West Midlands Strategic Health Authority The changing policy

West Midlands Strategic Health Authority The changing policy context around patient experience – What do we really know? Dr Lisa Bayliss-Pratt Assistant Director of Nursing NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

What do we think patients care about? West Midlands Strategic Health Authority Care and Compassion Clean environments NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

What the research tells us… West Midlands Strategic Health Authority 10 most important items 10 least important items A clean ward Being given help to eat my meals when I need it Staff cleaning their hands before touching patients Being given accurate information about ward routines Being treated quickly in an emergency Not having to wait around in hospital once I have been told I can go home Getting the best treatment for my condition Being given help to arrange transport home Doctors knowing enough about my condition and treatment Having a choice about which hospital to go Clear expectations about what will happen during an operation or procedure Not having to pay too much to make phone calls Being told the risks and benefits of any treatment in a way that I can understand My religious beliefs being respected Clear expectations of my condition or treatment Being able to watch television without having to pay for it Being treated with dignity and respect Being able to get an interpreter Being told how my operation or procedure has gone in a way I can understand Having access to food when I am hungry NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

What the research tells us…. West Midlands Strategic Health Authority • Complaints data is not typically collated or analysed at national or local levels • ‘Relational’ aspects of care (dignity, empathy, emotional support) are very significant alongside functional aspects (access, waiting times) • Current data collection, analysis and reporting have evolved – not a science… Ref: Robert et al (2011) What matters to patients? – Developing the evidence base for measuring and improving patient experience. National Nursing Research Unit, King’s College London NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

The national picture – patient experience: West Midlands Strategic Health Authority q Focus on acute care q Relevant to services rather than patient journeys q Not timely q Not representative NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

What is happening across the NHS West Midlands Strategic Health Authority • Maintaining quality and safety during transition • The quality architecture – still to be determined • Develop a single quality operating model for the SHA Clusters • Develop a standardised set of quality metrics NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

How are organisations using the information? West Midlands Strategic Health Authority Wide range of capabilities Clinical effectiveness, patient safety and experience do not have the same status Poor links between dedicated to measuring and improving patient experience ‘Real time’ approaches are common but focus on ‘snapshots’ CQUINS not seen to be a significant leverage Organisations do not know their costs to the NHS of collecting patient experience data Innovative work not always recognised by commissioners Six universal challenges: structural, political, cultural, educational, emotional and technical NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

Emerging architecture… West Midlands Strategic Health Authority Harm Free Care Dashboards Triangulation ? ? ? ? ? ? ? ? ? ? ? NHS Safety Thermometer Thoughts about capturing Primary Care NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

The Hypothesis… West Midlands Strategic Health Authority If the system is performing well at the highest level of aggregation it will perform well at lower levels too NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

BIG Dot West Midlands Strategic Health Authority • - Big dot criteria NHS-wide Outcome driven (not a process indicator Connect to other ‘little’ dots or processes (multifaceted) Triangulation? ? NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

Timelines of measurement West Midlands Strategic Health Authority Metrics that are captured frequently v No less frequently than quarterly (excludes annual surveys) v Preferably monthly v Move towards more regular closer real time NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

The Selected Big Dots West Midlands Strategic Health Authority Outcome Framework Big Dots Preventing people from dying prematurely Avoidable mortality Enhancing quality of life for people with long-term conditions Right Care First Time – Emergency admissions Help people to recover from episodes of ill health Readmissions Ensuring that people have a positive experience of care Patient Experience Timely Care Harm Free Care • Infection Free • Severe Harm • Never Events • Harm Free Care • Safeguarding NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

Alternatively…. Is perception West Midlands Strategic Health Authority Net Promoter Initiative: would you recommend this to your family and friends? NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

The Patient Revolution West Midlands Strategic Health Authority NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

What is a Patient Revolution? West Midlands Strategic Health Authority • Co-production between patients & professionals • Community participation between the public & the Service • Customer experience of patients & carers NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

We know what needs to done, e. g. West Midlands Strategic Health Authority • • Appointments and access Physical comfort Attitudes of staff Organisation and communication • Knowledge of the patient • Cleanliness • Privacy and dignity NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

Putting the ‘S’ back in the NHS West Midlands Strategic Health Authority • The Problem – Customer Service & patient experience is not a Board level priority – Little real time monitoring – No incentives to improve – No learning from other industries, e. g. First Direct – Just a nursing issue • Best practice to build on – Real time feedback – used by almost all acute trusts in West Midlands, and was being used routinely by commissioners – Ipsos Mori ‘Attitude to Health Surveys’ – including Net Promoter scores – East Midlands Patient Experience Service NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

West Midlands Strategic Health Authority “I have seen other hospitals asking more immediate questions, with more relevant and particular questions, like, “when you pressed the call button, was the response what you expected, better than you expected or worse than you expected? ”. Such questions, done frequently and disaggregated to wardlevel where possible, give a management focus on what is happening in a hospital. ” Andrew Lansley’s first speech as Secretary of State, 8 th June 2010 NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

A national and local priority West Midlands Strategic Health Authority • Operating Framework, e. g. - Diffusion of innovation - Summary Care records - Patient feedback and patient surveys • Commissioning Framework, e. g. - Standardised ‘Net Promoter’ question and methodology is asked in all existing patient surveys from 1 April 2012 NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

What will be different by April 2013 West Midlands Strategic Health Authority • A paradigm shift in the attitudes of NHS Boards, clinicians and patients • NHS Boards across the NHS Midlands and East using the simple metric of the ‘net promoter’ score • Year on year improvements in the ‘net promoter’ score • Sustainable mechanisms in place NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

Programme Governance West Midlands Strategic Health Authority • System-wide Creating and Patient and Customer Services Revolution Steering Group • Executive Sponsorship providing assurance and strategic leadership • System change through task and finish work streams NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

The Steering Group • New approach to an age old problem • Being ambitious in the ambition! • External challenge and leadership • System & Leaders • 3: 1 ratio • From bog-standard to West Midlands Strategic Health Authority NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

Task and Finish Groups West Midlands Strategic Health Authority Customer Services Culture Communit y and Citizen Participati on Patient & Custom er Services Revoluti on Coproductio n between Clinician and Patients • System Led • Clinical Sponsorship • SHA Management & Secretariat support • Defining what good looks like • Share good practice • Upscale and adoption • Innovative solutions to age old problems NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

Task and Finish – Being Part of the Revolution West Midlands Strategic Health Authority Customer Services Culture • Net Promoter • Assurance & Reporting Framework • Leadership Development • Customer Services Recognition • Patient Revolution Alliance Community & Citizen Participation • PPE Framework • Statutory Duties • Health watch and HWB Development Co-production • Shared Decision Making Tools • Patient Education • Clinical Education Information and Knowledge Management e. g. Web Portal, NHS Local NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB

Thank you for Listening West Midlands Strategic Health Authority NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England NHS West Midlands Chair: Sarah Boulton Chief Executive: Sir Neil Mc. Kay CB