Transcript Measuring for Improvement - Health Quality & Safety Commission

Welcome to the Partners In Care
Webex 10 – 13th February 2013
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© NHS Institute for Innovation and Improvement, 2012
Don’t forget.....
© NHS Institute for Innovation and Improvement, 2012
Agenda
• Welcome
• Next Webex Date
– Friday 8th March 8am -From Start to Finish & Fond Farewells
• Update on workbooks
• Sharing- from Partners In Care Projects
• Time for questions
© NHS Institute for Innovation and Improvement, 2012
Sandra Vandenburg
Consumer
Engagement
and Patient
Satisfaction
Surveys
Completion of Patient
Satisfaction surveys and
trials of questionnaires on
the Medical wards
What was planned……
 Patient
satisfaction surveys completion
on every medical ward.
 Quality acting as ‘Independent
distributor’ to ensure patient’s concerns
regarding care being affected not a
limiting factor
 Required feedback on the surveys by
consumer group to ensure that the
correct questions were being asked
 Evaluation of results
Planning the Project
 Due
to the high level of nursing
complaints and nursing related issues,
senior management were in support of
gauging what patient experiences were.
 Survey tool developed by the NHS in the
past as part of ‘Releasing Time to Care’
project, and adapted for use in WDHB
MHoPS. Consultation with CNM Quality
group and adapted, with support shown.
Consumer Engagement
 Discussion
with Community Engagement
Coordinator- best way to engage
consumers.
 Survey relayed to consumers by
coordinator at Healthlinks Consumer
Group.
 Group convenes monthly with full
agenda
 Item on wait list just under two months.
 Feedback received from group after
surveys completed on wards.
Meanwhile, Patient Surveys
Completed
 Patient
Surveys completed on the wards
 Results collated and fed back to the
wards in within two weeks for action to
be completed on results.
 Positive feedback for staff and CNMs, but
improvement areas noted.
 Results displayed on “Dashboards”
Findings/Lessons Learnt

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Speaking with patients 1:1 gives them confidence in
the program, and high response rate received
May also be attributed to anonymity of distributor
Patients wait for engagement and conversation
before elaborating on response. (KEY!!!)
Consumer engagement takes time!!
Patients don’t want to be seen to be complaining!
Having a conversation about experience can be
more “neutral ground” than complaining,
specifically when known that it is for improvement
purposes. Patients enjoy talking about their
experiences- BOTH positive and not so good .
I heard, “I’m not complaining BUT……”.
Also heard, “That’s just what you expect in a
hospital….”
Generally: appears to be a real desire by patients to
help make the system better, and sympathy for hard
working staff.
Findings/Lessons Learnt
Contin.


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

Querying about more specific aspects of care can
be helpful. -But only a conversation can delve
deeper. More helpful findings/responses when
asking about only topic A or B, not A, B, C, D and E
all at once.
Sometimes prompts from other patient’s
experiences can work: “We’ve had (a few patients
who feel that sleeping is difficult on this ward) or
(patients mentioning the noisy neighbour down the
hall). Did the noise wake you at all last night?
E.g. responses“Oh no I haven’t had any problems sleeping here.”
“Oh yes and those noisy trolley wheels wake you up
in the middle of the night too.”
Findings/Lessons Learnt
Contin.




