Dr Joanne Watson Clinical Director of The King’s Fund Point of Care Hospital Programme Clinical Director of Patient Experience and Consultant Physician, Musgrove Park Hospital, Taunton Quality Improvement Fellow (The Health Foundation & IHI) UK perspective on patient experience
Dr Joanne Watson: The King's Fund Annual Conference
Jun 22, 2015
Dr Joanne Watson, Clinical Lead, Hospital Pathways Programme, and Consultant Physician in Diabetes and Endocrinology, Taunton and Somerset NHS Foundation Trust, gives a UK perspective on patient experience at The King's Fund Annual Conference.
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Dr Joanne Watson
Clinical Director of The King’s Fund Point of Care Hospital Programme
Clinical Director of Patient Experience and Consultant Physician, Musgrove Park Hospital, Taunton
Quality Improvement Fellow (The Health Foundation & IHI)
UK perspective on patient experience
Patientexperience
Safety
Effec
tiven
ess
Patient-centred
Timely
Efficie
ncy
Equity
Patient experience as our Raison d’Etre
Mirror, Mirror, on the wall
whose isthe fairest
healthcare system of
all?
Seven Nation Summary Ranks on Health System Performance, 2010
“Nice but not necessary”
“Nice but too expensive”
Every system is perfectly designed to get the results it gets.
Paul Batalden
Dartmouth Institute, NH.
National in-patient survey results
% People rating their experience as excellent
020406080
100
2002 2003 2005 2007 2008 2009 2010 2011
The situation is too bad and time is too short for pessimism
Dee HockFounder of Visa
The Point of Care Programme
Source: The Point of Care, 2009
“Nothing about me without me"
Where to direct the ‘energy’ to make the difference?
• Leadership and culture• Staff hearts and minds• Respectful partnership• Reliable care 24/7• Delivering effective evidence-based care
Leadership and culture
What leadership pays attention to, gets attention
(Jim Conway, IHI)
The human impact of what we do as a board is at the heart of our responsiblities
Chairman and CEOMid-Staffordshire NHSFoundation Trust
Staff hearts and minds
Staff EngagementKF34 % staff that would recommend the
trust as a place to work
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Aint
ree
Uni
vers
ity H
ospi
tals
NH
S Fo
unda
tion
Trus
tAi
reda
le N
HS
Trus
tAs
hfor
d an
d St
Pet
er's
Hos
pita
ls N
HS
Trus
tBa
rkin
g, H
aver
ing
and
Red
brid
ge H
ospi
tals
NH
S Tr
ust
Barn
et a
nd C
hase
Far
m H
ospi
tals
NH
S Tr
ust
Barn
sley
Hos
pita
l NH
S Fo
unda
tion
Trus
tBa
rts a
nd T
he L
ondo
n N
HS
Trus
tBa
sild
on a
nd T
hurr
ock
Uni
vers
ity H
ospi
tals
NH
SBa
sing
stok
e an
d N
orth
Ham
pshi
re N
HS
Foun
datio
nBe
dfor
d H
ospi
tal N
HS
Trus
tBl
ackp
ool,
Fyld
e an
d W
yre
Hos
pita
ls N
HS
Foun
datio
nBr
adfo
rd T
each
ing
Hos
pita
ls N
HS
Foun
datio
n Tr
ust
Brig
hton
and
Sus
sex
Uni
vers
ity H
ospi
tals
NH
S Tr
ust
Brom
ley
Hos
pita
ls N
HS
Trus
tBu
ckin
gham
shire
Hos
pita
ls N
HS
Trus
tBu
rton
Hos
pita
ls N
HS
Foun
datio
n Tr
ust
Cal
derd
ale
and
Hud
ders
field
NH
S Fo
unda
tion
Trus
tC
ambr
idge
Uni
vers
ity H
ospi
