NHS GRAMPIAN

Patient Experience Service Improvement Pilot Project for Cancer and Haematology services - Final Project Report

Aim

This report summarises the NHS Grampian three year pilot funded by NHS Scotland’s Better Together Programme to evaluate approaches to service improvement in cancer services; bringing patient, carer and staff experiences together and using this information to identify and drive forward service improvement.

Strategic Context

In Scotland, achieving better health for all the population is set against a backdrop of social justice and reducing inequalities in health. Better Health Better Care sets out a vision for a mutual NHS. This vision is a significant shift away from seeing people as “patients” or “service users” to a new ethos for health in Scotland with the Scottish people and NHS staff working as partners or co-owners of the NHS. A mutual NHS is one where all partners, staff and patients will have a greater voice that is heard and patients become genuine partners in the delivery of their care.

Better Together is Scotland’s National Patient Experience Programme which aims to support Boards, frontline staff and patients to work together in partnership to improve services for the benefit of all. The programme also aims to support the sharing of best practice to lead to service improvements at local and national level.

The NHS Scotland Healthcare Quality Strategy was published in May 2010 and sets out the vision for NHS Scotland’s healthcare services around three quality ambitions to achieve person‐centred, safe and effective care. The Quality Strategy is based around a set of priorities identified following consultation about what people feel is most important about the provision of healthcare.

During 2009 the Scottish Government Health Directorate, through its Better Together Programme provided funding to Grampian, Greater Glasgow and Lothian NHS Boards (covering the three regional cancer networks) to run three year pilot projects in Cancer Services. The aim was to develop programmes of work to evaluate different methods for gathering, learning from, and improving services based on the experiences of patients and staff. All three pilots were to have a strong focus on addressing equalities issues in relation to Cancer and Haematology services.

The project report describes the governance arrangements, the different projects undertaken within the pilot; their processes and impacts, and reflects on the success factors, constraints and lessons learned in applying the Experience Based Design (EBD) processes.

Discussion

Implications for NHS Grampian cancer services

  • Reassurance of the high quality of patient care within cancer and haematology services
  • Feedback has shown that the way services are organised and communication issues are most often the cause of a poor patient experience. There can be communication breakdowns for patients as they move from one part of the care pathway to another particularly in the communication of test results and follow up appointments
  • The contribution patients and their family and friends can make to discussions about future cancer service development.

Implications for NHS Grampian Person Centred Care Strategy and achieving positive experiences for all patients

  • The pilot has clearly demonstrated the benefits to be gained from carrying out patient, carer and staff experience gathering work and how the information gathered can act as a catalyst for change and improvement
  • There are implications for operational services in how this work is led, managed and monitored and sustained in future
  • There is evidence that staff feel they lack the skills and capacity (mainly time) to plan and carry out EBD projects. Also that staff are often reluctant to expose themselves to the level of scrutiny this work brings and the resulting expectation on themselves of being able to effect change.
  • Positive feedback has been morale boosting for staff

Legacy arrangements and future sustainability

The Project Team has worked very closely with the Patient Experience Lead for NHS Grampian and supported the ongoing local work to drive the Person-Centred-Care Quality Strategy ambitions. The learning from the pilot has helped to inform a future sustainability plan which will include:

  • Patient Experience Intranet resources page – also displaying the Better Together In-patient survey results
  • Improving patient and carer experience toolkit for staff and introduction of mandatory staff training on person centred care
  • A new patient/carer experience form to be used in conjunction with the pledges work being led by the Quality, Governance and Risk Unit
  • Plans to support and train a small group of lay members and staff who would be available to carry out patient story interviews on behalf of NHS Grampian
  • Plans under development to introduce Patient Experience Walkrounds

Key Risks

A potential risk at the conclusion of this pilot project is that the evidence of real improvements to patient care and services is overlooked if the development of tried and tested tools and techniques for gathering and using experience is not embedded into mainstream practice and rolled out across NHS Grampian.

This risk is mitigated by the measures described in the legacy arrangements and future sustainability section of this report.

Conclusion(s)

A number of conclusions can be drawn which are detailed in full in the report.

  • Clear evidence of very positive feedback from patients and carers about cancer and haematology services, and the care and compassion shown by staff, and the responsiveness of services.
  • NHS teams have much to gain by providing patients, carers and staff with opportunities to share their views and tell the story of their experiences in their own words and in using this information to help ensure everyone has a positive experience.
  • Different approaches to gathering feedback elicit different types of data, with qualitative methods, e.g. patient stories and discussion groups, contributing the most valuable information with which to identify areas for improvement. Patients, carers and staff groups’ own testimonies of their experiences are compelling. The pilot has clear evidence of where the link between this feedback and service improvement can be demonstrated.
  • Taking services through a full EBD process is time and resource intensive, and there will be occasions where this level of detail is necessary. Taking a more pragmatic approach to the EBD processes, within the current resources available, has been shown to be equally effective in achieving service improvement.

Recommendation(s)

The Board is asked to endorse the project report and recommendations for future sustainability.

Laura GrayLinda Oldroyd

Director of Corporate CommunicationsNurse Consultant (Patient Safety

Board Secretary& Patient Experience)

February 2012

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