Tick box surveys are insufficient! They do not
give the why, when, what?
“I was in ED and asked that they don’t use that
same leur site. I had already requested last
time, and three more staff wrote it down this
time but still there was no change and they
used the same site.”
“When I get out of here I’m going to set up a
trolley company as a supplier to the hospital!”
“They sometimes take a bit longer to answer
the call bell, but the staff are so busy, they do a
good job.” (So how long does it take till you
get a response to the call bell?) “Oh usually
right away, but sometimes can be about half
an hour. Not often though.” !!!!
Example of the Survey
OTHER COMMENTS
What worked well for you?
_____________________________________
_____________________________________
Is there anything you think we could improve?
_____________________________________
_____________________________________
_____________________________________
_____________________________________
Is there anything particularly good about the
service you received from our staff?
_____________________________________
_____________________________________
_____________________________________
_____________________________________
Please feel free to make any other
comments
_____________________________________
_____________________________________
_____________________________________
_____________________________________
Today's Date: _______________________
THANK YOU VERY MUCH FOR YOUR HELP
Put your completed survey in the ‘Feedback
Booth’ in the North Shore Hospital main reception or post your survey, please send to: Sandra
Vandenburg, 3 Mary Poynton Crescent, North
Shore Hospital, WDHB
Understanding the Patient Experien ce
PATIENT SURVEY
Please help us to improve our service to
you and others by completing this survey
(approx 5-10mins)
We don’t need your name and any feedback
you give will not affect your care in anyway.
Thank you for your time and assistance.
Example of the Survey
Date of Admission: _________________
Ward: ___________________________
1. When you arrived on the ward did the
nurse explain the ward routine and the lay
out of the
ward and where you were?
� Yes
� No
2. Were you made to feel welcome and comfortable?
� Yes
� No
3Were staff understanding and friendly
during your stay?
� Yes
� No
4. Did the staff on the ward introduce
themselves to you?
� Yes � Sometimes � No
5. How clean is the ward?
� Very clean
� Fairly clean
� Not very clean � Not at all clean
6. Is your bed space always free of clutter?
� es
� ostly
� Sometimes
� No
7. Did you get enough assistance from staff
to be comfortable in the bed or chair?
� Always
� Sometimes
� No
� Not Applicable
8. Did you get enough help from staff to eat
your meals?
� Always � Sometimes � No
� I did not need help to eat meals
9. Did the staff assist you to move around
your room and the ward safely?
� Always
� Sometimes
� No
� Not Applicable
16. Were you given enough information
about your medical condition?
� Yes
� No
10. Did staff wash their hands or use hand gel
before and after you were attended to?
� Always � Sometimes � Not at all
17. Did you understand the information
you were given?
� es
� ostly
� Sometimes
� No
11. Did you feel that all your personal hygiene
needs were met?
� es
� ostly
� Sometimes
� No
12. Do you feel comfortable to use the call
button for help?
� es
� ostly
� Sometimes
� No
13. When you used the call button, how long
did it take to get the help you needed?
� Right away � 5-8 minutes
� 1/2 an hour � longer than 1/2 an hour
� I never used the call button
14. Did you understand the information about
your medications?
� Yes � No � I had no medications
15. Was pain relief available to you when
needed?
� Always � Sometimes
� No
� I did not want any medication
16. Overall, do you feel you were treated
with respect and dignity during
your stay?
� Always � Sometimes � No
17. Overall, how would you rate the care
you received?
� Excellent
� Good
� Very Good
� Fair
� Poor
Example of Findings –
Quantitative Display
Ward 14
A survey was completed to assess patient's perceptions of the ward and the service provided by staff.
The results are outlined below. Not all patients answered every question.
16 patients participated in the survey for Ward 14
Medical/Nursing
ALL
ALL
Nursing
On admission, did the nurse explain
the ward routine and the lay out of
the ward and where you were?
Yes
Did staff wash their hands or use
hand gel before and after they
attended you?
Always
Sometimes
No
Not at all
Do the staff assist you to move
around your room and the ward
safely?
How many minutes after you used
the call button did it usually take
before you got the help you needed?
Always
Right away
Sometimes
5-8 minutes
No
1/2 an hour
Not applicable
longer than 1/2 an hour
I never used
Were you given enough information
about your medications?
Were staff polite and courteous
during your stay?
Yes
Yes
No
Sometimes
I had no medications
No
If you experienced pain were you
offered medication to help manage
it?
Did the staff on the ward introduce
themselves to you?
Is your bed space always free of
clutter?
Yes
Mostly
Sometimes
No
Overall, do you feel you were treated
with respect and dignity during your
stay?
Do you get enough assistance from
staff to be positioned comfortably in
the bed or chair?
Always
Sometimes
No
Not Applicable
Do you get enough help from staff to
eat your meals?
Always
Always
Sometimes
No
I did not want any medication
Were you given enough information
about your medical condition?
Yes
Always
Sometimes
Sometimes
No
No
How clean is the ward?
Yes
Very clean
Mostly
Fairly clean
Sometimes
Not very clean
No
Not at all clean
Were you able to easily understand
the information you were given?
Yes
Mostly
Sometimes
No
Sometimes
No
I did not need help
Overall, how would you rate the
care you received?
Excellent
Very good
Good
Fair
Do you feel that all your hygiene
needs were met?
Yes
Mostly
Sometimes
No
Example of FindingsQualitative Display
No, the service has been
very good.
Staff get a bit ratty at
times.
No. x3
Everything fine.
Is there
anything you
think we
could have
done better?
Dr Henderson came to see
me. Nurses help each other
out when necessary.
I am very pleased to have
received the care and
Friendly manners and
devotion given. English
helpfulness.
difficult, especially with a big
hearing loss.
More staff needed,
especially at nights.
This is a great service.
Is there anything particularly
good about the
service
Yes- the general care
you received
and enthusiasm shown
from our staff?
by all.
I have (I hope) shown
my appreciation in
the ticks overpage.
Dedicated and
friendly.
I'm grateful to
everybody and
everything.
Very attentive to our
needs.
Kind.
None further
to make.
Please feel free to
make any other
comments
I found it very
difficult to
understand some of
the staff.
The
cheerfulness
of staff is
infective.
The 1 negative comment is being
forgotten by physio "pusher" who left
me in the ward at 1.30pm, and not
returning.
Very kind.
You do your upmost! But the
nurses ARE very isolated.
Noticeable that the foreigners stand
out, they do a great job.
Ward 14
Evaluation of Findings
 Richest
data was in the qualitative
feedback- areas for improvement,
experiences through system of care
 Insufficient time to present data to ward
staff at meetings, but would be helpful for
engagement- new project underway to
improve this feedback cycle.
 Topical areas of concern found: call
bells, meals and understanding of
explanation of condition/details.
Then…..
 Hourly
Rounding introduced on wards
end of last year.
 Developed two EBD questionnaires
looking at: Meals, Call Bells.
 Trialled call bell survey on 2 wards with
insightful results.
Now:

