Shared learning database

Medway Community Healthcare CIC
Published date:
January 2013

Utilising the Patient Experience in Adult NHS Services Quality Standard (QS15) in an innovative way to reinforce our commitment to providing high quality care.

Our pledge is developed by each of our services to increase the focus on the quality of the patient experience in an increasingly demanding environment.

This enables services to focus service provision and resources into providing care that really matters to their patients.

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

The aim of the project is to utilise the NICE Quality Standard 15 -Patient experience in adult NHS services and Clinical Guideline (CG138) in an innovative way that reinforces our commitment to high quality and, compassionate patient care, the 6 C's and our organisational values, whilst ensuring privacy and dignity is supported in practice.

The objectives are to:
- establish a clear concept and understanding of our patients' expectations
- identify what is a good experience and how to ensure the same
- join up the relevant guidance to reduce confusion and duplication and make best use of resources
- put policy/guidance into practice
- engage staff to take ownership of the provision of an excellent patient experience
- provide a conduit to turn organisational values into everyday practice
- develop marketing material to enable patients to recognise our commitment to ensuring they have a positive experience

Reasons for implementing your project

We wanted to review and evidence compliance with NICE standards in an innovative way; a baseline assessment identified that although we complied with the spirit of the guidance there were gaps and some difficulty evidencing sentinel markers.

The following areas were considered as current issues and potential benefits of implementing a new process;

1). Medway Community Healthcare became a social enterprise in 2011 and developing Our Values with stakeholders, particularly our staff and patients, was a key part of this transition. We wanted to measure compliance in a way that engages staff and increases ownership of improving the patient experience, empowering staff to turn the organisational values into appropriate behaviours. Our organisation has undergone a lot of change and restructure, which can inevitably impact on staff morale. Establishing a clear concept of quality makes it easier for staff to deliver services they are proud of and for people to receive care and support with dignity and respect, fully meeting their needs.
2). Like many organisations we have a library of policies and guidance with no assurance of how staff value their importance. The privacy and dignity policy was due for review, this is based on common sense principles, however we needed to find an innovative way to put this into practice.
3). We wanted to incorporate other incentives/guidance e.g. 6C's, NHS Constitution, to avoid duplication and ensure high quality care is at the heart of all we do.
4). We needed to present the guidance in a way that is applicable to the whole organisation. A lot of national guidance is acute, profession or adult focused. This creates a challenge when relating to community services.
5). Each service already had a bespoke patient experience programme collecting very specific patient data that leads to real improvement. A recent self-assessment of our programme (Ipsos Mori, NHS III) highlighted our improvement areas as organisational culture and staff engagement. The results from previous programmes are not based solely on patient experience but also researching their needs and expectations. The results inform future service developments and provide staff with a level of understanding that ensures they provide an experience that meets needs and expectations. By fully understanding these, staff feel empowered to make changes bringing our values to life.

From this, Our Pledge was created.

How did you implement the project

Organisational methodology:
1. A generic poster and leaflet template has been developed by mapping the patient experience Quality Standards into our values:
- we are caring and compassionate
- we work in partnership
- we deliver quality and value. This was piloted to ensure it was fit for purpose.
2. A brief guide was developed identifying the purpose, method and outcome measures of Our Pledge. This was consulted on, agreed and ratified though our quality governance structure which included patient involvement.
3. Our pledge was launched at our Governance Assurance Information Network (GAIN) where all services are represented by a clinical/operational lead. Examples and an explanation on how to develop the pledge were provided to ensure maximum ownership by teams. The GAIN members were responsible for ensuring their team developed and agreed their own pledge.
4. To assist the teams with the development, a 'how to guide' (hints and tips) and an intranet page with resources and examples was provided and identified on a communication to GAIN members. The Clinical Quality facilitators provided support and facilitated sessions for some teams to assist development of the pledge.
5. Work is on-going incorporating our pledge into recruitment, appraisal and induction processes.

See 'How to Guide' in supporting documentation.

Problems and mitigating actions:
Problem - Ensuring staff engagement with a new concept.
Action - We developed the concept based on existing organisational values and presented to our senior management team, executive team and quality committee for approval. Clinical leads were consulted (virtually and through GAIN). The clinical leads were identified as pledge champions. The Clinical Quality facilitators supported services to develop their pledge.

Problem - Developing a service specific pledge was difficult for some services.
Action - How to guide identified the process with top tips on compilation, and support available from Clinical quality facilitators.

Problem - Not all services have enough space to display posters.
Action - leaflets made available for staff.

Problem - Ensuring sustainability.
Action - Pledge to be reviewed at least 3 yearly (as per policy procedure). New starters to be talked through the pledge during induction. Pledge to be discussed in context of organisational values as key aspect of appraisal.

Key findings

A key outcome of the work has been maximising the focus on the quality of the patient experience in an increasingly demanding environment. It has been, and will continue to be, a good marketing exercise to ensure we are aware of our patients wants and expectations and that patients know our values. This enables the services to focus service provision and resources into providing care that matters to patients. Staff have been engaged in the project and understand the organisation's expectations.

Engagement has been impressive and services have embraced the exercise. Staff and managers are keen to use their pledge as a visual tool for both staff and patients. One manager commented, 'the process is just as important as the product'.

Every service pledge is being displayed, where possible, for patients to see the experience they can expect from the service. Where it is not possible to display it, a leaflet is made available. Our Pledge facilitates meaningful discussions in appraisal and team meetings about how our values are 'lived' and make a difference, enhancing staff engagement and behaviours. Service level leaflets and information are provided as part of induction.

Outcome measures:
1. Our Pledge guidance ratified and outcome measures reviewed annually.
2. Services use questions based on their pledge in their 2013/14 patient experience programme. This will measure commitment to the pledge and will specifically target service level statements and how these are being met.
3. Triangulation of patient experience findings with complaints and compliments data to review correlations, trends and improvements.
4. In Oct 2012 self-assessment (Ipsos Mori, and NHS III) score was 31/50. This represents pockets of excellence with the need to improve to ensure consistency throughout the organisation. This will be reassessed Oct 2013 to review improvements particularly in organisation culture and engagement.
5. Staff survey will be undertaken annually with interim short temperature checks to evaluate levels of staff engagement.

Key learning points

Our key points to share would be;
1. See what will work for your organisation - one size does not fit all.
2. Check what you have in place already - is this adequate or could it be more effective?
3. Build on existing organisational values and look for opportunities to embed these by making the links clear and consistent for staff.
4. Use clear guidelines and develop a how-to-guide for development.
5. Ensure teams and especially senior managers are engaged with the idea.
6. It is vital to make it specific to each service to ensure ownership and move away from generic irrelevant tick box exercises to create a meaningful experience.
7. By developing local guidance and presenting a number of pieces of national policy in an easily understandable, relevant form has provided ownership and understanding.
8. Developed into a good marketing exercise (by-product).
9. Get everyone involved - it is important that every member of the teams feels engaged.
10. Keep your statements jargon free and plain English

Contact details

Vicky Ellis
Head of clinical quality
Medway Community Healthcare CIC

Is the example industry-sponsored in any way?