7.1 Patient Engagement and Experience Strategy - TB · Agreed a working definition of patient experience in October 2011 and published the NHS Patient Experience Framework. This framework

Paper 7.1

TRUST BOARD30th May 2013

TITLE Patient Engagement and Experience Strategy

EXECUTIVE SUMMARY The Patient Engagement and Experience Strategy is one ofthe enabling Strategies for the Quality, Safety and RiskManagement Strategy. This outlines the plan and direction forimproving the experience of patient and their families as theywork with the Trust to best use our services to get better andrecovery from illness.

BOARD ASSURANCE(RISK)/IMPLICATIONS

As an NHS Foundation Trust the needs of our members aswell as the users of the services are best served with a clearand accepted plan around patient engagement andexperience. Risks to achieving Strategic Objective one will bemanagement effectively if the elements of this strategy areimplemented reviewed and its impact evaluated.

STAKEHOLDER/PATIENT IMPACT ANDVIEWS

There was extensive consultation with all stakeholders on thisstrategy.

EQUALITY ANDDIVERSITY ISSUES

None identified

LEGAL ISSUES None identified

The Trust Board is askedto:

Approve the strategy.

Submitted by: Suzanne Rankin, Chief Nurse

Date: 24th May 2013

Decision: For Approval

Paper 7.1

13

The Patient

Engagement and

Experience Strategy

2013 – 2018

3

Contents

Section Page

Introduction 4

1. Background and Key Drivers 4

1.1 The national context 4

2. The vision for patient experience at

ASPH.

6

2.1 Local context 7

3. What are the enablers? 8

4. Future planning 12

Appendix 1 – Key Performance Indicators 13

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Patient experience is integral to quality healthcare provision.

Introduction

It is the vision of ASPH to be a top performing Trust nationally in key measures of patientexperience and satisfaction, achieving this by working in partnership with our staff, patients andtheir families and carers. This paper will explore the current national and local approaches toimproving patient experience and describes how this has influenced the vision for improvingpatient experience at Ashford and St Peter’s Hospitals over the next five years.

This paper follows the Quality, Safety and Risk Management Strategy, 2012 - 2017 for Ashfordand St Peter’s Hospitals NHS Foundation Trust (ASPH) and will describe the strategy forimproving Patient Experience in our hospitals over a five year period. This paper will respond tothree key questions:

What are the key drivers for improving patient experience at ASPH? What is the vision for patient experience at ASPH? What are the enablers?

1. Background and key drivers?

1.1 The national context.

The NHS Operating Framework 2012/13:

States that the NHS should collect and use patient experience information in real time and useit for service improvements: "NHS organisations must actively seek out, respond positively andimprove services in line with patient feedback. This includes acting on complaints, patientcomments, local and national surveys and results from 'real time' data techniques".

The NHS Outcomes Framework:

Encourages culture and behaviour change related to improvement. Domain four of thisframework focuses on ensuring that people have a positive experience of care.

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The NHS National Quality Board (NQB)

Agreed a working definition of patient experience in October 2011 and published the NHS Patient

Experience Framework. This framework outlines those elements which are critical to the patients'

experience of NHS Services:

1. Respect of patient-centred values, preferences, and expressed needs2. Coordination and integration of care3. Information, communication, and education4. Physical comfort5. Emotional support6. Welcoming the involvement of family and friends7. Transition and continuity8. Access to care

NICE Quality Standards:

In February 2012 NICE recommended a Quality Standard for patient experience in adult NHSservices in England (QS 15, 2012). The standard sets out clear components of patientexperience in 14 statements:

1. Patients are treated with dignity, kindness, compassion, courtesy, respect,understanding and honesty.

2. Patients experience effective interactions with staff who have demonstratedcompetency in relevant communication skills.

3. Patients are introduced to all healthcare professionals involved in their care, and aremade aware of the roles and responsibilities of the members of the healthcare team.

4. Patients have opportunities to discuss their health beliefs, concerns and preferences toinform their individualised care.

5. Patients are supported by healthcare professionals to understand relevant treatmentoptions, including benefits, risks and potential consequences.

6. Patients are actively involved in shared decision making and supported by healthcareprofessionals to make fully informed choices about investigations, treatment and carethat reflect what is important to them.

7. Patients are made aware that they have the right to choose, accept or decline treatmentand these decisions are respected and supported.