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Consumer engagement to be completed
with these questionnaires now that pilot has
finished- booked in for 11th March with
consumer representative meeting. To discuss
these project findings/events as well as
discuss feedback for questionnaires
developed.
Results of hourly rounding implementation to
be evaluated
Impact of hourly rounding on patients to be
assessed.
Going forward:

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Continuing work: project completed but
continuous feedback cycle to be used for
analysis of hourly rounding implementation
results.
May need to complete a
questionnaire/patient stories around
communication of diagnosis to patients
considering responses to question.
CNMs to continue to share improvements at
quality group.
Questions/comments?
© NHS Institute for Innovation and Improvement, 2012
Marc and Philippa
Canterbury and West Coast District Health Boards
An Experience Based Design Initiative:
Using Focus Groups to Understand the
Experiences of Patients
and Deliver Better Value Services
© NHS Institute for Innovation and Improvement, 2012
Consumer Council:
‘Nothing about us,
without us’
© NHS Institute for Innovation and Improvement, 2012
Partners:
Marc Beecroft (Consumer Council) Philippa
McQueen (Planning & Funding)
A third partner joined;
Eade, Facilitator for the Aged Residential Care
(ARC) Service Level ().
Thanks Lorr, you were fantastic!
© NHS Institute for Innovation and Improvement, 2012
Aim:
Show how to use ebd to influence
quality improvements for service
users, in this case respite care
© NHS Institute for Innovation and Improvement, 2012
Preparation:
Gaining senior management and
staff buy-in is key!
Meet, talk, meet talk, and give
good information to staff
Meet, talk, meet talk, and give
good information to staff
© NHS Institute for Innovation and Improvement, 2012
Tools:
We used focus groups,
Likert scales and experience
questionnaires
© NHS Institute for Innovation and Improvement, 2012
Feedback…
…was open, honest, and sometimes humbling,
e.g.
“The other ladies were clicky and wouldn’t
speak to me and
I didn’t like that”
© NHS Institute for Innovation and Improvement, 2012
Learning # 1
Ebd breaks down barriers of stigma and discrimination,
as every stakeholder has an equally valid contribution
© NHS Institute for Innovation and Improvement, 2012
Learning # 2:
Look after your project
partnership
Keep communicating!
© NHS Institute for Innovation and Improvement, 2012
Learning # 3
Accept criticism and
make changes: this
increases the project’s
credibility
© NHS Institute for Innovation and Improvement, 2012
Learning # 4
Some ebd feedback
may be challenging
and raise more
questions for
clarification.
© NHS Institute for Innovation and Improvement, 2012
Outcomes (1)
Results from the Likert scales are yet to be
considered by senior management
Focus group results have helped strengthen
the restorative respite service, which is
currently in Request for Proposal (RFP)
process
© NHS Institute for Innovation and Improvement, 2012
Outcomes (2)
A participant of one of the focus
groups, the carer of a person with
dementia, has been invited to join the
RFP assessment panel
© NHS Institute for Innovation and Improvement, 2012
Outcomes (3)
Senior management
supports ebd as a
quality improvement
technique
© NHS Institute for Innovation and Improvement, 2012
Next step:
Undertake ebd with
the Facilities
Development team
for the build/rebuild
of ’s hospitals and
community health
services.
© NHS Institute for Innovation and Improvement, 2012
Questions/comments?
© NHS Institute for Innovation and Improvement, 2012

