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Patient Experience Revolution


Nancy Fontaine, Deputy Director of Nursing
Patient Safety and Quality,
Whipps Cross University Hospital


Tim Keogh, Partner,
April Strategy
Patient Experience
                  Revolution
    Nancy Fontaine Deputy Director of Nursing Patient Safety and Quality,
                  Whipps Cross University Hospital Trust

                      Tim Keogh Partner, April Strategy




2
Context
    • Vacancy rate 27%
    • Lack of corporate
      vision for patient
      experience
    • No systematic
      reporting of
      patient experience
      metrics
    • No strategy for
      improvement
3
We needed a revolution
                        Despite pockets of
                        excellence and many
                        committed staff, patient
                        experience was in the
                        bottom 20% of trusts for
                        over 2/3 of the 62 inpatient
                        survey indicators.

                        Especially underperformed
                        in service delivered by:
                        doctors, nurses and overall
                        patient care and in the
                        hospital and wards.


4
The Start of the revolution…

    • Trust Board key stakeholders
    • Patient Experience
      Improvement Board
    • Talking Excellence
      Programme
    • Nursing and Midwifery led
      patient experience strategy
    • Executive Patient Safety
      Walk rounds
    • April Strategy

5
Principles of the revolution

    • Mass engagement of staff and
      patients
    • Harness passion, anger and
      intolerance of committed staff
    • Empower a social movement
    • Create energy to sustain change

6
Start with a positive ambition
    Pockets of great service… analysis of compliments in 08/09
    Caring                         40
    Kindness                       25
    Professionalism
    Efficient
                                   15
                                   14
                                                                         Kindness
    Attentive
    Helpful
                                   13
                                   13
                                                                         and caring
    Took time (listen / explain)   13                                          = 30% of
    Considerate                    11                                        compliments
    Compassion / sympathy          11
    Cleanliness                    9
    Friendly                       7
                                            “Kindness itself and a credit to their profession.”
    Reassuring                     7      “We felt confident and reassured not only by Mr A’s
    Polite / courteous             6    obvious competence and experience, but also his caring,
    Hard working                   6                       attentive nature. “
    Great teamwork                 5
                                        “A personal touch that made us feel at ease and always
    Good sense of humour           5
                                        available to answer any concerns or questions we had.”
    Smile                          4
    Respect / dignity              4       “Everyone had a kind word and genuine care and
    Patience                       4
                                          compassion for my mother who was treated with so
    Encouraging / supportive       4
                                            much dignity and respect. You are shining stars.
    Available                      3
    Personal touch / gentle        2


7
The Revolution …
    Start with appreciation…

    Listened to patients: in 7 ‘In your shoes’ events
    •   250 staff listened to 160 patients’ stories
    •   Connect with good and bad experiences
    •   We learned what patients would like us to promise

    Listen to staff: a conversation about the future
    •   Future-values survey: an online conversation with 10%+
        of staff about what they want it to be like round here
    •   Values into action with over 200 staff to set the standards

    Co-created the patient experience revolution

8
Here’s what patients said
    • Reminded us that patients feel very
                                                                     The nurses didn’t see that while
      different to us in hospital – need to                           it was routine for them, it was
      put ourselves ‘in your shoes’                                       an anxious time for me.


    • Patients told they want us that they feel better when they feel
      cared for, feel safe and feel confident in their treatment

     “I want to feel                 “I want to feel                      “I want to feel
        cared for”                        safe”                              confident”
                                      I would have asked more
      She felt like a burden and                                              Taking time to listen to
                                     questions, but she said she
      was afraid to call for help.                                           my concerns reduced my
                                      was busy. They’ve time to
       She was left in her own                                               anxiety about what might
                                     gossip amongst themselves.
         faeces and urine.                                                        happen to me.
                                      I didn’t feel in safe hands.


