2016

Sue French and Gill Fisher, I³

Waitemata DHB

5/5/2016

Waitemata District Health Board Patient Experience Week

P.E.W 2016 Outcome Report

Outcome report for

Patient Experience Week

7 - 11 March 2016 Prepared by Sue French; Project Manager I³. Gill Fisher; Patient Experience Coordinator I³

Approved by: Jarrard O’Brien; Associate Director of Innovation

“Kind words can be short and easy to speak, but their echoes are truly endless” Attributed to Mother Theresa

Background

Enhancing patient experience is a priority for the Waitemata District Health Board. Evidence shows that patient experience is a robust indicator of quality, and that enhancing patient and whānau experience is

essential to achieving high quality health outcomes. Furthermore, enhanced patient experience leads to better emotional health, symptom resolution; less reported pain and more effective self-management1. The three Auckland DHBs agreed that Patient Experience Week 2016 would concentrate on the theme of ‘communication’. Waitemata DHB refined this to ‘listening’ to support our strategic aim of improving patient experience by understanding the perspectives of people receiving care2. The King’s Fund UK recently reported that the perspectives and knowledge of patients and service users are an important resource for policy-makers and for those involved in the design and delivery of local services3. In line with this, the aim of the programme was to bring events to people; a move away from the more centralised, corporate style of the 2015 week, and to get as many people as possible talking about what matters to them.

The Events and Evaluation Formalisation of Patient Story Art Pieces Patient stories are a powerful medium for demonstrating the impact of not only what we do, but how we do it. It takes courage for people to share their experience and describe how it has influenced the physical,

psychological and cognitive health of themselves or their loved ones – it is a selfless act of goodwill towards us as their healthcare provider and others who might learn from their experience. This act

deserves special recognition so it was agreed with the Art Committee that a still photo from each patient story would be professionally printed on canvas and hung with a permanent plaque.

We worked with Factory Frames in Mairangi Bay and Speedy Signs of Glenfield to achieve a uniform look

for art hangings around the DHB. The location of the images was reviewed and now includes:

The ground floor and Entrance 4 corridors at North Shore Hospital

The Radiology foyer and Entrance F at Waitakere Hospital.

As more stories are captured over the coming year canvases and plaques will be hung in relevant areas as a reminder to all of how our actions are perceived and what impact they have on those we care for.

1 Manary MP, Boulding W, Staelin R, W. Glickman SW. The patient experience and health outcomes. N Engl J Med 2013;

368:201-203 2 Waitemata DHB Annual Plan 2015/16 – Introduction of Strategic aims (pg. 10) 3 Retrieved from: http://www.kingsfund.org.uk/leadership/leading-collaboratively-patients-and-communities. 04 May 2016

P.E.W 2016 Outcome Report

Using feedback from our communities to generate meaningful and sustained improvement continues to be our priority. Last year we highlighted the 2015 Kings Fund and Picker Institute report that showed

information from patients was not being adequately used to improve services at a local level, or truly valued as a resource by organisations, clinicians and those directly responsible for patient experience4. For

this reason we developed a campaign that would signify to staff, patients and their families that we listen to them and use their feedback to generated actions with tangible outcomes. We also wanted staff to

understand that not all change needs to be big to make a meaningful difference - that small actions create positive outcomes too. Staff were asked to highlight a minimum of two pieces of feedback (positive or constructive), and what their team had done, or was doing, in response. The senior management and executive leadership teams agreed to give at least one hour (many gave more) during the week to visit at least two areas who had agreed to participate. The aim was for senior leaders to listen to staff and learn how they were responding to patient feedback. It was also an opportunity for staff to receive support and encouragement from the organisation’s leaders. Initially the campaign was planned for inpatient clinical areas because of their use of our in-house electronic survey (the Friends and Family Test). Due to incidental enquiries and conversations about the ‘orange posters’ the campaign grew to include over 60 clinical and non-clinical areas and expanded to

outpatient and community settings. This success can in part be attributed to: Enthusiasm from participating areas once they heard that an executive would come to listen and

discuss their poster The one-to-one approach of the patient experience team in visiting each area to explain the

campaign and encourage participation in the process

4 www.kingsfund.org.uk/blog/2015/12/using-patient-feedback-drive-improvement

You said . . . We did campaign

P.E.W 2016 Outcome Report

Feedback from staff following the executive walk-around was extremely positive; overwhelmingly, staff expressed their gratitude that senior leaders took the time to come to their area and listen to them. In many areas staff had heard of, but never met, the executive who visited them. There was a sense of pride in being able to show that their team was listening to patients and implementing their ideas for improvement. The executive and senior leadership teams also acknowledged the value of visiting areas and meeting people whom they would not normally interact with. They were impressed with the number of projects and improvements that were having a positive impact, and with the sheer number of areas who participated. The teams did, however, discuss the need to have a more structured programme to make maximum use of their time and asked for guidance in future on standard questions to ask. At the end of Patient Experience Week there was unanimous agreement that the poster campaign should be run twice each year to continue to build the relationship between senior leaders and other staff, and to continue to show colleagues and our communities that we are listening and acting on their feedback.

