Transcript LLR - Full non-emergency transport insights

Leicester, Leicestershire and Rutland
Commissioning Insights:
Non-emergency transport
Drivers and frontline staff
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Focus commissioning question
‘What needs to happen so that patients in
Leicester, Leicestershire and Rutland who are
eligible experience effective, safe, appropriate
and timely non-emergency transport
services?’
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Co design: What we did
Captured the experience of:
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People who use transport (n = 43)
Family carers and escorts (n = 11)
Drivers (n = 18)
Frontline staff: NHS staff (n = 16) and
Arriva/PTS staff (n = 5)
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Analysis: what we did
• Themed data
• Created emotional maps
• Created commissioning insights
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Drivers
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Current and desired experiences
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Current and desired experiences: summary
• Currently drivers have largely negative experiences, with
particular low points around: saying no to ineligible escorts,
which they find awful; getting patients to the clinic, which is a
struggle; and delayed pick up, which they find frustrating
• Drivers say they would like: for information about pick ups to
be more organised; for information about patients to be more
reliable; and to have time to wait for people to be ready, to
make the process stress free. They also say the would like to
be prepared when getting patients to the clinic and for people
to understand when there is a delayed pick up
• High points for this group include their relationship with
patients, which is friendly, and supporting people with special
needs, which drivers find rewarding currently.
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SUMMARY: WHAT IS WORKING WELL ABOUT THE
NON-EMERGENCY TRANSPORT SERVICE?
The key themes that emerge are:
Things that are working well:
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Good relationship with patients
Good attitude and work of drivers
Good management and support from control
A supportive team
A good service; on time
Out of county pick ups
Well-equipped vehicles
Service valued by patients
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What is working well about the transport service
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Good relationship with patients
‘Generally good. I know patients, family and history’
‘I try and have a chat with everyone. It makes it easy’
‘Be as friendly as you can. This reassures patients, make them feel you
know them… I try and make the journey as pleasant as I can’
‘I would like to think I have a good relationship. I see patients 3 times a
week so build up good relationship’
‘Regular renal patients, drivers get fairly close relationships as take 3
times a week’
‘You get to know them and assess the situation to see if they want to talk
or not. Happy atmosphere on board’
‘I understand people – I get through the day with that’
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What is working well about the transport service
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Good attitude and work of drivers
‘Drivers are motivated’
‘Drivers want to do the job as best they can’
‘Drivers are good, caring and passionate’
‘Drivers do job well and to best of capacity’
‘Come to work to do a job regardless of structures’
‘Drivers work well’
‘Drivers are good with patients’
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What is working well about the transport service
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Good management and support from control
‘Well supported by management and control’
‘Control has more people answering the phones’
‘If I have issues, I can look to planning [control]’
‘The cleric system works well as long as the information is updated.
We keep in touch with the control centre by text’
‘I am supported by my base manager who helped me find where I needed to
go’
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A supportive team
‘Staff I work with are understanding and helpful’
‘Good staff rapport’
‘Always ready to help me if I need it’
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What is working well about the transport service
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A good service; on time
‘Overall a good service’
‘On time most of the time’
‘We are getting patients in for the appointments’
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Out of county pick ups
‘Out of county pick ups are working well’
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What is working well about the transport service
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Well-equipped vehicles
‘Having wheelchairs in the vehicles’
‘More vehicles that are better and are suitably equipped’
•
Service valued by patients
‘Patients feel it is a valuable service’
‘Some say thank you’
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SUMMARY: WHAT IS NOT WORKING WELL ABOUT
THE NON-EMERGENCY TRANSPORT SERVICE?
Thing that are not working well:
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Getting incorrect information
Poor availability of wheelchairs
Waiting for the patient to get ready
Poor relationship with patients
Unrealistic targets and expectations
Issues with parking
Poor planning
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What is not working well about transport service
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Getting incorrect information
‘Wrong information given therefore wrong vehicle sent. Wrong address
leads to delays. We have to remember patients have been waiting
months for this appointment and if its wrong and they have to wait more
they lose faith and will get ill’
‘Unprepared for the day – phone with a couple of words on the patient
and the journey… usually the patient has sent the info in an incorrect
way’
‘Information is not accurate… frustrating especially as I am quite new in
the job and don’t know the hospital well’
‘Often information about the patient hasn’t been updated… when the
wrong information is given it causes delays’
‘Sometimes it’s very frustrating. Information you get can be too much,
not enough, don’t know if the mobility is right. Old notes get taken off
and information can conflict’
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What is not working well about transport service
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Getting incorrect information (cont.)
