Shared learning database

Merseycare NHS Trust
Published date:
April 2014

Mersey Care has used NICE Quality Standards to measure the quality of service received from the patient perspective, these standards have enabled the measurement of quality based on the key elements of effective, safe and efficient care. There are many ways to gather the views and opinions but the patient experience surveys that the Trust has developed underpin this and give a Trust wide perspective. The survey questions were written in consultation with service users and carers and this enables the trust to measure compliance against these standards from the patient perspective and evaluating the impact of NICE standards. By asking the questions it raises the awareness with service users of what and how services should be provided. The key outcomes of this initiative are delivering a system to collect views and opinions of service users and carers with robust systems that are embedded in the processes of the organization ensuring it is sustainable with minimal resource implications.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

Mersey Care is committed to providing the best possible experience for everyone who comes into contact with the Trust. To support the delivery of this it is essential to measure, evaluate and improve services influenced by the patient experience. Patient experience and is not just about the care received but how we communicate, how our environments impact on the service delivery and experience and is essential to ensure that services are developed and improved as a result of patient opinions and feedback. Service users and carers need to see evidence that their views have been listened to and it is essential that information gathered and lessons learned are reported through governance arrangements to ensure that they affect change.

By implementing this approach the trust aim to - Capture real time data
- Measure the patient experience against national and local standards
- Influence service improvement
- Feedback to service users and carers
- Evidence progress and actions taken to improve areas of concern
This survey is an overarching survey which is expected to give a quick overview of the significant areas affecting the patient experience and patient care, it acts as an early warning indicator giving services the opportunity to act in a timely manner where the results indicate action is required.

Reasons for implementing your project

The introduction of the surveys using technology enabled the trust to gather patient experience from all the services of the trust. Prior to this surveys were ad hoc and localized without the scope to measure the trust as a whole. Early exploration of a trust wide system was trialled using an external company however this had cost implications did not fully meet the requirements in capturing the level of detail required. As a result work was undertaken with the IT department to build a system that enabled the capture of real time data and was compatible with the internal reporting systems providing the opportunity for instant access automated reporting.

The surveys were tested out across the inpatient services looking at the ease of use of the technology and the interpretation of the questions. The survey is quite lengthy and may have been an area of concern however this proved not to be the case when used on the ipads. To ensure that this system could be used across all inpatient services and in the community an off line version of the survey was used as not all areas has wifi access and it also enabled off site use.

Utilizing existing systems minimized and resource implications, the only outlay was for the purchase of the ipads and a small cost for the application to develop and run the surveys. There are no on-going resource implications and the collection, upload and reporting of the data is not resource intensive.

How did you implement the project

The survey questions were developed with service users and carers, we began with an outline of the key themes from NICE Quality Standards, CQC Essential Standards, NHS Constitution and the NHS Outcomes Framework. Previously we had developed a survey linked to the NICE Quality Standards for Mental Health, theses were kept as a reference point whilst the other standards were looked at. A matrix table was developed to look at the NICE standards for mental Health, Adult NHS and Alcohol Dependence (copy attached) this was a working document to enable the group to link the standards into themes such as medication and effective care. The questions relating to theses areas could then be refined based on the individual standards.

Service users were keen that the responses as fare as possible were yes or no as the felt that rating scales made it difficult to give an instant response and made the questions clearer and more direct. The first survey developed was the inpatient survey and all the service users involved had recent experience of a range of in patient services, once the questions had been developed from the standards we explored any other areas that they felt were important to measure.

One of the challenges in the development of the survey was the number of questions, however service users felt strongly that all the questions were important and if they could see the relevance of the question then the questions should remain. The greatest challenge however was identifying a definitive team list, inpatient wards were relatively straightforward but agreeing on the names for the community and specialist teams proved to be more complex, especially with reconfiguration of services and teams. It was important that the list was accurate and included all the services that were to be measured as this was then built into the recording and reporting sysytems.The questions relate to effectiveness, safety, overall experience and involvement in decision making specifically care and treatment, medication and service improvement, whether people feel that are treated with dignity and respect and can discuss there care and treatment in privacy, do they feel safe on the ward, can they talk to staff, do they feel listened to. Supported by questions relating to access to services, including preference of whether people would like to be treated in hospital, at home and in the community if they have a choice of where they see a practitioner.

Key findings

The results are accessible in real time with instant reporting as a result of the use of technology and systems built to support the process. The results are reported monthly enabling services to highlight areas of/or for quality improvements and provide evidence of any improvements or impact of service change. The Trust Board receives quarterly reports as part of the Quality Dashboard and analyzed at the weekly Quality Surveillance meetings where the data is linked with other data sources and local intelligence.

One service has already used the data as an early warning indicator where the responses to 'do you feel safe on the ward' require further attention. Only 4 out of 25 service users surveyed stated that they felt safe in comparison with a similar ward which reported 10 out of 14. This was brought to the attention of the senior management and discussed at the acute care forum where any other concerns relating to this specific ward were discussed. Action were quickly put in place to address this and by the next month the results had significantly improved and remained that way. By a few prompt and direct actions the experience of the services users on the wards was greatly enhanced. It evidenced that by using real time data, believing the results and responding in a positive manner the impact can be meaningful to the people who receive care.

Key learning points

- Spend time getting the questions right, what are you measuring, what do you want to know.
- Identify the teams to be surveyed.
- Have the IT and reporting systems in place.
- Be supportive to services in the implementation phase.
- Use the results to learn and improve from.

Contact details

Kim Guy
Patient Experience Lead
Merseycare NHS Trust

Is the example industry-sponsored in any way?