8. Patients are made aware that they can ask for a second opinion.

9. Patients experience care that is tailored to their needs and personal preferences, takinginto account their circumstances, their ability to access services and their coexistingconditions.

10. Patients have their physical and psychological needs regularly assessed andaddressed, including nutrition, hydration, pain relief, personal hygiene and anxiety.

11. Patients experience continuity of care delivered, whenever possible, by the samehealthcare professional or team throughout a single episode of care.

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12. Patients experience coordinated care with clear and accurate information exchangebetween relevant health and social care professionals.

13. Patients' preferences for sharing information with their partner, family members and/orcarers are established, respected and reviewed throughout their care.

14. Patients are made aware of who to contact, how to contact them and when to makecontact about their ongoing healthcare needs.

The NHS Commission Board:

Sets out guidance for the commissioning for quality and innovation (CQUIN). For 2013/14 thegoal to improve patient experience in line with Domain 4 of the NHS Outcomes Framework willfocus on delivery of the Friends and Family Test, in order to provide timely, granular feedbackfrom patients about their experience.

The NHS Constitution:

Commits the Government to providing a statement of NHS accountability. Key elements of thiscommitment are:

Empowering patients and public Empowering and valuing staff Creating shared purpose, values and principles

The NHS Constitution sets out the right of patients to be involved in and make choices abouthealth care.

The final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry:

Recommendations stress the importance of listening to patients and effective complaintshandling. Action planning resulting from the Strategy will take account of any recommendationscoming from the Trust response to the Francis Report.

2 . The vision for patient experience at ASPH:

Ashford and St. Peter’s Hospitals NHS Foundation Trust (ASPH) is passionate about improvingthe experience of our patients, their relatives and carers. It is therefore the vision of ASPH tobe a top performing Trust nationally in key measures of patient experience and satisfaction,achieving this by working in partnership with our staff, patients and their families and carers.

The Trust is committed to deliver excellent Patient Experience in line with NICE guidance.

The Trust’s vision to be one of the best healthcare providers in the country is underpinned bythe core values of the organisation:

Patients First

Personal Responsibility

Pride in our Team

Passion for Excellence

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As a key step in implementing these values the Trust set up a series of ”Living our Values”workshops. These workshops are designed for the participants to examine the Trust’s sharedvalues in more detail and to listen to patients, relatives and carers share their experiences andtell their stories. In 2012, more than 2,800 (86%) of ASPH employees attended Living ourValues workshops.

It is important that the Trust build on the Living our Values programme. This strategy is anenabler of this ambition and, in addition will work to embed a culture of actively andcontinuously seeking and considering patient feedback in order to improve patient experience.

The commitment to realising this vision is highlighted in the Trust Quality Safety and RiskManagement Strategy which sets out the Trust’s goal to show Pride in our Team by ensuringthe processes and structures are in place to enable the Workforce, patients and carers to workin partnership.”

2.1 Local context

Involvement – Creating a Patientforce

The Trust has a long history of patient involvement and currently has a Patient Panel and aGovernors’ Patient Experience Group.

Patients, carers or relatives are regularly invited to tell their story to Board and this has provedinvaluable opportunities for learning and improvement.

Patients were involved in the Living our Values workshops, sharing their experiences bothgood and poor and inspiring staff to consider what they can do to make a difference to patientexperience.

•Improved ClinicalOutcomes - LIPS

•MortalityImprovements

•Initiatives

•GovernanceFramework

•Risk Management•Patient Experienceand Engagement

•Individual Leaders•Capabilities•Safety-positiveCulture

•One of the best•Planning•OperationalQuality

Strategy, Visionand Purpose

Leadership,Capabilities and

Culture

Measurement,Analysis andAssurance

Processes,Structures andEngagement

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Since September 2012 a patient story DVD is presented at monthly staff induction

There are a number of groups, involving patients in a variety of ways, which are hosted bySpecialities across the Trust. Thus creating a Patientforce.

Patient feedback

Net Promoter Score and Friends and Family TestSince 2011 the Trust has been collecting a measure of patient satisfaction – the Net PromoterScore (NPS) which had been reported monthly. However there was variation across the wardsand specialties in the number of returns, resulting in the limitation of reporting to divisionallevel.

In line with Government guidance this will be replaced by the Friends and Family Test. Workhas already started to ensure the Trust is able to respond to the DH requirements for this byMarch 31 2013.

