Involving patients in service improvement is a great way of ensuring that services meet local needs. Catherine Oakley and Anne-Marie Conneally explain how one trust has achieved this

Patient and public involvement is an increasingly important component of delivering healthcare services. In pursuing patient choice at all levels, common sense tells you it is a useful tool for designing services patients want to use. Historically, patients have given their opinions on diverse subjects, but there have been few drivers to use this information to shape services at a local level.

The cancer reform strategy recognised the need for a more robust way to capture patient experiences. It proposed formalised processes such as the NHS cancer patient experience survey, which set out to give commissioners a mechanism to track the extent to which improvements were being delivered.

St George's Healthcare trust has done just this through its current programme of patient and public involvement work, which began in response to the cancer peer review process.

Key objectives for the strategy have been to obtain patient views on referral, treatment, rehabilitation and palliation and for patient views to be heard and acted on by all members of the cancer team. The strategy has also aimed to inform practice and strategic development of services within cancer and at a wider trust level and to create a culture of ownership and acceptance of patient involvement work among healthcare professionals.

Gathering views

Our team used a variety of techniques to gather opinions. In addition to the standard cancer patient survey questionnaire, a series of tumour-site specific focus groups were held, as well as groups for paediatrics, chemotherapy services and black and minority ethnic users.

The surveys gave us an overall understanding of many patients' views, while the small focus groups gave us a rich understanding of how and why participants thought and felt a particular way about an issue. Participants were able to consider their own views, and discussions aided the development of ideas and solutions facilitators had not considered.

Focus group leaders used a pre-defined script to guide discussions. Before the meetings, all staff attended a session in facilitation skills commissioned from the hospital's patient advice and liaison service team.

Key findings

The work produced a range of comments, both positive and negative. Interestingly, key themes about the exceptionally high quality of care and experience were linked intrinsically to individual multi-disciplinary teams and their local practice. Negative themes, which broadly covered environment, catering and parking, were common to many of the groups.

The findings from each group were developed into action plans, which were monitored locally through multi-disciplinary team operational meetings and at trust level through the monthly cancer directorate meeting.

Building on this success, the cancer team ran an evening event where we used small groups to explore what patients wanted from St George's. We also identified patients who would be interested in working with the trust to integrate patient involvement into ongoing practice. This larger group was distilled into a group called improving the cancer experience. This patient-chaired and constituted group has around 12 members and works with St George's to advise on a wide range of issues, from redesign of outpatient facilities to supporting patients after discharge.

The group's flexible and collaborative approach is a world away from the stereotype of argumentative axe-grinding. And it is set to be an invaluable asset in the future.