Surrey and Sussex Healthcare NHS Trust Patient Experience ... and Sussex Healthcare NHS Trust –...

Surrey and Sussex Heal thcare NHS Trust – Pat ient Experience Strategy 2014 - 2019

Surrey and Sussex Healthcare NHS Trust Patient Experience Strategy 2014 to 2019 Version 1.5


Version Control Version Date Author Key changes Distribution Draft 1.0 03.02.14 Cathy White Draft 1.1 Cathy White Re-working of Patient

Experience Plan chapter Ian Mackenzie, Fiona Allsop, Nicola Murray, Tasha Gardner

Draft 1.2 Cathy White Incorporating PALs, Complaints National survey and Patient Opinion paragraphs plus minor improvements to text

Ian Mackenzie, Fiona Allsop

Draft 1.3 05.02.14 Cathy White/ Ian Mackenzie

Amended definition of short/ medium / long term plus re-wording of elements into positives

IM/ FA/Richard Durban

Draft 1.4 17.03.14 Cathy White/ Ian Mackenzie

Final wording changes Executive Board

Version 1.5 15.04.14 Cathy White/Colin Pink

In response to feedback from SQC – links to Quality Strategy, remove PE vision, incorporate smart technology

Trust Board


Contents Page 1. Foreword 4 2. Introduction 5 3. Organisational Tenets 6 4. Patient Experience Vision, Themes and Objectives 10 5. Where Are We Now? 16 6. Detailed Patient Experience Plan 23 7. Strategy Evaluation 28 8. Patient Experience Strategy Implementation 31


1. Foreword This Patient Experience Strategy has been developed by Surrey and Sussex Healthcare NHS Trust (the Trust/SaSH). Its purpose is to expedite a disciplined yet agile approach to improving patients’ experience of the services the Trust provides over the next five years and as such is a key element of delivery and supports the Trust’s Quality Strategy. The Patient Experience Strategy is aligned with the Quality Strategy and other strategic plans for other divisions within the Trust and is based on the premise of ensuring clinical and financial sustainability. At the time of preparing this Strategy, the healthcare economy and landscape are subject to the impact of continuing, major legislative, organisational and policy changes. There is consensus across the system that change is both necessary and inevitable; the way forward, however, is not prescribed. Financial pressures are juxtaposed with continuously increasing levels of clinical activity and whilst flexibility is inherent, a five-year strategy set out in this context must be taken and read as reflecting the Trust’s current expectations of the period ahead. The Strategy will be revisited, reviewed and revised as the variables and dynamics impacting on the healthcare system evolve and are developed - and as the SaSH Clinical Strategy progresses.


2. Introduction Surrey and Sussex Healthcare NHS Trust provides a comprehensive range of emergency and non-emergency services, primarily for the residents of east Surrey, north-east West Sussex and south Croydon, covering the major towns of Crawley, Horsham, Reigate and Redhill. The Trust owns East Surrey Hospital (ESH) which is located just south of Redhill and from this site delivers elective and non-elective services, including major and minor Accident and Emergency. East Surrey Hospital is a Trauma Unit and is the designated hospital for Gatwick Airport and sections of the M25 and M23 motorways. The Hospital is situated at the heart of a local community of over 500,000 people and the Trust employs around 3,500 staff. To enable the provision of appropriate services at locations which are closer to home for our patients, SaSH staff also deliver a range of day case, outpatient and diagnostic services at premises owned by other organisations. These include Crawley, Caterham Dene and Horsham Hospitals and Oxted Health Centre. This Patient Experience Strategy has been developed in collaboration with colleagues across the Trust including the Executive Team and Board. The process also involved conducting a patient experience workshop among staff and reviewing on-going feedback from patients collected via our Your Care Matters survey, the Patient Advice and Liaison Service (PALS) and Complaints. The Patient Experience Strategy aims to deliver aspects of the Trust Quality Strategy, as detailed in Section 3 – Organisational Tenets. As described in the Trust Quality Strategy, our patients can expect that they will be kept fully informed and involved in the decisions about their care and they will be treated with dignity and respect. We will expect our staff to be open and candid when things go wrong and provide the highest quality of care they can and we are also expecting that all staff will have a quality objective set in their annual appraisal. This should include relevant objectives to improve patient experience. Our Quality Strategy states that we will further improve Patient Opinion ratings and not be in the bottom 20% for any response in the National Inpatient Survey. The Patient Experience Strategy will look to drive the continual improvement of patient experience and help the Trust meet the goals described in our Quality Strategy.


