Derbyshire Community Health Service NHS Trust:
A great place to be a patient
Patient Experience and Involvement Strategy
1
CONTENTS
Foreward
1. Introduction
Our Vision is:-
Our Values are:-
2. Aim of the Strategy
3. Our commitment and promise
4 Strategy Direction
Capabilities and Culture
Process and Structure
Measurement
5. Transforming Strategy into Action
Action Plan
National Context
Foreword
‘At Derbyshire Community Health Services NHS Trust we put the quality of our patient care at the heart of everything we do .We believe that our staff are central to this, ensuring that we provide care where patients are treated with dignity and respect, where we cause no intentional harm and where we ensure a good patient experience ‘
Tracy Allen Andrew Fry
(Chief Executive) (Chairman)
1. Introduction
The experience of our patients, relatives and carers is very important to Derbyshire Community Health Service NHS Trust (DCHS). It is essential that experiences told to us in patient feedback received whether compliments, comments concerns or complaints are listened to and understood. This is the first time DCHS has proactively planned how it will continue to improve patient involvement and experience in one overarching strategy. DCHS understands how experience goes well beyond the health outcomes of care. By listening and acting upon patient experiences, suggestions and concerns, DCHS has a duty to focus on quality and make improvements based on patients experiences, suggestions and concerns of the population we serve.
Our Vision is:-
‘To be the best provider of local healthcare and to be a great place to work’
Our Values are:-
- To get the basics right
- To act with compassion and respect
- To make a difference
- To value and develop teamwork
- To value everyone’s contribution ‘everyone matters’
These five values underpin our current and continued ethos as the Trust prepares for Foundation status in 2012. This strategy illustrates the Trust’s approach to capturing, measuring, sharing data and a commitment to improving patient experience.
2. Aim of the Strategy
The aim of the strategy is to strengthen the existing culture that
‘the patient is the centre of everything we do’ and ‘Making a difference together’. It is our intention to become better informed about what our patients opinions are regarding the care they receive, what is good, what could be improved and how could it be improved. More importantly it is how DCHS plans to take further action based on patients’ comments and endeavours to meet those expectations, maintain a good quality service and be the provider of their choice and recommend our services to family and friends.
Derbyshire Community Health Services NHS Trust Quality Strategy for 2012/13 – 2017/18 supports the delivery of high quality and equitable services to meet the population needs of DCHS. An essential element for quality is that our patients, carers and service users inform us that their experience of the services we deliver is positive. When a patient’s experience does not meet their expectations, DCHS can assure them that they are being listened to and appropriate improvements are being considered and/or put in place.
A key commitment of the DCHS Equality, Inclusion and Human Rights Strategy 2011 – 2013 is reducing health inequalities for the communities DCHS serve.
Improving access to health services is one mechanism to combat health inequalities; another is involving people in decisions surrounding their own health care and treatments and also improving people’s experiences of the services we provide. Through delivery of the objectives within the patient experience strategy a significant contribution will be made to this achieving this.
As DCHS strives towards Foundation Trust status in 2012 a consultation with local people has been undertaken and a substantial majority (91.5%) are in favour of the plans. The Membership Strategy [1] describes how DCHS will provide new ways for people from Derbyshire and other areas to influence the Trust’s success. DCHS will seek to achieve this through an active public and staff membership and a Council of Governors, which is fully engaged and involved in the development of our organisation.
‘It is also the mechanism through which DCHS will become actively involved in the local communities we serve. As a large employer and as an organisation which is invited to play a part in the lives of so many people, DCHS is strongly committed to playing a wider role in supporting local people and our partners to improve their health, their wellbeing and their communities’.
The Marketing and Communications Strategy[2] for DCHS raises the need to close the gap between our perception of people’s knowledge of DCHS and the reality. DCHS has access to sources of information which do describe how well the organisation is performing. One example of this is through the results of our own patient surveys.
3. Our commitment and promise
Our commitment is to be a patient focused organisation that actively seeks the views of our patients and service users and engages them in the shaping and development of our services, whilst consistently providing a high level of satisfaction.
DCHS is committed to providing
- Safe, high quality, co-ordinated care
- Building closer relationships
- Clean comfortable friendly places
- Improving access and waiting times
- Better information and choice
Working the DCHS Way is a commitment between the organisation and staff within the Trust. The expectations from the organisation to staff include:
Share and support staff in understanding our vision, values and priorities
Be clear as to what is expected of staff and what their part is to play in the organisation
Support staff to deliver our job in the best way
Manage and support staff to maximise their performance
Communicate with staff in a timely, open and honest way
Listen to staff and involve staff in decision making
Respect and value diversity
Expectations of DCHS from staff
Put patients at the heart of what we are doing promoting their health at every opportunity
Go the extra mile for patients, carers, colleagues and the good of the organisation
Continuously improve performance and services
Eliminate waste and ensure we work efficiently and flexibly as possible
Live the DCHS values and behaviours
Fulfil the requirements of our professional standards
Take responsibility for promoting the reputation and image of DCHS at every opportunity
Our focus upon quality improvement is to ensure that DCHS makes the delivery of our services safe, effective, patient centred, timely, efficient and equitable.
