org.uk/sites/default/files/user_profile/a_complete_guide_to_emotional_changes_after_stroke.pdf
Break
Reflections from coaches – part 2
Lorna Dunshire
Mandy Dawley
Using PET in mental health settings
Lorna Dunsire (Lead Occupational Therapist)
Acute Mental Health Services,
Bradford District Care NHS Foundation Trust
The importance of Service user involvement work
• Occupational Therapists: promoting positive experiences and active involvement
• Past experiences of service development / value peer support workers
• Desire to improve services • Power of patient’s subjective
experience
Different hospitals, different demographics: just as
effective The Yorkshire Patient Experience toolkit has been really effective in facilitating service user involvement groups across the two sites, despite the differences.
Things to consider when facilitating YPET in mental health services
• Accessibility
• Advertising
• Peer support
• Facilitation
• Open, safe space to speak
• ‘Ground rules’ to keep it a ‘safe space’
• Environment
• Meaningful and purposeful
Added Value: What the Yorkshire Patient Experience Toolkit brings to
Mental Health services
• Helping service users to feel listened to and understood
• Creating a forum to facilitate change • Empowering staff care and create
lasting change • Ownership and accountability • Sense of achievement • True person-centred care • Focus on theming • Support to stay focused (thank you
Laura and Claire!)
Lessons learnt
• The information gathered can be rich, powerful and sometimes difficult and of a sensitive nature
• Importance of how to feedback to staff
• Leadership and empowering teams • If an initiative isn’t owned, it won’t
have the same meaning, momentum or influence
• Staff feeling told off/ told what to do / blamed
• Staff morale, involvement and sense of achievement
What next?
• Theming! Lots of themes – processing rich information
• Staff focus groups - how our teams respond to the feedback
• Supporting and trusting our staff to make positive changes
• New projects responding to feedback – inspiring and encouraging leadership at all levels
Caring, Learning and Growing
Humbernhsft
www.humber.nhs.uk
Linking the Patient Experience Toolkit
to other Frameworks
Mandy Dawley Head of Patient and Carer Experience and Engagement
Context
• Initial Scoping Exercise to determine:
– Which teams are involved in Quality Improvement initiatives including patients, service users and carers
– Which methodologies are currently being used
• Where Quality Improvement initiatives identified, to look at using the Patient Experience Toolkit (PET) as well as other tools and techniques
Caring, Learning and Growing
Role and Responsibilities
• Strategic Lead for ensuring the patient, service user and carer
voice is heard
• To identify the best way to apply the PET in the Trust from a strategic and operational perspective
• To market the PET across teams as another way to identify and implement quality improvement initiatives
– Regional Coaches Network
– Quality Improvement Forum (June 2019)
– Humber Centre
• To support services with the implementation of the PET framework
• To host the Regional PET Coaches Network
Caring, Learning and Growing
Links to other Tools
Caring, Learning and Growing
Step 1 - Collaboration Patient Council Patient and Carer Experience Forums Scoping Exercise
Step 2 – Gathering Feedback
Emotion Mapping Surveys Workshops Other Feedback sources
Step 3 – Making Sense Always Events©: Plan, Do, Study, Act (PDSA) Cycles
Step 4 – Team priorities
Step 5 – Making a Change
Step 6 - Review
Impact vs Ease for Implementation
IMPA
CT
EASE low high
high
Additional Fruit to Ward
Menu Planning
Relationships /Culture
Lessons Learnt
• Maintaining momentum – Can be difficult: It is important to engage the right staff
(innovators)
• Don’t over complicate your existing approach – We have tailored the PET to enhance our existing patient
experience and QI approach so as not to overwhelm staff
• One size does not fit all – It’s useful to have a menu of methodologies, tools and
techniques that complement each other
Caring, Learning and Growing
What Next?
• Strategic Direction
– To work towards embedding the PET within the Trust’s Quality Improvement Approach (2018 to 2020) and the Patient and Carer Experience Strategy (2018 to 2023) priorities
• Operational Direction
– To ensure the PET is made available to all staff involved in a Quality Improvement initiative
Caring, Learning and Growing
What Next?
Caring, Learning and Growing
Mandy Dawley
Head of Patient and Carer Experience and Engagement
Website: https://www.humber.nhs.uk/
Caring, Learning and Growing
Contact us
Lunch
Evaluation findings
Luke Budworth
Research Fellow
Bradford Institute for Health Research
Evaluation • Research questions around:
• Barriers / different approaches / networks & spread
• Methods:
• Participants were recruited via advertisement emails to all members of the coaches’ network.
• Simple online survey questionnaire (SurveyMonkey) for basic info on PET use progress, barriers, spread, engagement and sample characteristics.
• Semi-structured telephone interviews were used to gain more in-depth data.
• 11 surveys ; 7 interviews
• Insights & reflections from the field – Claire & Laura
The Coaches Network: lovely document, easy to follow but……
….it’s hard to get started
Lots of attendance at early meetings but uncertainty about where to begin and what first
steps to take – ‘who will collect feedback?’ ‘what departments will engage?’ how can
feedback be analysed?’ ‘does this fit with my organisational strategy for patient experience?’ ‘what about other systems such as FFT?’ ‘how can I engage frontline teams who have a busy workload? It has to appear valuable to them’
One-to-one support more effective than groups
Attendance at groups starting to tail-off. On-the-ground support to get started has
energised teams (e.g. help to collect feedback; help speaking to colleagues; help theming & presenting feedback) ‘support in theming has been invaluable’. ‘Maybe the meetings will be
more valuable once further along in the process’
Is it OK to focus effort on qualitative feedback? Collection of survey data & FFT still takes
precedence and can make it difficult to find time for PET. It is not always clear how PET can
fit in as it will never provide cross-organisational data: is this OK?
It can be daunting collecting open-ended feedback instead of closed survey questions.
Collecting and analysing qualitative data is more intensive and requires more skill
and organisation.
Network resources are not yet fully utilised by coaches
The resources on the website are not regularly accessed and more could be provided on the
site (e.g. meeting notes). Few responses to the invites to coaches to request support from
Laura/Claire. Perception that the document and resources are not always as freely available
as would like. Perhaps the website could be improved to aid navigation or have other
features like a forum.
What next for the network in 2020?
Table exercise: How would you
like to see Patient Experience
improvement work develop in
your Trust?
Table exercise: If you had a
blank sheet of paper how would
you like your PET coaches role
to develop?
Table exercise: What support do
you need from the PET Coaches
Network in 2020?
Thank you for attending Please complete the evaluation form in your pack,
and return your badges before leaving
Contact Details
@Improve_Academy
@ImprovementAcademy
www.improvementacademy.org
t: 01274 383966