3. Organisational Tenets Over recent years, SaSH has worked to develop a culture that supports consistent improvement, resourcefulness and efficiency in clinical and non-clinical functions. Progress has been evidenced and recognised in many areas; recent examples include:

• CQC Hospital Intelligent Monitoring analysis which placed the Trust in the highest banding for offering safe, effective, high quality care

• Friends and Family Test combined inpatient and Emergency Department scores which reported SaSH as having the best District General Hospital score in its region in December 2013

• The January Friends and Family Test score for our Emergency Department placed us as fifth best in the country.

Our Vision Statement, Strategic Objectives and Values provide direction and stimulus for the Trust as well as offering a reflection of the character and aspirations of the Trust leadership and its staff. Aligned with its geographical and operational positioning, the Trust approach is summarised in its Vision Statement which is to deliver: ‘Safe, High Quality Healthcare which puts our Community First’ This Vision is enshrined in five Trust Strategic Objectives. They are: Safe – To deliver excellent quality of services in the top 20% against our peers by ensuring that:

o the safety of patients and staff comes first in all we do o we embed safety and quality into everyday systems and processes o we are open and transparent o we achieve harm free care o we maintain and exceed a “Good” CQC rating o we support safety by providing excellent learning environments and supporting our

students as the workforce of tomorrow. Effective – To deliver clinically and financially sustainable services and to control our own destiny by ensuring that we:

o have appropriately qualified and competent staff providing care o achieve the best possible clinical outcomes for our patients o demonstrate full compliance with all NICE guidelines o use quality evidence at the point of care o live within our means to remain clinically and financially sustainable o embed a culture of lifelong learning, ensuring our education and training meets our

needs to enable the best delivery of care.


Caring – To ensure patients are cared for and feel cared about by ensuring that we: o deliver high quality care around the individual needs of each patient o show compassion and go the extra mile at all levels o treat patients and their families with dignity and respect o always work to the highest standards of professionalism and ethics.

Responsive to people’s needs – To become the secondary care provider and employer of choice for the populations of Surrey and Sussex by ensuring that we:

o listen to patients and their families o involve patients and carers in their treatment and care o use feedback to shape and improve the experience of patients and the services they

receive o ensure an effective patient journey with the right patient, in the right place, at the

right time o maintain improving patient satisfaction and friends and family test results.

Well led – To develop the East Surrey Hospital site to provide a range of specialist and tertiary services closer to home and in response to local and national priorities in partnership with others, ensuring that:

o we are an organisation that is clinically led and managerially enabled o we are a well governed organisation working in partnership with stakeholders o all staff consistently demonstrate the Trust’s values and behaviours o we have visible leaders who are engaged and play a valuable part in the local health

and social care system to ensure the development and delivery of safe and sustainable services.

Underpinning achievement of these objectives are the Trust’s Values:


These tenets are further developed to describe the basis of the Quality Strategy (which in turn informs the Patient Experience Strategy) as follows: • Our patients deserve the best possible care and we intend to deliver good clinical and

quality outcomes by further improving patient safety, patient experience and clinical effectiveness.

• We will provide a broad range of high quality, integrated district general hospital services that allow us to be a clinically and financially sustainable organisation and to especially work with other expert providers to bring tertiary services and expertise locally to our patients.

• We recognise that a good reputation is key to the delivery of our services, and we aim, therefore, to meet all local and national expectations which include meeting the needs of our patients and our commissioners. We are committed to academic training, research and innovation and aim to be both the provider and employer of choice.

• We understand that we cannot deliver our services in isolation and it is, therefore, imperative that we work in partnership with our NHS and commercial partners to deliver appropriate services and models of care, which include utilising clinical networks. Partnership means working with others across the whole health economy, both providers and commissioners, working to the same agenda of delivering high quality, safe and affordable care.


• So that we remain clinically and financially sustainable, we are working hard to improve our productivity by adopting better ways of working. We recognise the role that technology has to play in doing this. We also believe that it is vital to use intelligent information and benchmark our performance. By being sufficiently informed with the right information, we can make better decisions about improving and sustaining our performance.

The Trust’s Clinical Strategy drives and shapes the provision of services by SaSH and therefore sets the broad direction that each of the clinical divisions will follow. This in turn informs strategies such as Quality and Patient Experience, to ensure clear alignment with the overall Trust vision and objectives. It should be noted that strategic planning is the starting point for the Trust’s rolling five year business planning process which will develop and test the detailed plans of the individual clinical divisions and services. These, based on robust activity, capacity and financial planning, form the core of the Integrated Business Plan.


