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Quality Improvement Development for NHSScotland Organisational Development Leads. Workshop 1 Patient-Centred Quality Improvement Stakeholder Analysis. Agenda. Welcome and introduction Quality Improvement – aims and objectives Participant introduction Patient-centred quality improvement

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slide1

Quality Improvement Development for NHSScotland Organisational Development Leads

Workshop 1

Patient-Centred Quality Improvement

Stakeholder Analysis

agenda
Agenda
  • Welcome and introduction
  • Quality Improvement – aims and objectives
  • Participant introduction
  • Patient-centred quality improvement
  • Stakeholder engagement
learnings
Learnings
  • Understand the elements of patients’ experience
  • Define what is meant by patient-centred care
  • Understand the process for achieving patient-centred care
  • Find out ways to implement patient-centred care
lord darzi s vision
Lord Darzi’s Vision

An NHS that gives patients and the public more information and choice, works in partnership and has quality of care at its heart

High Quality Care for All

slide6

“The balance is wrong between task-focused care and patient-focused care. […] We need to listen better and listen more to patient experiences”

Ann Abraham, Ombudsman

how satisfied are patients
How satisfied are patients?

Q3. Overall, how would you rate your care and treatment during your stay in hospital?

Q1. Overall, how would you rate your admission to hospital?

Q4. How did you feel about being involved in decisions about your care and treatment?

Q2. Overall, how would you rate your the hospital environment?

Scottish Inpatient Patient Experience Survey 2010

does it matter
Does it matter?
  • “Our patients aren’t complaining, so we must be meeting all their needs “
  • “Providing patient-centred care is too costly”
  • “Patient-centred care is nice, but not important”
  • “Being patient-centred is too time consuming”
why patient centred care is a priority
Why patient-centred care is a priority
  • Room for improvement regarding patient experience
  • Improved outcomes – evidence to show results in reduced mortality and morbidity1
  • Reducing costs – less likely to develop complications or need readmission
  • Indicator of poor care

1 Feeling Better – Improving Patient Experience in Hospital, 2010

what patients want
What patients want…
  • fast access to reliable health advice
  • effective treatment delivered by trusted professionals
  • participation in decisions and respect for preferences
  • clear, comprehensible information and support for self-care
  • attention to physical and environmental needs
  • emotional support, empathy and respect
  • involvement of, and support for family and carers
  • continuity of care and smooth transitions.

Picker Institute, 2009

case study a e handover
Case study – A&E handover
  • Aim – to provide timely, coordinated and seamless care to patients
  • Benefits
    • Improved patient experience
    • Greater accuracy
    • Safer
    • Faster turnaround times
  • Approach:
    • Patient walkaround “in your shoes”
    • Highlighted inefficiencies and poor patient experience
  • Outcome – improved experience for patients, faster turnaround for staff and new processes that improved safety.
case study good hydration practice
Case study – Good hydration practice
  • Aim – review the actual level of intakes and increase water consumption on ward
  • Benefits:
    • improve the level of hydration of patients
    • improve the level of awareness of the need for good hydration among staff
    • improve the level of patients’ awareness of the health benefits of drinking more fluids
  • Approach:
    • review of good practice
    • audit of water intake
    • introduced new tools and good practice
  • Results:
    • evidence showed good hydration improved recovery
    • Improved feedback from patients
key steps for patient centred approach
Key steps for patient-centred approach
  • Understand what patient feedback is and how you obtain it
  • Understand findings from your surveys
  • Share feedback
  • Create action plan for improvement
quantitative research numbers
Quantitative research(Numbers)
  • self-completion postal surveys
  • interviewer-administered face-to-face surveys
  • telephone surveys
  • automated telephone surveys (interactive voice response – IVR)
  • online surveys using web-based or email questionnaires
  • surveys using hand-held portable devices (PDAs or tablets on-site)
  • surveys on touch-screen kiosks (on-site)
  • surveys on bedside consoles (on-site)
  • administrative data/routine statistics
qualitative research words
Qualitative research(Words)
  • focus groups
  • in-depth face-to-face interviews (may be audio- or video-taped)
  • patient stories
gather user feedback
Gather user feedback
  • In pairs
  • Select one person to answer the questionnaire on travel to the venue (1 minute)
  • Same person tell story of journey
  • Role of the other person is to listen and prompt
  • 10 minutes
qualitative research words1
Qualitative research(Words)
  • focus groups
  • in-depth face-to-face interviews (may be audio- or video-taped)
  • patient stories
  • comment cards or suggestion boxes (on-site)
  • video boxes (on-site)
  • complaints and compliments
  • patient diaries
  • mystery shopping and observation
  • experience based design (EBD)
  • customer journey mapping.
the experience based design approach
The Experience Based Design Approach

