Health Scrutiny Committee - Patient Experience update
Angela Thompson, Director of Nursing and Patient Experience
Introduction
East and North Hertfordshire NHS Trust (ENHT) has as its vision ‘to be amongst the best performing NHS Acute Trusts in the country’, with high quality care and excellent patient experience very much incorporated within the Trust values that underpin the vision:
P- putting our patients first
I - striving for excellence and continuous improvement
V- valuing everybody
O - being open and honest
T- working as a team
The Trust’s ‘Our Changing Hospitals’ programme will see the Lister Hospital transformed through £150m investment in new facilities into our main hospital for emergency and inpatient care. We recognise that providing new facilities does not automatically lead to excellent patient experience. To achieve our goal to be amongst the best we need our staff to be fully engaged, highly motivated and patient focussed.
The Trust launched an organisational development strategy in May 2011 supported by a programme called ARC – it’s all about you:
Accelerate – quality, staff training, communication
Refocus – on our patients, on our staff, on our values, on our partners
Consolidate – services, patient pathways, our hospitals, our teams
The ARC name is underpinned with the strap line ‘it’s all about you’ – which works well from both a staff and patient perspective. ARC is a Trust-wide programme of activities to aid us in delivering the highest quality of healthcare to our patients whilst recognising that an engaged and effective workforce is essential in achieving this aim. One of the ARC programme’s key areas of focus in 2012-13 is our need to improve our patient experience and the Trust is investing in a new customer care training programme for all staff to help us achieve this.
We aim to provide our patients and their carers with the best possible experience whilst they are using our services. We know that involving patients and their carers in decisions about their care and treatment leads to improved patient experience and this is why putting our patients first is one of the Trust’s core values. We recognise that we have more to do to improve our patients and carers experience and look forward to the challenges ahead.
Patient and Carer Experience Strategy 2012-15
The Trust’s three year Patient and Carer Experience Strategy has been approved by the Risk and Quality Committee and Trust Board (Appendix 1). The objectives of this three year strategy are:-
- To provide patients and carers with excellent experiences when they use East and North Hertfordshire NHS Trust services.
- To actively seek the engagement of patients and carers in service development and patient experience work streams, ensuring vulnerable groups, children and young people are included.
- To achieve performance in patient experiences which matches the top 20% of NHS Trusts.
- To achieve top quartile performance in Net Promoter Scores when benchmarked against other Trusts.
The Strategy sets out the Trust ambitions for ensuring excellence in patient and carer experience, namely:-
Ambition 1 – Improve patient experience from start to finish of their journey
Ambition 2 – Improve patient experience of accessing hospital services
Ambition 3 – Improve communication with patients
Ambition 4 – Meet the patient’s physical comfort needs
Ambition 5 – Provide patients with the emotional support they need whilst using Trust services
Ambition 6 – Respect the needs of patients and recognise their individuality
Ambition 7 – Improve involvement of patients and carers
The Ward to Board reporting structure for patient experience is shown below:
ENHT Quarterly Inpatient Postal Survey (Q4 January 2012)
The Trust undertakes a quarterly inpatient postal survey, the most recent was sent to all patients, aged 18 or over, who were an inpatient in the hospital in January 2012. The questions within the inpatient postal survey reflect those asked in the national inpatient survey.
1644 questionnaires were posted and 563 responses received (34.2% response rate).
Improvements since Quarter 3:
§ Doctors giving understandable answers
§ Privacy when being examined or treated
§ Treated with respect and dignity
Deteriorated since Quarter 3:
§ Patients having to wait a long time to get a bed on a ward after arrival at hospital
§ Patients disturbed by noise at night from other patients.
The quarterly inpatient survey is currently being sent to all patients who were an inpatient in the Trust during April 2012 and the results of this survey should be known in July 2012.
ENHT Patient Experience Trackers (PETs) – Meridian Results
The Trust introduced PETs to its inpatient wards, maternity, A&E and outpatient clinics at all four sites managed by the Trust in January 2010. The questions within the PET surveys reflect those asked in the national inpatient survey. These electronic trackers enable patients to provide feedback about their experiences in a user-friendly and confidential way. The responses are fed directly into an internet based system that allows ward staff and department managers to view the results daily. This enables staff to address any concerns that are highlighted immediately.