4. Patient Experience Vision, Themes and Objectives 4.1 What is Patient Experience? The term ‘patient experience’ has become common currency in the NHS. It is increasingly acknowledged that a patient’s experience is broader than just the clinical aspects of care; it is made up of both their clinical and non-clinical interactions with the health system. There is often a heightened sense of anxiety when people are using our services, with each interaction taking on extra significance. This makes how we interact with our patients and their families all the more important in delivering an excellent service. We aim to include the full range of clinical and non-clinical encounters in the Strategy. These all contribute to the overall experience patients have of us. From pre-admissions through to post discharge, the way we treat our patients and the systems we have in place all have an impact on their experience and that of their families, visitors and carers. It is their experience whilst they are with us that influence their perceptions of the Trust once they have left our care. Every interaction an individual has with us as a Trust affects how our patients view us and feel about the care and service that they are receiving. Whilst we may not have control of all encounters (e.g. National media coverage of the NHS, social media, local reporting), for those we do have control over they offer us the opportunity to deliver excellent service for all our patients. Increasingly people are taking their experiences in consumer organisations and applying expectations from there to other service providers such as healthcare. The best consumer organisations such as John Lewis, Disney and Starbucks focus on delivering a targeted, repeatable experience, taking account of the evolving behaviours, needs and expectations of their customers. There are lessons we can take from this approach to assist us in re-assessing how we deliver care from the perspective of the patient.

Deloittes define Patient Experience as: “The quality and value of all the interactions – both direct and indirect, clinical and non-clinical – spanning the entire duration of the patient:provider relationship”

Deloittes – The Patient Experience

The CQC’s revised approach to regulation explicitly sets out that it focuses more on: ‘people’s experience of care, rather than on the processes the care provider uses’.


As a Trust, we aim to broaden what is the widespread notion of patient experience to include the entire patient pathway, from before the patient comes to hospital, through their time with us, to after the patient leaves our care. Implicit in our approach is the understanding that we have a wide range of patients whose needs and expectations will be varied. Our services need to accommodate this variety and ensure that our patients feel safe, confident in their treatment, cared for and cared about. 4.3 Our Ideal Our Patient Experience objectives are driven substantially by:

• the outcomes of the patient experience workshop, held in January 2014 • talking and listening to our partners and stakeholders • feedback from patients via our Your Care Matters patient survey, the Friends and

Family Test, PALs and Complaints • the Trust’s Quality Strategy; the expectation that we will have an ‘excellent’ CQC

rating, that we will become a Foundation Trust and ensure that we put patient experience at the centre of how we design and deliver our services

The Strategy is aligned with the Organisational Tenets, including the Trust Vision described in Section 3.0 of this document, the Patient Experience Strategy and objectives. 4.4 Patient Experience Objectives Our objectives embrace both seeking feedback from our patients and responding to it. We aim to:

• emphasise the importance of obtaining feedback from our patients, their relatives, friends and carers

• allow feedback to be given in a variety of different ways • demonstrate to our stakeholders that comments and views made by, or on behalf of,

patient bring about change and improvements for future users of our services. • create a culture of continuous improvement and learning • have robust governance mechanisms that identify issues of concern and ensure

lessons are learnt and shared rapidly across the Trust • be able to share good practice across different wards and departments within the

Trust • further develop a culture that empowers staff to make improvements • reinforce a culture that recognises and rewards staff for embracing and delivering

excellent patient experience 4.5 Key Themes


We have identified five key themes that impact upon patient experience. In practice, there is a great deal of overlap between these different themes and during the evaluation of each new initiative the opportunities for benefits in each of these themed areas will be assessed and integrated where feasible. 1. Attitudes and Behaviour How our staff interact with patients, relatives, visitors and carers is critical to setting the tone and expectations of a visit to us. Our staff are the face of our Trust and everyone has a role to play in creating a good impression and making our patients feel welcome, cared for and cared about. All our staff should live the Trust values that we advocate. What we say, how we say it and how we behave towards our patients, their visitors and each other all impacts on the service we provide. This theme encompasses setting standards of behaviour that are expected of our staff, making them explicit, training staff, assimilating these expectations into the recruitment process and acknowledging when we see especially good examples of what is expected.