tals
NH
S Fo
unda
tion
Trus
tC
entra
l Man
ches
ter U
nive
rsity
Hos
pita
l NH
S Fo
unda
tion
Che
lsea
and
Wes
tmin
ster
Hos
pita
l NH
S Fo
unda
tion
Che
ster
field
Roy
al H
ospi
tal N
HS
Foun
datio
n Tr
ust
City
Hos
pita
ls S
unde
rland
NH
S Fo
unda
tion
Trus
tC
olch
este
r Hos
pita
l Uni
vers
ity N
HS
Foun
datio
n Tr
ust
Cou
ntes
s of
Che
ster
Hos
pita
l NH
S Fo
unda
tion
Trus
tC
ount
y D
urha
m a
nd D
arlin
gton
NH
S Fo
unda
tion
Trus
tD
artfo
rd a
nd G
rave
sham
NH
S Tr
ust
Der
by H
ospi
tals
NH
S Fo
unda
tion
Trus
tD
onca
ster
and
Bas
setla
w H
ospi
tals
NH
S Fo
unda
tion
Dor
set C
ount
y H
ospi
tal N
HS
Foun
datio
n Tr
ust
Ealin
g H
ospi
tal N
HS
Trus
tEa
st a
nd N
orth
Her
tford
shire
NH
S Tr
ust
East
Che
shire
NH
S Tr
ust
East
Ken
t Hos
pita
ls U
nive
rsity
NH
S Tr
ust
East
Lan
cash
ire H
ospi
tals
NH
S Tr
ust
East
Sus
sex
Hos
pita
ls N
HS
Trus
tEp
som
and
St H
elie
r Uni
vers
ity H
ospi
tals
NH
S Tr
ust
Frim
ley
Park
Hos
pita
l NH
S Fo
unda
tion
Trus
tG
ates
head
Hea
lth N
HS
Foun
datio
n Tr
ust
Geo
rge
Elio
t Hos
pita
l NH
S Tr
ust
Glo
uces
ters
hire
Hos
pita
ls N
HS
Foun
datio
n Tr
ust
Gre
at W
este
rn H
ospi
tals
NH
S Fo
unda
tion
Trus
tG
uy's
and
St T
hom
as' N
HS
Foun
datio
n Tr
ust
Har
roga
te a
nd D
istri
ct N
HS
Foun
datio
n Tr
ust
Hea
rt of
Eng
land
NH
S Fo
unda
tion
Trus
tH
eath
erw
ood
and
Wex
ham
Par
k H
ospi
tals
NH
SH
eref
ord
Hos
pita
ls N
HS
Trus
tH
inch
ingb
rook
e H
ealth
Car
e N
HS
Trus
tH
omer
ton
Uni
vers
ity H
ospi
tal N
HS
Foun
datio
n Tr
ust
Hul
l and
Eas
t Yor
kshi
re H
ospi
tals
NH
S Tr
ust
Impe
rial C
olle
ge H
ealth
care
NH
S Tr
ust
Ipsw
ich
Hos
pita
l NH
S Tr
ust
Isle
of W
ight
NH
S Pr
imar
y C
are
Trus
t - A
cute
Sec
tor
Jam
es P
aget
Uni
vers
ity H
ospi
tals
NH
S Fo
unda
tion
Kette
ring
Gen
eral
Hos
pita
l N
HS
Foun
datio
n Tr
ust
King
's C
olle
ge H
ospi
tal N
HS
Foun
datio
n Tr
ust
King
ston
Hos
pita
l NH
S Tr
ust
Lanc
ashi
re T
each
ing
Hos
pita
ls N
HS
Foun
datio
n Tr
ust
Leed
s Te
achi
ng H
ospi
tals
NH
S Tr
ust
Luto
n an
d D
unst
able
Hos
pita
l NH
S Fo
unda
tion
Trus
tM
aids
tone
and
Tun
brid
ge W
ells
NH
S Tr
ust
May
day
Hea
lthca
re N
HS
Trus
tM
edw
ay N
HS
Foun
datio
n Tr
ust
Mid
Che
shire
Hos
pita
ls N
HS
Foun
datio
n Tr
ust
Mid
Ess
ex H
ospi
tal S
ervi
ces
NH
S Tr
ust
Mid
Sta
fford
shire
NH
S Fo
unda
tion
Trus
tM
id Y
orks
hire
Hos
pita
ls N
HS
Trus
tM
ilton
Keyn
es H
ospi
tal N
HS
Foun
datio
n Tr
ust
New
ham
Uni
vers
ity H
ospi
tal N
HS
Trus
tN
orfo
lk A
nd N
orw
ich
Uni
vers
ity H
ospi
tals
NH
SN
orth
Bris
tol N
HS
Trus
tN
orth
Cum
bria
Uni
vers
ity H
ospi
tals
NH
S Tr
ust
Nor
th M
iddl
esex
Uni
vers
ity H
ospi
tal N
HS
Trus
tN
orth
Tee
s an
d H
artle
pool
NH
S Fo
unda
tion
Trus
tN
orth
Wes
t Lon
don
Hos
pita
ls N
HS
Trus
tN
orth
ampt
on G
ener
al H
ospi
tal N
HS
Trus
tN
orth
ern
Dev
on H
ealth
care
NH
S Tr
ust
Nor
ther
n Li
ncol
nshi
re A
nd G
oole
Hos
pita
ls N
HS
Nor
thum
bria
Hea
lthca
re N
HS
Foun
datio
n Tr
ust
Not
tingh
am U
nive
rsity
Hos
pita
ls N
HS
Trus
tO
xfor
d R
adcl
iffe
Hos
pita
ls N
HS
Trus
tPe
nnin
e Ac
ute
Hos
pita
ls N
HS
Trus
tPe