National Patient SurveysThe Trust continues to commission a variety of National Patient Surveys for in and out patientsas well as maternity and cancer services. Workshops to explore the data are held with key staffand divisions develop action plans aimed at improvement. Divisions report progress againstactions to the Clinical Governance Committee.

Living our Values and Board storiesFollowing the Living our Values programme there has been an increase of face to face patientfeedback. This is an approach that the Board has taken up and, as mentioned earlier, eachmonth a patient, carer or relative attends Trust Board to tell their story. There is some variabilityin the uptake of this approach across the Divisions.

Complaints and PALSThe handling of complaints is devolved to the Divisions and following an internallycommissioned audit of the complaints process, the need for tighter central control andincreased clinical engagement have been identified. In line with the Auditors’ recommendationsthere is continued development of mechanisms and processes to support the devolved processand to provide an assurance to complainants and the Board of high quality complaintshandling.

The Trust collates quantitative and qualitative information from formal complaints and PALS(Patient Advice and Liaison Service), which are reported both monthly and quarterly for avariety of Trust committees and groups, including the Complaints Monitoring Group (CMG), theQuality Governance Committee (QGC) and Trust Board.

Performance ReportingSince July 2012 a Patient Experience Dashboard has provided a single page report atdivisional level on key patient experience measures, such as PALS, Complaints, NPS andtimeliness of response to complaints.

Using patient feedback for improving patient experience

Divisions report action plans for all grade three and four complaints to the CMG and QGC.Whilst there has been some success in reducing specific issues, for example complaintsrelating to discharge, it is clear that other recurring issues and themes remain a cause ofconcern and complaint.

Whilst individual areas have made local improvements following patient feedback, there isvariability and a greater scope sharing good practice and learning.

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Some progress in reducing specific issues (e.g in relation to discharge) of concerns howeverrecurring themes and issues remain

3 What are the enablers?

To bring to life the Trust vision to be a top performer in key measures of patient experience andsatisfaction we will:

Build on the successes and learning from the Living our Values programme and theensuing Valuing Frontline Feedback, commenced following an award from the NHSInstitute for Excellence and Innovation. This project has a focus on supporting teams toactively seek patient feedback and use it to improve patient experience.

Seek to develop a closer understanding of the relationship between staff and patientexperience and to support staff, patients and their carers to work in partnership toimprove patient experience.

Work with patients, patient groups and stakeholders to unify the purpose of ourinvolvement and engagement activities aimed at improving patient experience.

Maintain an up to date knowledge of national guidance, current and cutting edgeapproaches to improving patient experience, ensuring this knowledge is shared acrossthe Trust and the necessary mechanisms, processes and materials are in place tosupport and skill leaders, so that they can lead in improving patient experience.

Inspire staff at all levels to see patient feedback this as relevant to the improvement ofthe care and services we offer our patients.

Take a whole pathway focus involving key stakeholders, including Surrey CountyCouncil, ambulance services, community health care providers, local voluntary andcommunity organisations.

The strategy will be enabled by an improvement approach to ensure we use patient feedbackand involvement to improve services:

Collect feedback

There will be a systematic and rigorous collection of patient feedback. Using multiplemethodologies to ensure all patients have the opportunity to provide feedback about theirexperience.

Listen and understand

All types patient feedback will be considered, from Ward to Board in order to identify gaps andrecurring themes and to provide robust evidence for change.

Act to Improve

We will work in partnership with patients and carers to improve service, ensuring staff andpatient have the skills, materials and opportunities to do so.

Measure and Disseminate

We will celebrate evidence of improvement from patient feedback and share as best practiceacross the organisation. Share successes with patients and key stakeholders.

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Opportunities for feedback

Support and facilitate multiple opportunities for involving staff, patients and volunteers inseeking and collecting patient feedback

Provision of multiple resources and materials, including technological solutions to supportdivisions in capturing and utilising real time feedback.

This will include the Friends and Family Test, Patient Experience CQUIN measures and theuse of bespoke patient experience surveys and audits to test the efficacy of improvementactions.

PALS and Complaints

Provide a streamlined approach to responding to and handling concerns and complaintsacross the Trust and within the Patient Experience Team.

Ensure data from PALS and complaints are captured and accurately recorded.

National Surveys

Continue to commission inpatient, outpatient, maternity and cancer services. Continuouslyreview the value of each survey and consider commissioning further surveys as serviceschange and develop.