An ageing (and declining) district
population of 62,210

High rates of social deprivation with a
range of multiple and complex social
issues relating to higher levels of
unemployment
and
workforce
participation

Low annual household income

Lower levels of educational attainment

A high and growing proportion of
Maori (23%) and people ages over 65
years(16%)

A small provincial hospital (Whanganui
District Health Board) that services a
widely dispersed population.

Two Primary Health Organisation (PHO) providers, National Hauora
Coalition, Whanganui Regional Primary Health Organisation
(WRPHO)

Focus on reducing inequalities and improving health outcomes in
partnership with the community.

WRPHO enrolled population 56,271 (Jan 2013)

11,750 Maori or Pasifika (21%) and 11,016 other Deprivation 5 =
40% high needs patients

Approx 30 fulltime GPs, with 15 general practices.

Consumer involvement and connection has always been
valued by the WRPHO, although this has been more
community-focused than directly consumer driven.

Increasingly, the WRPHO has identified that
the consumer voice hasn’t been captured
effectively in regard to recent regional
changes in service delivery models.

The WRPHO had a Community Advisory
Group (CAG) made up of approx 13
individuals who represented a variety of
community groups and interests. However,
it functioned more as an information
sharing group rather than being an
influential strategy group.

The Partners In Care project provided
the perfect place for the WRPHO to work
with a variety of consumers to reshape
how it could involve them at a strategic
level.

This meant a desire to reshape the
governance structure within the WRPHO,
and then look to work across services in
the district, including the WDHB.
The initial plan was for the project to identify:

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
The attributes of an effective consumer – values, skills,
and competencies
The essential enablers for effective consumer
engagement and for a consumer voice
The mechanisms locally to engage Maori and Pasifika
consumers
Development of a set of agreed principles for
consumer partnership and a way of working when codesigning services or clinical models of care
The qualities we are seeking if a single consumer
voice is used in co design, and how do we grow such
individuals
Development of an agreed process for engagement,
ie how and who do we engage with and when
This took some time to shape as we spent
the first 3-4 meetings capturing stories from
8
regularly
contributing
consumer
members
about
their
wide-ranging
consumer experiences.
 The group decided that the development
of a consumer toolkit would provide a
useful framework for enabling services and
organisations to engage with consumers.
 There were also directed conversations
with approx 4 clinical leaders (GPs and
nurses) regarding how they capture patient
experiences and utilise them in service
delivery.

Goal
Primary Drivers
Secondary
Tertiary
Effective consumer
voice in system
redesign locally
Effective consumer
engagement into
systems co design
across providers
Gain buy in by general
Current ways of working are not sustainable
practice teams to
Ie Cultural shift required
experience based design
(EBD) for proactive quality
systems
Ie through district wide
diabetes project
Interventions
Individual – improved quality, safety and
Authoritative decision
making working against
community needs
Ie Regional integration
Regional women’s health
service plan
Vertical and horizontal integration of services
ie must include consumer involvement at all levels of
systems redesign
Build a collaborative approach with consumers to
Relevance of
WRPHO/WDHB
Community Advisory
Group to inform service
redesign
service design/improvement
Consumers can get together to share their
experiences
experience of care

Development of an agreed process valuing
the consumer perspective at an operational
level

Development of training programme for
clinicians on EBQ

Operational structure, processes inclusive of
consumer engagement

Consumer feedback shapes service model
and consumer outcomes
Systems – best value from public health systems
resources collaboration
Agreement at governance level on principles of
consumer participation as partners in policy, service
planning, and evaluation
Develop a framework for consumer engagement that
includes ;
set of agreed principles for consumer partnership; and
a way of working when co designing service or clinical
models of care
consumer involvement at all levels of health systems
design
identify how to engage consumers
educate/prepare articulate consumers at a
governance level
Population – improved health & equity for all
populations
Leadership & partnership in consumer engagement
processes

Development of leadership capability for
consumers / clinicians
Use of data to determine resources for population
health collectives
Develop a tool kit for use at governance and strategic
levels to enable effective consumer input including:

attributes of an effective consumer –(values,
skills, and competences)

essential enablers for effective consumer
engagement and for a consumer voice

mechanisms locally to engage Maori and
pasifika consumers

barriers to participation

orientation programme
 “What will you create that will make the world
more awesome… nothing if you’re just sitting
there” Kid President

We realised early on that we needed to
trust in the process, having faith that it
would take us where we needed to be,
enabling our consumer stories to always
shape the project. Always. And that would
mean our results would be awesome.