‘We rely on the journey notes which are not always up to date. Information at
all stages is vital. Sometimes it’s just small details that can be left out e.g.
book a wheelchair, but not stated a wide wheelchair… another time we turned
up for a standard transfer, needed to gown and glove up as the patient was
infectious’
‘We don’t always get the right locations. Details on phone can be completely
wrong. Frustrating for me’
‘Most of the time the notes are not up to date’
‘Need to look at how the call centre takes info – 90% of the time patient does
not know what they are to bring; the call handler can’t be bothered to take
the right info and that cascades to poor service’
‘Not always correct information mobility wise’
‘Inaccurate information – which clinic? Wastes time pushing the patient
around the hospital to find the right clinic’
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What is not working well about transport service
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Poor availability of wheelchairs
‘We get the patient there on time and spend 20 minutes finding a
wheelchair… distance to clinic is very far’
‘Time consuming if you have to find a wheelchair… need to find a chair
and clinic don’t have one’
‘Our wheelchairs are small so we need wheelchairs at the hospital, we
can never find one. Big bug bear at the LRI. You think you are asking for
the world’
‘No wheelchairs available, this impacts delays’
‘Availability of wheelchairs can be a problem’
‘Sometimes can be an issue when you can’t find a wheelchair, some
hospitals don’t have them’
‘Lack of hospital wheelchairs is a problem’
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What is not working well about transport service
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Waiting for the patient to get ready
‘I am annoyed when [patient] is not ready. It impacts on the day’
‘It can be hard because if they are not ready, it causes delays. It has a
knock on effect. I feel annoyed when this happens’
‘Routine – especially in care homes. We are on a tight schedule. Any
delay has a knock on effect. For example, a lady with an electric
wheelchair. It was rainy so carers didn’t get the wheelchair out of the
garage. Little things still cause a delay’
‘Control says you can only wait 10 minutes, but if it’s an old lady who’s
not ready, you can’t just leave after 10 minutes’
‘Its not the right thing for us to go. We have to wait. Nursing homes are
the most disorganised’
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What is not working well about transport service
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Poor relationships with patient
‘I keep them at arm’s length. I don’t get involved; I detach from patient’
‘We don’t have that much contact’
‘If they are non-regulars, you do your best. It can get strained at times
when you are in a hurry’
‘Some patients are not so nice’
‘It can be varied. Some people want to be quiet/ distant’
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What is not working well about transport service
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Unrealistic targets and expectations
‘It is not helpful having people at 15 minute intervals as targets will be
missed – not realistic’
‘They take into account arrival and departure time only. They need to
give us the time to off load the patients and deal with all the other issues
and then get back to the vehicle. I can’t do anymore, I work at 100%’
‘I don’t think control understand how long it really takes to pick up a
group of patients. Unbelievable expectations’
‘Even when I have a day when everything is running on time, control
puts extra patients in. This puts pressure on and means I don’t always
have time to complete the paperwork’
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What is not working well about transport service
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Issues with parking
‘Parking is the main thing… very time consuming’
‘Time consuming… parking is a problem’
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Poor planning
‘Delayed before we start if planning is not accurate e.g. appointment at
10am, pick up for 10am. 1pm appointment – one at LRI, one at LGH at the
same time – frustrating’
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SUMMARY: WHAT IS WORKING WELL AROUND
SUPPORTING PATIENTS SO THAT THEY ARE READY
TO LEAVE IN GOOD TIME?
The key themes that emerge are:
Things that are working well:
• Being notified when the patient is ready
• Patient ready when collected
• Having a single pick up point
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What is working well around supporting patients
so they are ready to leave in good time
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Being notified when the patient is ready
‘Outpatients call to say they are ready for collection, this works really
well’
‘Some wards call to say the patient is ready for pick up – this works well’
‘Out patients clinics let the PTS know when patients are ready, so no
delay in starting the journey home’
‘Leaving is to do with hospital ringing us and stating patient is ready’
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Patient ready when collected
‘Don’t think we have a problem with people ready to travel – by and large
patients are usually ready for us when we collect’
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What is working well around supporting patients
so they are ready to leave in good time
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Having a single pick up point
‘At the LRI the discharge lounge works well as we pick up patients from
one place’
‘Discharge lounges or one place for patients to wait and be picked up
from clinic LRI and Glenfield, not available at LGH’
‘It works well when a hospital has a discharge lounge or an ambulance
desk – one point of contact means a quick turn around and reduces
delays’
‘Discharge lounge works well. Patients all in one place’
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SUMMARY: WHAT IS NOT WORKING WELL
AROUND SUPPORTING PATIENTS SO THAT THEY
ARE READY TO LEAVE IN GOOD TIME?
Things that are not working well:
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Patients not being completely ready
Difficulty leaving if patient is not ready
Being late for pick ups
Nothing working well
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What is not working well around supporting
patients so they are ready to leave in good time
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Patients not being completely ready
‘Patients are not made ready by nurses on some wards – especially on
Renal’
‘A few issues when we pick up from hospital – nurses will have them
ready, but they won’t have their medicines’
‘Patients think that once they doctor says they go home they can go
immediately. It is not made clear to the patients that they can only go
home once they have medications, dressing etc… then when the
ambulance arrives they see a delayed service’
‘Patients never ready because the wards are so busy, this impacts on
other patients, maybe in the ambulance or waiting on another ward/
discharge lounge not being ready’
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What is not working well around supporting
patients so they are ready to leave in good time
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Patients not being completely ready (cont.)