External sources

Capture negative and positive feedback and recommendations on NHS Choices/PatientOpinion websites.

Maximise the opportunities for working with Health Watch, NHS Choices and PatientOpinion to improve patient experience.

To further explore issues that can cause patients to detract, promote or complaint aboutservices a range of methods can be used. We can use these methods as opportunities forunderstanding more about a range of factors (cultural, spiritual, social, psychological andphysical) that can influence patient experience. We want to continue to explore the touchpointsbetween patient and staff experience throughout the patient pathway.

Complaints

Commission annual content analysis of formal complaint letters to draw out key issues andto inform improvement in capturing issues at an early stage.

Increase the involvement of complainants in both the resolution process and improvementactivities.

Friends and Family – follow up question

Gives patients the opportunity to say why they scored as they did. Provide frequent reports from Ward to Board in a user friendly format to support

improvement activity.

COLLECTION – a quantitativeapproach

LISTEN AND UNDERSTAND – aqualitative approach

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Patient stories

Build on the use of patient stories to inspire staff, from Ward to Board to make sustainableimprovements to services. Support Divisions in utilising this rich source of feedback andpowerful influence for behaviour and culture change.

Patient diaries

Provides an opportunity for ward managers to engage with patients about their experienceand make improvements real time.

Focus groups

Led by trained facilitators these sessions are helpful when we need to explore views andopinions about a service in more detail.

Local patient and carer groups

Increase engagement and involvement activities with these groups to explore ways ofworking together to capture patient feedback and to inform service improvement.

Patient representatives

Develop a unified purpose in support of improving patient experience.

Knowledge and skills

Provide resources and training for staff, volunteers and patients engaged in activities aimedat improving patient experience.

We will use the themes that emerge during the first two stages, from Ward (and all patientfacing areas) to Board to identify opportunities for improvement. Some feedback will drive rapidand simple improvement actions, other feedback will require further planning and this activitywill happen at a variety of levels:

Locally – patient facing areas

Build on and embed learning from the Valuing Frontline Feedback project. Provide the necessary tools, materials and opportunity. Ensure that staff leaders and

patients have the knowledge and skills to undertake local improvement work. Involve patients and carers to enable truly patient centred service improvement. Develop a Patient Experience Handbook for all staff. This will provide information about the

NICE patient experience statements as well as guidance and information relating toimproving patient experience.

Recognise good practice in relation to using patient feedback to improve patient experienceand we will celebrate this.

Divisional level

Divisions will work with patients as partners in using patient feedback information as part ofplanning any change or improvement. The focus will move from driving down the number of

ACT to IMPROVE

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complaints to identifying gaps, recurring themes and issues and providing evidence ofimpact of improvement activities.

Ensure high quality action planning in response to complaints. Track and monitor actionsand share learning.

Board level

The Board will agree the priorities for improving patient experience on an annual basis. The Trust will consider opportunities for wider involvement and sharing learning internally,

within the local community and across the NHS.

The reporting of patient feedback and improvement data from ward and department level todivisional level will allow benchmarking and comparison both within the Trust and incomparison to other NHS health care organisations.

Annual goals and targets will be set in agreement with the Board and Divisions will be requiredto report against these at Performance Review Meetings.

Appendix one sets out key performance indicators to monitor the effectiveness of this strategyin improving patient experience.

4 Future Planning

Over the five year period there will be a continuous review of best practice relating to improvingpatient experience.

We will actively seek opportunities to be involved in any local and national projects aimed atimproving patient experience. These opportunities will be scoped to assess the benefits inrelation to achieving the key objectives of this strategy.

A plan will be developed to manage the delivery of the strategy, this will be updated annually.

MEASURE

Paper 7.1

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APPENDIX 1 – KEY PERFORMANCE INDICATORS

Aim Task Objective Responsibility Deadline CompletedInitiate Approve and

launch StrategySubmit Patient Experience Strategy tothe Trust Executive Committee forapproval.

SuzanneRankin/HeatherCaudle/ LynnRobinson

January2013

Disseminate copy of the Strategy to theDivisional General Managers, Heads ofNursing and Divisional Directors.

