www.england.nhs.uk Does the NHS measure quality effectively and reliably for people with mental health conditions and / or a learning disability to deliver positive experiences of care? Scott Durairaj Head of Patient Experience: Mental Health & Learning Disability Head of NHS England Workforce Equality and Inclusion June 2015
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www.england.nhs.uk
Does the NHS measure quality
effectively and reliably for
people with mental health
conditions and / or a learning
disability to deliver positive
experiences of care?
Scott Durairaj Head of Patient
Experience: Mental Health &
Learning Disability
Head of NHS England Workforce
Equality and Inclusion
June 2015
www.england.nhs.uk
www.england.nhs.uk
1 Hitting the Target
Missing the Point
2 Features of NHS
Quality
3 NHS model
4 Latent Errors,
Healthcare Deviation
5 Dimensions of
experience
6 Interlude: you have a go
7 Metric can portray a
truth
8 Transformational
Change
9 Considerations for
improvement
Contents
www.england.nhs.uk
Patient Experience – NHS Model
There isn't a model – but often a pattern
The size of a Trust, dispersal of sites, history, demographics and corporate culture play a huge part in how well the work is undertaken.
Critical success factors include:
• Clarity of the patient experience team’s role and purpose
• Embedded within wider Strategic governance and performance structures (e.g. service improvement, corporate services, Clinical and medical leadership and communications, membership and volunteering, Complaints or PALS information services)
• Supportive culture - leadership
• Ability to make space for work on service improvement (rather than merely focusing on data gathering and reporting)
10/07/2015
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The purpose of the paper was to analyse how the NHS
measures quality in general with an emphasis on how
this relates to people with mental health conditions or a
learning disability.
The examination of academic and policy research
demonstrates a significant lack of research into quality
for people with mental health conditions or a learning
disability in an Healthcare setting.
The paper also suggests that quality measurement
research is often focused on the metrics used and
minimum compliance standards rather than the
cultures and values that would lead to innovation and
improved quality of care.
Research Purpose
I Feel…..
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Patient Experience
Clinical Effectiveness
NHS Quality Triangle
Safety
Three Dimensions of Quality (adapted
from Keogh)
7
Leadership
Professionalism
NHS Organisational
Quality Features
Governance
Absent quality features
(adapted from Keogh)
Quality – What matters
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‘What begin as deviations from standard operating rules
become, with enough repetitions, ‘‘normalized’’ practice
patterns’ (Vaughan, Gleave, & Welser, 2005).
At this juncture, personnel no longer regard these acts as
untoward, but rather as routine, rational and entirely
acceptable. These latent errors become entrenched in the
system’s operational architecture and dramatically enhance its
vulnerability when a future, active error is committed. (Banja,
2010)
Staff who may be well trained and well meaning can find
themselves working in an environment where their colleagues
and teammates are ambivalent to health or professional
standards, feeling that they get in the way of effective clinical
practice; in many cases some of the deviances highlighted are
perpetrated “in the best interest” of the patient. However the
cumulative outcome of this type of organisational culture can
lead to systemic quality and safety failures.
Patient Experience – NHS Model
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It is useful to note the research of Grönroos (1993)
who suggests that service attributes might be divided
into two groups:
Functional (process) such as ambiance and provider
attentiveness that describe how the service is
delivered; and
Technical (outcome) such as outcomes that describe
the quality of what is delivered.
Developing understanding
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Carman’s paper empirically investigates acute hospital services
and demonstrates that consumers evaluated the technical
dimensions of nursing care, physician care and outcome as
more important than the functional accommodation of hospital
environments.
He suggested that the six dimensions that seemed to offer the
greatest reliability in measuring quality accurately across studies