Yorkshire Patient Experience Toolkit

Coaches’ Network Celebration: 1 year on

NHS Horizons, Leeds

Friday 6th December 2019

academy@yhahsn.nhs.uk / 01274 383966 www.improvementacademy.org

Welcome and introductions

Beverley Slater Director

Yorkshire & Humber Improvement Academy

Housekeeping

Tweet whilst you’re here!

#PatientExperienceToolkit

How was your journey today?

Programme

A year of the coaches network

Laura Proctor

Project Manager

Improvement Academy

The PET coaches network a year on….

1.Opportunities to connect with other coaches

2.Opportunities for training & support

3.Access to online resources

Q. What do you want from the Coaches Network?

The PET coaches network a year on….

Navigating the website

• https://www.improvementacademy.org/tools

-and-resources/the-yorkshire-patient-

experience-toolkit.html

• https://www.improvementacademy.org/our-

networks/patient-experience-coaches-

network.html

There is one page about PET and its development:

There is another page about the coaches network and resources:

The PET coaches network a year on….. • Linking to Trust broader QI initiatives in some instances (e.g. Mid Yorks,

LCHT). (Involvement of senior managers, benefits)

• Newsletter

• Development of PET leaflet

• Development of toolkit - staff experiences

Q.1 What has been your experience of working on this ward?

Q.2 Is there anything that is not quite as you would like?

Q.3 Is there anything that would make your role better?

Q.4 Any other comments?

• Supporting volunteers

The facilitator is key to the entire PET process

and the success of making changes

As a result one-to-one support developing

Developing the coaches role

Patient Experience:

a changing policy landscape

Claire Marsh

Patient & Public Engagement Lead

Improvement Academy

Latest research

A Sheard, L. ‘Understanding and enhancing how hospital staff learn from and act on patient

experience data’ (estimated publication Sept 2019)

B Weich, S. ‘Evaluating the Use of Patient Experience Data to Improve the Quality of Inpatient

Mental Health Care’ (estimated publication March 2020)

C Donetto, S. ‘ This study identified five key themes that helped explain how patient

experience data work could lead to quality improvements in acute hospital trusts’(published

October 2019)

D Locock, L. ‘Understanding how frontline staff use patient experience data for service

improvement – an exploratory case study evaluation and national survey’ (estimated

publicatione 2019)

E Powell, J. ‘Improving NHS Quality Using Internet Ratings and Experiences (INQUIRE)’

(estimated publication January 2020)

F Sanders, M. ‘Enhancing the credibility, usefulness and relevance of patient experience data

in services for people with long-term physical and mental health conditions using digital

data capture and improved analysis of narrative data’ (estimated publication January 2020)

G Rivas, C. PRESENT: Patient Reported Experience Survey Engineering of Natural Text:

developing practical automated analysis and dashboard representations of cancer survey

free text answers (published July 2019)

H Burt, J. Improving patient experience in primary care: a multimethod programme of

research on the measurement and improvement of patient experience (published May 2017)

I Graham An evaluation of a near real-time survey for improving patients’ experiences of the

relational aspects of care: a mixed-methods evaluation (published March 2018)

Preview • Embrace all forms of feedback

• Not all data for improvement needs to be ‘hard’, valid, representative

– narrative feedback inspires improvement

• Should not try to triangulate all different types - they are different

• Draw learning from positive feedback

• Presenting some data to staff (on relational experience) is complex.

• Leaders need to give staff the authority and resources to act

• Facilitators can help decide what action to take

• Engaging staff and patients in co design helps sustainability

• Online feedback is a growing field, but staff often don’t have the

systems or know-how to respond

Published evidence for facilitation & skills development

Health Expect. 2019 Feb;22(1):46-53. doi: 10.1111/hex.12829. Epub 2018 Sep 22.

Putting evidence into practice

• A partnership approach

• Reviewing & developing the coaches network for

continued support in Yorkshire & Humber

+

Reflections from coaches – part 1

Heather Thrippleton

Tamsyn Wright

Heather Thrippleton (heather.thrippleton@nhs.net)

Jo Twigger (Joanne.twigger@nhs.net)

Leeds Community Healthcare

Children’s Nursing Service

• Context – With which teams/services have you used PET

and how did this come about?

• Your role – What has your main role been and who have you

worked with?

• Added value – What benefits have you seen through using

PET e.g. patients, staff, trust, team, you?

• Lessons learnt – How has PET added to your understanding

of patient experience and its relation to staff?

• What next – How would you like to develop this work?