…about using experience to gain insights from which you can identify opportunities for improvement

…about experiences not attitudes or opinions

ebd gathering the experience
EBD – Gathering the experience
  • Collect stories and thoughts from both patients and staff:-
    • Interviews
    • Story boards
    • Photography and film

Intimidating

Stressful

Clean

Impersonal

Time-consuming

gather user experience
Gather user experience
  • In pairs
  • Think about your last visit to dentist
  • Use Product Reaction Cards
  • Find cards that describe the experience (first reaction)
  • Select top 5
  • Explain why you selected these 5
  • Take 15 minutes
slide23

Actions

Responses

Language

Feelings

Deep Emotions

Deep understanding tool –Peeling the Onion

Layer 1: Actions What people do? Why? What is driving them?

Layer 2: Responses What people say? Why? – what’s behind the words? How honest do you think they are being?

Layer 3: Language How people say things. What words do they use. Capture real quotes. What is body language

Layer 4: Feelings what are they feeling? Trust? Comfort? Irritation? What is causing this?

Layer 5: Deep Emotions: What are their real loves and hate? Where are the passion points?

gathering user experience observation
Gathering user experience – observation
  • Observation of patients and staff delivering and receiving care
    • People do not always do what they say they do
    • People do not always do what they think they do
    • People do not always do what you think they do
    • People cannot always tell you what they need
    • Observation lets you find out what people really do and need

IDEO 2006

73% of doctors say they wash hands before patient contact

9% actually do so

Bill Kirkup 2006

case study ebd in brighton
Case study – EBD in Brighton
  • Aim
    • to better understand the real patient experience, including the issues and challenges faced by patients with digestive conditions
  • Benefits
    • Improve service for patients
  • Approach:
    • Patient diary/camera/dictaphone
    • Feedback to team
    • Process mapping with selected patients and develop new pathway
  • Outcome:
    • Identified barriers and delays in system
    • Improved staff understanding
    • Process re-designed to eliminate delays and poor experiences
gathering patient feedback summary
Gathering patient feedback – summary
  • set clear goals
  • identify relevant stakeholders
  • decide who you want to gather feedback from
  • secure adequate resources
  • choose the most appropriate methods
  • consider how you will act on the feedback gathered
key steps for patient centred approach1
Key steps for patient-centred approach
  • Understand what patient feedback is and how you obtain it
  • Understand findings from your surveys
  • Share feedback
  • Create action plan for improvement
understanding findings from your surveys
Understanding findings from your surveys

Careful examination of patient feedback will highlight the areas that need improvement to provide a better service for patients, and supply the evidence for change.

review patient journey

22,799

21,898

20,310

6,347

6,303

7,126

100%

96%

89%

31%

28%

28%

All referrals

to OP

Appointments

given

Appointments

attended

Decisions

to admit

Offers of

admission

Admissions

Review patient journey

Hip and Knee Replacement – activity figures for Q1-Q4

compare results with other organisations
Compare results with other organisations

5 Boroughs Partnership Patient Survey

compare results internally
Compare results internally

Overall satisfaction by specialty

understanding patient s perspective personas
Understanding patient’s perspective - personas
  • Develop your personas as a team
  • Identify the traits that are common among that type of patient - key demographics, habits and personality
  • Add a photo, name, age, gender, location, family ties, profession and lifestyle
  • Include personality traits, goals, behaviour or motivations in relation to life
  • Validate your personas with your customer advisory group
  • Communicate your personas widely
develop your own persona
Develop your own persona
  • Work in groups
  • Develop a persona for a new day surgery unit
  • Come up with name, demographics, traits
  • Likes and dislikes about hospital
  • 15 minutes
key steps for patient centred approach2
Key steps for patient-centred approach
  • Understand what patient feedback is and how you obtain it
  • Understand findings from your surveys
  • Share feedback
  • Create action plan for improvement
sharing feedback
Sharing feedback

Raising awareness is an essential part of involving patients and the public in improving healthcare services. Communicating the results of your enquiries – and what you plan to do with them – will help to ensure that they are used effectively and not forgotten.

