A London trust improved patient experiences with dedicated staff - and came up with an award-winning campaign concept. Stuart Shepherd explains

Being told you are an outlier on the national patient survey programme is one thing; knowing how that equates to the patient experience of your services, deciding what could be changed and how to make those improvements is something else.

Especially when, as Newham University Hospital trust in London discovered, researchers tell you that considering your results alongside a number of demographics (such as age, diversity, deprivation), you are performing as would be predicted.

"With local sampling of perceptions giving us a very different, more positive picture the surveys were never going to be a good enough measure of what it was really like for our patients." says acting chief executive Graeme Jolly. "The rigorous explanations from the researchers of what was behind all that helped us park the depressing stuff. The next thing was to find out what we needed to know and what to do about it."

Focus groups and desk research pointed to some key issues, such as staff attitudes, information giving and visible cleanliness. The campaign concept that was decided on - Patients First - sought to bring together approaches that would tackle these concerns while building up the trust's reputation to better reflect its actual performance.

"The idea was that we capture through feedback what was happening for the patients much closer to the point of actual experience," says Graeme. "We were already getting complaints, but by their nature they are very specific. They give you something to put right but often that learning is from an isolated incident."

Patients First was launched in 2005 through a number of local events and the accompanying "brand" and logo has been widely promoted through pens, magnets and posters in various community languages. News items highlighting Patients First initiatives and successes also figure prominently across a wide range of trust and partner organisation media outlets.

"Since day one the foot has not come off the pedal," says head of communications Kate Shurety. "Patients First was never going to be a short-term project. You know things are happening. People come back and report regularly on all the work carried out under its banner."

The Patients First steering group, which meets monthly, has always been one of the key drivers for this activity. As well the communications lead and representatives from patient and public involvement and health advocacy, membership includes the directors of integrated governance, patient support and environment and nursing - a reflection of the high levels of board support for the campaign.

As part of the launch initiative a Patients First manager was appointed to take trust staff through the feedback, talk about what behaviour needed to change and facilitate customer care training. The customer care co-ordinator - a role created to coincide with the opening of the Gateway surgical centre and devised to promote high standards - has been working with reception, nursing and support staff to look at the pre-admission information needs of the unit's patients.

"This is more than 'Have a nice day' stuff," says Kate. "This is about telling patients what to expect and anticipating their needs so that they have the best possible experience from beginning to end. Maintaining this kind of focus makes a huge difference."

A recent trust-commissioned survey of the Gateway centre bears such an assertion out, with satisfaction levels suggesting performance at least to the national average if not better. And it picked up the communications category at last year's HSJ Awards.

Mainstream roles

The Patients First dedicated roles have since been mainstreamed and now sit within the nursing directorate. One of the major responsibilities of customer care co-ordinator Dean Celestine is to collect and collate the feedback material generated by patient comment cards, reintroduced with the launch of the campaign.

"I break down the comments into categories such as treatment, staff attitude, waiting time, cleanliness and food," says Dean. "We total them up and the steering group compares what we find with our priorities, which this year include nutrition, discharge co-ordination and talking to patients."

Newham has found the comment cards an invaluable source of information on their performance and the impact of the Patients First campaign. Before it started, cards were returned at a rate of around 30 per month. Now they can count on 200-300 monthly responses, with many more of them identifying the patient giving the feedback.

"The cards provide us with reliable and measurable data that we can track and trend," says Kate, "while at the same time they let us hang on to individual respondent phrases and voices."

This material goes to the leadership group every month and the executive board each quarter. An in-depth document is also circulated monthly among matrons and senior managers. The trust still gets as many complaints as it used to. Three out of four comment cards, however, have something good to say. Where an individual member of staff is named, they and their line manager get to hear about it.

"We used to try and sort out everything that needed fixing all at the same time," says Graham. "Now we watch themes develop and set priorities. Last year the feedback was telling us there was an issue with pain control. We addressed this as a multidisciplinary team from every angle and the latest patient survey results show a significant improvement."

Getting the message to Newham's many community groups about the drive to better understand and respond to the patient experience is also an important part of the Patients First project. Shahid Sardar, former PPI manager and now membership involvement manager, represents the trust at meetings throughout the borough and is a further source through which comment and criticism can be brought back and responded to.

"At a time when we are looking ahead to foundation trust status and developing a membership," says Graeme, "it is clear that this campaign has done a great deal in terms of laying the ground - at board level and on the frontline - for listening and taking much more seriously what patients are telling us."