      And staff told us they value the same things

9
March 2010 Launch
                         Promise to our patients

                         • 300 staff / board members
                         • Patient stories heard
                         • Letting patients know ‘It’s
                           your hospital’, and we are
                           here for each and every
                           one of them.
                         • Everyone employed by
                           Whipps Cross signs up to
                           our four patient promises

10
Promises inspire standards
 Quality domain          Patient experience                                     Patient safety                            Patient outcomes
 Value                          Value - Kind                               Value - Professional                            Value - Excellent
 In your shoes               “I feel cared for”                                    “I feel safe”                           “I feel confident”
                                                                                                                      You feel confident in your treatment, by
                        You feel cared for by kind and helpful          You feel safe, in a clean and comfortable
                                                                                                                           skilled teams of compassionate
 Patient              staff, with a polite and welcoming attitude,      environment, with highly professional staff
                                                                                                                      clinicians, who listen, keep you informed
 promise                who strive to maintain your dignity and          who work together to ensure you are in
                                                                                                                       at every step and understand your time
                                   privacy at all times                                safe hands
                                                                                                                                      is valuable

 Knowledge & skills         KSF CD1 Communication
                                                                                    KSF CD3 Safety                               KSF CD5 Quality
 framework                KSF CD6 Equality and Diversity


                            1. Welcoming                                    4. Clean (are safe)                         7. Communicate

 Standard                        2. Helpful                              5. On stage (feel safe)                                8. Timely

                             3. Respectful                              6. Speak up (stay safe)                        9. Compassionate


                                       Innovation                    Value – Improving                     “I feel it’s getting better
                                                             KSF CD4 Service improvement & KSF CD2 Personal development


                                                                     10. Improving for patients

11
Service Standards Manifesto
      • The 10 service standards are brought to life in a pocket
        manifesto given to all staff – expectations of behaviour
      • Detailed competency statements with helpful ‘do’s
                       and don’ts’ to be used   5. On stage
                       in training, appraisal
                       and team meetings




12
Embed in the employee lifecycle
     • Recruit the attitude
       • Website, job descriptions and
         person specs
       • Competency-based interviewing

     • Manage the attitude
       • Build standards into appraisal,
         PDPs, progression
       • HR support managers in robust
         performance management

     • Speak up for the attitude
       • Support for staff who speak up:
         “Continue. Begin.”
       • Appreciation and celebration,
         awards, compliments

13
Service skills training for all

      • Mandatory core service       Service standards skills: agenda
        skills - 3 hour workshop     • Introducing the patient experience
        introducing the standards,     revolution

        and practicing powerful      • How does service make you feel?
                                       • Challenging myths: time, staffing,
        personal impact and              resources
        service skills               • Listening and communicating
                                       confidently
      • Mandatory for all staff to     • Having a choice over how we perceive,
        attend – consistency of          feel and act

        expectations and skills      • Challenging and difficult customer
                                       behaviours
      • Supplemented by                • Use of ‘continue, begin’
                                       • ‘we grow difficult patients’
        manager module
                                     • Making personal commitments


14
Support for staff

     • During the revolution staff
       identified the support they
       need to make the change

     • Solutions identified and
       rolled out quickly e.g.
       hourly nurse rounding

     • Improves safety and
       experience – puts nurses
       back in control and frees
       up more time to care


15
Listening to improve
     • In Your Shoes: all services once a year,
       gives all staff a chance to take part
     • Handheld PETs: real time feedback
       supported by interim IP and OP surveys
     • JAM card: ‘just a minute’ – patients can tell
       us what went well / what can be improved
     • Nurse listening rounds, feeding        How was your experience today?
       into…‘You said, we did’ monthly
       report on ward / dept notice boards
     • Net Promoter Score – launch
       early 2011. Card to every patient –
       one measure of patient experience
       on directorate / ward scorecards

16
Nursing quality tool

          Ward name




                            Ward name




17
2009 survey: journey of improvement

     Start point: in
     2008 in the lowest
     20% of trusts for
     2/3 of the survey
     indicators

     Within 6 months
     of initiating the
     patient revolution
     we had made
     significant
     progress…




18
2010 compliments analysis
     Caring and kindness still up there. Big climbers – compassion, considerate, personal touch




                                                                                       Size of words is
                                                                                  proportional to number
                                                                                        of mentions in
                                                                                    compliments letters
                                                                                  written to Whipps Cross
                                                                                  teams in 2010. Thanks
                                                                                       and well done!.




19
The Revolution in 2010/11…

     • Continue ‘In Your Shoes’ methodology
     • Patient stories at Trust Board
     • Women’s Health Revolution
     • Interim IPS / OPS surveys June 2011
     • Organisation Development Strategy
     • National presentations to CNO, HSJ, NHS Confederation
     • NHS Institute training DVD

                                        Winner
                                        Innovative Acute Care
                                        NHS London


20
Why is this so important?
      The people we serve deserve the best experience                     Evidence
                                                                MORI study of inpatient surveys of all UK
      Patient choice is very real in N.E. London – and        acute trusts shows that patient satisfaction is
                                                               driven far more by how we treat patients as

      satisfaction is driven 91% by patients’ experience           people (91%) than how we treat their
                                                                             condition (9%).


