Royal National Orthopaedic Hospital Nhs Trust

ROYAL NATIONAL ORTHOPAEDIC HOSPITAL NHS TRUST

REPORT TO EXECUTIVE AND

TRUST BOARD

NATIONAL INPATIENT SURVEY 2007

Introduction

The Healthcare Commission is the independent watchdog for healthcare in England. They have a statutory duty to assess and report on the quality and safety of services provided by the NHS and the independent sector, in order to promote continuous improvement in healthcare for the benefits of patients and public.

To improve the quality of services delivered by the NHS, it is important to understand what patients think about their care and treatment. One way of doing this is by asking the patients who have recently used the Trust to tell us about their experiences.

The fifth survey of adult inpatients involved 165 acute and specialist Trusts (just under 76,000 patients). Although 166 Trusts took part in the survey the RNOH Trust’s results are not included in the published findings on the Healthcare Commission website due to an error in the sampling. The Trust has however received the average data from the 165 Trusts and has been able to undertake its own comparison. The data will be considered in the Healthcare Commissions assessment of NHS performance (annual health check).

It is important to adopt systematic, appropriate and effective ways to survey patients about their experiences, and use this information to shape and improve the way healthcare is delivered.

Patient surveys can help deliver the NHS Plan commitments by:

Providing information to support local quality improvement initiatives
Tracking changes in patient experience locally over time
Providing information for active performance management
Providing information to support public and parliamentary accountability
Providing information for the Healthcare Commission’s programme of reviews and inspections

By asking each trust to carry out an inpatient survey in a consistent way, the Healthcare Commission is building a detailed picture of patients’ experiences in acute NHS Trusts.

Process

The questionnaires focus on the quality of the patient experience but do not include any questions about the patient’s specific medical condition, diagnosis or treatment. There are 72 core questions.

In line with the above the Trust was required to distribute 850 postal questionnaires to recently discharged inpatients. Two reminders followed in order to obtain approximately 500 responses. The surveys were distributed in November 2007; a total of 538 inpatients completed the survey (a return rate of 63%), which reviewed their journey from admission through to discharge.

Comments from patients

This is the first year that the Trust has been sent copies of additional comments made by the patients returning the survey. A selection of these are outlined below.

Good comments / Bad comments
Words fail me! I have had a few operations in my time and although I have had good service from the NHS in the past, nothing compares with the treatment at Stanmore. / Food – décor – privacy.
I was amazed at how hard the staff worked to keep the ward clean. / Bathrooms and toilets could do with more looking at to ensure they are cleaned more frequently.
I can honestly say from my heart, that on the 2 occasions that I stayed in rehab pain clinic, was in every way fantastic and has changed my life for the better, and I can only bless all the fabulous staff for helping me in every way with my long painful condition. / The condition of the buildings at the RNOH is very poor, I understand funding is a problem, but it is very difficult to keep old buildings completely clean.
No MRSA. / Access to wards via a very steep slope was very difficult to negotiate.
I vote the RNOH to be cleanest hospital I have ever seen, also the care, both physically and emotionally from both nursing and doctors is excellent. / The bathrooms are rather shabby, but I realise that there are problems with old buildings.
I would like to take this opportunity to thank everyone for taking care of me, I couldn’t ask for a better place to be cared for – many thanks. / I could not believe how old and broken down every where looked, just the hospital rebuilt.
I cannot praise the hospital highly enough, obviously the premises are old but care was second to none and I consider myself to be extremely lucky to have been treated at the RNOH. / The buildings definitely need a face lift.
I felt I got excellent care from both nursing staff and doctors, many thanks. / Better staffing levels at night.
Staff expertise and care. / Need new buildings and facilities to assist less able.
I found the entire staff to be most caring and kind, I have nothing but admiration for them. / Next of kin for patients who come a long way should be allowed to stay on the premises.

Aspects of service that have improved since the last survey in 2007

The overall quality of care
Team work of doctors and nurses described as “excellent”
The number of times admission dates were changed
The quality of the hospital food

The choice of food available
The explanation of the risk and benefits given to patients before their operation/procedure
The explanation of how they would expect to feel after their operation/procedure

Aspects of service that have deteriorated since the last survey in 2007

Doctors washing or cleaning their hands between touching patients
Nurses washing or cleaning their hands between touching patients
Access to doctors for families
The explanation about the purpose of the medicines to take home
Not being told about medication side effects on discharge
Delayed discharge waiting for medicines
The noise at night from other patients
Not being able to find someone to talk to about their worries or fears
The call button not being answered “right away”
The cleanliness of the wards and bathrooms
Privacy on the wards
Not receiving copies of letters between the hospital and GP’s

Key points in comparison with other Trusts are detailed in Appendix 1.