NGO open day

Waitakere and North Shore sites hosted successful NGO Open Days.

NGOs provide flexible, responsive and innovative frontline

service delivery in our community. This includes a diverse number of services offered in primary care, mental health,

health promotion, and disability support services, and includes kaupapa Māori, Pacific, and Asian health services and support.

The open days provided an opportunity for over 30

organisations such as Asthma Auckland, Health Link North and Waitakere Health Link, and Arthritis New Zealand to meet and talk to staff about their role in the community and the support

they can offer patients and families.

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Regional consumer forum:

Following the success of Waitemata DHB’s first consumer rep forum in November 2015, it was agreed that Patient Experience Week 2016 would include a regional consumer rep forum. Consumer reps are key to enabling consumer-centred planning, delivery, and improvement of services. The intention of the forum was to bring consumer reps together from across the Auckland region so that they could share their experiences, gain new knowledge and skills, and provide feedback to the Auckland DHBs on how to best support consumer engagement. Dr Chris Walsh, the HQSC Director for Partner’s in Care attended and gave a keynote address. A diverse range of people attended and discussed topic such as: • Understanding the health and disability system in NZ

• Building confidence and making sure you are heard • Improving communication with and between consumer representatives

• What is the future of consumer engagement and how do we get there?

Patient Engagement System:

In 2015 we asked patients what one change we could make to the physical environment to improve their experience.

Feedback was clear that access to the internet was most important, followed by entertainment options to relieve

boredom in hospital. We now have 24/7 free WiFi access and, in a first of its kind for the country, partnered with

Vodafone to trial bedside iPads in one of our acute orthopaedic wards. This innovation is allowing patients to

keep in touch with family and friends, manage their business or financial life and enjoy favourite programmes whenever they like. Other benefits were realised immediately such as the use of translation apps to allow staff and patients to communicate more easily. We have also included important health information such as the ward orientation leaflet and a pain management guide. The

pilot will run for six months before next steps are decided. What is clear already is that a multimedia device at the bedside creates huge opportunity to better engage with and inform patients, as well as giving them a greater sense of connectedness and control while in hospital.

P.E.W 2016 Outcome Report

Faces – photographic book of mental health consumers Andrew Blackburn, Consumer Advisor for adult mental health services created a photographic booklet of images and brief stories from a range of mental health consumers. The booklets statement is one against

stigma and discrimination – a means of showing that mental health problems affect everyone, and a reminder to treat people with compassion. Copies of the booklet have been provided to all the

participants and several are available within mental health services. Following the final print run copies have also been requested for purchase and are available to the general public.

Front cover image of Christian, a consumer since the age of 15

Christian’s words: “My first reaction was relief – that there was help and that I’m not the only one going through this”. “At the beginning we weren’t on the same side of the fence . . . then I started to realise that the staff – one care worker in particular – do care”

P.E.W 2016 Outcome Report

Your service – your words: When I need Healthcare selfie campaign

The “selfie” booth was built for Patient Experience Week 2015. Originally a video booth, it was unsuccessful because staff found it hard to leave clinical areas and members of the public did not have enough guidance, or were simply uncomfortable creating videos. This year the booth was re-purposed as a photo booth. It was moved according to a rotating schedule of venues across both hospital sites and people were asked to simply finish this statement: “when I need healthcare it matters to me that…” The question was an intentional effort to ask something relevant to everyone, irrespective of whether they were a patient, whānau member or staff, which would provide us with an understanding of priorities from our multiple stakeholders. Despite the schedule of locations, we knew that there would be people who still could not leave clinical

areas so two members of the Institute for Innovation and Improvement (I³) visited inpatient, outpatient and community facilities where access to the photo booth could not be offered. Areas visited included

mental health (including 3 areas in the Mason Clinic), Community Alcohol and Drug Services (CADS), medical and surgical wards, community and inpatient child health services, Wilson Home, maternity,

hospital operations teams, community dialysis, allied health teams and Radiology.