                                                               Clinicians’ tone of voice directly linked to

      Outcomes: patients who are less anxious and more        malpractice suits – irrespective of content of
                                                                        conversation. (Harvard)
                                                               Pre-surgical anxiety linked to greater post-
      involved in their own care recover more quickly         operative pain, poorer self-rating of recovery,
                                                                     and slower healing. (Auckland)

                                                                Hourly nursing rounds to check patients’

      More cost-effective, reducing harm, simplifying         pain, position, needs and questions reduces
                                                              call bells by 40-60%, slips and falls by 50%,
                                                               pressure sores by 13% and nurses walk a
      pathways and getting it right first time for patients   mile less a day. £2m safety dividend for the
                                                                       average NHS acute hospital.


                                                                ‘The Minister said payment by results will
      Drives income: payment linked to innovation, and        focus more on patient experience; “we must
                                                               have a relentless focus on measuring what

      from next year linked to patient experience too          matters - clinical quality, safety and patient
                                                                          satisfaction”.’ 17/9/09


                                                                Studies show that the extent to which a
      Better for staff: creates a more positive working       hospital meets its patients’ expectations for
                                                              care is strongly related to how the hospital’s

      environment for individuals and teams                      employees feel about their workplace.
                                                                              (Forum, NYC)




21
Link to staff wellbeing

      NHS acute hospital – staff
      health and wellbeing status
                                                                                    Poor       Average       Good
      Patient satisfaction                                                                74     77.5         80.6

      MRSA (infections / 10k bed days)                                                1.41       1.09         0.82

      Staff turnover rate                                                           15.1%       13.4%        11.9%

      Absenteeism rate                                                              4.84%       4.45%        4.08%

      Proportional agency spend                                                     4.49%       3.86%        3.33%

      AHC - quality of services                                                 2.5 - good     2.8 - good   3.1 - good

      AHC - use of resources                                                      2.3 - fair   2.8 - good   3.3 - good

      NB – moving up one quartile in staff health / wellbeing can save £750k in absenteeism and recruitment costs
      Source: Health and wellbeing of NHS Staff – A Benefit Evaluation Model; June 2009




22
Because…

     If the patient
     revolution is                 You get
     about what
     I can do…        I do                       You do


                                     I get

                      The experience exchange cycle.
                      Influence what I can, and see my
                           sphere of influence grow

23
The next step is a staff revolution

      to give me the
      support I                  You get
      need to do it
                         I do              You do

               Trust
                gets               I get


                         Trust
                         does

24
Turning the organisation on its head


            From: front line
           staff in service of
        organisational priorities




                                      To: an organisation in
                                      service of its front line
                                    staff - that’s ‘here for you’


25
Headlines of staff revolution…
     • Promises now drive strategy / business planning
     • Front line staff drive improvement cycle
     • ‘Here for you’ management style – translating the
       manifesto into staff relationships
     • Band 7 & 8 Leadership and Development
     • Communications hub to ease email burden
     • Corporate customer services approach
     • We’ll come back in 2011 to share the results…

26

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Nancy Fontaine and Tim Keogh on the patient experience revolution at Whipps Cross

