In accordance with NICE Clinical Guideline 138 and Quality Standard 15 ‘Patient experience in adult NHS services: improving the experience of care for people using adult NHS Services’, this project has aimed to effectively gather and systematically use feedback on standards of care from a range of sources to improve patient experience.
Aims and objectives
The aim of this project was to ensure that best use was being made of the feedback received from patients about their experiences of using Trust services against standards outlined in NICE guidance CG138 and QS15.
Reasons for implementing your project
The importance of patient experience has been increasingly recognised within the NHS and CG138 and QS15 was produced by NICE to provide NHS providers with clear guidance on the different components of a good patient experience and provided the evidence and direction for creating sustainable change to deliver an 'NHS cultural shift' towards a truly patient-centred service.
The Trust has long recognised the importance of patient feedback about the standards of care they have received and has had a robust patient experience programme in place for many years. This programme has been recognised at a national level as an example of best practice, and uses a range of mechanisms to gather feedback from patients around both local standards and those outlined in the NICE guidance. This includes gathering real time feedback at a ward / service level. Running alongside this, the Trust has also had a robust complaints service which provides another valuable source of information about the quality of care patients have experienced. This is complimented with the feedback received via the PALS service.
In recent years, there has also been an increasing use of social media such as Twitter and Facebook by patients to feedback both their positive and negative experiences of care. All of these sources of information provide the Trust with important information on how well the NICE guidance and quality standards for patient experience are being implemented.
Prior to this initiative, each of the different feedback mechanisms (complaints, patient experience surveys, PALS information, and social media data) were analysed and reported on individually providing important information on the extent to which NICE standards relating to patient experience were being implemented. However, the Trust decided that there was value to be added by triangulating all of this different feedback to gather a greater insight into the ‘bigger picture’ of patient experience and the extent to which NICE standards were being met.
We therefore brought together relevant stakeholders from across complaints, patient experience, PALS and communications along with patient governor representatives to agree the best way forward. It was agreed that this approach would help provide assurance that the NICE standards pertaining to patient experience were being most effectively captured and reviewed to identify both areas of good practice and those in need of improvement.
How did you implement the project
The project group has since evolved into a formal Patient Feedback Sub-Committee of the Board and is now chaired by a Non-Executive Director. The main challenge was to try and identify the best way of consolidating the different streams of information into a single, meaningful format that could be easily and efficiently interpreted. A range of different approaches were trialled before deciding upon the final methodology. This methodology involves theming each of the different elements of patient experience into ‘transactional’ and ‘relational’ aspects of care. Transactional aspects of care relate to the following NICE standards:
• have opportunities to discuss their health beliefs, concerns and preferences to inform their individualised care
• are supported to understand relevant treatment options, including benefits, risks and potential consequences
• are actively involved in shared decision making and supported to make fully informed choices about investigations, treatment and care that reflect what is important to them
• are made aware that they have the right to choose, accept or decline treatment and these decisions are respected and supported
• are made aware that they can ask for a second opinion.
• experience care that is tailored to their needs and personal preferences, taking into account their circumstances, their ability to access services and their coexisting conditions
• have their physical and psychological needs regularly assessed and addressed
• experience continuity of care delivered, whenever possible, throughout a single episode of care
• experience coordinated care with clear and accurate information exchange between relevant health and social care professionals.
Relational aspects of care encompass the following NICE standards:
• are treated with dignity, kindness, compassion, courtesy, respect, understanding and honesty
• experience effective interactions with staff who have demonstrated competency in relevant communication skills
• are introduced to all healthcare professionals involved in their care, and are made aware of the roles and responsibilities of the members of the healthcare team.
The new process did not incur any additional costs and instead created efficiencies by merging together the different groups where patient experience and standards of care were previously considered and discussed
Overall results to date suggest that the interventions for improvement would be best focused on the transactional (systems and processes) aspects of care. Within the NICE guidance, this refers to areas such as: ensuring patients are given the right level of information, experience continuity, and have well-coordinated care.
The analysis shows that the majority of patients report a positive experience suggesting that the NICE standards are being effectively implemented. Patient experience and social media themes are also almost equally split between transactional and relational aspects of care and the majority of negative themes (79%) relate to transactional aspects of care.
The themes arising from this analysis, both in terms of relational and transactional aspects, are general/quality of care and information/communication/education are the strongest negative themes arising from complaints and PALS with the latter also a strong negative theme from patient experience data. Some of the strongest results are mirrored in both the positive and negative aspects of care.
These themes are general/quality of staff and quality/professionalism. Overall results to date suggest that the interventions for improvement would be best focused on the transactional (systems and processes) aspects of care outlined in the NICE standards. The project has delivered efficiencies in terms of how we review and manage patient feedback and has provided greater assurance that we are monitoring the implementation of NICE standards around patient experience in the most comprehensive way possible.
Key learning points
It is important to make best use of all patient experience information you gather in order to generate a higher level picture of where efforts to improve patient experience and the implementation of the NICE guidance need to be focussed. No single method will provide all of the information needed. Careful consideration should be given to how patient feedback is themed in order to ensure consistency and accuracy in the triangulation of data.
The NICE guidance provides a useful framework for grouping types of patient feedback. Consideration should also be given as to the depth of information collected from each source (i.e. complaints, PALS, patient experience and social media information).
Initially it may be enough to triangulate at a Trust or site level, however as the process develops it will be useful to ‘drill’ down to specific wards/departments or specialties. It is therefore important that this level of detail is available from each source to really ensure that NICE patient experience standards are being fully implemented across the organisation.