In addition, iPads and chalkboards were left with those services who requested them to capture images in their own time. All participants were given the option for their feedback to be kept anonymous and verbal

consent was obtained for the use of images. Images obtained from clients residing in Mason Clinic will not be used for promotional or publication purposes.

P.E.W 2016 Outcome Report

The roving cameras where extremely successful (90% of total answers received) but the mobile selfie booth again had low returns. Reasons for this have been considered as self-consciousness, uncertainty about the use of images without face-to-face reassurance of intent, insufficient advertising of the booth’s location and intent, and reluctance to engage in a different process. Given this the booth has been stored and is likely to be dismantled. Over the week 268 responses were captured, of which 49% were from patients and 51% from staff. 32% of respondents were male and 68% female. All answers were transcribed individually, colour coded into either patient/whānau or staff and themed according to the organisational values and behaviours – in line with the DHB values-based reporting. Analysis of feedback demonstrates that our consumer community value, in descending order, the fact that: (see table 1):

Care is evidenced-based and rich with continuous improvement initiatives (33%)

The manner in which we deliver care respects and protects individuality and is welcoming (28%)

We take the time to listen to and speak to people in a manner that is acceptable to the recipient (23%)

We demonstrate warmth and compassion in everything we do (15%).

Other interesting findings were that: Staff and patients value ‘Better, Best, Brilliant’ equally

Staff placed more value on ‘Everyone Matters’ and ‘Connected’ compared to patient feedback

Patients placed greater value on ‘With Compassion’ (table 2 and 3) compared to staff feedback Whilst comments were themed for their pertinence to each of the DHB’s values there was a clear message within the feedback that patients want to be listened to, understood, and communicated with in a manner appropriate to them and their whānau’s individual needs . Literature supports these findings; it informs us that people want the best care available and will tolerate less than courteous behaviour at the time if they believe they are getting the best care and feel safe. When they leave our care, however, and reflect on their experience it is the displeasing behaviours that they most recall and which have most impact on their overall impressions. Research also shows that whilst ‘we’ (the provider) focus on the mechanics and techniques of communication, patients seek relationships in which they experience trust, the right amount of autonomy, caring, and expertise. The perspectives of patients, clinicians, and communication experts do not always

define the same problems and often point to different solutions 5. This point iterates the importance of continuing to listen to patients, their families/whānau and staff together to understand the similarities and

differences in their experience and needs.

5 Epstein RM. Making communication research matter: What do patients notice, what do patients want, and what do patients need? Patient Education and Counselling. Vol 60, Issue 3, 2006 Pg. 272 -278

P.E.W 2016 Outcome Report

Table 1

Table 2

Table 3

Budget: The agreed budget from ELT was $6,770. The total spend for the week was $6,754.00. A full break down on expenditure is available on request.

0

10

20

30

40

50

60

70

80

90

Everyone

matters

With

Compassion

Connected Better, Best,

Brilliant

76

41

62

90

Patient and Whānau

Staff

Total

n= 269

25%

20%

21%

34%

Patient and Whānau

Everyonematters

WithCompassion

Connected

Better, Best,Brilliant

31%

11% 25%

33%

Staff

Everyonematters

WithCompassion

Connected

Better, Best,Brilliant

P.E.W 2016 Outcome Report

Lessons learnt for Patient Experience Week 2017: Consumer Rep Forum

o Break sessions into smaller audiences, this will encourage a more interactive type of session o Better visibility of speakers and less background noise o The venue needs to adequately accommodate a diverse range of attendees, taking account

of mobility and disabilities such as hearing impairment. A venue with better disabled parking, access and acoustics or the opportunity to have smaller break-out sessions would have helped those with hearing impairment

o Catering could be better o The consumer representatives have shared their thoughts with the programme organisers

and these will be taken into account in future

ELT Involvement o ELT members need more notice so their schedules can accommodate greater participation o Some would have appreciated more detail on what was expected of them during their visits

You Said…We Did Campaign

o Posters need to be ordered at least 12 weeks ahead o A ‘briefing sheet’ with confirmation of timings and distribution of posters I month before

the event, in addition to the existing email shot, Front line focus and personal visits) will meet everyone’s needs

The Patient Experience Week team would like to mention their special thanks to the following people and

teams, without whom Patient Experience Week would not have been the success it was: The carpentry team lead by Neville Freeman for all the work on the photo booth, chalkboards and

photo art installations The Clinical Support team members led by Rose Kumu and John Sullivan for making the photo-

booth movement possible Shelly Hughes for helping us with the ‘You Said…We Did’ campaign walk-around schedules

Lulu Caitcheon; consumer representative for her work on transcription and analysis