  • 1. Patient Experience Revolution Nancy Fontaine, Deputy Director of Nursing Patient Safety and Quality, Whipps Cross University Hospital Tim Keogh, Partner, April Strategy
  • 2. Patient Experience Revolution Nancy Fontaine Deputy Director of Nursing Patient Safety and Quality, Whipps Cross University Hospital Trust Tim Keogh Partner, April Strategy 2
  • 3. Context • Vacancy rate 27% • Lack of corporate vision for patient experience • No systematic reporting of patient experience metrics • No strategy for improvement 3
  • 4. We needed a revolution Despite pockets of excellence and many committed staff, patient experience was in the bottom 20% of trusts for over 2/3 of the 62 inpatient survey indicators. Especially underperformed in service delivered by: doctors, nurses and overall patient care and in the hospital and wards. 4
  • 5. The Start of the revolution… • Trust Board key stakeholders • Patient Experience Improvement Board • Talking Excellence Programme • Nursing and Midwifery led patient experience strategy • Executive Patient Safety Walk rounds • April Strategy 5
  • 6. Principles of the revolution • Mass engagement of staff and patients • Harness passion, anger and intolerance of committed staff • Empower a social movement • Create energy to sustain change 6
  • 7. Start with a positive ambition Pockets of great service… analysis of compliments in 08/09 Caring 40 Kindness 25 Professionalism Efficient 15 14 Kindness Attentive Helpful 13 13 and caring Took time (listen / explain) 13 = 30% of Considerate 11 compliments Compassion / sympathy 11 Cleanliness 9 Friendly 7 “Kindness itself and a credit to their profession.” Reassuring 7 “We felt confident and reassured not only by Mr A’s Polite / courteous 6 obvious competence and experience, but also his caring, Hard working 6 attentive nature. “ Great teamwork 5 “A personal touch that made us feel at ease and always Good sense of humour 5 available to answer any concerns or questions we had.” Smile 4 Respect / dignity 4 “Everyone had a kind word and genuine care and Patience 4 compassion for my mother who was treated with so Encouraging / supportive 4 much dignity and respect. You are shining stars. Available 3 Personal touch / gentle 2 7
  • 8. The Revolution … Start with appreciation… Listened to patients: in 7 ‘In your shoes’ events • 250 staff listened to 160 patients’ stories • Connect with good and bad experiences • We learned what patients would like us to promise Listen to staff: a conversation about the future • Future-values survey: an online conversation with 10%+ of staff about what they want it to be like round here • Values into action with over 200 staff to set the standards Co-created the patient experience revolution 8
  • 9. Here’s what patients said • Reminded us that patients feel very The nurses didn’t see that while different to us in hospital – need to it was routine for them, it was put ourselves ‘in your shoes’ an anxious time for me. • Patients told they want us that they feel better when they feel cared for, feel safe and feel confident in their treatment “I want to feel “I want to feel “I want to feel cared for” safe” confident” I would have asked more She felt like a burden and Taking time to listen to questions, but she said she was afraid to call for help. my concerns reduced my was busy. They’ve time to She was left in her own anxiety about what might gossip amongst themselves. faeces and urine. happen to me. I didn’t feel in safe hands. And staff told us they value the same things 9
  • 10. March 2010 Launch Promise to our patients • 300 staff / board members • Patient stories heard • Letting patients know ‘It’s your hospital’, and we are here for each and every one of them. • Everyone employed by Whipps Cross signs up to our four patient promises 10
  • 11. Promises inspire standards Quality domain Patient experience Patient safety Patient outcomes Value Value - Kind Value - Professional Value - Excellent In your shoes “I feel cared for” “I feel safe” “I feel confident” You feel confident in your treatment, by You feel cared for by kind and helpful You feel safe, in a clean and comfortable skilled teams of compassionate Patient staff, with a polite and welcoming attitude, environment, with highly professional staff clinicians, who listen, keep you informed promise who strive to maintain your dignity and who work together to ensure you are in at every step and understand your time privacy at all times safe hands is valuable Knowledge & skills KSF CD1 Communication KSF CD3 Safety KSF CD5 Quality framework KSF CD6 Equality and Diversity 1. Welcoming 4. Clean (are safe) 7. Communicate Standard 2. Helpful 5. On stage (feel safe) 8. Timely 3. Respectful 6. Speak up (stay safe) 9. Compassionate Innovation Value – Improving “I feel it’s getting better KSF CD4 Service improvement & KSF CD2 Personal development 10. Improving for patients 11
  • 12. Service Standards Manifesto • The 10 service standards are brought to life in a pocket manifesto given to all staff – expectations of behaviour • Detailed competency statements with helpful ‘do’s and don’ts’ to be used 5. On stage in training, appraisal and team meetings 12
  • 13. Embed in the employee lifecycle • Recruit the attitude • Website, job descriptions and person specs • Competency-based interviewing • Manage the attitude • Build standards into appraisal, PDPs, progression • HR support managers in robust performance management • Speak up for the attitude • Support for staff who speak up: “Continue. Begin.” • Appreciation and celebration, awards, compliments 13