The Trust was above average for information, choice, clean comfortable and friendly, safe, high quality co-ordinated care and building relationships, however the Trust was below average on access and waiting.

Action Plan (Appendix 2)

The attached action plan highlights the areas requiring improvement. For clarity this outlines action required as well as the lead director and the timescale for completion.

Conclusion and Recommendations

In conclusion, overall the 2007 survey represents positive feedback from patients treated at the RNOH. However the survey identifies a number of areas of development and the Trust Board is asked to note the findings of the survey and to approve the action plan as outlined in Appendix 2 in order to ensure the areas are addressed and improved.

Kathryn Corder

Acting Director of Nursing

May 2008

Key points in comparison with other TrustsAppendix 1

% National response / % RNOH response / Highest Trust % / Lowest Trust %
Overall Care
Excellent/Very Good/Good / 92% / 94% (same as 2006)
Excellent / 42% / 49% (an increase of 4% from 2006) / 77% / 24%
Respect and dignity
Always treated with respect and dignity / 78% / 79% (a decrease of 1% from 2006) / 92% / 64%
Mixed-sex accommodation and shared bathrooms
Shared a sleeping area with patients of the opposite sex when they were first admitted / 24% / 12% (an increase of 1% from 2006)
Used a bathroom or shower area that was used by patients of the opposite sex / 30% / 19% (an increase of 5% from 2006) / 1% / 45%
Help from staff
Did not get enough help with eating / 20% / 9% (new question) / 3% / 42%
The call button was answered “right away” / 17% / 10% (a decrease of 9% from 2006)
Waiting longer than 5 minutes for the call button to be answered / 15% / 10% (the same as 2006) / 2% / 29%
There were always or nearly always enough nurses on duty / 56% / 60% ( a decrease of 5% from 2006) / 83% / 38%
Cleanliness and hand washing
The room/ward was” very clean” or “fairly clean” / 93% / 95% (the same as 2006)
The room/ward was “very clean” / 53% / 58% (a decrease of 3% from 2006)
The toilets and bathrooms were “very clean” or “fairly clean” / 88% / 87% (a decrease of 5% from 2006)
The toilets and bathrooms were “very clean” / 47% / 44% (a decrease of 3% from 2006) / 81% / 22%
Doctors “always” washed their hands / 68% / 44% (a decrease of 27% from 2006)
Nurses “always” washed their hands / 70% / 54% (a decrease of 15% from 2006) / 25%
NHS Staff acknowledging patients
Doctors “sometimes” talked in front of them as if they were not there / 22% / 15% (an increase of 1% from 2006)
Nurses “sometimes” talked in front of them as if they were not there / 17% / 14% (the same as 2006)
Privacy and noise
Always given enough privacy on the wards / 87% / 87% (a decrease of 4% from 2006)
Always given enough privacy when discussing their treatment/condition / 69% / 69% (a decrease of 3% from 2006)
Bothered by noise at night from hospital staff / 20% / 13% (a decrease of 1% from 2006)
Bothered by noise from other patients / 38% / 38% (an increase of 5% from 2006)
Involvement in decisions
“Definitely” involved in decisions about treatment and care / 51% / 57% (the same as 2006) / 72% / 34%
“Definitely” involved in decisions about their discharge / 53% / 54% (new question)
Quality of food
Food was rated as “good” or “very good” / 55% / 52% (an increase of 6% from 2006)
Food was rated as “fair” / 15% / 32% (a decrease of 1% from 2006)
Offered a choice of food / 77% / 86% (an increase of 68% from 2006)
Waiting times
Waited more than 6 months for a planned admission / 21% / 35% ( an increase 22% from 2006)
Discharge delayed / 39% / 37% (an increase of 3% from 2006) / 18% / 51%
Discharge delayed by more than 2 hours / 53% / 35% (an increase of 13%)
Discharge delayed waiting for medication / 61% / 59% (an increase of 16% from 2006)
Discharge delayed waiting for a doctor / 17% / 13% ( a decrease of 3% from 2006)
Security
Felt threatened during their stay in hospital by other patients or visitors / 4% / 2% (new question) / 1% / 9%
Had somewhere to keep their belongings that locked / 28% / 28% (new question)
Had somewhere to put their belongings but were not able to lock it / 67% / 63% (new question)
Teamwork
Teamwork of doctors and nurses was “excellent” / 39% / 42% ( an increase of 5% from 2006)
Teamwork of doctors and nurses was “excellent”, “very good” or “good” / 92% / 95% ( a decrease of 2% from 2006)
Information
Doctors did not reply to questions with answers they could understand / 6% / 4% (an increase of 1% from 2006)
Staff did not give conflicting information / 66% / 64% (an increase of 3% from 2006)
Completely informed about the risks and benefits of the operation/procedure / 81% / 83% (an increase of 6% from 2006)
Completely informed afterwards about how the operation/procedure had gone / 65% / 68% (an increase of 1% from 2006)
Not told about the possible side effects of medication on discharge / 46% / 28% (a decrease of 19% from 2006)
Not told how to take medication in away they could understand / 9% / 3% (new question) / 2% / 19%
Choice
Offered a choice of hospital / 28% / 25% (new question)
Not offered a choice / 72% / 69% (new question)
Offered a choice of admission dates / 27% / 32% (an increase of 3% from 2006) / 58% / 15%
Complaints
Remembered seeing posters and leaflets on how to complain / 37% / 33% (new question) / 69% / 21%
Wanted to complain / 7% / 8% (new question) / 1% / 15%
Leaving hospital
Given written or printed information about what they should or should not do after leaving hospital / 61% / 75% (new question)
Told who to contact if they were worried about their treatment or condition after they left hospital / 74% / 73% (the same as 2006)
Doctors or nurses gave their family or friends the information they needed to care for them / 43% / 33% (a decrease of 10% from 2006)
Did not receive copies of letters between the hospital and the patient’s family doctor / 61% / 40% (a decrease of 4% from 2006)
Did receive copies of letters between the hospital and the patient’s family doctor / 39% / 51% (a decrease of5% from 2006)

