ARISEv1.0 Nov 2015 /

ARISE

The Wessex Patient Safety Collaborative

modelfor patient engagement


Forward

Patient involvement in the NHS has a long history but it has come a great deal further than just asking people about car parking or hospital visiting hours. Involving ‘customers’ in the design and delivery of services has, over the years, led to a marked improvement in efficiency. This in turn has led to greater satisfaction and better outcomes for both patients and health staff. However, as always, it must be recognised that along with the gains comes some challenges. How do you find these patients/carers? How do we best make use of them? How do we support them whilst they are working with us? Also, most importantly, how do we try and ensure we have not ended up trying to put a square peg into a round hole.

The ARISE model that has been developed by Wessex Patient Safety Collaborative is an excellent tool to assist anyone who is looking for the answers to these questions. Patients and carers are an enormous, largely untapped, resource. I am sure that the information given here will be of help to healthcare professionals who want to utilise that resource to ensure meaningful patient engagement in both service design and delivery.

Georgette Houlbrook, Patient Representative – Wessex Patient Safety Collaborative Faculty

Acknowledgements

Wessex Patient Safety Collaborative would like to acknowledge the contribution of the following organisations in helping to develop this model:

Wessex Community Voices (WCV)

Patient and Public Involvement Solutions (WCV)

Healthwatch Organisations from Dorset, Hampshire, Isle of Wight, Portsmouth & Southampton

National Society for the Prevention of Cruelty to Children (NSPCC)

Professional Partnerships & Consultancy Services (NSPCC)

RAISE Health and Social Care, a project delivered through South West Forum

The Kings Fund

National Institute for Health Research - Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) – Northwest London

ARISEmodel for patientengagement

The ARISE model for patient1 engagement has been developed by Wessex Patient Safety Collaborative(PSC) in response to requests from NHS organisations across Wessex for guidance about how to engage effectively with patients.

The ARISE model has been developed by a working party of Wessex PSC organisations based on their experiences of attempting to develop patient engagement across a year long Breakthrough Series project.

The model is aligned with the Patient and Public Participation approach being developed by the NHSE and the CLAHRC initiative based on the NSUN (National Survivor User Network) standards.

How to use the ARISE model

The ARISE model highlights established practices familiar to NHS staff such as: establishing aims & objectives; recruiting people; team building; developing individuals and evaluating progress and demonstrates how these processes can be applied when working with the voluntary sector.

The ARISE model also aims to help NHS organisations to recruit the most suitable people to work with the patient safety agenda. Key to this approach is the assessment of the attitudes, values and motives of those who are applying for the job.

The steps in the ARISE model

The ARISE model consists of 5 steps. The word ARISE is an acronym for Aims – Recruit – Integrate – Support – Evaluate.

These stages also reflect 5 questions that seem to come up very frequently: What do want patient representatives for; where do we find them; how do we integrate them into our team; how can we support them once we’ve found them and how do we know if our engagement process has yielded any benefits?

The ARISE model helps teams plan the process of patient engagement from the “why do it”, through the “how to do it” to the “how well did we do it”.

1 The term patient includes other terms such as service user as well as friends, family, carers etc.

ARISE model for patient engagement – Step 1: Aims

The first step in the ARISE model for patient engagement is defining the purpose, aims and objectives of the proposed workstream.

  • Principles
  • The rationale for engaging with patients
  • Co-design, co-production
  • Beginning with engagement
  • Aims / Objectives / Expected Outcomes
  • What are the aims of this engagement process
  • Where is the pressure to engage coming from
  • Do patient reps change staff behaviour
  • How do we know what we want the patients to do
  • What are the roles for patients: Strategic, Operational, Project, Administrative, Consumer Advisers?
  • Tools
  • ARISE Roadmap
  • Engagement Cycle
  • Baseline Assessment Ladder of Engagement
  • Patient engagement standards (NHSE; NSUN)
  • MfI 3 questions
  • Deliverables
  • Driver Diagram
  • Project Plan / Gantt Chart / Critical Path
  • Role Outline
  • Appropriate metrics / measurement methodology
  • Template documents for organisations / teams

Using the ARISE model will help organisations and teams address questions such as:

  • What do we want our patient representatives to do?
  • How can we assess our culture, identify good practice and address coercive behaviours?
  • How does the organisation think / behave to patients & staff?
  • How effective is the Board to Ward communications / strategy?
  • Is there an individual patient focus linked to service delivery?
  • How can we recognise and reduce resistance to patient engagement?
  • Do we know where the patient representatives are in our organisation and what do we do if we don’t?
  • Should we recruit patients then decide projects or decide projects then recruit patients?
  • How can we identify the most appropriate engagement method to fit the “work”?

ARISE model for patient engagement – Step 2: Recruit

The second step in the ARISE model is to clarify the role of the desired patient representatives and following on from that how, and where, to go about recruiting them.

  • Principles
  • Meaningful engagement in equal and reciprocal relationships between professionals, people using services, their families and their neighbours.
  • Aims / Objectives / Expected Outcomes
  • How to identify and recruit the patients that we want to engage with
  • How to identify and use local patient networks
  • Do to better understand the patients personal agenda / motivation
  • Tools
  • Values based interviewing
  • Network Map
  • Directory of Resources
  • Deliverables
  • Recruitment strategy
  • Volunteer Fair
  • Website
  • Social Media Platform
  • Patient representatives
  • Succession strategy

Using the ARISE model will help organisations and teams address questions such as:

  • How can we meaningfully engage with patients?
  • Is it easier to engage with patients on some projectsthan others?
  • How can we best target patient engagement?
  • How can we engage with “hard to reach” patients?
  • When should we consider developing a new local patient network / media platform?
  • What is the best selection / appointment process for patient reps?
  • Should our patient reps be remunerated?
  • Can one patient represent any other / all patients?
  • Should we be looking for individual patient stories or establishing a broader perspective?
  • How can we ensure that we select the right patient for the right project?
  • How can we decide best context for Patient stories and avoid re-traumatising the patient?
  • When should we consider a broader engagement methodology e.g. focus groups /surveys?
  • How to achieve a balance of positive patient experience alongside the challenging stories?
  • Can we positively discriminate to achieve a balance of representation?
  • How do we allow for differences in staff attitudes and patient rep background
  • Should we consider engaging with staff patients?