Children Community Nursing Service: Supportive, professional, lovely, communicative,

valued, lifeline

The service is a lifeline because..... Of the relentless nature of caring within the family

Carers/parents often puts themselves in the position of protector/defender due to

high anxiety

Parents and families view the service as a lifeline and are really appreciative of the

service and staff - fabulous, listening, professional, kind, supportive

It "Keeps our family intact” The staff are appreciated and valued, they are a God

send

The families' homes can therefore be highly emotive, high-stress environments, presenting very complex needs for support from the service including psychological as well practical.

Families seek clarity on service provision.... Care plan isn’t always used to enable a consistent approach to the child's care and

this can therefore undermine confidence

More clarity about service provision would be helpful to patients/carers; What can

staff do when visiting? Can they take my child out? Who gives medical care? Can

they play with my child?

Continuity and consistency in approach is very important to parents and to

children who respond well to particular people/approaches, -but inconsistency can

lead to lack of confidence in the service

Positive relationships built on trust & openness are

fundamental The way in which families are informed of changes to service provision (e.g.

reductions in care input) is important and can cause upset if there is no warning or chance to discuss implications

Trusting relationships are evident and are really valued

Feeling involved and listened to is so important to families and can allay the fears

that families have and build their confidence in the service.

Enhancing flexibility in communication approaches (understanding children's

needs, e.g. Makaton) could be helpful

Point of contact for addressing queries not always clear to families but makes a

massive difference when it's working well

The limitations of resources & funding cause

anxieties….

Worries about the future and the changing needs of the child (especially post 18

yrs.) Who to ask about this? How to cope with implications?

Flexibility in care rotas that respond to family’s needs is really appreciated; not

losing rota'd care hours when they clash with other family commitments.

Information and signposting really appreciated; e.g. Peer support groups and

Direct Payments/PHBs are often poorly understood.

The service is a lifeline because.....

Of the relentless nature of caring within the family

Carers/parents often puts themselves in the position of protector/defender

due to high anxiety

Parents and families view the service as a lifeline and are really appreciative of

the service and staff - fabulous, listening, professional, kind, supportive

It "Keeps our family intact” The staff are appreciated and valued, they are a

God send

The families' homes can therefore be highly emotive, high-stress environments, presenting very complex needs for support from the service including psychological as well practical.

Families seek clarity on service provision....

Care plan isn’t always used to enable a consistent approach to the child's

care and this can therefore undermine confidence

More clarity about service provision would be helpful to patients/carers;

What can staff do when visiting? Can they take my child out? Who gives

medical care? Can they play with my child?

Continuity and consistency in approach is very important to parents and to

children who respond well to particular people/approaches, -but

inconsistency can lead to lack of confidence in the service

Positive relationships built on trust & openness are fundamental

The way in which families are informed of changes to service provision (e.g.

reductions in care input) is important and can cause upset if there is no warning or chance to discuss implications.

Trusting relationships are evident and are really valued

Feeling involved and listened to is so important to families and can allay the fears

that families have and build their confidence in the service.

Enhancing flexibility in communication approaches (understanding children's

needs, e.g. Makaton) could be helpful

Point of contact for addressing queries not always clear to families but makes a

massive difference when it's working well

The limitations of resources & funding cause anxieties….

Worries about the future and the changing needs of the child (especially

post 18 yrs.) Who to ask about this? How to cope with implications?

Flexibility in care rotas that respond to family’s needs is really appreciated;

not losing rota'd care hours when they clash with other family

commitments.

Information and signposting really appreciated; e.g. Peer support groups

and Direct Payments/PHBs are often poorly understood.

Any Questions?

Thank you

Tamsyn Wright , The Mid Yorkshire Hospitals NHS Trust

Began a project using the YPET with support from the Improvement Academy after the unit had been agreed to carry out a staff culture survey project.

Conversations with staff and Improvement Academy re. value of speaking to staff about how they find working on the Unit.

Wide range of staff: Nursing staff – Nurses, Healthcare Assistants

Therapists – OT and Physio

Medical Staff

Pharmacists

Volunteers

Domestic support

Patient admission purpose:

Reviewed FFT feedback

Interviewed patients using YPET structure:

IA developed questions to frame conversations with staff

Supported in carrying out staff interviews – Liaison with Nurse Unit Manager

Challenges – time/availability

Patients and staff were grateful to have the time to ‘offload’ and express how they were feeling

Linking themes and topics show similar and additional themes

Potential added value of early engagement of staff in looking at potential improvements – even if bigger problems can’t be resolved

*Waiting*

*Busy Staff*

*Therapy time*

*Not enough staff*

*Emotional impact*

*Sitting out/TV/dining room*

*Nursing staff listen*

*Hard working*

*Volunteers*

*Caring*

*Kind*

STAFF QUESTIONS:

• What has been your experience

of working on this ward?

• Is there anything that is not

quite as you would like?