There are six main surveys available via the PETs:-
· Inpatient
· Maternity
· Accident and Emergency
· Outpatients
· Neonatal (from June 2012)
On leaving hospital all patients are given a card which includes details of who they should contact if they need any further advice and a link to the website www.tellusmore.org.uk where patients are asked to complete the relevant survey.
East and North Hertfordshire NHS Trust web-site (survey links):
PET usage results for March and April 2012 are summarised below:
Survey / Response TotalsInpatient / 1052
A&E / 220
Maternity / 298
Outpatient/day case / 1121
Total / 2691
An example of the ward reporting view from the PET results is attached (Appendix 2).
The top three areas of patient experience from the tracker results for March/April 2012 are:-
§ In Maternity that the 20 week scan was clearly explained to women
§ In Accident and Emergency patients involved as much as they wanted to be in decisions made about their care and treatment.
§ Patients feeling they have been treated with dignity and respect (all areas)
The bottom three areas of patient experience are:
§ Patients not being told on arrival in an outpatient clinic how long they would have to wait
§ Patients not having a secure area to store belongings on wards
§ Length of time patients waited to get help after using the call button
Access to the results of the Meridian tracker surveys is available to all staff throughout the Trust via the Trust’s Knowledge Centre. Staff are able to access electronically the detailed results for their ward and view written comments made by patients as soon as they are submitted.
Net Promoter
The net promoter question ‘how likely is it that you would recommend this service/hospital to friends and family?’ has been added to the Trust’s Meridian tracker surveys. The responses are fed directly into the Meridian system which enables the responses to be available real-time.
Respondents are given six options to choose: Extremely likely (Promoter), likely (Passive), neither likely or unlikely, unlikely, not at all, don’t know (detractors). The percentage of detractors is then subtracted from the percentage of promoters to obtain the net promoter score.
By the end of April 2012 the Trust had to demonstrate that the question was established and reported using the SHA proforma. The question had to be answered by at least 10% of inpatient discharges, surveyed at or within 48 hours of discharge. Based on the discharge information received for the period 1-28 April there were 2057 inpatient discharges (including maternity); 274 respondents completed this question, this is a 13.32% response rate which exceeds the 10% target. The net promoter score was 80.29 for this period, which put the Trust in equal 7th position out of 42 Trusts in the East and Midlands SHA cluster.
A summary report showing the net promoter score broken down by ward/Division/Trust for each week/month is reviewed at the Trust’s Risk and Quality Committee (Appendix 3).
CQC National Inpatient Survey 2011
The survey of adult inpatient services involved 161 acute and specialist NHS Trusts. The survey was undertaken by patients who stayed in the hospital in July 2011 and shows ENHT as about the same as most other trusts in the survey for seven sections eg waiting list and planned admissions, waiting to get to a bed on a ward, nurses, care and treatment, operations and procedures, leaving hospital and overall views and experiences.
ENHT was in the worst performing Trusts for three sections eg, emergency department, hospital and ward, doctors. There was one question within each of these sections for which responses were in the red/worst of the Trusts who completed the survey.
The Trust is closely monitoring responses to these questions within its quarterly inpatient surveys and is pleased to note an improvement in these three areas from the January 2012 survey results:-
(undertaken
Jul-11) / Upper limit of expected range for all Trusts
(CQC) / Quarterly ENHT inpatient survey
(undertaken Jan-12)
score equates to:
Emergency Department:
Following arrival at the hospital, how long did you wait before being admitted to a bed on a ward? / 4.4/10 / 7.11/10 / 7.3/10
Hospital & Ward:
Were you ever bothered by noise at night from hospital staff? / 6.9/10 / 8.56/10 / 7.8/10
Doctors:
When you had important questions to ask a doctor, did you get answers that you could understand? / 7.5/10 / 8.62/10 / 8.0/10
In summary, compared with the 2010 CQC national survey, the Trust demonstrated a significant improvement in scores in 4 questions, a decline in scores in 3 questions, and no significant change in scores in 56 questions.
