Published: 19/08/2004, Volume II4, No. 5919 Page 24 25

The patients accelerating change project puts the public in the driving seat of innovation. Mary-Louise Harding and Emma Forrest see how it works at a local level

Too often, 'involving' patients in improving health services means wheeling them in near the end of the process to rubber-stamp ideas and decisions that have already been made. The thinking behind the patients accelerating change (PAC) programme is different.

It is based on the premise that, with the right support, patients can often take a fresher view of innovation and drive change from its inception.

After all, they have not had their minds shaped by an organisation's status quo.

The PAC programme, which is jointly run by the Department of Health's clinical governance support team and Picker Institute Europe, recently expanded as part of a second wave.

From an initial nine pilot sites set up 13 months ago, 50 more trusts joined in June. The first wave used information from local patient surveys to highlight priority areas.

These included information on post-operative pain management, new visiting time systems and better signage and information in accident and emergency.

Project lead Bridget O'Hagan says PAC helps the trusts analyse survey results as well as organising other initiatives to gather information from the wider public, for example, with stalls in shopping centres. Patients have been directly involved through existing patient advice and liaison services, patient forums and through specific PAC committees reporting to the board.

Patients have also been put on the frontline - The Dudley Group of Hospitals trust in the West Midlands, for example, appointed two 'patient trackers' to keep patients and carers up to date with information. The trust also used patients to train A&E staff in better customer care awareness.

Similarly, in Huntingdon, Cambridgeshire, Hinchingbrooke Healthcare trust's PAC steering group created a home to home programme to manage information, medication and care given during and after discharge.

The timebomb

Retired NHS manager Lee Foord was asked to volunteer for the patients accelerating change project on patient visiting times at Royal Bournemouth and Christchurch Hospitals trust after working with the trust's patient advice and liaison services.

'Finding out what patients wanted was a bomb waiting to go off, 'he says.

'Some wards had open visiting, some had restricted visiting, others had protected meal times.'

PAC project lead and the trust's patient advocacy and liaison services co-ordinator Linda Witchell says patients had complained to PALS that they were unhappy with the trust's visiting arrangements and wanted a say in them.

'There was confusion about children's visits and different visiting times on different wards.Some staff were unsure of what visiting hours were supposed to be, and some wanted protected meal times.'

A volunteer team of 10, including Mr Foord, toured over 30 wards at the trust's two hospitals, carrying out 245 interviews, to find out what patients really wanted.Mr Foord believes his position as an 'outsider'gave him a 'fresh'eye.

'We asked what their preferences were on visiting times: morning, afternoon or evening; open or restricted?

'Some people were happy to speak to someone independent like me.'

Ms Witchell placed posters around the trust and was interviewed for the local newspaper and hospital radio to raise publicity for a trust-wide patient questionnaire.

Staff, the hospital visiting service and voluntary groups were canvassed.After a further patient and public involvement event, she collected all the opinions.

The hospital visiting policy fixes hours but allows special arrangements to be made. It is still being worked on and has to be reviewed by patients, the public and staff.'But we aim to have a policy in place in six months, ' says Ms Witchell.

Pace setter: redesigning A&E

When retired psychiatric social worker Roger Clarke fractured his shoulder while running, he first endured a long wait at Bolton Infirmary accident and emergency before it was decided it would be best to treat him at his local hospital on the other side of the Pennines.

Ninety minutes later he arrived to find it closed.Staff would not book an appointment for the next day but insisted he used their A&E system - a further two-hour wait.

Eight hours after the accident he was at home with a sling, painkillers and no appointment with a specialist.

'The link between A&E and the fracture clinic plainly needed review - but it was only one example of bad communications, 'he says.He went on to help redesign A&E services as a patient representative on the Patients Accelerating Change pilot.

Elsewhere in A&E, improved signage, more comfortable seating, better lighting and a playpen for children have been introduced.

Plasma screens now give information in real language rather than NHS-speak.

The project ran for a year and was led by former A&E sister Lorraine Webb.She says: 'Some issues were really simple.For example, many patients didn't understand the word 'triage' so this has been renamed the Patient Assessment area.'

The PAC team also introduced a system where shift leaders (the nurse in charge) would regularly update patients on delays.

Further information

PAC programme. www. cgsupport. nhs. uk/Programmes/ Patients_Accelerating_Change_Project. asp

Patient surveys. www. pickereurope. org