2. Communication Linked to attitudes and behaviour is communication. This theme covers specific initiatives such as ‘Hello, my name is’ that are already active within the Trust. But it also includes other channels of communication and ways to make it easier for patients and visitors to interact with us. For example, the expectations around answering telephones, having clear name badges, an explanation of the different uniforms that are worn. The mechanisms by which we communicate are also included. Making sure letters to patients are written in plain English, using ward and department names that are consistent with the signage in the hospital, and including all the details we know that patients would like. Improving how we communicate information such as waiting times also has a significant impact on how our patients perceive the work we do. Communication is a two way process and expanding the patient voice is part of this theme. This means building on our existing feedback mechanisms and increasing the ways we have of listening to what patients have to say. Ideas such as patient forums and focus groups will be considered. Seeking feedback about our services has little value unless we then act on what we hear and learn from it, through sharing outcomes with staff. Our ‘You said…. So we have’ initiative aims to communicate to both patients and staff at ward and clinic level that we act upon the feedback we receive. There are other ways this can be done such as via events like patient story sessions and open forums. These would be the next step once the ‘You said … so we have’ approach is established across the Trust. Finally this theme also encompasses how we communicate patient experience information and activity to our external stakeholders such as GPs, Clinical Commissioning Groups, and


local interest groups. There is a clear connection between this theme and the Trust Communication Strategy. 3. Process Process covers how the processes and systems we work to: Have an impact on the ability of our patients to access the services they need - Using the broad definition of patient experience that we advocate, how support services (such as booking offices) and also services themselves (such as outpatient clinics), operate and the times they are available to patients will impact upon the wider patient experience. Can be used to keep patient experience on the agenda at different levels within the Trust – by ensuring that patient experience is a rolling agenda item at appropriate meetings throughout different levels of the Trust.

Can combine different sources of patient feedback into a coordinated approach to identifying and prioritising improvements – Themes and issues come to our attention via a range of channels. It is essential that information coming in via these different sources is pulled together to allow us to develop plans based on all the information. 4. Leadership It is an established principle that leadership is key to bringing about change. If senior leaders are not signed up to improving patient experience or willing to give it the exposure it needs then they cannot expect others to be. One way of demonstrating commitment is to lead by example and make it clear to staff that they are prepared to be involved and understand issues from different perspectives and from direct experience. Management structures and systems need to allow our staff to:

• Lead by example • Sit, see and listen • Go back to the floor • Share good practice • Support staff to improve • Challenge poor attitudes or behaviour as a critical friend

Tools can also be developed to share good practice across clinical areas. The ‘You said …… so we have’ initiative results in very positive changes at ward level. Feedback also leads to changes at a broader, Trust level. Sharing these changes and improvements will assist staff who may have been presented with similar challenges from the patient feedback that they have received. The Intranet can be used as a tool to provide staff with useful information and signpost them towards examples of good practice.


5. Environment The physical environment of the hospital is a central part of creating the right impression. Car parking, signage, how clean areas are and the quality of the building fabric all contribute to how patients and visitors perceive the Trust and how easy it is for people to use the services they come to us for. Within this theme a series of issues have been raised that we anticipate including in the detailed plan, for example:

• Sufficient car parking that prevents queues or congestion for patients, visitors and staff

• Car parking charges that are sufficiently flexible to accommodate instances when patients or visitors stay for a long time

• Comfortable and spacious waiting areas for patients that aim to avoid patients with varied medical reasons for their attendance mixing inappropriately. The ED reception area, the Obstetrics and Gynaecology waiting area and Ophthalmology waiting areas have all been raised as places that could benefit from improvements

• Signposting that is consistent with the written material that we give to patients • Ensuring that patients receive nutritious and appetising food and a well-balanced

diet

4.6 The Role of Staff It is an established fact that organisations whose staff are better engaged deliver better care. We know from the Annual NHS Staff Survey that staff engagement is improving across the Trust, but we need to ensure that this continues to improve. Our staff are the face of the Trust and are vital to setting positive yet realistic expectations patients have of their visit. Staff have a key role to play across all these five themes - employees who feel committed and valued by their employer are also more likely to feel empowered to move the Trust forward. Having the right organisational culture will show in the behaviours of people and how they interact with patients and stakeholders. As a Trust we have a responsibility to our staff to:

• Provide them with the understanding of what we expect of them • Provide them with appropriate training • Ensure they feel supported and empowered to deliver high quality patient

experience and continuously improve services • Ensure they feel confident that their concerns or ideas will be listened to and acted

upon • Acknowledge and celebrate success • Share examples of good practice

At the same time, our staff have a responsibility to the Trust to:


• Strive to continually live the Trust values in all that they do • Speak out for patient experience • Communicate actions they have taken to improve services based on patient

feedback • Challenge poor behaviour in their colleagues


5. Where Are We Now? It is essential that our patients know that what they have to say about the care that they receive matters to us. Moreover, we listen to what they say and take steps to improve wherever it is deemed appropriate. There is a range of different ways that patients can provide feedback and these can all result in changes at all levels within the organisation. Each source of feedback is described in greater detail below. The Trust has developed a process whereby we triangulate these sources of information, identify key issues and report them into the Patient Experience Committee. The Committee then agrees the relative priority of issues, how to address them and the desired timescale. We are continually improving how we communicate improvements that have been made to stakeholders and how we share learning from them among staff. Friends and Family Test scores, staff commendations and changes that have been made are displayed on wards and via the digital screens located throughout the hospital. 5.1 Recent Improvements at SaSH There are many examples of how patient feedback has improved patient experience at SaSH. It is often small things that make a difference, some of the small, ward based improvements are:

• Providing earplugs to help reduce noise at night • Replacing bins with soft close versions • Fixing showers • Having more entertainment options on the ward such as TV and radios

We have also addressed issues raised about communication such as:

• Providing greater detail of what to expect in appointment letters • Improved written information for patients to take home • Changing how our staff on a ward communicate vital information to relatives • An initiative to reduce how often a patient is asked the same question

And then there are larger changes around:

• Car parking • Reducing the time taken for discharge medications to be dispensed • Reducing staff noise at night • Improved pain control • Acoustics in the Emergency Department reception area


5.2 How We Listen to Patients The National Patient Survey Programme This survey is was established as a result of the Government’s commitment to ensuring that patients and the public have a say in how NHS services are planned and developed. Surveys are conducted annually for Inpatients and Cancer services and on a three year programme for Emergency, Maternity and Outpatient Departments. Response rates among our patients are in the region of 50%. Results from each survey are reported to the Board and at Divisional level action plans are developed to improve performance. The surveys are very useful in allowing us to benchmark SaSH’s performance against National results. However, for inpatients and cancer services the relatively short time between the results being available and the next wave of fieldwork make it difficult to develop action plans, implement change and embed them within the service in order to make a difference to the next year’s results. The Friends and Family Test This is a simple question that asks patients to rate how likely they would be to recommend the care they received to Friends and Family if they needed similar care or treatment. It became a requirement for all Trusts to ask the question of inpatients and emergency department patients in April 2013 and

Maternity services in October 2013. Data are uploaded to NHS England via Unify.

The monthly results for all Trusts are published and available via the link: http://nww.fft.england.nhs.uk/index.php/analyse This allows the net promoter scores (the Friends and Family Test score) for each patient pathway to be compared with all other Acute Trusts, both nationally and against other local providers. Our inpatient score of +76 for January 2014 put us just above the National average of +73. Our score of +80 for the Emergency Department means we are ranked the 5th best in England.

Your Care Matters The Friends and Family Test provides a headline score. There is also a requirement that patients are given the opportunity to explain why they have rated their experience the way

http://nww.fft.england.nhs.uk/index.php/analyse


they have. The intention is that this can assist in identifying how services could be improved. At SaSH we have gone further. In 2012 we recognised the need to implement a robust system that continually tracks how our patients rate the service they received. We enlisted the assistance of an organisation with an established track record in customer relationship management in the service sector. In collaboration with them we developed our ‘Your Care Matters’ Survey. This asks questions covering a wide spectrum of service delivery including:

• Communication • Respect and dignity • Involvement in decision-making • Explanations of medication • Care and compassion

• Confidence and trust in staff • Food and cleanliness • Staff and patient noise • Emotional support • Pain control

In addition to providing quantitative data there is an opportunity in the questionnaire for respondents to mention staff who they feel have gone ‘above and beyond’ what they were expecting. These Commendations are emailed daily to the relevant Ward Manager and copied to Matrons, Divisional Chief Nurses, our Chief Nurse and other staff key to that ward/department. These SenSASHional commendations are valued by staff who greatly appreciate being recognised and thanked for the work they do – both by patients and their Ward Managers. We believe we are one of just a handful of Trusts that have this staff commendation loop integrated into our patient survey. Many of the questions on the Your Care Matters survey for inpatients are taken from the National Inpatient Survey and are scored the same way so that we can monitor performance at ward level and be responsive to implementing change where necessary. Ward dashboards are updated monthly and are available on the Trust intranet. At the end of the survey patients are also given the opportunity to add any additional comments they may wish to make. These Additional Comment reports are also emailed to Managers at the end of each month. This gives each Manager an opportunity to review these comments and take steps to implement changes to improve patients experience where appropriate. The survey is live in our inpatient wards, the Emergency Department, the maternity unit, outpatient departments, day surgery, chemotherapy, endoscopy. We receive in excess of 1,000 responses per month across the different pathways.