‘Very frustrating. Recently when to 3 different wards, none of the patients
had medications. All 3 transports had to be aborted. Frustrating for staff
and patients’
‘More delays on the wards, wards say patients ready when they are not.
They think that the ambulance will be delayed, think they will be ready
when the ambulance gets there – then they are not’
‘If you have to collect from the ward and patients often aren’t ready –
takes time to find the named nurse – long day’
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Difficulty leaving if patient is not ready
‘When control says just leave due to the patient Ward 15 and 16 at the
LRI… if it’s a really important appointment, it’s difficult to leave the
patient. This is stressful. It differs from day to day, don’t always feel
supported by control. We know and understand the impact on patients’29
What is not working well around supporting
patients so they are ready to leave in good time
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Being late for pick ups
‘Sometimes I do not pick up on time’
‘I am frustrated and embarrassed. When people say they have been
waiting 3 hours, you think why?’
‘It is annoying. We don’t want to be late for the patient’
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Nothing working well
‘Not a lot that is working well’
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SUMMARY: WHAT IS ONE THING YOU WOULD
IMPROVE TO MAKE THE SERVICE BETTER FOR
PATIENTS ?
The key themes that emerge are:
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Having the right information
Giving the correct information at booking
Keeping patients informed
The booking system
Patients being ready on time
Calling ahead
Vehicle quality
More vehicles
Prioritise patients
Better prepared for traffic
Eligibility issues
Reliable phones
More supportive taxi drivers
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One thing you would improve to make the service
better for patients
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Having the right information
‘Correct information on the patient we are collecting’
‘Keeping patient information updated’
‘Staff understanding the importance of giving the correct information’
‘We need to get more information in that message – the patient booking,
should have a card so can fill out with the GP and go through it on the
phone. Then it won’t be wrong’
‘To have the right information’
‘Having all the correct information’
‘Right information, accurate first time’
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One thing you would improve to make the service
better for patients
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Giving the correct information at booking
‘Review the patients questions on booking’
‘Needs to be right at the booking stage. We are given the opportunity to
say what we need and think, but these things never materialise… e.g. for
a stretcher case, are there steps, can we get in and out of the house,
does the clinic know? We need really detailed information’
‘When booking the correct information is vital’
‘Detailed/ accurate information at the booking stage’
‘Need to ask the right questions at the time of booking’
‘I think they need to ask questions properly on review’
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One thing you would improve to make the service
better for patients
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Keeping patients informed
‘Keep patients informed’
‘Patients to be kept informed’
‘Keep people informed. People appreciate contact’
‘Keeping patients informed of what they need to do’
‘Patients need a clear understanding of all that needs to be in place
before the ambulance can take them home’
‘Giving patients the information that we are not a 1:1 taxi service and that
delays will occur’
‘That every patient knows what to expect’
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One thing you would improve to make the service
better for patients
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The booking system
‘The booking system is letting the whole system down’
‘Look at the system. Patients get erased’
‘Stop stressing over booking’
‘We need better understanding of the process at the time of booking for
clinical staff’
‘It needs to be made sure that the booking is correct’
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One thing you would improve to make the service
better for patients
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Patients being ready on time
‘Be ready when you are there – patient information/education – need a
longer buffer at the control stage, not for the driver to do’
‘Need patients to be ready. Staff need to really understand the reason for
this’
‘The patient must be ready to leave the ward. Reason for fairly frequent
delays when patients are being collected from wards needs to be revised
and addressed’
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Calling ahead
‘Calling ahead works well. It would make a better experience for
everyone’
‘It would help if there was an automated system e.g. by text, to say your
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driver’s estimated time of arrival, so the patient was ready’
One thing you would improve to make the service
better for patients
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Vehicle quality
‘Vehicles are aging – need repairing’
‘Vehicles that work properly’
‘Newer vehicles’
‘Vehicles that work better’
‘Not designed for purpose – can’t get some patients into seats because they
are too weak – need tail lifts or ramps’
‘Bigger cars – not wide enough’
‘Suspension on the vehicles – causes people to feel sick and also the crew’
‘I would like new vehicles, vehicles without rattles’
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One thing you would improve to make the service
better for patients
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More vehicles
‘We need more vehicles’
‘More vehicles’
‘More wheelchair vehicles. Situation when come with wrong vehicle and
have to go back to base and change’
‘More vehicles needed. Can’t be in two places at once’
‘In an ideal world, we would have more vehicles’
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One thing you would improve to make the service
better for patients
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Prioritise patients
‘Spilt service, runs up into categories – renal drivers, EOL patients,
mental health – they need prioritising’
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Better prepared for traffic
‘Don’t offer patients appointments before 10am; don’t have to face traffic
at peak times; tell us if there is a fault on the road and we can go another
way. Control don’t know, they need to look at traffic news and tell us –
we can then be prepared and go another way’
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One thing you would improve to make the service
better for patients
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Eligibility issues
‘Telling patients to only use the service if they really need to’
‘Tighter booking criteria is needed’
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Reliable phones
‘Phones need to be more reliable’
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More supportive taxi drivers
‘Taxi drivers being more helpful to poorly patients. They just sit in the
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car’
SUMMARY: WHAT IS ONE THING YOU WOULD
IMPROVE AROUND THE TRANSPORT SERVICE SO
YOU CAN DO YOUR BEST WORK?
