Presentation Title 36pt Arial BoldSub heading 24pt Arial

Patient Opinion in an Acute Trust

Ian Mackenzie

February 2013

An Associated University Hospital of Brighton and Sussex Medical School

Page 2

Background

• Trust formed 1998 • 650 Beds• £220m turnover• 3,350 wte staff• East Surrey Hospital but services across a number of different sites• 50/50 split between Surrey and Sussex• 2006 – one of largest debts in NHS £56m• History of poor performance• Imbalance between demand and capacity

Page 3

Background

• New Chief Executive & Chairman Autumn 2010• Focus on Quality, Safety and Performance• £47m Investment in East Surrey Hospital

• Three new wards – 56 Beds• Day Surgery Unit• Main Entrance – WH Smith’s & Boots• Rebuild of A&E – significant expansion• Theatres modernisation• Children’s Outpatients• Refurbished and enlarged Post Graduate Centre

• Buildings demonstrated changes were happening

Page 4

Patient Experience

• History of poor Patient Survey results – e.g. Inpatient Survey bottom 20%

• Featured on Channel 4 dispatches programme – 2011• Poor reputation among local people• Poorly perceived in local media• Last two years -

– Significant investment in site– Improved performance – “Most improved hospital in the south”

• But need to engage with patients, carers and families

Page 5

Patient Opinion

• First properly engaged with Patient Opinion late Spring 2012• All patients invited to put comments on Patient Opinion website• Published comments live to Trust website – no editing• Significant concern amongst staff

• Washing dirty laundry in public• Drawing attention to problems/issues• Staff being named and shamed

• All comments circulated to all senior staff• Staff actively encouraged to write responses

– Variable take-up of this option– Why are some staff reluctant to answer comments?

Page 6

Patient Opinion – a personal view

• I first became involved in June 2012• Patient posted :“My mother was admitted into ES Hospital last week. I live 3 hours journey from the hospital

but have managed to visit most days ( 6 hours travel per day). I bought her a mobile phone and put money on it only to discover that her Ward has no phone signal. I try to phone her every morning but rarely does anyone answer and they cannot bring a phone to her bed. There are no portable landline phones in this ward. I feel this is a really significant shortcoming as the morale of patients directly impacts on their physical well being. Why cannot something be done about this?”

• There was no reason why something could not be done• Bought mobile phones for wards and contacted relative and

she was then involved in testing

Page 7

Patient Opinion – a personal view

• The relative seemed genuinely surprised that we :– Had read and listened to her comment– Had taken note of what she’d said– Done something about it – i.e. bought a phone

• Illustrated the power of small things• I now try to personally answer all comments relating to my

areas, and some that don’t!– Almost all have been positive and have led to change– Change for one patient - e.g. moving a bed– Change for many patients – e.g. ward housekeepers now tasting the

food and understanding menus better

Page 8

Patient Opinion

• We’ve now had 388 stories told• 10 have led to changes• 78% would recommend the Trust • What’s good :

– Patients and relatives talking about the Trust in an open way– Trust responding publicly to comments– Making changes as a result of feedback– Trust talking about patient experience from ward to Board – patient stories at Board

meetings– Sense of personal responsibility

• What’s not so good :– Sometimes we seem to get things wrong and everyone knows– By drawing attention to it do we appear worse than others?– Do we appear worse than we are?

Page 9

Patient Opinion

• Some examples :“My mother is currently on ……Unfortunately, she is seriously ill. Being in her condition, she is unable to carry out basic functions -

washing herself, going to the toilet and getting out of bed. When I visited her this week, she was very depressed and wanted to give up on life. When I enquired

as to why she felt this way, I was astonished to find out that earlier that day, my mother had requested to go to the toilet. Staff provided her with camode, assisted her onto it and then left her. When my mum had finished, she rang the bell for assistance, no one responded for over 30 mins.

This obviously upset my mother and left her feeling totally incapable of looking after herself, which in turn prompted her desire to 'end it all'.

Whilst I appreciate staff are busy, my mother is seriously ill and should never have been left for that length of time.

My other concern is the lack of response to her repeated requests for help.

Page 10

Patient Opinion

• Replied by saying I have just spoken to Sally Brittain - our Acting Chief Nurse - who will look into this immediately. It

would be helpful if you could e-mail or call me to let me know your mother's name; my details are ian.mackenzie@sash.nhs.uk or 01737 231988

• Relative responded“The response from the senior ward staff has been fantastic!My mum has been moved closer to the nurses station in order for them to be able to respond far

easier.The matron spent nearly an hour talking to family, discussing the treatment and care plans. The staff

have been attentive to my mothers needs, making her feel more comfortable.They have also implemented a new hand over policy where the staff walk round the ward talking to

patients, ensuring staff are aware of problems and patients have an opportunity to voice any concerns.

All in all I experienced the true NHS, caring and treatment second to none!”

Page 11

Patient Opinion

• Some examples :“My father was admitted by ambulance to A&E on Friday 29th September approx 9pmI just wanted to say a big thank you to the porter who looked after us and transported him to

the ward. He was an absolute star on what was a very stressful night. I'm just so sorry I didn't get his name - if you manage to track him down please say thank you from me.”

• Replied by saying Thank you for your comments about the A&E Porter who helped you and your father on the

29th September.As the Director responsible for portering - amongst other things - I'm very pleased that our

staff helped you in the way that you have described. I'm confident I will be able to find out which porter it was and it would be really good if you could contact me so that I could let you know that I have been able to do so.

My telephone number is 01737 231988 or you can e-mail me at ian.mackenzie@sash.nhs.uk

• Managed to track-down the porter and he was personally thanked

Page 12

The Future

• As part of Friends and Family Question• On-line and telephone survey of all adult discharges• On-line survey finishes by promoting Patient Opinion• We get :

– Detailed information on each discharge – Patients/relatives can commend staff who are then personally

thanked– Ward level patient experience data– Increased responses via Patient Opinion– Greater visibility of what our patients think

• I would like to publish ward-level data on website and within the hospital – not quite ready yet

Page 13

The Future

• The more we are open the greater the trust our patients and their relatives will have in us

• But there is a balance about openness and appearing to have more issues than we actually do or more than other Trusts

• Would be good if all Trusts embraced as much as we have• I’ve used the website myself :

– One Trust replied and made a change– One didn’t respond at all

• There is a significant move toward openness in the NHS and we feel we’re at the forefront of this.