As DCHS prepares for Foundation status, the Monitor’s Quality Governance Framework[3] lists four areas that require detailed answers to ten questions to provide assurance that the organisation is progressing and has plans in place to achieve Trust status.
The four areas are
Strategy
Capabilities and culture
Processes and structure
Measurement
As patient experience is a central dimension in all our work our commitment to improve based on real patient consultation, is captured within the four areas.
4. Strategic Direction
Within the DCHS Quality Strategy 6.4, Quality Improvement states‘ Our focus upon quality improvement is to ensure that DCHS makes the delivery of our services safe, effective, patient centred, timely, efficient and equitable.’
To achieve this, the focus will be on the following six strategic objectives
4.1 The Trust Board will play an active leadership role in advocating
improvements in the patient experience.
The Trust Board is actively involved in listening to and improving the patient experience. Basic elements such as actions, words and behaviours of all clinical and non clinical senior leaders can have a profound effect on what happens to patients.
Capabilities and Culture
4.2 Develop training with accompanying toolkit to assist leaders and
teams to sustain capacity and capability of individual team members
to impact positively on patient experience.
Patient experiences depend heavily on individual acts and commitments and better experiences will only come about with the willing co-operation and effort of all staff. Staff need to believe in and own the DCHS vision and values. The DCHS way shapes the culture of the Trust which in turn needs to be a priority and reflected in how managers and staff behave towards each other and towards patients and families.
The following key areas collectively impact on the patient experience:-
Essence of Care
Communication
Equality and Diversity
Cleanliness and Environment
Infection Control
Patient and Public Involvement and Feedback
Patient Information
Spiritual care
End of Life Care
Patient and Public Involvement Champions, Privacy and Dignity Champions, Hand Washing Champions, Falls Champions and End of Life Champions are identified in services across DCHS. They are all dedicated in promoting the value of good patient experience to patients and colleagues.
4.3 To provide support for willing patients, governors and other
stakeholders with teams in making service improvements.
The level of involvement varies from person to person, it is therefore important that a range of options are available for those individuals who wish to use their experiences to influence services. DCHS will continue to build on its reputation as a first class provider.
Moving forward to Foundation Trust status, it is important that DCHS builds a clear role for the governors appointed as part of the membership scheme in shaping the Trust’s strategic objectives around patient experience.
National and local change is affecting the where and how DCHS delivers services. Consultation and engagement with patient and public and the Improvement and Scrutiny Committee are fundamental to decisions taken. The partnership with Derbyshire LINk and Derbyshire County Council’s Improvement and Scrutiny Committee has strengthened during 2011 and will continue especially as the role of LINk merges into Healthwatch. (See appendix 1))
Process and Structure
4.4 To provide assurance that DCHS has a robust mechanism of
acting on managing patient experience to inform service
improvement.
Feedback in the form of complaints offers the Trust an opportunity to correct an immediate problem and frequently provide constructive ideas for improving services, culture and attitudes.
DCHS’s philosophy for being open and striving to achieve patient and public satisfaction shifts the emphasis from defending DCHS in the face of complaints/concerns, to a culture of acceptance and a commitment to continually improve services, to learn and strive to deliver the best care possible. All complaints are received positively, investigated promptly and responded to empathetically, with action, where appropriate, to prevent recurrence of the circumstances leading to the complaint.
DCHS effectively manages complaints until local resolution is reached (very few of our complaints are referred to the Health Service Ombudsman) and has a robust internal complaints protocol and joint protocol with regional organisations. DCHS currently receives ten times more compliments than complaints and the compliment, comments, concerns and complaints leaflet is available to service users in all service areas and receptions.
Measurement
4.5 To build on the foundations of existing processes and further
develop the collection, analysis and feedback of patient surveys
/questionnaires.
This will necessitate the further collection of quantitative and qualitative data about what our service users feel about the services we deliver. The gathering of this information will inform DCHS about service quality .This will also provide evidence for our commissioners and regulators.
The Friends and Family Test.
The Net Promoter question[4] currently asked within DCHS surveys and comment cards. If a friend or relative had to use this service would you recommend Derbyshire Community Health Services NHS Trust will be amended in line with the NHS Midlands and East SHA and Commissioners’ requirements. In future this will read “Please rate on a scale of 0 to 10 how likely is it that you would recommend this service to friends and family?”