The key themes that emerge are:
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Better planning
Realistic expectations and targets
More staff
Better pay and funding
Better communication with control
Better communication with hospital staff
A central pick up point
Wheelchair availability
Parking availability
Vehicle comfort
Flexibility in system
Voluntary drivers
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One thing you would improve to do your best
work
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Better planning
‘Better planning and organising’
‘Better planning needed’
‘Good planning is essential e.g. driver is due to finish at 6pm but cleric
system times the end time to 7.30pm. The cleric system doesn’t allow
accurate journey times – planning puts the times and journey in’
‘Better planning for work’
‘Planning issue. Sometimes people are added late. It could be because
other drivers delayed. I feel frustrated as I don’t like being late’
‘Better timing and planning’
‘Better logical planning’
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One thing you would improve to do your best
work
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Realistic expectations and targets
‘Allowances need to be made for traffic – reasonable expectations’
‘Change the 15 minute pick up – hit one target but miss the other two’
‘Problems with KPIs – it isn’t realistic’
‘Get managers out on the road so they can see what it is like’
•
More staff
‘More staff’ x5
‘In an ideal world we would have more drivers’
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One thing you would improve to do your best
work
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Better pay and funding
‘More funding’
‘Better pay’
‘Better pay and conditions’
‘Better treatment. Bring in incentives’
‘Better pay – no equality – 3-4 different pay levels’
‘We do overtime everyday. I very rarely finish on time, but I never get
paid for overtime’
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One thing you would improve to do your best
work
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Better communication with control
‘Better communication – not waiting 15 minutes for control to answer the
phone’
‘Better communication – can be very frustrating – want to do a good job
despite control’
‘Everyone singing off the same page – currently drivers on one page and
control on the other’
‘But if you need to talk to control, it can take a while to contact – need a
hotline for quick responses’
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One thing you would improve to do your best
work
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Better communication with hospital staff
‘Better communication between ourselves and hospitals’
‘Better communication to the frontline staff form line managers’
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A central pick up point
‘Patients waiting in a central location for pick ups’
‘Liaison desks – the freedom to come to the desk and see what we can
pick up – this is in place at LRI and Glenfield but not LGH – good for
patients and drivers’
‘Have one central place to pick up patients from – we go into one place
rather than running all around the hospital to collect patients – this
would save time and prevent delays’
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One thing you would improve to do your best
work
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Wheelchair availability
‘Wheelchair available at LRI’
‘More wheelchairs at hospitals, need to be in one place’
‘Hospital chairs available for transfer’
‘More wheelchairs at destination. Currently we can’t transport a patient’s
wheelchair unless they are sitting in it. The patient still needs a
wheelchair at the hospital’
‘Need more wheelchairs on arrival’
‘More access to wheelchairs, some we carry are not suitable’
‘More wheelchairs available at the hospitals’
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One thing you would improve to do your best
work
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Parking availability
‘Need parking spaces’
‘More spaces to park’
‘Better parking at discharge lounge in operation’
‘Nice to have more car parking spaces at hospital. Parking issues at LRI.
Other hospitals okay. Dedicated parking spaces. When travellers were
there last year, it was 25 minutes to park. It was extreme’
‘Condition of the car park can impact on access. New multi-storey at the
LRI has made a big difference; we can now get in and out’
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One thing you would improve to do your best
work
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Vehicle comfort
‘Comfort of vehicles’
‘More comfortable ambulances’
•
Flexibility in system
‘More flexibility to the system’
•
Voluntary drivers
‘Bring back voluntary drivers’
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Frontline staff (patient transport and
health care professionals)
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Current and desired experiences
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Current and desired experiences: summary
• Currently frontline staff have mixed experiences of nonemergency transport services
• High points include their relationship with the transport crew,
as they feel they know them and they are friendly. They also
feel getting the patient ready to leave is organised. This in
contrast to patients’ views
• Frontline staff say they would like to feel more capable when
deciding to book transport; for changing a transport booking
to be simple; and to be more in control when getting patients
ready to leave. They also want to be more reassuring when the
patient is waiting and for the impact of transport on their work
to be less stressful
• Low points for this group include: the aftermath of the journey,
which is stressful and a challenge and their feelings when
patients are waiting. Currently they are left feeling concerned,
frustrated and helpless, which means transport makes their
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work stressful and dealing with it takes time
SUMMARY: WHAT IS WORKING WELL ABOUT THE
ARRIVA TRANSPORT SERVICE?
The key themes that emerge are:
Things that are working well:
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Good staff; friendly and supportive
Good team and management
Good relationship with staff
Direct contact
Keeping patients informed; accurate information
Flexibility
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What is working well about the transport service
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Good staff; friendly and supportive
‘They are very professional staff and they make sure that the patient is
safe and comfortable during the travel’
‘Staff manner – friendly staff; flexible and supportive’
‘Helpful drivers’
‘They are caring and supportive of patients’
‘Drivers are helpful and friendly’
‘Arriva drivers are more caring than taxi drivers’
‘Friendly and supportive staff’
‘They work very hard’
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What is working well about the transport service
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Good staff; friendly and supportive (cont.)
