Service improvement: dignity by design

Patient dignity and well-being used to be seen as secondary to finance and clinical care. But with more emphasis now on the whole patient experience, NHS organisations need to identify where they fall down on these issues and how they can improve.

United Lincolnshire Hospitals trust believes it may have found a way of doing this by training staff as patient well-being champions. As the training rolls out, the trust is looking at how it could be extended to all 7,000 staff in some form. Other healthcare organisations in the area are also interested.

The training, which is a collaboration between staff in the clinical training department and the chaplaincy, aims to help staff identify issues around well-being in their own areas and examine their own behaviour and attitudes. Once back in the workplace, they can also act as a contact point for patients.

Those trained so far - who have tended to be frontline staff in direct contact with patients such as nurses and healthcare support workers - have each agreed to take on a project to improve well-being in their own working environment.

These have ranged from small improvements which can be quickly implemented to longer-term plans which might need substantial expenditure and even board approval. Plans have to be discussed and approved with their managers, and respond to some identifiable patient need or concern. "We are responding to customer demand at a local level but it has to reflect the national priorities," says senior clinical tutor Marie McDermott, who helped to develop the programme.

One project, for example, provided disposable earplugs for patients being disturbed by noise at night; easily achieved but a definite contribution to a better patient experience. Others have covered what might seem simple issues such as clear signage of male and female areas, and setting aside a teenage area off a children's ward, equipped with TV, PlayStation and games.

Another project has produced laminated "do not enter" signs to be hung on curtains around beds, discouraging staff from barging in at inappropriate moments.

One staff member looked at the dignity issues involved in transferring patients to theatre in Boston's Pilgrim Hospital and concluded that a separate patients' lift was needed so they did not have to be wheeled into a public lift on a trolley on the way to theatre. This needed approval for the extra expense and took several months to achieve.

Spiritual needs

The idea of the champions came from the trust's senior and managing chaplain, Tim Couchman, who had been looking at how the trust dealt with the religious and spiritual needs of dying patients. He found that staff members felt they did meet these needs but the evidence suggested otherwise.

His thinking soon expanded to cover all patients, rather than just those who were dying, and other aspects of their care. The training now covers aspects such as multi-faith and cultural awareness (including the area's recent immigrants from Eastern Europe); dignity; confidentiality and consent; communication; breaking bad news; and helping patients cope with loss and change - not just bereavement but also changes to lifestyle and body image that illness can bring.

"The dignity challenge has come out of care for the elderly but we want to ensure the dignity of all patients in our care," he says. But while these might be seen as the softer side of care, there is a harder edge. Patient choice is an obvious link - treating patients with dignity and enhancing their well-being may make the trust a popular choice for elective care, with both reputational and financial benefits.

Training has been adjusted to meet the different needs of individual groups of staff. Health support staff, for example, get an intensive one-week course while other staff groups may have the training spread across several weeks. Since April senior managers, nurses and doctors from some clinical directorates have been taking the course together.

Initially staff were selected by their managers for the course but increasingly they are putting themselves forward.

Senior support

Senior sign-up has been key to the scheme. The trust's chief nursing officer, Sylvia Knight, and chief executive, Gary Walker, have been enthusiastic supporters. Ms McDermott says getting matrons on board was also important. Initially, many matrons felt the programme covered things they were already doing. But monitoring of patient complaints linked to "essence of care" issues showed there was room for improvement - an argument which matrons swiftly accepted.

Trained champions are meant to be given time and resources to carry out their role and not expected to do it on top of their existing jobs.

The programme has been written into the trust's service and financial plan with an emphasis on the behaviour and attitudes which underpin the programme. Progress on the individual projects is also monitored and is tied into the reporting structures of the trust.

Although not every suggestion can be funded, the success of some of the projects has helped dispel the belief that it is not worth putting forward ideas because of lack of money. "There is a framework for small and large issues to be forwarded in a structured way and without the dreaded financial kibosh being put on them," says Tim Couchman. "Empowering staff is really important."

An evaluation tool to show the outcome of the training is being developed. It is likely to compare the area where champions have been trained with those where no training has taken place to show where there is a positive outcome. "We need hard evidence," says Ms McDermott. "We want to be known locally as the hospital which has dignity at the heart of its agenda."