Significant improvements since 2010:
§ Cleanliness of hospital room/ward
§ Cleanliness of toilets/bathrooms
§ Staff explaining how operation/procedure had gone
§ Patients receiving copies of letter from hospital to GP
Significant decline since 2010:
§ Posters/leaflets asking patients/visitors to wash their hands
§ Discharge delayed
§ Length of delay at discharge
An action plan for the national inpatient survey has been developed and will be closely monitored through the Patient Experience Committee.
CQC National Outpatient Survey 2011
The survey of adult outpatient services involved 163 acute and specialist NHS Trusts. The survey was undertaken by patients who attended an outpatient department appointment during May 2011. ENHT shows amber/same as other Trusts who completed the survey for all sections of the survey. There were two questions within the survey responses which were in the red/worst of the Trusts who completed the survey. These were:-
§ Did doctors and/or staff ask you what was important to you in managing your condition or illness?
§ Did a member of staff tell you about medication side effects to watch for?
A comprehensive Outpatient Action Plan has been developed to improve all aspects of the survey results. Since development of the action plan:-
§ DNA rates and cancellation rates have reduced.
§ A single point of contact call line has been established for patients to call regarding any outpatient issues.
§ Extended appointment reminder systems have been established for ten specialties.
§ A Central Clinical Cancellation Team was established from December 2011 introducing electronic clinic change requests thus improving control and communication
§ A quarterly outpatient newsletter has been introduced (Appendix 4).
The action plan is closely monitored within the outpatient performance review meetings. Feedback from outpatients is also continually monitored through the Meridian tracker responses.
Focus Groups
We have held focus groups with a wide range of patients, carers and community groups. Initially these were held to develop our Patient and Carer Experience Strategy but we are now extending these to include development of a carer survey and to gain patient feedback on other developments within the Trust and to inform service delivery.
Patient engagement is currently being sought for the Trust’s Transforming Inpatient Management (TIM) Programme Board and sub-groups. The TIM Programme Board will be co-ordinating the implementation of the Trusts management of pathways for inpatients and reporting to the Board on progress.
Secret Shoppers
We have plans to recruit volunteers to act as ‘secret shoppers’ in wards and clinical areas throughout the Trust. These volunteers will receive training and have a checklist to complete which will capture the overall atmosphere in the clinical area as well as record information about how staff talk to patients, how clean and tidy the area is and whether the volunteer is approached by a member of staff.
Within maternity services we will be recruiting nine women per quarter to act as mystery shoppers (3 from Lister, 3 from Queen Elizabeth II and 3 from Hertford County) to provide feedback of their antenatal care, screening, labour and postnatal experience. Anonymous surveys will be collected from each of the women over a nine month period and information from these surveys fed back to staff and used to improve services.
CQC Unannounced Inspection of Stanborough and Bayford Wards QEII, 5th April 2011:
Stanborough and Bayford Wards, QEII had an unannounced inspection from CQC on 5th April 2011. The purpose of the inspection was to review the quality of care for older people, in particular whether older people are treated with respect and dignity (outcome 1) and whether their nutritional needs are met (outcome 5). This is part of a national inspection programme of approx 100 NHS Hospitals.
The inspection team were on site all day and this included observation of the environment and care provision, talking to staff, patients and visitors and reviewing documentation and evidence.
The CQC inspection team were impressed by the care the patients received and how they were supported and encouraged to eat etc, and stated the wards were both calm and welcoming. They did not highlight any areas of concern or any areas of non compliance. Learning points from the inspection are being shared across the Trust.
The Trust was found to be fully compliant with both outcomes tested.
Complaints, Litigation, Incidents & PALS Report
A high level report detailing all adverse incidents, litigation, complaints and PALS data is presented monthly to the Risk and Quality Committee. This report identifies common themes and trends and focuses on prevention of future incidents.