Patient Advice and Liaison Service (PALS) The Patient Advice and Liaison Service (PALS) was established to offer a confidential, independent source of advice and support to patients, their families and members of the public. PALS works by: • Listening to the comments of the people who use or are affected by the services

provided by Surrey and Sussex Healthcare NHS Trust • Resolving their concerns or information needs quickly and informally by negotiating

with staff at all levels or working with other statutory organisations or voluntary agencies

• Ensuring that the opinions and experiences of patients and their families are taken into account in the organisation’s service improvement work. This is done by reporting back to service managers on a case-by-case basis and by feeding PALS themes into the Trust’s formal committee structures.

Collating the activity from PALS contacts gives us a clear view of what our service users think, allowing us to understand and learn from patient experiences. We are able to identify trends and gaps in service provision via report and learn mechanisms and provide divisional leads with the opportunity to tailor services to meet the needs of its service users and make required improvements. Currently PALS at Surrey and Sussex Healthcare NHS Trust receives an average of 247 cases per month. Complaints Complaints are managed under the Surrey and Sussex Healthcare NHS Trust Complaints Policy and in accordance with The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009. Complaints regarding dissatisfaction with services are investigated by the divisions and responded to with the aim of resolving the concerns of the individual and recognising required improvements to the care and treatment we provide. Currently the Trust receives an average of 40 complaints per month. There is a structured method for recording the outcome of a complaint on a case-by-case basis, whereby the severity, justification, potential learning and any subsequent action plans are identified, shared and monitored through divisional governance meetings. There is a requirement that learning from complaints is shared across the Trust and this is done via formal committee structures.


Other Sources of Patient Feedback We are actively engaged in Patient Opinion an independent website which allows people to post their experiences of the services we provide, both good and bad. We welcome this feedback as another way to improve our services. We run a live feed of all the comments on the home page of our website. We joined Patient Opinion in September 2012. Since then 464 comments have been posted, an average of 28 a month. These comments have been viewed a total of 127,163 times. We aim to answer each comment promptly, ideally within 48 hours. The posts are forwarded on to a member of staff in the relevant department or responded to by the Communications Team. All comments are passed onto the areas/staff mentioned so managers can share the feedback with their teams. Patient Opinion has regularly praised the Trust for the way it uses the forum and as a great example of a trust dealing with patient comments in an open and transparent way. Our Patient Experience Forum comprises fifteen people, selected via an interview panel. We aim for these representatives to be from our entire catchment area. The forum meets every two months and individuals from it are valued members of various Trust working groups. These different sources of patient feedback provide a powerful way of understanding what people think of our services, enabling us to respond to patients’ needs, to continually monitor performance and to take steps to improve. The Friends and Family Test for Staff This is due to go live nationally in April 2014. All staff are to be asked two questions along the same lines as the Friends and Family Test for patients:

• How likely are you to recommend this organisation to friends and family if they needed care or treatment?

• How likely are you to recommend this organisation as a place to work? • Plus the opportunity to elaborate on their responses via a ‘free text’ box • We will also look at asking additional questions to provide a ‘temperature check’ on

any key issues facing staff These questions will be asked of all substantive, Bank and voluntary staff three times a year. Monitoring staff engagement in this way will provide us with the ability to respond to comments staff make and effect change in a similar way to how we do for patients. We will also be able to correlate the results of the Friends and Family Test for different groups of respondents.


5.4 Communicating Change It is important that we demonstrate to our patients that not only do we listen, we take action as a result of what we hear. Our ‘You said …. So we have’ initiative sets out to communicate changes to patients and visitors. Each ward noticeboard displays posters of:

• the Friends and Family Test score in month • changes that have, or are, being implemented • staff commendations that have been received

Examples of changes, staff commendations and the Trust FFT score in month are also displayed on digital screens around the hospital.

Posters displayed on each inpatient ward


Staff commendations displayed on digital screens

Examples of changes that have been made displayed on digital screens Our Trust FFT scores for the past three months for inpatients and our Emergency Department are on our website. The FFT scores for each of the four maternity touchpoints have also recently been added. In addition to communicating these messages publically, the changes we make at ward level can be useful for others wards and departments. By collating all these changes we develop a powerful learning tool to share and learn from. These are updated monthly and are available as part of the Patient Experience Toolkit on our Intranet.


