In the summer of last year we embarked on (what was thought then to be) a year long programme of work – The Patient and Carer Experience Review. The aims of the review were straight forward, to:
- better understand how we listen to, understand, share, respond to and act upon feedback from patients, carers and families in our services
- evolve our approach to the above, with the primary aim of increasing the impact of patient, carer and family experience on services
Those four words – ‘increasing the impact of’ – are really important. This is not about trying to get more feedback, for its own sake. We’ve done a lot of work over the last ten years to find ways to capture feedback, and generally it’s been very successful. Last year alone we had over 20,400 surveys returned to us and 597 stories on Care Opinion. That’s a lot of people, telling us a lot about our services.
This programme of work is about increasing the impact of feedback from patients, carers and families – it’s about understanding what it’s like to be cared for by our services, and then making sure that understanding leads us to deliver the kind of care we’d all want for ourselves and our loved ones.
The list of tasks and objectives under those two aims started big and got considerably bigger! Everything feels ‘within scope’ (as the project management nerds would say) but it’s hard to see that as a negative if it’s a measure of the massive potential for improving how well we understand patient, carer and family experience and what we do with it.
Just to give an indication of the kinds of things we’re thinking about in the review, we’re trying to answer questions like:
- How do we make sure that we ask for feedback often enough but not so often that it’s annoying?
- How do we analyse the comments we receive (looking for the recurring compliments and criticisms, and also for strength of feeling) in ways that mean we can make quick sense of thousands of people’s experiences?
- How do we know if feedback is having a positive impact on the care that people are receiving
- Just how much choice should we (and can we, practically) offer in the ways people can share feedback with us?
- How can we show people that we’re listening and doing something with their feedback – especially when it’s offered anonymously and some people never come into our buildings?
We’ve just completed the first phase of the review, which ran from September 2018 to March of this year. I did set out with an intention to blog about progress but failed miserably (hangs head in shame) so this is both a catch-up blog and simultaneously a vow to be better through phase two.
What did we do in phase one of the review?
Well, phase one was about asking lots of different people lots of questions. We wanted to know what it was like to give us feedback and what it was like to receive it, what we were doing well and what we were not doing well, how we were using feedback to improve care and why we were sometimes failing to do anything at all with it.
- We met with senior leaders and patient experience bods in every area of service at Notts Healthcare, and we met with patients
- We spent half a day with our experience-focussed volunteers
- We met with our neighbouring mental health Trusts to compare what we were all doing and what we were all struggling with (and also agree how we could work together)
- We had researchers from University of Nottingham analyse our patient and carer experience data, and complete a patient experience research and literature review
- We started some really interesting conversations in our own organisation (Learning and Organisational Development, our clinical directors, our staff experience and wellbeing team) and with organisations who we thought might challenge us and help us evolve our approach (OpenLab, Care Opinion, Northumbria Healthcare)
It was great to just get around, ask some questions and give people the opportunity to be really honest about what was being done well and what was difficult. I’ll admit that to begin with I did assume I mostly knew what our staff and patients would say, but phase one taught us a lot, and there were plenty of enlightening moments in the conversations.
What did we learn from phase one of the review?
We concluded phase one in March with the Feedback Matters event on Friday 15th March at our HQ, supported by Care Opinion and the national Patient Experience Network. The event was attended by 80+ staff, including patient experience leads from neighbouring mental health Trusts, and also our volunteers. Thank you to everyone who came along and to those who presented – you made it the great day it was. The commitment to patient and carer experience was palpable and hugely reassuring.
The aim of the day was to feed back the findings from the previous six months’ field work and to stimulate discussion and ideas for phase two. I think we achieved that (I hope those there would agree). I was chuffed to hear so much constructive and honest conversation on tables about what was and wasn’t working, and lots of good suggestions and gritty debate on what was now needed to really step things up.
We chose to take a small step (or perhaps for NHS events, a giant leap) forward by opting to capture what was discussed and suggested on the day through live social media reporting, rather than end the day with reams of paper.
Three of the tweets that particularly stood out for me (though I feel guilty highlighting only these, I read every single one and was grateful for them all):
This from Catherine, relating to the session encouraging us to think about how we learn more from positive feedback.
This from Lou, commenting on the well received presentation by Michael and Steve (volunteers at the Trust) on the conditions of good quality conversations with patients about their experiences.
And this from Coumar, picking out the key message from our new CEO John, on the importance of feedback in building a caring culture.
I would strongly encourage you all to have a quick skim through the tweets from the day via this link – #NottsPCX (look for all tweets from 15th March). Even more so than I had envisaged, they form a great record of the conversations on the day.
See below the slides from a presentation which talked about what we had learned from phase one – the research and literature, from staff and from patients:
The main headlines from phase one were:
- We need to tackle survey fatigue, felt by staff and service users/families alike, by trying new ideas for capturing feedback (many were suggested by services in our conversations)
- We need a concerted effort to capture more feedback from people seen in the community and in their own homes
- We should learn more from the positive feedback, seeing it as insight and examples of excellence, not just praise
- We must show people more clearly and visibly how we’re listening to them and what we’re doing as a result (patients told us this was the No.1 motivation for sharing feedback – seeing how feedback was valued and used)
- We should focus on quality over quantity – particularly where we can make time for better quality conversations with patients, carers and families about their experiences
- We could better our offer of support and training on patient, carer and family experience for our staff (things like reporting on and responding to feedback isn’t always easy)
- We should continue to develop our Your Feedback Matters website, particularly the analysis of feedback and the reports, and work to connect staff experience, patient safety, clinical effectiveness and patient experience as the key measures of good patient outcomes
What are we planning for phase two (May – Dec 19), and beyond?
Phase two will be all about rethinking our approach and testing new thinking and ideas. The intention is to work on the big themes coming out of phase one (as well as some of the less significant but really interesting stuff) and to do this collaboratively with staff, with patients and families and with other organisations who are facing many of the same struggles.
We’ll begin by scoping out the projects/ideas that were suggested by services in our conversations (for example, we want to capture more stories from people who’ve supported loved ones at the end of their lives). We will work with teams to tackle survey fatigue, allowing and supporting them to be more free and creative in capturing feedback in ways that suit the people accessing their services.
Some of the other things we’re intending to do:
- A qualitative analysis of +11,000 positive comments received last year to extract the learning, feeding the themes back to teams as possible Quality Improvement projects.
- A collaborative project with volunteers to improve the ways we show service users, carers and families how we are using their feedback to improve care.
- A meeting with community services of all kinds to consider new or adapted ways to capture feedback from people in own homes/in the community.
- Continual development of our data analysis methods and reporting functions on YFM website.
I’ll blog again soon to update on our plan for phase two, and how things are going. None of this work will be done strictly to schedule – lots of it started before the review, lots of it is happening now and is changing before our very eyes, and lots of it will go on long beyond the review or will take longer than even our most generous estimations could predict!
This is not a quick fix, and it would fail to make any real change if it was. Phase three (start of 2020) will evaluate the impact of our new approaches and phase four, probably late 2020, will be all about ‘fine tuning’ what we’re doing and will take us right up to 2021 – which by anyone’s standards is just too far away to worry about now.
Feel free to leave a comment if you have any suggestions, objections, offers or special skills – all very welcome. You can also email us on firstname.lastname@example.org and you keep up to date with the review on #NottsPCX and @InvolveT1.