From the outset it was important to
establish an environment of trust and
safety. We wanted to ensure that
everyone felt safe to share their views,
and as programme partners we ensured
that we listened as much as we could
without attempting to influence the
course of the discussion.

In developing the consumer toolkit we
worked closely with all the consumers
involved to write it up; and a draft was
trialled with one of the project members
in regard to the development of a
consumer job description for the WDHB
(which was then implemented, hoorah!).
There were two key projects at play
together: the development of the
consumer toolkit; and the incorporation
of the EBD tool within general practice in
relation to diabetes services being
modified
into
a
self-management
practice (for patients).
 The EBD questionnaire was largely a
foreign concept for general practices.
This helped to identify that more work
needed to be done in regard to how
general practice teams could see it as a
valuable way of working.

That outcome supported the work we were
progressing with the consumer toolkit, and
provided valuable learning in that we
identified we needed to adopt a clearer
approach (rather than the high level
strategic approach we had initially taken).
This meant a toolkit that talked about
consumers at strategic level, as well as
consumers as patients.
 Enabling
opportunities for consumers’
stories to influence the design and
implementation of services was the key.

Key measures important to our progress:




Consumer participation and attendance at
meetings
Involvement in other projects, ie restructure
and appointment to the WRPHO board,
appointment to Maternity Quality &Safety
Advisory Group, and assisting with developing
consumer job description for WDHB
Ability to politically influence the sector with
our high level sponsors, and a team of
credible consumers
Ability to create a safe places for consumers
stories to be told
Measurement
Criteria
Rationale
Outcome
Increased consumer participation at a policy level
Increases ability to influence approach to population
health




Establish a representative of consumers at governance level



Increased awareness by clinical leaders of consumer
participation in co design


Evidence that project leaders understand and value
Evidence of a collaborative approach
consumers voice
A toolkit has been developed and endorsed by




Identifies what the consumer will need to be effective

Operationalised stories told



Consumers included on 2013/14 district annual planning
Consumer included at beginning of new initiatives ie
establishment of local polypharmacy project
Consumer involvement on regional projects , mental health,
po ph
o n’ h
h
Consumers leading design and development of consumer
toolkit
Consumer appointed to WRPHO board
A cohort of articulate consumers engaged on national and local
projects
Three consumers on MAMHAG planning group Consumers on
g on
o n’ p og
.
Diabetes contract has consumer engagement built in project
Integrated quality framework – aligns with consumer toolkit
A o
n
on of on
n “ k ho
”
Routine means of achieving consumer engagement in SOPs
Routine feedback on meetings/projects by all participants
Innovative opportunities created for consumer participation
(WAM)
Draft toolkit in place
leaders across the sector
Barriers identified for clinicians to engage consumers
Feedback on consumer toolkit from key consumer
groups identifies value of tool
Attendance and participation of consumers at project

Inclusiveness of process enables engagement
meetings
Project brief meets design need



Evidence of operational structures processes and
systems to enable consumer engagement

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




Health service co design toolkit and EBD
Funding barriers to be identified
Feedback from regional and national consumer group
colleagues
Feedback from working group of consumers
Participants responded on mass to all emails sent out for
feedback
% of attendance at all meetings
P oj p
p n ook
n ng’ n o o on M
n
S f An A
o g o p g on
o n’
h
Service Development Group
P oj
f
n
of
n ng’
Community advisory group disestablished
Consumer member of project team appointed to PHO board of
trustees
Diabetes consumer feedback gained by EBD
Echat strategy supported
Informed development of consumer JD
Influenced WDHB HR practices

Being open to enabling a number of projects to
come out of this key body of work – it’s not a singular
process, it’s about encouraging and supporting
consumers to feel good about being true partners in
care across all levels in the health sector, and
trusting in what happens next.

Some of the aside conversations, particularly in
relation to the use of the EBD tool, highlighted the
ways in which clinicians often lack value in each
other, and that limits their ability to see true value in
consumers and their experiences

Key learning = the journey has been most important.
Questions/ Comments ?
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Next Webex Date
Friday 8th March 8am
Thank you!!