‘Good, supportive people work here’
‘Friendly staff’
‘All members of the team care about the patients’
‘Arriva staff are friendly and polite’
•
Good team and management
‘Good team management’
‘The management change has been better’
‘We have a great team’
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What is working well about the transport service
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Good relationship with staff
‘The relationship with most crews that deal with hospital discharge is
friendly’
‘We know their traits and speak to them on individual level. Training and
build relationships’
‘Been doing job a long time. Work alongside them, being friendly, do
things for me they might not do in other areas’
•
Direct contact
‘We have direct contact with Arriva - we can phone them any time’
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What is working well about the transport service
•
Keeping patients informed; accurate information
‘Keep patients informed and given truthful and accurate information’
•
Flexibility
‘Arriva are a flexible company – we can change shifts if needed’
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SUMMARY: WHAT IS NOT WORKING WELL ABOUT
THE ARRIVA TRANSPORT SERVICE?
The key themes that emerge are:
Things that are not working well:
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Issues with booking
No cut-off time for booking
Auto-allocation
Eligibility issues
Delays and long waits
Poor communication about delays
Using staff escorts
Poor relationship with transport crew
Lack of equipment
Dealing with complaints
Too many patients
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What is not working well about transport service
•
Issues with booking
‘Discharges being booked as early as possibly, but it can be difficult for
hospital staff e.g. hospital rounds, medicines to take out. This means
that as the patients are ready later in the day, more of our transport is
already allocated and this can cause problems’
‘Too many phone numbers [for booking], not clear in the communication,
difficult to get through, especially in evening’
‘It can be confusing [booking], you have criteria to meet’
‘Input a lot of stuff that isn’t relevant. [Booking] should be swifter.
Between 9-11am staff have to book transfers for patients as Arriva not on
desk until 11am’
‘Out of hours the calls are not answered, can take time, have other things
to do’
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What is not working well about transport service
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Issues with booking (cont.)
‘Sometimes you are just kept hanging on the phone. If only the caller had
all the correct information at the time of the call, it would be much better.
This really delays the booking. Sometimes when booking discharge, the
staff get confused. They will tell us the time when the patient will be
ready e.g. 12 hours. We will ask them to ring and confirm as the 12
hours is an estimate when pre-booking. Often staff don’t ring as in their
minds, they have booked the transport and it should have arrived at 12
hours. These problems are around process’
‘It is difficult to change last minute or cancelled clinic journey if clinic is
changed’
‘Booked transport for discharge planning, booked on the day, should be
booked 24 hours before – LRI is a knee jerk reaction, has a knock on
effect’
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What is not working well about transport service
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No cut-off time for booking
‘No cut off time for booking a transport’
‘Over the weekend, people can ring for an appointment, first thing on
Monday morning therefore we can have 30-40 last minute patients we
have to accommodate – very big problem’
‘Patients don’t realise we are open 24/7. We ask patients to book 48
hours in advance, not including weekends. This allows time for planning,
we still take the [later] bookings but this can cause delays for the patient.
We should have a cut off point for taking the bookings so that transport
can be booked and planned appropriately to avoid disappointment for
the patient’
•
Auto-allocation
‘Auto allocation for outpatients sometimes misses patients’
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What is not working well about transport service
•
Eligibility issues
‘From a management point of view, we take a lot of people who don’t require
our transport. This is avoidable if the right questions are asked and the
right answers are given. However, some people who don’t get the service
with one call taker will call again and give answers which result in the
transport being allocated. Patients who can take a taxi or get there
normally are using our service inappropriately. This is frustrating and
avoidable as we have some patients who need our transport waiting and
experiencing delays’
‘Eligibility criteria is very weak. Don’t have medical reason but can get
through. Put more pressure on – frustrating. Takes up resources. Criteria
is very open ended’
‘If someone hasn’t travelled before they can tell us what they want – no
checks – so many people are using the service now. E.g. a patient phoned
to go to the sys clinic, said he was visually impaired, provided with an
escort and ambulance. The nurse at the clinic called to ask why the patient
had been provided with an ambulance and escort. When told because he
was visually impaired, the nurse confirmed the patient was not visually
impaired’
‘Criteria its too easy to get through if you don’t require transport’
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What is not working well about transport service
•
Delays and long waits
‘No flexibility… The patient can be waiting hours along with a staff