• Is there anything that would

make your role better?

• Any other comments?

*Busier*

*Less Staff*

*Low morale*

*Patient safety *

*External factors*

*Senior management*

*Moving wards*

*Team work*

*Prioritise patient care*

*Loyalty*

WHAT’S NEXT? • Continue with YPET steps– merging themes and topics into delivery of feedback

to interested staff identify improvements/issues to escalate…

• ?Opportunity to involve patients in further stages co-production….

• Gain stronger support from Senior Corporate Nursing Team re. value of YPET.

“Despite the volumes of data being collected, most of it does not scratch the surface of telling the patient story or capturing the experience of the teams that are at the front lines of patient care.” IHI Multimedia Team (2019).

“…Very quickly, it became apparent that the care team, patients, and family shared similar values and

reported similar struggles” IHI Multimedia Team (2019).

“…Without safe staffing levels in place, nursing staff are struggling to provide patients with the safe

and effective care they would like to, and which patients deserve. In England there is no law related to

nurse staffing. The RCN is campaigning for legislation to guarantee nurse staffing levels in England across all

sectors and settings” Royal College of Nursing (2019).

“There is evidence that the quality of patients’ experience is closely related to staff experience – happy staff

make happy patients” Raleigh et al (2009).

“…effective managerial support, good working conditions and positive staff morale are essential steps

towards providing a good-quality experience for patients. Monitoring patients’ experience via regular

surveys is also necessary, but not sufficient, to ensure that services are truly patient-centred. This needs to be

supplemented by other ways of ensuring that staff focus on patients’ needs. The ability to view services

through patients’ eyes should be the starting point for any quality improvement programme” Coulter, A. (2012) .

“Feeling low, anxious or angry, or not being able to control your emotions are all very common after a

stroke, especially in the first few months” Stroke Association (2018).

Coulter, A. (2012) Leadership for Patient Engagement. The King’s Fund, London

IHI Multimedia Team. (2019) Co-Designing an Environment Where Patients and Staff Thrive. http://www.ihi.org/communities/blogs/co-designing-an-environment-where-patients-and-staff-thrive

Raleigh VS, Hussey D, Seccombe I, Qi R (2009). ‘Do associations between staff and inpatient feedback have the potential for improving patient experience? An analysis of surveys in NHS acute trusts in England’. Qual Saf Health Care, vol 18, pp 347–54

Royal College of Nursing (2019) Safe staffing campaign. https://www.rcn.org.uk/employment-and-pay/safe-staffing

Stroke Association (2018) A complete guide to emotional changes after a stroke [online] https://www.stroke.org.uk/sites/default/files/user_profile/a_complete_guide_to_emotional_changes_after_stroke.pdf

Break

Reflections from coaches – part 2

Lorna Dunshire

Mandy Dawley

Using PET in mental health settings

Lorna Dunsire (Lead Occupational Therapist)

Acute Mental Health Services,

Bradford District Care NHS Foundation Trust

The importance of Service user involvement work

• Occupational Therapists: promoting positive experiences and active involvement

• Past experiences of service development / value peer support workers

• Desire to improve services • Power of patient’s subjective

experience

Different hospitals, different demographics: just as

effective The Yorkshire Patient Experience toolkit has been really effective in facilitating service user involvement groups across the two sites, despite the differences.

Things to consider when facilitating YPET in mental health services

• Accessibility

• Advertising

• Peer support

• Facilitation

• Open, safe space to speak

• ‘Ground rules’ to keep it a ‘safe space’

• Environment

• Meaningful and purposeful

Added Value: What the Yorkshire Patient Experience Toolkit brings to

Mental Health services

• Helping service users to feel listened to and understood

• Creating a forum to facilitate change • Empowering staff care and create

lasting change • Ownership and accountability • Sense of achievement • True person-centred care • Focus on theming • Support to stay focused (thank you

Laura and Claire!)

Lessons learnt

• The information gathered can be rich, powerful and sometimes difficult and of a sensitive nature

• Importance of how to feedback to staff

• Leadership and empowering teams • If an initiative isn’t owned, it won’t

have the same meaning, momentum or influence

• Staff feeling told off/ told what to do / blamed

• Staff morale, involvement and sense of achievement

What next?