terb
orou
gh a
nd S
tam
ford
Hos
pita
ls N
HS
Foun
datio
nPl
ymou
th H
ospi
tals
NH
S Tr
ust
Pool
e H
ospi
tal N
HS
Foun
datio
n Tr
ust
Ports
mou
th H
ospi
tals
NH
S Tr
ust
Que
en E
lizab
eth
Hos
pita
l NH
S Tr
ust
Que
en M
ary'
s Si
dcup
NH
S Tr
ust
Roy
al B
erks
hire
NH
S Fo
unda
tion
Trus
tR
oyal
Bol
ton
Hos
pita
ls N
HS
Foun
datio
n Tr
ust
Roy
al C
ornw
all H
ospi
tals
NH
S Tr
ust
Roy
al D
evon
and
Exe
ter N
HS
Foun
datio
n Tr
ust
Roy
al F
ree
Ham
pste
ad N
HS
Trus
tR
oyal
Liv
erpo
ol a
nd B
road
gree
n U
nive
rsity
Hos
pita
lsR
oyal
Sur
rey
Cou
nty
Hos
pita
l NH
S Tr
ust
Roy
al U
nite
d H
ospi
tal B
ath
NH
S Tr
ust
Roy
al W
est S
usse
x N
HS
Trus
tSa
lford
Roy
al N
HS
Foun
datio
n Tr
ust
Salis
bury
NH
S Fo
unda
tion
Trus
tSa
ndw
ell a
nd W
est B
irmin
gham
Hos
pita
ls N
HS
Trus
tSc
arbo
roug
h an
d N
orth
Eas
t Yor
kshi
re H
ealth
Car
eSh
effie
ld T
each
ing
Hos
pita
ls N
HS
Foun
datio
n Tr
ust
Sher
woo
d Fo
rest
Hos
pita
ls N
HS
Foun
datio
n Tr
ust
Shre
wsb
ury
and
Telfo
rd H
ospi
tal N
HS
Trus
tSo
uth
Dev
on H
ealth
care
NH
S Fo
unda
tion
Trus
tSo
uth
Tees
Hos
pita
ls N
HS
Trus
tSo
uth
Tyne
side
NH
S Fo
unda
tion
Trus
tSo
uth
War
wic
kshi
re G
ener
al H
ospi
tals
NH
S Tr
ust
Sout
ham
pton
Uni
vers
ity H
ospi
tals
NH
S Tr
ust
Sout
hend
Uni
vers
ity H
ospi
tal N
HS
Foun
datio
n Tr
ust
Sout
hpor
t and
Orm
skirk
Hos
pita
l NH
S Tr
ust
St G
eorg
e's
Hea
lthca
re N
HS
Trus
tSt
Hel
ens
and
Know
sley
Tea
chin
g H
ospi
tals
NH
S Tr
ust
Stoc
kpor
t NH
S Fo
unda
tion
Trus
tSu
rrey
and
Sus
sex
Hea
lthca
re N
HS
Trus
tTa
mes
ide
Hos
pita
l NH
S Fo
unda
tion
Trus
tTa
unto
n an
d So
mer
set N
HS
Foun
datio
n Tr
ust
The
Dud
ley
Gro
up O
f Hos
pita
ls N
HS
Foun
datio
n Tr
ust
The
Hilli
ngdo
n H
ospi
tal N
HS
Trus
tTh
e Le
wis
ham
Hos
pita
l NH
S Tr
ust
The
New
cast
le U
pon
Tyne
Hos
pita
ls N
HS
Foun
datio
nTh
e Pr
ince
ss A
lexa
ndra
Hos
pita
l NH
S Tr
ust
The
Que
en E
lizab
eth
Hos
pita
l Kin
g's
Lynn
NH
S Tr
ust
The
Rot
herh
am N
HS
Foun
datio
n Tr
ust
The
Roy
al B
ourn
emou
th a
nd C
hris
tchu
rch
Hos
pita
lsTh
e R
oyal
Wol
verh
ampt
on H
ospi
tals
NH
S Tr
ust
The
Whi
tting
ton
Hos
pita
l NH
S Tr
ust
Traf
ford
Hea
lthca
re N
HS
Trus
tU
nite
d Li
ncol
nshi
re H
ospi
tals
NH
S Tr
ust
Uni
vers
ity C
olle
ge L
ondo
n H
ospi
tals
NH
S Fo
unda
tion
Uni
vers
ity H
ospi
tal B
irmin
gham
NH
S Fo
unda
tion
Trus
tU
nive
rsity
Hos
pita
l of N
orth
Sta
fford
shire
NH
S Tr
ust
Uni
vers
ity H
ospi
tal o
f Sou
th M
anch
este
r NH
SU
nive
rsity
Hos
pita
ls B
risto
l NH
S Fo
unda
tion
Trus
tU
nive
rsity
Hos
pita
ls C
oven
try a
nd W
arw
icks
hire
NH
SU
nive
rsity
Hos
pita
ls o
f Lei
cest
er N
HS
Trus
tU
nive
rsity
Hos
pita
ls o
f Mor
ecam
be B
ay N
HS
Trus
tW
alsa
ll Hos
pita
ls N
HS
Trus
tW
arrin
gton
and
Hal
ton
Hos
pita
ls N
HS
Foun
datio
n Tr
ust
Wes
t Her
tford
shire
Hos
pita
ls N
HS
Trus
tW
est M
iddl
esex
Uni
vers
ity H
ospi
tal N
HS
Trus
tW
est S
uffo
lk H
ospi
tals
NH
S Tr
ust
Wes
ton
Area
Hea
lth N
HS
Trus
tW
hipp
s C
ross
Uni
vers
ity H
ospi
tal N
HS
Trus
tW
inch
este
r and
Eas
tleig
h H
ealth
care
NH
S Tr
ust
Wirr
al U