patient escort…Often if the transport is too late for the appointment the
doctors get annoyed with us’
‘Patients are late, this puts stress on staff’
‘Patients waiting to be treated is concerning and not good for
patient/staff’
‘Sometimes it can be a long delay and the appointment has to be
cancelled. Sometimes I ring the patient up and apologise. I am prepared
although this situation can be stressful and challenging as it happens
quite a lot’
‘People forget that mental health patients often need more explanation
and tender loving care. Some patients have dementia. They don’t
understand the reason for delays and long waits. This makes me feel
disappointed as they have a lack of understanding and we are not
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empathetic to their needs’
What is not working well about transport service
•
Poor communication about delays
‘Phoning control to chase delays is frustrating’
‘Being stonewalled with the answer ‘I don’t know’ does not help when a
patient has been waiting 6-7 hours for transport’
‘I feel angry with the attitude from control – ‘its only 2 hours’. This really
upsets me’
•
Using staff escorts
‘The patient can be waiting hours along with a staff patient escort. We
lose a member of staff from the ward, which can be understaffed. We
often need to order a taxi to take new shift member of staff to relieve
escort as it is time for that member to go home. We often result to using
voluntary drivers or taxis rather than Arriva. This is really frustrating as a
clinical member of staff’
66
What is not working well about transport service
•
Poor relationship with transport crew
‘Sometimes they question my professional knowledge and opinion in
terms of patient’s physical health’
‘[Relationship] could be better. No one understands each others’
problems’
‘We don’t know them, we speak on rare occasions’
‘We don’t have a relationship’
•
Lack of equipment
‘It can be messy. If you need to get a patient in for an operation at 8am
and they need specialist equipment e.g. a bariatric stretcher, you can’t
guarantee it will be available in time for the 8 am arrival. Even with
stretchers there seems to be a shortage of equipment’
67
What is not working well about transport service
•
Dealing with complaints
‘The frustrating part is when patient’s complain, but delays occur due to
us trying to meet the volume needed’
‘The liaison assistant has to put up with a lot of moaning and abuse’
‘It can be really frustrating as only the patients who have family members
call to complain. Because they complain, we know to take action.
However, the poor 90 year old lad who has no relatives for example
doesn’t complain and is an unheard voice’
•
Too many patients
‘The amount of patients we have on a daily basis is more than we are
contracted to do’
68
SUMMARY: WHAT IS WORKING WELL AROUND
SUPPORTING PATIENTS SO THAT THEY ARE READY
TO LEAVE IN GOOD TIME?
The key themes that emerge are:
Things that are working well:
•
•
•
•
•
•
•
•
•
On time appointments and transports
Pre-booked transport
Keeping patients informed
Looking after patients who are waiting
Helping get the patient ready
Informed when patient is ready
Team work
Good management
The right staff
69
What is working well around supporting patients
so they are ready to leave in good time
•
On time appointments and transport
‘The patients aren’t waiting long, so ambulance crew can arrive early’
‘If patients come in on time for HD session, then going home isn’t a
problem. If they are late, it can affect their going home time’
‘Transport coming on time’
•
Pre-booked transport
‘All transport in the HD unit is pre-booked in and out’
‘Cars booked in advance’
‘In community hospital transfers, all journeys are pre-planned in with at
70
least 24 hours notice’
What is working well around supporting patients
so they are ready to leave in good time
•
Keeping patients informed
‘Our patients are fully informed of what is happening’
‘Inform and explain. Check on system to make them ready. Keep
checking in system. Keep telling patient. Keep them up to date’
‘I would inform them if time to help them and inform them’
•
Looking after patients who are waiting
‘I reassure them that I won’t forget them and make them laugh. This
relieves stress. I even have shawls in my office for if patients are waiting
a long time and are cold. I find caring for the patients when
unaccompanied very rewarding. I get attached to patients’
‘I make tea, talk to patients, and do all I can to make their wait shorter’ 71
What is working well around supporting patients
so they are ready to leave in good time
•
Helping get the patient ready
‘I get them into the chair etc. elderly escort. Help to get to the vehicle. I
carry out all the circles activities e.g. organise, support and prepare the
patient at times’
‘Organised. Don’t make the patient ready for transport until they are
ready, home meds, letters etc. go up to wards they aren’t ready, end up
wasting time. Can be 2/3 patients already in the vehicle’
‘We allocate a member of staff to get the patient completely ready – up,
dressed, food and drink before ambulance staff is due to arrive’
‘We have more staff deployed to help move patients’
•
Informed when patient is ready
‘Staff at the clinic call to let us know when the patient is ready’
72
What is working well around supporting patients
so they are ready to leave in good time
•
Team work
‘Dedicated, organised team work from staff’
‘Working as a team’
‘Team work – having staff at peak time’
‘Speed of response from team’
•
Good management
‘Managers are on top of things for the patients’
•
The right staff
‘Having pharmacy technician in DC lounge’
73
SUMMARY: WHAT IS NOT WORKING WELL
AROUND SUPPORTING PATIENTS SO THAT THEY
ARE READY TO LEAVE IN GOOD TIME?