SuzanneRankin/HeatherCaudle/LynnRobinson

February2013

Disseminate copy to the Patient Panel,Patient Experience Group and other keystakeholders for comment prior tosubmission to Trust Board


February2013

Submit to Trust Board SuzanneRankin/HeatherCaudle/LynnRobinson

March2013Moved toMay2013

Raise Trust awareness - TrustNet andAspire


February2013

Collection Provide processesand mechanisms tocapture feedback

Commence review of structure of PatientExperience Team (PET)


April2013

Review triage process for handling andresponding to concerns across Trust andPET


April2013

Solutions to improve process in place SuzanneRankin/HeatherCaudle/LynnRobinson

Sept.2013

Co-ordinated team of patient feedback Suzanne April

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volunteers Rankin/HeatherCaudle/LynnRobinson

2013

Implement Friends and Family Test(FFT) delivery action plan (to includetechnological solutions).


January– March2013

commenced

FFT >20% increase in returns from April2013 baseline

SuzanneRankin/HeatherCaudle/LynnRobinsonDivisional Headsof Nursing

March2014

FFT Top 50% of Trusts for returns SuzanneRankin/HeatherCaudle/LynnRobinsonDivisional Headsof Nursing

July2014

Complete review and update of patientinformation relating to opportunities forraisingconcerns/complaining/suggestions andbeing involved. Roll out patient diary.


July2013

Listen andunderstand

Provideknowledge,mechanisms, tools,and materials s tosupportengagement inimproving patientexperience and apartnershipapproach

Continue to roll out Valuing FrontlineFeedback project, reviewing learning andimplement action plan to ensuresuccesses and learning are embedded


Sept2013

Agree Divisional work stream leads inFFT delivery plan delivery plan to takeresponsibility for using the FFT scoreand qualitative feedback to improvepatient experience.


February2013

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Agree work stream FFT delivery plan toexplore the relationship between staffand patient experience, to understandand improve staff likelihood to promoteASPH.


February2013

Improvement in Staff survey promoterquestion from 2012/13

Louise McKenzie March2014

Review Voluntary Service process andfunctions to ensure a high quality, lowrisk service and create a unified purpose.


Sept2013

Initialreviewcommenced

Review patient representative groups tocreate a unified purpose


Sept2013

Increase in complainants telling theirstory to teams. At least one by divisioneach quarter


Dec2013

Develop patient engagement toolkit tosupport leaders in developing local usergroups/focus groups


Sept2013

Review and implement Shared DecisionMaking project plan and terms ofreference for project steering group.


February2013

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Improvement from baseline for measureto assess SDM Tool


March2014

Form and maintain close and openworking relationship with Health WatchSurrey.


April2013 andon-going

Act to improve

Improve outcomes

FFT >20% increase in returns from April2013 baseline


March2014

FFT Top 50% of Trusts for returns SuzanneRankin/HeatherCaudle/LynnRobinsonDivisional Headsof Nursing

July2013

FFT Top 50% of Trusts for score SuzanneRankin/HeatherCaudle/LynnRobinsonDivisional Headsof Nursing/DGMs/DivisionalDirectors

March2014

Year on year sustained5% reduction in recurring themes raisedthrough PALS and Complaints

Divisional Headsof Nursing/DGMs/DivisionalDirectors

FromMarch2014

Sustained 95% response against agreedtimescale for complaints


Dec2013

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Follow up complaints < 10% Divisional Headsof Nursing/DGMs/DivisionalDirectors

Dec2013

National inpatient survey – review actionplans and measure effectiveness ofactions to date. Picker facilitatedworkshops to focus on top issues.

Against CQC benchmarking - to beworse than other trusts for zeroquestions and better than other trusts inone question per annum – sustained.



2013-2017

National A&E patient survey – reviewaction plans and measure effectivenessof actions to date. Picker facilitatedworkshops to focus on top issues.

Against CQC benchmarking - to beworse than other trusts for zeroquestions and better than other trusts inone question per annum – sustained.



2013-2017

Recognise and celebrate good practicein relation to learning from patientfeedback. Increase in submissions forExcellence in Patient ExperienceAwards, month on month from pilot.

SuzanneRankin/HeatherCaudle/LynnRobinson/Divisional Headsof Nursing

April2013

Sustainedimprovement topatient experience

Monitor progress Quarterly report against PatientExperience Strategy KPIs to ClinicalGovernance Committee


2013 -2017

Annual Patient Experience Improvementplan


2013 –2017

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Documents

7.1 Patient Engagement and Experience Strategy - TB · Agreed a working definition of patient experience in October 2011 and published the NHS Patient Experience Framework. This framework