Patients as Partners:at the Forefront of Service Redesign

An Introduction to

Patient Focus Public Involvement

Policy context

• Designed to Care: Renewing the National Health Service in Scotland (1997)

• Our National Health: A Plan for Action, a Plan for Change (2000)

• Patient Focus & Public Involvement (2002)

• Partnership for Care (2003)

Independent Advice and Support Servicefor Users of Local Health and Community Care Services A National Service Framework March

2006

Provide:• advice and support services to patients wishing

to make a complaint or raise concerns about NHS services

• information and advice to patients on a variety of issues that impact on their health and well-being in order to maintain or improve these

Duty to encourage public involvement

It is the duty of everybody….to take action with a view to securing, as respect to health services for which it is responsible, that person to whom those services are being, or may be provided, are involved in, and consulted on-– the planning and development, and– decisions to be made by the body significantly

affecting the operation,

of those services. National Health Service Reform (Scotland) Act 2004

Building a Health Service FIT FOR THE FUTURE

(2005)

Moving public consultation to the front end of service change rather than as a last step:

• involving the public in the planning and delivery of services

• involvement of individual patients in decisions about their own care

What are patients and the public

telling us about their experience?

‘Satisfaction is clearly linked to a number of factors, notably waiting times – the shorter the wait (for any kind of consultation or appointment or admission), the higher the level of satisfaction, both with the individual service and with the NHS as a whole’.

Public Attitudes to the NHS in Scotland 2004 Survey

Patients prioritise improvements for A&E as follows:

LowPriority

Medium Priority

High Priority

Televisions

Reducing waiting times to see receptionist/triage nurse

Drinks machines/refreshments

Doctors/nurses will not rush patients

Waiting area will be a clean and pleasant environment

Children’s play areas

Staff will be friendly and caring

Privacy (most feel that this is already adequate)

Explanations in layman's terms, of relevance to their situation

Reducing waiting times to see doctor/ get treatment

Plenty of information available in waiting areas (on screens/and from staff)

Staff will all be polite and sensitive to patients’ situation

Mrs Foley

Consider the journey **

‘Every system is perfectly designed to get

the results that it gets

If we want to change the patient

experience, we must change the system

To change the system, we must think in

fundamentally different ways’Donald Berwick

Institute of Health Care Improvement

A Patient Focus in Public Involvement

• Questionnaire

• Focus Groups

• Patient Mapping

• Patient Tracking

• Patient Shadowing

• Patient Diaries

• Discovery Interviews

Patient journey analysis

Improving the

experience

Increasing detail of analysis

Questionnaire/ Patient Satisfaction Survey

Focus Group

Patient Flow Analysis

Patient Mapping

Individual Patient

Patient Tracking

Patient shadowing

Patient Diaries

Questionnaires

• Can target a wide audience or sample • Critical mass for service reconfiguration and

redesign of provision• Includes benchmark scores and/or written

comments• Un-ambiguous and easy to count

Picker Institute

Picker Institute Europe works with patients, professionals and policy makers to promote understanding of the patient's perspective at all levels of healthcare policy and practice. We undertake a unique combination of research, development and policy activities which together work to make patients' views count.

http://www.pickereurope.org/

Expert patients/ focus groups

• Focus groups of patients

• Delegates from focus groups meet with staff to discuss improvements to service

• A plan is agreed and staff select actions to take forward

Flow mapping• Views the system from the patient perspective

following their journey across organisational boundaries

• Helps staff understand how complex and confusing processes appear to the patient

• Organisation specific• Diagnostic, and used as a basis for redesign,

actively involving frontline staff in the process

Patient tracking

• Validate or challenge process and flow map

• Identifies patterns in presentation of patients

• Identifies frequent ‘Hand-offs’ of patients or paper

• Identifies periods of waiting

Patient shadowing

• Patient, member of staff or volunteer accompanies patient

• Provides objective observational feedback

• Builds up comprehensive picture of patient and staff perception of service.

Flow Analysis Tool

A&E Major receptionist checks patient is expected

A&E Major receptionist logs patient onto A&E IT system

BB bleep SHO

BB create paper record

BB fax A&E & MAU

BB request patients notes

BB log patient onto BB IT system

GP rings BBGP rings BB again

GP rings for ambulance

Patients wife rings GP

Patient Collapses

Patient assessed by GP

Patient & his wife arrive A&E

Patient triaged on Majors

0:152:30 2:00

GP Bed Bureau

GP Bed Bureau

A&E Receptionist

A&E Receptionist

Triage Nurse

GP Ambulance Triage Nurse

Patient diaries

• A patient record of events throughout their healthcare

• Offers a personal account

• Can be in any format - written, visual or audio – patient’s choice

• Diaries are confidential and agreement must be made before any material is shared

Discovery interviews

• Semi-structured interviews of patient and/or carer

• Follows a framework to interview

• Allows local teams to gain insight and identify needs

• Patient consent, confidentiality and anonymity are essential

• Ethical approval may be required

In groups discuss the statement…

‘I am going in completely blind – I have no idea what is expected of me, if anything for that matter. Am I just a token gesture or am I there as somebody who has some impact?’

Patient