Action Plan 2007

Appendix 2

AREA ASSESSED / ACTION / LEAD INDIVIDUAL / TIMESCALE
Doctors not washing or cleaning their hands between touching patients / Consultants to lead by example and stress process to junior staff. Encourage peer challenge. Ensure process is visible to patients. / Joint Medical Directors / Immediate
Nurses not washing or cleaning their hands between touching patients / Floor posters to be introduced at the entrance of every ward. Infection control nurse/Matrons to undertake spot audits and continue with raising awareness of the importance of hand hygiene at induction and the annual infection control updates. Ward staff and domestics to ensure that alcohol gel is readily available.Ensure process is visible to patients. / Acting Director of Nursing / Immediate
Access to doctors for families / Teams should inform ward managers of the times they can be approached (appointment system, verbal or face to face with seniority of doctor to be mutually agreed) / Joint Medical Directors / September 2008
The explanation about the purpose of the medicines to take home and not being told about medication side effects on discharge / Staff to ensure that all medication that patients are being discharged on is discussed in detail including side effects.
Staff to ensure that the patient is aware of the additional information included with their medication.
To be included in medicines management training / Acting Director of Nursing / Immediate
Delayed discharge waiting for medicines / Service Improvement work to be led by a General Manager to look at roles of junior doctors, pharmacy, nurses and porters / Director of Operations / September 2008
Not being able to find someone to talk to about their worries or fears / Ensure regular ward rounds are carried out. Encourage patients to voice their concerns (positive approach from the medical team). / Joint Medical Directors/Acting Director of Nursing / Immediate
The cleanliness of the wards and bathrooms / A new method of cleaning is to be implemented (microfibre) and a rolling programme of deep cleaning approved. / Director of Projects, Estates and Facilities / March 2009
Not receiving copies of letters between the hospital and GP’s / Secretaries to ensure that patients are copied in on all correspondence between the hospital doctors and their GP’s. Currently the Trust is achieving 60%.
Policy to be written and agreed by Clinical Governance Committee with input from Medical Staffing Committee. / Joint Medical Directors / September 2008