S187 - Day 1 - 1200 - Gaining insight and acting on patient feedback

Building choice of high quality support for commissioners

Insight and feedback – why it matters and what we are doing about it

Dan WellingsHead of Insight and Feedback

Insight and feedback – what

do we do?

What does insight mean?• Using qualitative and quantitative data to inform what we do

• It is not based on one data source

• It is about using whatever sources we have– Not just surveys; whole range of market and social research techniques

• Term widely accepted in private sector– Question mark over public sector

• Always asking the question, what don’t we know?

• As much an art as science

• Answering the question “So what?”

Why is it important? “The confidence that individuals

have in their beliefs depends mostly on the quality of the story they can tell about what they see, even if they see little. We often fail to allow for the possibility that evidence that should be critical to our judgement is missing – what we see is all there is”

Daniel KahnemanThinking, Fast and

Slow

Why it matters...

“Doesn’t bother me, it’s rubbish here.”

Blackburn resident

What does a “very good” experience mean?

Source: GP Patient Survey 2012-2013

Very good

Fairly good

Neither

Poor

All respondents who answered the question (948,758)

Q Overall, how would you describe your experience of your GP surgery?

18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85 +

5% 5% 4% 3% 2%

13% 12%10% 9% 7%

5% 4% 4%

49% 49%46%

44%41%

33%29% 29%

31% 32%39% 43%

49%

60% 66% 65%

812

171720

27262525

344537

465755

6257

7074

8881

74727168

636260

5547

4039

3431292926

19171480

11110

DoctorsTeachers

ProfessorsJudges

ScientistsClergyman/Priests

The PoliceTelevision News Readers

Social workersThe ordinary man/woman in

Civil ServantsManagers in the NHS

PollstersTrade Union officials

Local councillorsBusiness Leaders

BankersManagers in local

JournalistsGovernment Ministers

Politicians generally

% Not trust % Trust

How do we take our love of doctors into account?Q. “For each, would you tell me whether you generally trust them to tell the truth or

not?”

Base: 1,026 United Kingdom adults aged 15+, 10-16 June 2011 Source: Ipsos MORI/BMA

To what extent do we need to tackle “gratitude bias”?

1983 1984 1986 1987 1989 1990 1991 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

-40%

-20%

0%

20%

40%

60%

80%

Pre War (born before 1945) Baby Boomers (born 1945-1965)Generation X (born 1966-1979) Generation Y (born 1980 onwards)

Data: BSA 1983-2010. Each data point represents >100 respondents

Net satisfaction with the running of the NHS

So what impact will the changing demographic have on satisfaction?

83 84 85 86 87 89 90 91 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%% sample universe from pre war generation

% Generation Y

% Generation x

% Baby boomers1983: All adults aged 39 and over

Proportion of UK population from each generational grouping

Source: Eurostat

2010: All adults aged over 66

1983: All adults aged under 39

2010: All adults aged between 45

and 65

2010: All adults aged between 44

and 31

2010: All adults aged under 31

How was your experience? (1)Adult Inpatient Survey 2012

0 1 2 3 4 5 6 7 8 9 100%

5%

10%

15%

20%

25%

30%

1% 1% 1% 2% 2%5% 6%

12%

24%20%

25%

Overall…

I had a very good experienceBase: 61399 (all respondents). Fieldwork: Sept 2012 – Jan 2013

Source: CQC/Picker Institute

18% rated their overall experience lower than

7/10

I had a very poor experience

How was your experience? (2)Adult Inpatient Survey 2012

Base: 61399 (all respondents). Fieldwork: Sept 2012 – Jan 2013

Source: CQC/Picker Institute

BUT 62% reported at least one aspect of poor care

18% 62%Poor overall experience Experienced some form of

poor care

Overall experience measures good for tracking satisfaction but not for rooting out problems?

© Ipsos MORI

Paste co-brand logo

here

Sometimes an overall measure can mask poor experience

• On third day she asked for a bedpan

• Nurse told her it wasn’t worth running back and forth, told her to do it in the bed

• Nurse complained to her in the morning that she was soaking wet

“… in [the hospital] they treated me well”

“Oh yes I found it satisfactory”

Female, white, 65+, in hospital for several monthsHer report… Her experience…

UNCLASSIFIED

Means nothing if nothing is done

Friends and Family Test

Friends and Family Test OverviewSimple test based on Net Promoter Score methodology

‘How likely are you to recommend our <ward / A&E department> to friends and family if they needed similar care or treatment?’

1 Extremely Likely2 Likely3 Neither Likely nor Unlikely4 Unlikely5 Extremely Unlikely6 Don’t know

A measure and an intervention?

UNCLASSIFIED

Methodology – pros and cons

RobustnessUsability

Are we trying to shoehorn FFT into model it can’t fit into?