Things that are not working well:
• Patients kept waiting
• Too few staff
• Difficulty booking transport
74
What is not working well around supporting
patients so they are ready to leave in good time
•
Patients kept waiting
‘Poorly people in wheelchairs should not be sat in there for 2 hours. No
staff to put them in a chair, clinic staff just leave them’
‘Feel sorry for patients, waiting for 3 hours is not good. Drivers
sometimes waiting for patients’
‘When dialysis patients are very tired and want to go home and delay
puts stress on patient and staff’
‘Feel for them. Wait 4-6 hours, some are regular patients, both outpatient
and inpatient. Not fair on them, this is not proper clinic and nearly full’
‘Not a nice experience when patients are waiting so long’
‘A 90 year old lady was waiting 3.5 hours. This is not unusual. Another
example is when a patient in an electric wheelchair waited 5 hours’ 75
What is not working well around supporting
patients so they are ready to leave in good time
•
Too few staff
‘Staffing is poor here today. They have been moved. We don’t have
facilities to meet their [patients] needs’
‘When we are short staffed, its difficult with patients needs’
•
Difficulty booking transport
‘When hospitals are booking transport it may be difficult. When the
hospitals booking transport they don’t always have the information we
need…Hospitals can be very busy. This means it takes more time and
can delay for example a patient being discharged. For example we
need to know the patients mobility capabilities and sometimes the
caller won’t have that information. They will go and find out = time
delay’
76
SUMMARY: WHAT IS ONE THING YOU WOULD
IMPROVE TO MAKE THE SERVICE BETTER FOR
PATIENTS ?
The key themes that emerge are:
•
•
•
•
•
•
•
•
•
•
•
•
•
Better forward planning
Earlier booked transport
Area spread
Timings; on time transport
No long waits
More time with patients; build relationships
Focus on patient care
Less administration
Better communication
Inform patients
Focus on quality
Discharge lounge facilities
Patient feedback
77
One thing you would improve to make the service
better for patients
•
Better forward planning
‘Better planning – a more flexible approach from the transport service’
‘More forward planning for potential next day discharges and weekend
discharges and patients referred to rehabiliation’
‘Need to let planners know about the logistics of the actual journey’
‘Acute hospitals to pre-plan booking’
‘Need to prioritise when booking. Planners say they don’t have time to read
notes and check who is a priority. Planners can’t plan more than 2 days in
advance’
‘Change the knee jerk reaction at Royal planning. As part of discharge
planning, all transport should be booked in the morning even if the person is
not leaving until afternoon’
‘Planners to take time to read notes’
78
One thing you would improve to make the service
better for patients
•
Earlier booked transport
‘If transport could be booked once the patients are on the machine, I
believe the transport system on the unit will work better’
‘When a patient’s treatment is started, the predicted finish time should be
automatically transferred to the transport service’
•
Area spread
‘New point of care needs looking at. It has doubled and vehicles need to
travel further’
‘Look at having certain vehicles in certain areas’
79
One thing you would improve to make the service
better for patients
•
Timings; on time transport
‘Transport arriving in a timely manner’
‘To get them home on time or in time’
‘Be on time’
‘Transportation turning up on time’
‘Be here on time’
‘Run to time’
‘Flexible and punctual’
‘All wards to aim for discharges to be ready to travel by 4pm so elderly
80
are at destination at a reasonable time’
One thing you would improve to make the service
better for patients
•
No long waits
‘Less waiting time’
‘Stop elderly patients having to wait for a long time – find this stressful
and upsetting’
‘Quicker allocation of ambulances for inpatients lounge as some can be
sat up to 8 hours even if they are ready to travel at 8.30am and others
aren’t collected until after department should have closed at 8pm’
‘No long waits (excessive waits) for patients’
‘Don’t wait too long’
‘Not to make the patient wait’
81
One thing you would improve to make the service
better for patients
•
More time with patients; build relationships
‘Spend more time with patient to get to know them rather than the
production line’
‘Need to spend time reassuring people; I don’t like seeing elderly
patients here late at night’
‘Enough time and not rushing patients’
‘More time with one patient and have adequate time with next patient’
‘Time to support them’
‘Timing of slots – we have tight schedules. Too many patients need
treatment’
‘More time to spend with patients to talk to them and get to know them’
82
One thing you would improve to make the service
better for patients
•
Focus on patient care
‘Think more of patient needs’
‘Make life easier for patient’
‘Better patient care – Arriva do not have patient care in mind’
•
Less administration
‘Arriva staff can’t be expected to be on administration and help patients’
83
One thing you would improve to make the service
better for patients
•
Better communication
‘Improve communication lines’
‘Better communication between drivers and nursing staff and transport
co-ordinator’
‘Teamwork and good communication for staff/ patient’
•
Inform patients
‘Patients informed of arrival time so they can go get a drink or food.
Being sat in here drives them mad. Need proper control’
‘To let patients know if anything has occurred as soon as possible’
‘Be honest about wait time’
84
One thing you would improve to make the service
better for patients
•
Focus on quality
‘Call takers have call settings – object to call settings – it’s not about
quantity it is about quality’
‘To make team morale about quality not prizes and targets’
‘Quality of the call should be the priority – right information to inform the
service needed. However the 3.5 minute call is measured as how many
calls each day, target. Shouldn’t be target driven. This would mean that
good, high quality information was gained on all equipment, right
assistance or not, car or ambulance. We get it right first time’
85
One thing you would improve to make the service
better for patients
•
Discharge lounge facilities
‘Make sure there are refreshments in the discharge lounge’
‘Tea/coffee machine in discharge lounge for patients. Patients should
bring own food, it’s a hospital not a charity’
‘Give [patients] a drink and a paper’
•
Patient feedback
‘Record patient feedback and pass it on to staff or drivers’
86
SUMMARY: WHAT IS ONE THING YOU WOULD
IMPROVE AROUND THE TRANSPORT SERVICE SO
YOU CAN DO YOUR BEST WORK?