nive
rsity
Tea
chin
g H
ospi
tal N
HS
Foun
datio
nW
orce
ster
shire
Acu
te H
ospi
tals
NH
S Tr
ust
Wor
thin
g an
d So
uthl
ands
Hos
pita
ls N
HS
Trus
tW
right
ingt
on, W
igan
and
Lei
gh N
HS
Foun
datio
n Tr
ust
Yeov
il Dis
trict
Hos
pita
l NH
S Fo
unda
tion
Trus
tYo
rk H
ospi
tals
NH
S Fo
unda
tion
Trus
t
<Index>
Whipps Cross University Hospital
CQC inpatient survey 2008 in the bottom 20% => Patient Experience Revolution• The approach − In your Shoes events with 10
core behavioural standards• The impact − staff empowered through making promises to patients and now rated as average in the CQC 2009 survey
Respectful partnerships − Nothing about me without me
A supportive system
Activated patients Prepared, proactive teams
Optimal functional and clinical outcomes
Working in partnershipSharing decisionsPlanning care
Chronic Care Model − Wagner, 1999
(Thanks to Dr Alf Collins for these slides)
Living with a long-term condition
Hours with professional = 3 in a year
Self management = 8757 in a year
Living with a long-term condition
Co-Creating Health
The patient:•is in the best possible condition for surgery
•has the best possible management during surgery and anaesthesia
•experiences the best possible post-operative care
En
han
ced
Rec
ove
ry P
artn
ersh
ip P
rog
ram
me
Principles of Enhanced Recovery
•Helps people to recover sooner so that life can return to normal as quickly as possible•Gives people a better overall experience due to higher quality care and services•Enables people to choose what’s best for them throughout the pathway of care•Makes hospital stay shorter and much less stressful
En
han
ced
Rec
ove
ry P
artn
ersh
ip P
rog
ram
me
Benefits of enhanced recovery
Making the most of the environment
The _________ _____ is the best hope wehave ever had to change process and culture.
Reliable care 24/7
The Productive Ward is the best hope wehave ever had to change process and culture.
22 January 2009
Thanks to Helen Beaven for these slides
Direct Care Time
Motion Admin Discussion Handovers InformationRoles
Opportunity to increase safety and reliability of
care
Rol
e T
ime
(e.
g. n
urse
)
Total Time
“Everything I need to do my job is
conveniently located”
“The paperwork is easy to
understand and quick to
complete”
“I am not interrupted by
people requesting information or
looking for things”
‘’Handovers are concise, timely and
provide all the information I need”
‘It is clear to everyone who is
responsible for what”
‘We have the information we
need to solve our own problems, and find out if we were
successful”
Releasing time to care: The Productive Ward
‘Major on the minor’- Mayo Clinic
www.kissingitbetter.co.uk
Delivering effective, evidence-based care
Summary
PatientExperience
Safety
Effec
tiven
ess
Patient-centred
Timely
Efficie
ncy
Equity
Leadership & Culture
Staff Hearts & minds
Respectful Partnerships
Reliable Care
Effective Care
PatientExp
The sun will sometimes melt a field of sorrow that seemed hard frozen; may it happen for (the NHS).
Sheenagh Pugh
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