Friend and Family Test - outcomes

• Soft closing bins have been purchased for inpatient areas as a response to patients feeding back that noisy bins kept them awake at night

• Comments regarding disturbed nights led to Introducing the ‘Quiet Protocol’ to help patients sleep well at night

Environmental issues

Mid Staffs NHS Foundation Trust

Sandwell and West Birmingham

Hospitals NHS Trust

• The A&E department’s self-check in service had no disinfectant hand gel. This has now been provided

• Feedback from a patient with a stoma bag that it would be useful to have a shelf in the patient toilets in the surgical ward has led to the Trust fitting shelves in the toilets so people have somewhere to place their belongings

Hygiene related issues

Hull & East Yorkshire

Hospitals NHS Trust

East and North Herts NHS Trust –

Lister Hospital

Friend and Family Test - outcomes

• After negative feedback, the Trust has introduced medication cards for patients who are off the ward during drug rounds to alert them that their medication is waiting to be dispensed

• "Was in pain on previous admission, felt ignored by staff" – comment led to self-medication programme - patients manage their own analgesic medication when they are in pain

Medication issues

The Royal Wolverhampton

NHS Trust

The Royal Wolverhampton

NHS Trust

Friend and Family Test - outcomes

What is most effective model for data usage?

Why is insight important?

“The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end”

A promise to learn – a commitment to actThe Berwick Report

@[email protected]

We look forward to working with you

Neil Churchill

Director of Patient Experience - (Domain 4 Lead)

‘If you’d asked me the most important quality of a doctor, I would have said competence. When I became a patient I soon realised how important compassionate attributes in the people looking after me were’

Kate Granger

www.institute.nhs.uk/theguide

http://www.kingsfund.org.uk/projects/ebcd/experience-based-co-design-description

The priorities for patients with breast and lung cancer were differentLung cancer Breast cancerCommunication of diagnosis Functioning of day surgery unit

Information about treatment Appointments system and conduct of OP clinics

Continuity and coordination of care Communication

Information about symptoms

State of Caring survey 2013

84% of carers surveyed said that caring has a negative impact on health. Up from 74% in 2011/12

State of Caring

“Good care empowers and enables both the carer and

the cared-for. Poor care leads to ill-health and stress

for both carer and cared-for.”

Carers Trust’s Triangle of Care – a therapeutic alliance between, carer, patient and professionalSix Key Standards to ensure carers are included and supported:

1. Carers and the essential role they play are identified at first contact or as soon as possible thereafter.

2. Staff are ‘carer aware’ and trained in carer engagement strategies.

3. Policy and practice protocols regarding confidentiality and information sharing are in place.

4. Defined post(s) responsible for carers are in place.

5. A carer introduction to the service and staff is available, with a relevant range of information across the care pathway.

6. A range of carer support services is available.

© Ipsos MORI

Paste co-brand logo

here

To what extent do we need to tackle “gratitude bias”?

1983

1984

1986

1987

1989

1990

1991

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

-40%

-20%

0%

20%

40%

60%

80%

Pre War (born before 1945) Baby Boomers (born 1945-1965)Generation X (born 1966-1979) Generation Y (born 1980 onwards)

Data: BSA 1983-2010. Each data point represents >100 respondents

Net satisfaction with the running of the NHS

CASE STUDY

“I went to the dentist, reported to the receptionist and the receptionist forgot about me. I’m not used to my sight loss and lost my orientation and couldn't bring herself to ask anyone for help and just felt too nervous to shout out or anything. I ended up sitting there for hours and it was an extremely frightening experience.”

a) Welcoming

b) Safe

c) Caring and involving

d) Well organised and calm

The 15 Steps Challenge – what to look out for…

Point of Care 2014

Staff Satisfaction = Improved Patient Satisfaction and Care

Patient experience is closely linked to patient involvement and engagement

Experience Involvement

Being involved is part of having a good experience

Involving patients is one means to understanding and improving experiences

Individual

Individual and collective

17 April 2013Derbyshire Healthcare NHS Foundation Trust

Opening Ceremony

@GrangerKate

Everyone Counts: Planning for Patients 2014/15 to 2018/19

 – Plans are expected to demonstrate measurable improvement in patient experience as well

as continued investment in generating feedback. Improvement will be supported through: tools to help establish who is receiving poor care and where poor care is to be found;

– proven methods to enhance feedback and insight from vulnerable patient groups; – tools to measure and improve the experience of carers; – independent evaluation of improvement methodologies and easier access to proven

techniques and support for their implementation, including train the trainer and master classes;

– recommended methodologies to strengthen forms of staff engagement which can support improvements in patient experience through better staff experience;

– support for the collaborative sharing of learning and good practice; and – a strategy to learn from complaints and improve the experience of making a complaint.