sharing feedback1
Sharing feedback
  • Internal audiences include:
    • board members
    • senior managers
    • staff at all levels, in both clinical and support roles
    • volunteers.
  • External audiences include:
    • patients
    • public
    • local community and voluntary groups
    • commissioners
    • other healthcare organisations
    • local authorities
    • the media.
communications strategy
Communications strategy
  • Who you want to reach
  • What you want to share
  • Why you want to share the information
  • When and where you are going to communicate
  • How you will share your information
make the information more interesting
Make the information more interesting
  • Graphs are often a better way of presenting data than tables
  • Include anonymous patient quotes
  • Photos and other visuals help make a document more engaging
  • Highlight how people can get involved so that they feel a sense of ownership.
key steps for patient centred approach3
Key steps for patient-centred approach
  • Understand what patient feedback is and how you obtain it
  • Understand findings from your surveys
  • Share feedback
  • Create action plan for improvement
create an action plan
Create an action plan
  • SMART Objectives (Specific, Measurable, Achievable, Realistic and Time)
  • Continue to involve patients
  • Senior management sponsor
  • Gather a supporting team
  • Make a plan
  • Communicate, communicate, communicate

Picker Institute

agenda1
Agenda
  • Welcome and introduction
  • Quality Improvement – aims and objectives
  • Participant introduction
  • Patient-centred quality improvement
  • Stakeholder engagement
learnings from the stakeholders session
Learnings from the stakeholders session
  • Find out how to improve the outcomes and sustainability of your service improvement by working effectively with your stakeholders.
  • Learn about the categories of stakeholders
  • How to manage effective communications
who are your stakeholders
Who are your stakeholders?
  • Anyone in or around your project who affects or can be affected by your project
  • Identify your stakeholders
    • Select one project
    • Brainstorm all stakeholders
    • Write each on a Post-It note
    • 15 minutes
9c model
9C Model
  • Commissioners: those that pay the organisation to do things
  • Customers: those that acquire and use the organisation’s products
  • Collaborators: those with whom the organisation works to develop and deliver products
  • Contributors: those from whom the organisation acquires content for products
  • Channels: those who provide the organisation with a route to a market or customer
  • Commentators: those whose opinions of the organisation are heard by customers and others
  • Consumers: those who are served by our customers: ie patients, families, users
  • Champions: those who believe in and will actively promote the project
  • Competitors: those working in the same area who offer similar or alternative services
stakeholder classification
Stakeholder classification
  • Patient (consumer, commentator, customer)
  • Healthcare workers (commentator, collaborator, channel, champion)
  • Healthcare charities (commentator, collaborator, channel)
  • Private healthcare providers (commentator, competitor)
  • Department of health (collaborator, consumer)
  • Media (commentator, collaborator)
  • Local authorities (commentators)
  • Government (commentator, consumer)
populate your stakeholders
Populate your stakeholders?
  • Place your stakeholders in the 9C framework
  • How many more can you identify?
  • 10 minutes
prioritise your stakeholders
Prioritise your stakeholders

Stakeholder has High Power over the project

Satisfy

Opinion formers. Keep them satisfied with what is happening and review your analysis of their position regularly

Manage

Key stakeholders who should be fully engaged through full communication and consultation

Power over the project

Stakeholder has Little or No Power over the project

Monitor

This group can be ignored if time and resources are stretched

Inform

Patients often fall into this category. Consider increasing their influence by organising into groups or taking active consultative work

Impacted by the project

prioritise your stakeholders1
Prioritise your stakeholders
  • Create a grid on the flip chart and place your Post-It notes in the relevant grid
  • 10 minutes
summary
Summary
  • Patient-centred care improves care for the patient, but also reduces costs and improves outcomes
  • Key steps for introducing patient-centred care:-
    • Understand what patient feedback is and how you obtain it
    • Understand findings from your surveys
    • Share feedback
    • Create action plan for improvement
  • Stakeholders
    • Map out before you start project
    • Manage their involvement
resources
Resources
  • Care and compassion? Report of the Health Service Ombudsman on ten investigations into NHS care of older people, http://www.ombudsman.org.uk/care-and-compassion/downloads
  • Better Health Better Care Action Plan, Scottish Government 2007
  • Feeling better? Improving patient experience in hospital, NHS Confederation, 2010, http://www.nhsconfed.org/Publications/Documents/Feeling_better_Improving_patient_experience_in_hospital_Report.pdf
  • Equity and Excellence: Liberating the NHS, DoH, July 2010, http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353
  • The Point of Care review paper, King’s Fund, 2008, www.kingsfund.org.uk/document.rm?id=8142
  • Patient-Centred Care Improvement Guide, 2008 http://www.patient-centredcare.org/
  • Kissing It Better; examples of how to improve environment, http://www.kissingitbetter.co.uk/
  • Local Involvement Networks (LiNKS), patient stories and examples of local involvement, http://www.nhs.uk/NHSEngland/links/Pages/links-make-it-happen.aspx
  • www.pickereurope.org for examples and templates