Results from using the ten point scale will be mapped to the following scoring system
Promoters / Extremely likely / 10 or 9Passive / Likely / 8 or 7
Detractors / Unsure
Unlikely
Not at all
Don’t know / 0-6
The percentage of detractors will then be subtracted from the promoters to obtain a Net Promoter Score with an overall objective of creating more “Promoters” and fewer “Detractors”.
DCHS has developed an Early Warning System (EWS) which has been built on from an EWS initiative developed by the Commissioners in response to some of the lessons learnt from the Mid Staffordshire Hospital Foundation Trust Inquiry.
The DCHS EWS includes six categories of early warning indicators. This will support staff within services to receive an overview of all information regarding their service at any moment in time. For example ‘Does a rise in the number of complaints received link to staff absence or infection control issues?’ This detail will enable alerts to be raised early and escalate the action to be taken.
It is planned that a system will be operated by an EWS review panel who will meet regularly to review a selection of hard and soft information about DCHS. The concerns can arise from multiple data sources, e.g. poor staff survey results coupled with increased rates of infection or mortality. It is also possible for the concerns to be identified from a single event, e.g. findings from a serious case review or an independent investigation. An impression of DCHS will be gained from the submission of monthly data which will alert the Commissioners of any potential concerns early and the actions being taken by DCHS to remedy any precursors to underperformance.
4.6 Develop new Patient Experience key performance indicators (KPI) for
Corporate monitoring.
There needs to be an understanding of and learning from patient experience
at all levels from Ward to Board and assurance that effective action is taken to minimise any recurrence when the experience has been negative.
A monthly report is currently provided to Heads of Service, quarterly to Patient Experience Group and Quality Service Committee and annually to Board and Strategic Health Authority. Current processes provide evidence for the National Commissioning for Quality and Innovation (CQUIN) programme and
key performance indicators are currently in development to support the DCHS Quality strategy. The development of key performance indicators will give commitment at individual, team and service level to ensuring a good patient experience.
5. Transforming Strategy into Action
The following action plan details how DCHS plans to achieve 4.1 – 4.6 during year 1 2012/2013. The actions are linked to the MONITOR Quality Governance Framework, Ombudsman Learning the Lessons[5] , CQUIN indicators 2012/13, The NHS the Operating Framework 2012/2013, Regional Commissioning Framework 2012/13, The NHS Outcomes Framework 2012/13, NICE Quality Standard on Patient Experience 2012 and The Patient Revolution .I
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Action Plan
4.1 The Trust Board will play an active leadership role in advocating improvements in the patient experienceCommitment / Where are we now / Where do we want to be / Evidence will support
Adopt an holistic approach to service development and improvement / An annual complaints report is produced for the Board and Strategic Health Authority, which includes some of the outcomes and lessons learnt.
Patient Stories are shared from team meetings through to the Board / To develop a wider aggregated report that includes all aspects of patient experience from compliments, concerns, complaints and incidents. Also to include the feedback received from NHS Choices, Patient Opinion and Derbyshire LINks.
The Patient Experience Team will develop a range of approaches to ‘bring patients into the board room’.
Staff from services to be invited to the Board meeting to share the patient story from their perspective. / MONITOR Quality Governance Framework 3c
To demonstrate commitment to patient and family centred care / A Quality Performance dashboard report includes CQUIN quality indicators for 2011/12 in relation to patient and carers experience
Developing early warning indicators within the DCHS Early Warning System / Ensure the Board receives regular information about patient experience in a variety of formats. Outcomes from patient surveys, action plans, comments received from Patient Opinion/NHS choices.
Feedback will be collected weekly for in-patients discharges and reported monthly to the Board
Currently there are no regular measures available for leaders to be able to continually benchmark themselves against others. DCHS needs to develop a dashboard of patient experience data to give services and Board a snapshot view of performance and feedback.
Need to be smarter and more coordinated in gathering feedback from service users and need to use feedback more effectively and consistently. / MONITOR Quality Governance Framework 3c
CQUIN 12/13
Commitment / Where are we now / Where do we want to be / Evidence will support
.Exploring and producing audio and/or video recordings of patient and carer experiences. / Develop a programme of ‘Take it to the top’ meetings with Board members where dedicated time is given to service users and carers to spend time with them to put forward questions/queries about the service
Survey data including the net promoter question being entered directly into Business Intelligence providing real time results to services and the Board. This will result in services being alerted to “hotspots” and ability to take action appropriately.
Explore further other media for sharing patients’ stories / MONITOR Quality Governance Framework 3c
Safety walk rounds in the Community Hospitals / Visibility of Executive team and Board Members within services talking to patients and staff about patients experiences ensuring every patient or employee with whom they interact with are left with the message that the patient comes first.
Develop a programme of community services visits for Executive and Board members to include explicitly patient experience.