6. Detailed Patient Experience Plan In order to deliver this Strategy a detailed plan has been developed by bringing together the outputs of: the Patient Experience Workshop; stakeholder discussions; feedback from our staff and triangulating feedback received from the different ways we listen to our patients. Issues have been listed under the five key themed areas described in Chapter 4 to develop an overview. From this priorities could be discussed and agreed and timescales set. (see below). Detailed implementation plans and action owners will be developed by the Task and Finish Group that will be set up to deliver each action.

Overview and priorities resulting from the Patient Experience Workshop

Activities have been prioritised into short (up to one year), medium (1-3 years) and long term (three years plus) reflecting their importance, impact and the anticipated time required for implementation. The Patient Experience Committee monitors this Plan and the work of the Task and Finish groups (see Chapter 7 – Strategy Evaluation). The monthly meeting of a Triangulation Group will mean that these priorities will be continually under review in light of patient experience feedback that is received subsequent to this Detailed Plan being developed.


Theme Attitudes and Behaviour Short term (up to 1 year)

Establishing standards of behaviour required of staff: • how to introduce yourself • acknowledging the presence of people waiting • telephone style • corridor behaviour • wearing name badges • compassion • speaking well of each other

Customer care training to apply standards of behaviour for receptionists, using our Emergency Department as the pilot area.

• The importance of first impressions • Understanding a situation from different perspectives • Empathising with others • Having difficult conversations • Communicating with difficult individuals • Listening to patients and relatives • Managing conflicting demands/requests • Leading by example • Taking ownership • Being a critical friend • Keeping inappropriate conversations away from patients and visitors

Review the programme Embedding customer care training into our induction programme Medium term (1-3 years)

Following Customer Care Training review: Customer Care Training to apply standards of behaviour for ward clerks, HCAs and band 5 nurses (see above)

Applying standards of behaviour at recruitment Long term (3 years +)

Customer Care Training to apply standards of behaviour for remaining frontline staff


Theme Communication Short term (up to 1 year)

Document standards - Establish standards for written materials for patient appointments: • plain English • concise • include all relevant details • current location names • consistent with Trust signs and maps

Improve the consistency of written materials across the Trust Providing estimated waiting times in the Emergency Department via digital

screens Establish regular patient newsletters to inform patients and visitors of

recent changes and developments Ensure all staff have name badges that are easy to read Provide a way for patients and visitors to identify what different staff

uniforms mean Carry out an options appraisal of ‘smart technology’ to identify any

hardware or software that can be implemented to improve our communication with patients

Medium term (1-3 years)

Proactively engage with stakeholders • CCGs • Patient groups • Carers

Expand the patient voice by increasing the use of: • Listening forums • Focus groups • Open forums for staff to hear patient stories

Long term (3 years +)


Theme Process Short term (up to 1 year)

Keeping Patient Experience as a rolling Agenda item for ward, matron and divisional meetings to discuss:

Ward Meetings

Matron Meetings

Divisional Meetings

Commendations Individual staff members

Numbers and key themes

Additional Comments and suggestions

How to respond to suggestions

Themes across wards

Feedback on changes/improvements

Review and tweak

Sharing good practice

Improved co-ordination of sources of patient feedback - Your Care Matters, Friends and Family, PALs, Complaints – through monthly Triangulation meetings


Reviewing how support services could be amended to better meet the needs of patients, such as:

• Outpatient booking office opening hours • Clinic times

Bringing YCM, PALS and Complaints together as one team Carry out an options appraisal of ‘smart technology’ to identify any

hardware or software that can be implemented to improve our processes that support improvements to patient experience


Designing services for patients: • Running clinics to better suit patients’ needs and expectations • Fewer clinics, appointments, procedures and operations cancelled • Better alignment of clinical processes to the needs of patients


Theme Leadership Short term (up to 1 year)

Celebrating and thanking staff for a job well done • In team meetings • Star of the month • Annual staff awards

Sharing good practice: • Successful improvements at ward level • Mentoring • Shadowing • Intranet toolbox (you said … so we have; lessons learnt) • Open forums

Leading by example – senior management to regularly engage in:

• Visiting different patient areas • Sit, see and listen exercises


Being a critical friend: • Challenging poor attitudes or behaviour • Supporting staff to improve


Theme Environment Short term (up to 1 year)