• Theming! Lots of themes – processing rich information

• Staff focus groups - how our teams respond to the feedback

• Supporting and trusting our staff to make positive changes

• New projects responding to feedback – inspiring and encouraging leadership at all levels

Caring, Learning and Growing

Humbernhsft

www.humber.nhs.uk

Linking the Patient Experience Toolkit

to other Frameworks

Mandy Dawley Head of Patient and Carer Experience and Engagement

Context

• Initial Scoping Exercise to determine:

– Which teams are involved in Quality Improvement initiatives including patients, service users and carers

– Which methodologies are currently being used

• Where Quality Improvement initiatives identified, to look at using the Patient Experience Toolkit (PET) as well as other tools and techniques

Caring, Learning and Growing

Role and Responsibilities

• Strategic Lead for ensuring the patient, service user and carer

voice is heard

• To identify the best way to apply the PET in the Trust from a strategic and operational perspective

• To market the PET across teams as another way to identify and implement quality improvement initiatives

– Regional Coaches Network

– Quality Improvement Forum (June 2019)

– Humber Centre

• To support services with the implementation of the PET framework

• To host the Regional PET Coaches Network

Caring, Learning and Growing

Links to other Tools

Caring, Learning and Growing

Step 1 - Collaboration Patient Council Patient and Carer Experience Forums Scoping Exercise

Step 2 – Gathering Feedback

Emotion Mapping Surveys Workshops Other Feedback sources

Step 3 – Making Sense Always Events©: Plan, Do, Study, Act (PDSA) Cycles

Step 4 – Team priorities

Step 5 – Making a Change

Step 6 - Review

Impact vs Ease for Implementation

IMPA

CT

EASE low high

high

Additional Fruit to Ward

Menu Planning

Relationships /Culture

Lessons Learnt

• Maintaining momentum – Can be difficult: It is important to engage the right staff

(innovators)

• Don’t over complicate your existing approach – We have tailored the PET to enhance our existing patient

experience and QI approach so as not to overwhelm staff

• One size does not fit all – It’s useful to have a menu of methodologies, tools and

techniques that complement each other

Caring, Learning and Growing

What Next?

• Strategic Direction

– To work towards embedding the PET within the Trust’s Quality Improvement Approach (2018 to 2020) and the Patient and Carer Experience Strategy (2018 to 2023) priorities

• Operational Direction

– To ensure the PET is made available to all staff involved in a Quality Improvement initiative

Caring, Learning and Growing

What Next?

Caring, Learning and Growing

Mandy Dawley

Head of Patient and Carer Experience and Engagement

mdawley@nhs.net

Website: https://www.humber.nhs.uk/

Caring, Learning and Growing

Contact us

Lunch

Evaluation findings

Luke Budworth

Research Fellow

Bradford Institute for Health Research

Evaluation • Research questions around:

• Barriers / different approaches / networks & spread

• Methods:

• Participants were recruited via advertisement emails to all members of the coaches’ network.

• Simple online survey questionnaire (SurveyMonkey) for basic info on PET use progress, barriers, spread, engagement and sample characteristics.

• Semi-structured telephone interviews were used to gain more in-depth data.

• 11 surveys ; 7 interviews

• Insights & reflections from the field – Claire & Laura

The Coaches Network: lovely document, easy to follow but……

….it’s hard to get started

Lots of attendance at early meetings but uncertainty about where to begin and what first

steps to take – ‘who will collect feedback?’ ‘what departments will engage?’ how can

feedback be analysed?’ ‘does this fit with my organisational strategy for patient experience?’ ‘what about other systems such as FFT?’ ‘how can I engage frontline teams who have a busy workload? It has to appear valuable to them’

One-to-one support more effective than groups

Attendance at groups starting to tail-off. On-the-ground support to get started has

energised teams (e.g. help to collect feedback; help speaking to colleagues; help theming & presenting feedback) ‘support in theming has been invaluable’. ‘Maybe the meetings will be

more valuable once further along in the process’

Is it OK to focus effort on qualitative feedback? Collection of survey data & FFT still takes

precedence and can make it difficult to find time for PET. It is not always clear how PET can

fit in as it will never provide cross-organisational data: is this OK?

It can be daunting collecting open-ended feedback instead of closed survey questions.

Collecting and analysing qualitative data is more intensive and requires more skill

and organisation.

Network resources are not yet fully utilised by coaches

The resources on the website are not regularly accessed and more could be provided on the

site (e.g. meeting notes). Few responses to the invites to coaches to request support from

Laura/Claire. Perception that the document and resources are not always as freely available

as would like. Perhaps the website could be improved to aid navigation or have other

features like a forum.

What next for the network in 2020?

Table exercise: How would you

like to see Patient Experience

improvement work develop in

your Trust?

Table exercise: If you had a

blank sheet of paper how would

you like your PET coaches role

to develop?

Table exercise: What support do

you need from the PET Coaches

Network in 2020?

Thank you for attending Please complete the evaluation form in your pack,

and return your badges before leaving

Contact Details

@Improve_Academy

@ImprovementAcademy

www.improvementacademy.org

t: 01274 383966

e: academy@yhia.nhs.uk