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Patients at the heart of creating the right culture

David McNally

Deputy Director Patient Experience

NHS England10 July 2015

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Patients & carers:

what matters to you

Patient experience of

care

Leadership and culture

Delivering compassionate

care

Staff experience

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What is Patient Experience:

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• I am involved as an active partner in my care.

• I am treated as an individual – my needs, values and preferences are respected.

• There is a recognition that I am the expert on me.

• I am able to access services when I need them, and my care is coordinated.

• I am asked about my communication preferences so that communication is tailored to me.

• I have access to the information I need, which is presented in a way that is right for me.

• I have access to the support I need and is right for me, including emotional and practical support, and I am able to involve my loved ones in decisions about me.

• The environment in which I receive my care is clean and comfortable and makes me feel dignified.

(from ‘Improving experiences of care: Our shared understanding and ambition’, National Quality Board January 2015)

What is good experience of care?

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Not

“The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare”

A systematic review of evidence on the links between patient experience and clinical safety and effectivenessBritish Medical Journal (January 2013)

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Definition of quality care

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Clinical effectiveness; experience;

safety

Collect; interpret; act, assure

Surveys; FFT; complaints;

stories

Systematicapproach

Quality Context

Process

Range of feedback

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Patient experience in commissioner plans

• How you will set measureable ambitions to reduce poor experience of inpatient care and poor experience in general practice

• How you will assess the quality of care experienced by vulnerable groups of patients and how and where experiences will be improved for those patients

• How you will demonstrate improvements from

FFT, complaints and other feedback

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17 April 2013Derbyshire Healthcare NHS Foundation Trust

Opening Ceremony

@GrangerKate

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Open and Honest Care and Safe Staffing

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NHS North West Transparency Project

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• Clinical quality• A five per cent increase in staff working in real teams is associated

with a 3.3 per cent drop in the mortality rate (around 40 deaths a year in an average acute hospital).

• The link between staff satisfaction and mortality rates for both non-clinical and clinical staff, with the strongest correlation among nursing staff.

• Staff satisfaction is related to hospital- acquired infection rates.• Presenteeism, where staff feel pressure to attend work even though

they are unwell, has a knock-on effect for patient care.

• Patient experience • ‘Staff feedback [is] associated with patient-reported experience... and

the consistent direction of the findings is indicative of [causality.]’• Individual staff wellbeing is best seen as an antecedent rather than as

a consequence of patient care performance.

Staff engagement: the evidence

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• As could be expected, staff who feel that their work is valued are likely to recommend their organisation as a place to work.

• Staff who feel that their work is valued are also more likely to feel that care of patients is their organisation’s top priority

• Nationally, the proportion of staff who feel that care of patients is their organisation’s top priority has increased slightly, from 66% in 2013 to 67% in 2014.

• At organisations where staff feel that care of patients is the top priority, staff are also more likely to report that senior managers try to engage staff in important decisions

NHS Staff Survey 2014 – Organisation cultures affect the quality of patient outcomes

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• Nationally, almost three-quarters (73%) of staff reported that patient/service-user feedback is collected within their directorate/department.

• Staff who have frequent contact with patients are the most likely to report that patient feedback is collected at their organisation. However, this group feel relatively less informed about the way that patient feedback is used in decision-making. • General managers and commissioning managers are

significantly more likely than other staff groups to report that feedback is used to make informed decisions.

• Medical and dental staff are the least likely to feel that patient feedback is used to make informed decisions.

NHS Staff Survey 2014 – New questions about the collection and use of patient feedback

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The Staff Friends and Family Test (FFT) was introduced in April 2014 with the vision that all staff have the opportunity to feedback their views on their organisation at least once per year. The two FFT questions are similar to two Staff Survey questions (see table 2); as such, the Staff FFT is undertaken on a quarterly basis except in Quarter 3 when the Staff Survey is carried out.

The Staff FFT provides quarterly updates of staff advocacy for their organisation

Question Staff FFT Staff SurveyWork How likely are you to recommend the organisation

to friends and family as a place to work.I would recommend my Trust as a place to work (q12c)

Care How likely are you to recommend our services to friends and family if they needed care or treatment.

If a friend or relative needed treatment, I would be happy with the standard of care provided by this organisation (q12d)

Quarter Q1 Q2 Q3

Source FFT Staff SurveyMetric % recommend % agreeWork 62 61 56Care 76 77 64

Extremely Likely

Likely Neither Unlikely Extremely Unlikely

Don't Know0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

21%

41%

18%

12%

7%

1%

18%

41%

26%

10%

5%

FFT - Work

Staff Survey - Work

Figure 21: Breakdown of responses to both the Staff FFT and NHS Staff Survey work question

Table 2: Comparison of the Staff FFT and NHS Staff Survey question text

Table 3: Quarterly Staff FFT and Staff Survey results

While the Staff Survey results are lower than the FFT results overall (see table 3), fig 21 shows that the pattern of responses is fairly consistent across the options for both measures.

Source: Staff Friends & Family Test - Initial analysis (draft)

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• The Culture of Care Barometer presents staff with 30 attitude items and asks them to indicate their agreement with each on a scale of 1-5: from strongly disagree, to strongly agree.

• Section 1: Resources needed to deliver quality care • Section 2: Support needed to do a good job • Section 3: Worthwhile job with a chance to develop • Section 4: Opportunity to improve the way team works

Culture of Care Barometer

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• Adds value to existing tools such as the staff survey and Friends and Family Test and can best be targeted at teams where it was perceived as being particularly useful in fostering dialogue and surfacing how respondents felt about working in their organisation.

• Culture is everybody’s business and support for the use of the Culture of Care Barometer needs to come from the Chief Executive and the Board to ensure culture is not seen solely as a nursing responsibility.

• Implementation of the Culture of Care Barometer needs to be supported by a robust engagement and communications plan at Trust level and endorsed by the Board to promote uptake and response rates across different groups of staff.

Culture of Care Barometer - Recommendations

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• Schwartz Rounds are meetings which provide an opportunity for staff from all disciplines across the organisation to reflect on the emotional aspects of their work.

• A Round can either be based on different accounts of one patient or an event, or can explore a particular theme such as ‘when things go wrong’ or ‘memorable patients’. • lunch is offered before the start• presenting team talk for 10-15 minutes on a pre-planned topic• trained facilitators moderate the discussion• the audience is asked to share their thoughts, ask questions, offer similar

experiences• Round lasts for one hour in total.

• Research into the effectiveness of Schwartz Rounds shows the positive impact that they have on individuals, teams, patient outcomes and organisational culture.

Schwartz Rounds

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• April 2015, 116 UK organisations running Rounds

• Mix of NHS trusts – acute, teaching an non-teaching; mental health; community services – hospices and independent sector

• Audiences range from 120-150 in the largest to 30 in smallest

• Multi-professional and multi-disciplinary audiences in all

• Mix of staff varies between organisations: some mainly medical, others more nursing, therapists and support staff

Schwartz Rounds in the UK

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Discussion

• How is patient feedback gathered, considered and acted upon in your organisation?

• What could your organisation do improve

• Patient and carer experience of care?• Staff experience?

• What does your organisation do particularly well?

• What more could NHS England do to support local organisations?

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Thank You

David McNallyDeputy Director Patient Experience

davidmcnally@nhs.net