  • 14. Service skills training for all • Mandatory core service Service standards skills: agenda skills - 3 hour workshop • Introducing the patient experience introducing the standards, revolution and practicing powerful • How does service make you feel? • Challenging myths: time, staffing, personal impact and resources service skills • Listening and communicating confidently • Mandatory for all staff to • Having a choice over how we perceive, attend – consistency of feel and act expectations and skills • Challenging and difficult customer behaviours • Supplemented by • Use of ‘continue, begin’ • ‘we grow difficult patients’ manager module • Making personal commitments 14
  • 15. Support for staff • During the revolution staff identified the support they need to make the change • Solutions identified and rolled out quickly e.g. hourly nurse rounding • Improves safety and experience – puts nurses back in control and frees up more time to care 15
  • 16. Listening to improve • In Your Shoes: all services once a year, gives all staff a chance to take part • Handheld PETs: real time feedback supported by interim IP and OP surveys • JAM card: ‘just a minute’ – patients can tell us what went well / what can be improved • Nurse listening rounds, feeding How was your experience today? into…‘You said, we did’ monthly report on ward / dept notice boards • Net Promoter Score – launch early 2011. Card to every patient – one measure of patient experience on directorate / ward scorecards 16
  • 17. Nursing quality tool Ward name Ward name 17
  • 18. 2009 survey: journey of improvement Start point: in 2008 in the lowest 20% of trusts for 2/3 of the survey indicators Within 6 months of initiating the patient revolution we had made significant progress… 18
  • 19. 2010 compliments analysis Caring and kindness still up there. Big climbers – compassion, considerate, personal touch Size of words is proportional to number of mentions in compliments letters written to Whipps Cross teams in 2010. Thanks and well done!. 19
  • 20. The Revolution in 2010/11… • Continue ‘In Your Shoes’ methodology • Patient stories at Trust Board • Women’s Health Revolution • Interim IPS / OPS surveys June 2011 • Organisation Development Strategy • National presentations to CNO, HSJ, NHS Confederation • NHS Institute training DVD Winner Innovative Acute Care NHS London 20
  • 21. Why is this so important? The people we serve deserve the best experience Evidence MORI study of inpatient surveys of all UK Patient choice is very real in N.E. London – and acute trusts shows that patient satisfaction is driven far more by how we treat patients as satisfaction is driven 91% by patients’ experience people (91%) than how we treat their condition (9%). Clinicians’ tone of voice directly linked to Outcomes: patients who are less anxious and more malpractice suits – irrespective of content of conversation. (Harvard) Pre-surgical anxiety linked to greater post- involved in their own care recover more quickly operative pain, poorer self-rating of recovery, and slower healing. (Auckland) Hourly nursing rounds to check patients’ More cost-effective, reducing harm, simplifying pain, position, needs and questions reduces call bells by 40-60%, slips and falls by 50%, pressure sores by 13% and nurses walk a pathways and getting it right first time for patients mile less a day. £2m safety dividend for the average NHS acute hospital. ‘The Minister said payment by results will Drives income: payment linked to innovation, and focus more on patient experience; “we must have a relentless focus on measuring what from next year linked to patient experience too matters - clinical quality, safety and patient satisfaction”.’ 17/9/09 Studies show that the extent to which a Better for staff: creates a more positive working hospital meets its patients’ expectations for care is strongly related to how the hospital’s environment for individuals and teams employees feel about their workplace. (Forum, NYC) 21
  • 22. Link to staff wellbeing NHS acute hospital – staff health and wellbeing status Poor Average Good Patient satisfaction 74 77.5 80.6 MRSA (infections / 10k bed days) 1.41 1.09 0.82 Staff turnover rate 15.1% 13.4% 11.9% Absenteeism rate 4.84% 4.45% 4.08% Proportional agency spend 4.49% 3.86% 3.33% AHC - quality of services 2.5 - good 2.8 - good 3.1 - good AHC - use of resources 2.3 - fair 2.8 - good 3.3 - good NB – moving up one quartile in staff health / wellbeing can save £750k in absenteeism and recruitment costs Source: Health and wellbeing of NHS Staff – A Benefit Evaluation Model; June 2009 22
  • 23. Because… If the patient revolution is You get about what I can do… I do You do I get The experience exchange cycle. Influence what I can, and see my sphere of influence grow 23
  • 24. The next step is a staff revolution to give me the support I You get need to do it I do You do Trust gets I get Trust does 24
  • 25. Turning the organisation on its head From: front line staff in service of organisational priorities To: an organisation in service of its front line staff - that’s ‘here for you’ 25
  • 26. Headlines of staff revolution… • Promises now drive strategy / business planning • Front line staff drive improvement cycle • ‘Here for you’ management style – translating the manifesto into staff relationships • Band 7 & 8 Leadership and Development • Communications hub to ease email burden • Corporate customer services approach • We’ll come back in 2011 to share the results… 26