Increasing the number of visitor parking spaces, making it easier for patients and visitors to park, hence reducing queues and the risk of being late for appointments. Ensuring clear and widespread communication of waivers to staff, for them to apply to patients/visitors in exceptional circumstances Providing drop off zones at each of the entrances


Improvements to ED reception area to address: • patient confidentiality • queuing system • visibility for clinical staff


Reduce conflict of purpose in waiting areas (eg Obstetrics and Gynaecology outpatients) to prevent undue distress to patients


7. Strategy Evaluation The Patient Experience Strategy is routinely reviewed by the Patient Experience Committee which is charged with monitoring progress of the Task and Finish groups and discussing the outcome of the monthly Triangulation Group meeting. 7.1 Key Performance Indicators (KPIs) The following list provides broad KPIs that will serve to assess performance around patient experience:

• The number of staff attending Customer Care Training • An increase in The Friends and Family score in different patient areas • A reduction in comments about poor communication of waiting times • The removal of all redundant terms (such as Redwood, Maple House) from

Communications • An reduction in cancelled appointments • Extension of booking office opening times • A reduction in complaints

7.3 The Patient Experience Committee One of the five CQC inspection domains is Caring, along with Safe, Effective, Responsive, and Well Led. The structure of our quality governance reflects these five domains with five Executive Sub-Committees – Patient Experience, Patient Safety, Clinical Effectiveness, Access and Responsiveness, and Workforce. Each Committee meets monthly and reports from these meetings are presented to our Executive Committee.


Structure of the Patient Experience Sub-Committee Other Task and Finish Groups

Task & Finish Grp 1 Communication Written Material

- Letters - Signage - Maps

Task & Finish Grp 2 Attitudes and Behaviour Customer Care Training

for existing staff

Notes • Three Task and Finish Groups

operating at any one time • Leads of groups attend PE Sub-

Committee for duration of project

Processes Designing services to suit patients

- Office opening times - Clinic opening times

Processes Expanding the patient

voice

Process A more co-ordinated

approach to PE

Environment ED reception area

Processes - Embedding patient

experience into agendas - Celebrating good examples

Attitudes and Behaviour Customer care refresher

Leadership Leading by example

Leadership Sharing good practice

Attitudes and Behaviour Recruitment and

induction

Patient Experience Sub-Committee

Chief Nurse Director of Information and Facilities

Management Lead Communications Manager

Divisional Chief Nurses – Surgery, Medicine, WaCH Task and Finish Group representative

Monthly Triangulation Group – to identify themes

and propose actions YCM, PALS and Complaints

Staff FFT Group

Task & Finish Grp 3 Car Parking

Capacity Communicating charge waivers Drop off zones Disabled parking Dedicated areas


The following meetings ensure frequent oversight of various aspects of the Strategy: Frequency Event Purpose

Weekly Ward Meetings • To identify opportunities • Develop action plans • Implement change

Monthly Divisional Board • To review action plans • Monitor change • Share learning

Monthly Patient Experience Committee

• To monitor delivery of initiatives • Share learning across the Trust • Provide assurance to the Board


8. Patient Experience Strategy Implementation We are committed to continuously improve the quality of our services and the environment in which our staff deliver care. We are proud of our achievements so far and recognise the tremendous commitment required from our staff. The SaSH Patient Experience Team believes that this Strategy clearly sets out the context and shape of the activities which are likely to be undertaken during the next five years. It is anticipated that there will be changes to some of the specific schemes but key objectives such as will underpin all projects that are carried out. The implementation of this Strategy is intended to deliver high quality patient experience, in support of the Trust’s Clinical Strategy to enable the best possible clinical outcomes and delivery of patient care. The Patient Experience Committee commends this Strategy to you. References http://www.slideshare.net/paulroemer/defining-a-global-patient-experience-for-your-health-system https://www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/us_lshc_ThePatientExperience_072809.pdf

http://www.slideshare.net/paulroemer/defining-a-global-patient-experience-for-your-health-system

http://www.slideshare.net/paulroemer/defining-a-global-patient-experience-for-your-health-system

https://www.deloitte.com/assets/Dcom-UnitedStates/Local Assets/Documents/us_lshc_ThePatientExperience_072809.pdf

https://www.deloitte.com/assets/Dcom-UnitedStates/Local Assets/Documents/us_lshc_ThePatientExperience_072809.pdf

Surrey and Sussex Healthcare NHS Trust Patient Experience ... and Sussex Healthcare NHS Trust –...

Documents

Transcript of Surrey and Sussex Healthcare NHS Trust Patient Experience ... and Sussex Healthcare NHS Trust –...