ARISE model for patient engagement – Step 3: Integrate

The third step in the ARISE model is to enable patient representatives to be equal and effective partners in the process, and tohelp organisations ensure the patient representatives developreciprocal relationships within their teams.

  • Principles
  • Patient representatives to be equal and effective partners with staff
  • Staff to be equal and effective partners with patient representatives
  • Aims / Objectives / Expected Outcomes
  • To integrate patient representatives as equal and effective team members
  • To ensure staff are able to work as equal and effective team members with patient representatives
  • Tools
  • Induction Planner Checklist
  • Team building
  • Deliverables
  • Induction / Integration Process

Using the ARISE model will help organisations and teams address questions such as:

  • Are Patient Engagement difficulties due to a knowledge gap or an implementation gap?
  • What should we consider when preparing to work with patients as equals?
  • How we can develop staff whohave low confidence in the ability or willingness of patients to engage with us?
  • How can we help our teams to work together, improve multidisciplinary communications in meetings and consider whether there is a need to establish role boundaries?
  • How can we address cynicism about patient engagement?
  • How should we deal with challenging patients?

ARISE model for patient engagement – Step 4: Support

The fourth step in the ARISE model is to ensure that the patient representatives receive the appropriate support and personal development in their role.

  • Principles
  • To ensure patient representatives receive appropriate support on a personal and role related basis
  • To ensure patient representatives can access appropriate personal and role related development opportunities to ensure they are now, and continue to be effective members of the team
  • Aims / Objectives / Expected Outcomes
  • To provide patient representatives receive appropriate support and development opportunities
  • Tools
  • Development Needs Analysis
  • Training Needs Analysis
  • Deliverables
  • Role related guidance / handbook
  • Training Resources (Course Directory / Training Materials)

Using the ARISE model will help organisations and teams address questions such as:

  • What are the development and support needs of our patient reps?
  • How can we train / coach / educate our patient reps?
  • How can we develop our patient reps to improve their effectiveness /communication skills?
  • What resources are available to help us develop patient reps?
  • Do patient reps need to be familiar with the NHS Constitution?

ARISE model for patient engagement – Step 5: Evaluate

The final stage of the ARISE model is the evaluation or review process. The ARISE process starts by identifying purpose, aims an objectives and thisfinal stage reviews whether and how this has been achieved.

This is designed to: celebrate success, reflect on challenges, address barriersand to continually improve patient engagement practice!

  • Principles
  • To evaluate progress
  • To continually improve patient engagement practice
  • Aims / Objectives / Expected Outcomes
  • Celebrate success
  • Reflect on challenges
  • Address barriers
  • Tools
  • ARISE Roadmap
  • Engagement Cycle
  • Baseline Assessment Ladder of Engagement
  • Patient engagement standards (NHSE; NSUN)
  • MfI 3 questions
  • Metrics model / measurement methodology
  • Deliverables
  • Project engagement evaluation report

Using the ARISE model will help organisations and teams address questions such as:

  • Have we met our aims and objectives for our project?
  • Have we achieved meaningful engagement in equal and reciprocal relationships between professionals, people using services, their families and their neighbours?
  • Have our patient representatives been equipped and empowered to work as equal and effective partners in the project?
  • Have our patient representatives been able to receive appropriate support and development opportunities on a personal and role related basis?

Appendix A: Resources

NHS England

  • NHSE - Bite Sized Guides to patient and public participation
  • NHSE - Patient and Public Participation Policy

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  • NHSE – Public Voice
  • NHSE - Transforming Participation in Healthcare (Commissioning Guide)
  • NHSE - Transforming Participation in Health and Care (Resources)
  • NHSE - Working with our Patient and Public Voice Partners - Reimbursing out of pocket expenses and involvement payments
  • NHS Employers – Values based recruitment:

Other

  • 4Pi National Involvement Standards (National Survivor User Network)
  • Centre for Patient Leadership (InHealth Associates)
  • CLAHRC Wessex - Adaptation of the NSUN 4Pi National Involvement. Standards
  • Health Foundation – Patient Engagement
  • Kings Fund – Leading Collaboratively
  • National Voices
  • Volunteering.org.uk

Appendix B: Application of ARISE model to the BTS methodology

  • Scoping
  • Identify Critical Path
  • Develop ARISE model
  • Identify the Faculty
  • Identify budget (PSC / NHSE)
  • Develop Change Package / Metrics
  • Mobilisation
  • Develop toolkit
  • Develop Training materials
  • Clarify the patient role/s (for benefit of teams and the patient reps)
  • Develop any pre-work for the teams to do before the first Learning Event on BTS 2
  • Delivery
  • Familiarise PSC workstreams with the workstream
  • Train BTS2 teams to use ARISE model
  • Review
  • Monitor and Review Progress

Appendix C: Standards used to develop the ARISE model

NSUN (National Survivor User Network) standards.

4PI framework for involvement: a simple, yet robust framework around which to base standards for good practice, and to measure, monitor and evaluate involvement.

  • Principles
  • Purpose
  • Presence
  • Process
  • Impact

NHSE Patient and public participation –3.Planning for participation

  • Why planning for participation?
  • Core principles
  • Practical Steps
  • The Ladder of Engagement

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