The key themes that emerge are:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Eligibility concerns; tighter criteria processes
Accurate contract specification
Correct, detailed bookings
Educate patients
Capped bookings and restrictions
Patient information
Easier access to control
More funding and resources
More staff
Dedicated transport team
Use volunteers
More vehicles and equipment
Issues with agency staff
Issues with control
87
One thing you would improve to do your best
work
•
Eligibility concerns; tighter criteria processes
‘Ensure that mobile patients use their own transport or find own way in
and out’
‘Ask more questions about patient’s disabilities and aliments before
booking transport’
‘Look at all patients on record and check their eligibility and notify them
to tell them we are going to change – at the moment we have to book in
ineligible patients because management say book them in because we
get bad press otherwise’
‘Criteria for patient to get transport should be more stringent’
‘Ideally patients using our service would be those who really need it – to
achieve this the criteria would need to be changed’
88
One thing you would improve to do your best
work
•
Eligibility concerns; tighter criteria processes (cont.)
‘Needs to be specific criteria. We have no power to say no. Questions
need to be revised’
‘We need some kind of checking system around appropriateness of
patients using the service’
‘Criteria for transport is weak and needs to be reviewed’
•
Accurate contract specification
‘No grey areas in the contract specification – it needs to be accurate’
89
One thing you would improve to do your best
work
•
Correct, detailed bookings
‘Quality of information when a journey is being booked’
‘Make sure the correct vehicle requirements are made for each patients
for their in journey and their journey back home – sometimes have to
wait for hours’
‘Quality of the call should be the priority – right information to inform the
service needed. However the 3.5 minute call is measured as how many
calls each day, target. Shouldn’t be target driven. This would mean that
good, high quality information was gained on all equipment, right
assistance or not, car or ambulance. We get it right first time’
•
Educate patients
‘Better information to patients – educate patients on why and what
patient transport is’
90
One thing you would improve to do your best
work
•
Capped bookings and restrictions
‘Not to book more than X number of each category of patients that can
travel’
‘Need to cap how many bookings are booked and planned for in a day.
System allows as many bookings without a maximum. Need to cap
bookings for each day’
‘We do have late bookings, should be planned in 48 hours before. We
have people calling in a much smaller time period. It needs to be stricter
on the deadline. The late booking criteria needs to be adhered to by both
patients and hospital staff’
91
One thing you would improve to do your best
work
•
Patient information
‘This is the most important aspect – to have the correct information
about the patient and their mobility and capabilities’
‘Inpatients knows what’s going on, do they have home care package.
Know nothing about outpatients, need to know more about them if
outpatients be looked after in discharge lounge. Need to know about
carers to pass on to crew’
•
Easier access to control
‘Phones to be answered in appropriate time frame’
‘Able to get through quicker to transport services’
92
One thing you would improve to do your best
work
•
More funding and resources
‘More funding’
‘Increase funding – 50-60 outpatients a day and 20 inpatients – want to
increase this’
‘More resources’
‘More resources – embarrassed to work for Arriva because they have
cancelled appointments on the day because of no resources’
‘More driving resources would mean people are not waiting for such long
periods, especially at peak times e.g. renal patients in the evening along
with other discharges. They know we have renal as a priority. This means
discharges are left waiting’
‘More financial resource’
93
One thing you would improve to do your best
work
•
More staff
‘More drivers’
‘More staff’
‘More staff day to day’
‘More staff. This needs to change to accommodate the extra patients who
need food, toileting, drinks’
‘Having enough staff’
‘More staff on ambulance desk – used to be 2 now only 1’
‘More staff required’
‘Employ more people’
94
One thing you would improve to do your best
work
•
More staff (cont.)
‘More crew’
‘Having staff available in the discharge lounge to look after patients’
‘Better staffing so give more support’
•
Dedicated transport team
‘Dedicated transport team for general hospital patients’
•
Use volunteers
‘Volunteers to come and help, especially with older patients’
95
One thing you would improve to do your best
work
•
More vehicles and equipment
‘More vehicles’ x6
‘More vehicles on the road’
‘More vehicles looked after and well maintained’
‘More ambulances’
‘More vehicles needed’
‘More equipment’
96
One thing you would improve to do your best
work
•
Issues with agency staff
‘We need to manage agency staff better. They book in what they want
and don’t do it properly – so it has an effect on everything else’
‘Agency staff need to be managed better’
‘Why do we need agency staff anyway?’
‘Bank staff as appropriate – only when needed’
•
Issues with control
‘Currently control won’t cancel a taxi’
97