Tackling patient and staff wellbeing in A&E
An Experience Based Co-Design (EBCD) project at Royal Berkshire Hospital NHS Foundation Trust highlighted that when it came to the Emergency Unit, compassion was needed for staff as well as patients to improve patient care.
At Royal Berkshire Hospital, the doors of the A&E unit barely close, with a new admission every two minutes and an ambulance arriving every 10 minutes. The pace is immensely pressured and the environment can be noisy and hectic.
‘We wanted to improve patient experience in this busy part of the hospital, but the Friends and Family Test was not providing the level of detail we needed,’ explains Critical Care Sister and EBCD project lead Melanie Gager. ‘We selected Experience Based Co-design as a proven approach that could elicit meaningful patient experience data and highlight improvement areas.’
The department was deemed culturally suitable for EBCD as it was open and transparent, and staff were happy to be in the spotlight – important for a potentially revealing approach. However, for the fast-paced and highly focused A&E team, the organic and exploratory nature of EBCD was a challenge, withno clear timescales or outcomes at the start. ‘For A&E, this was a very new way of working, so it was a real step of faith,’ says Melanie. ‘That’s why trust and good relationships underpin this methodology.’
Patient and staff experience
The team followed the traditional EBCD steps, using observation, staff interviews and filmed patient interviews to gather data. ‘Even though I’ve been through the process before, I still used the EBCD toolkit as a reference,’ says Melanie. ‘Each stage is like a project in its own right, and it helps to see videos of people’s reflections on how they approached tasks and what worked best.’
To carry out observations, Melanie worked alongside four expert patients. One observer was especially affected by his experiences, describing the waiting area as ‘Armageddon’, with some patients in extreme distress, and police interventions. For Melanie, this highlighted the need for debriefing for all participants.
The patient interviews revealed that many patients had shared this sense of anxietyand confusion in the Emergency Department. Some felt that staff did not always know how to communicate with older people or those with mental health problems.
In their interviews, staff too described a confused, hectic environment, but also described the emotional burden they carried. ‘Staff relished having the time to talk in confidence,’ says Melanie. ‘Their stories revealed such trauma. They were real ‘can-doers’, but the pressure is immense. They were running on empty, and compassion fatigue was making their job even harder.’
Co-design work
Once the patients and staff came together, they agreed on four areas needing improvement. The most obvious one – inadequate facilities and lack of space – was already being addressed by the Trust, so the teams focused on three co-design projects:
- Improving information – working with a Royal College of Art design and technology team to develop innovative ways to clarify the patient journey through A&E, from mobile apps, to painting walls in different colours with maps to match.
- A staff education and training package on how to work with people with mental health problems and older people, with patients attending sessions to explain their perspectives and bring the issues to life.
- A volunteering project. Out of the project it emerged that a lot of people wanted to help, not just helping patients but also making teas and coffees for the staff.
Spin-off work
Having highlighted the pressures facing the team, Melanie used evidence from her interviews to run some compassion fatigue interventions among staff. Staff were also shown a ‘thank you video’ composed of clips of interviewees passing on their thanks to staff. One staff member described the film as having filled her ‘compassion bucket’ to the brim.
Learning points
- Make provision for interviews and observers to debrief.
- Realise that staff and patients’ needs must both be fulfilled in order to ensure a positive patient experience.
- Check that the culture of the department is suitable for EBCD and adapt approaches where needed.