Understanding and responding to patients’ experiences: the national context Richard Gleave

1. Understanding and respondingto patients’ experiences:the national contextRichard Gleave

2. Patient Feedback Feedback is • from patients’ experience • following care and treatment • as near real-time as possible We could not have asked for a better service – she was seen quickly by very competent and kind staff who were sensitive to her needs, made sure she was given adequate pain relief and quickly fixed her arm. She came out smiling and happy! • Dr Jones • Trust • Listen • Recommend •       This doctor is highly rated 90% 65% 100%

3. Range of patient feedback

4. is the systematic collection, analysis and reporting of feedback from patients immediately or soon after care or treatment, and the use of this insight to drive up quality enables organisations to collect and act on information quickly, to focus on local priorities at a ward, clinic or departmental level and to get rapid feedback on improvements made in response complements the information available from the National Patient Survey programme, conducted to a set timescale with nationally agreed questions Real-time patient feedback Real-time patient feedback Real-time patient feedback There is growing interest in using real-time feedback to understand patients’ experiences

5. Why put patient experience centre stage – local reasons • Quality of service • “Repeat business” model

6. Delivery Drivers National Policy Drivers Operating Framework sets out the case for commissioners and providers to work together to improve experience Local CQUIN Schemes must include some measures of patient experience Quality Accounts must include progress on measures in CQUIN schemes Regulatory Regime– the Act setting up CQC says it must look at people’s needs and experiences of care National Contractsrefer to the monitoring of quality High Quality Care for All confirms quality is the organising principle behind everything that we do NHS Constitution sets out rights and pledges relating to the quality of care. Commitment to the quality of care is one of six NHS values The Operating Framework sets out the 2009-10 requirement These combine to accelerate implementation of quality improvement programmes Why put patient experience centre stage – national drivers

7. Patient Experience Quality as the organising principle Clinical Effective-ness Safety Patient experience is a critical dimension of quality Successful quality improvement programmes require a sound understanding of patients’ experiences of care Getting feedback directly from patients enables NHS organisations to identify what needs to change to make their services more responsive to the people who use them Providers and commissioners need to have strong links between patient experience and the wider range of information that can be collected to improve services

8. The Quality Framework Bring clarity to quality – standards Measure quality Publish quality performance Recognise and reward quality Clinical leadership Safeguard quality Stay ahead • Expanded role for NICE • NHS Evidence • Metrics – local, national, international • Clinical dashboards • Quality accounts • NHS Choices • International measures • CQUIN • SHAs – Medical Directors; clinical advisory boards • National Quality Board • Care Quality Commission • SHA duty to innovate • Innovation funds and prizes • Academic Health Science Centres • Health Innovation and Education Clusters

9. Principles for Quality Improvement National Co-production at all levels of the system Regional Local Subsidiarity Team Local clinical ownership of indicators Sources of evidence-based indicators include Royal Colleges, specialist societies, NHS Information Centre, universities, commercial sector

10. The Operating Framework “Commissioners and providers will want to work in partnership to implement systems that respond to the views and experiences of patients and improve the patient experience of services. The opportunity to have near real-time feedback of patients’ experience gives providers and commissioners an unprecedented opportunity to respond to changes and improve the patient experience.”

11. The NHS Constitution

12. There is widespread enthusiasm in the NHS for real-time patient feedback but implementation is variable and unsystematic • Appetite for feedback has increased significantly – nationally and locally • Some providers are ahead of the game and are already collecting and using real-time patient feedback and a range of technologies • Others need support to get started • Commissioners are starting their journey also, linking into World Class Commissioning competency 3

13. The Secretary of State’s commitment “we need to ensure that the patient is placed even closer to the centre of the NHS. That is why I’m going to be asking every hospital Trust over the next year to collect immediate feedback from patients on their experience of care. Each hospital will know within two weeks how patients feel about their care. Only then can we start to link patient experience with the clinical outcome”.

14. Going Further • Not just for hospitals – GP and community services 2. Not just collect – use to transform services and lever up quality 3. To empower patients and support choice

15. The NHS needs to use patient feedback more effectively and report what it has done as a result of that feedback From: To: • Collecting data by itself has no value – surveys need to result in actionable data • if you ask the wrong question, the answer will never be right (or you won’t know what needs to be changed to improve experience) • Close the feedback loop to demonstrate to patients and the public that change has resulted from their feedback • Reporting timescales will differ • Variant of quality triangle, time continuum or frequency curve to show different between operational and strategic uses of patient feedback • Reporting vehicles will differ • ward, clinic, department level reports – ward boards and posters • NHS Choices • Quality Accounts, CQUIN schemes, annual reports,

16. Using data to bring about change • Create a culture that values deeper understanding of customers • Invest in the skills and resources to deliver the change • Invest time in defining the purpose of data collection and collecting he right data • Integrate customer data into performance management systems • Segment customers • Develop a ‘single customer view’(360 picture bringing all customer data together) National Social Marketing Centre

17. Provider Serviceimprovement Serviceplanning Real-time Right-time Informing Commissioning Contract Management Local Accountability Strategic planning Commissioner Real-time patient feedback serves a multiplicity of purposes • For providers, it offers a unique opportunity to make measurable improvements in service quality in a variety of settings, in order that services become more responsive • PCTs need real-time patient feedback to support commissioning and accountability

18. The NHS is getting better at gathering patient feedback in a variety of ways and at different times • National patient surveys • Local patient surveys • Hand-held technology • On-line surveys • Patient stories • Feedback websites • Kiosks • Comment cards • Bedside terminals • Compliments and complaints • Focus groups • Membership groups • Telephone interviews • On-line communities • PALS data • Walking the floor

19. To deliver, the NHS needs to build capacity and capability • Local (co-production and subsidiarity) • PCTs and providers to work together to avoid over-burdening patients and to use the system • Clear Leadership • Build into engagement strategies • National - what DH will do • Guidance, building on work to date and sharing good practice • Learning network to draw on experience of early adopters to accelerate progress • Engaging with suppliers

20. What really matters to patients • Get the basics right • Fit in with my life • Treat me as a person • Work with me as a partner