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Discovery Interviews

How Patients and Carers can Influence Service Improvement. Discovery Interviews. Dr Jeffrey Phillips Consultant in Intensive Care Medicine Princess Alexandra Hospital, Harlow. NHS Modernisation Agency Critical Care Programme.

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Discovery Interviews

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  1. How Patients and Carers can Influence Service Improvement Discovery Interviews Dr Jeffrey Phillips Consultant in Intensive Care Medicine Princess Alexandra Hospital, Harlow

  2. NHS Modernisation Agency Critical Care Programme Improve access, experience and outcomes for patients with potential or actual need for critical care

  3. Why? • The New NHS (1997) • Critical to Success (1997) • Comprehensive Critical Care (2000) • NHS Plan (2000) • Shifting the Balance of Power (2001) • NHS Reform Act (2002) • The Kennedy Report (2001) • Commission for Health Improvement

  4. Why? Patients are our raison d’être

  5. Aim • Patients and Carers to influence change • To understand what patients and carers perceive as important • New ways of working • Inclusive approach

  6. “Change has become a constant; managing it has become an expanding discipline. The way we embrace it defines our future.”

  7. Audit or Research? • Audit or qualitative research • Informing about previous experience • New information sought • Approval for project • LREC • MREC

  8. Patient and Carer Participation • Questionnaires • Low response rate • Questions set by professionals • Cover limited aspects of service • Results seldom improve care • Groups • Inhibition of introverts • Clash of opinion • Directed by professionals

  9. Discovery Interviews Provide opportunities for patients and their carers to directly tell the story of their illness or condition using a framework that guides them through the key stages of their experience

  10. Using Narratives Reflection • Listeners must ask: • “What is learned from the narrative?” • “What needs to change?” Action • Listeners must ask: • “How can change happen?”

  11. Discovery Interviews • Semi-structured • No formal direct questions • Interview spine derived from process mapping • Process map simplified

  12. Discovery Interview Spine First realising something was wrong Getting to the Critical Care Unit Being in the Critical Care Unit Leaving the Critical Care Unit Being on the Ward Going Home At Home

  13. Discovery Interviews • Subject encouraged to talk about experiences at each stage • Interviewer avoids direct questioning • Audio-recorded • Transcribed

  14. Analysis • Process initiated by the team in order to learn about the patient and carers experience • Non-confrontational process • Teams listen to uninterrupted narratives • Stories and narratives are a great leveller

  15. Action • Identify areas requiring improvement • Immediate Change • Process Mapping & PDSA • Service commissioning • Testament v Anecdote • Other areas for further inquiry

  16. Improvements • Orientation of patients when waking from a period of sedation • Strengthen pre-assessment phase of a patient’s journey • Communication and information • Noise

  17. The Future • Continue improving! • Roll out to all 29 Critical Care Networks • Different subject groups • The bereaved • Cascade throughout Trust • Those in power to learn from our experiences

  18. Summary • Learning from Patient and Carer stories • Powerful tool to understand from the • Patients’ and Carers’ perspective • Patients and Carers able to provide a • comprehensive picture of both • recollections and experiences • Strengthened partnerships

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