There are many ways to improve services but you have to talk with the right people to identify the problem areas. Mary Cook and Tony Hopwood find out about a project developed by the Royal Berkshire Foundation Trust which was shaped by patients’ views
The patient voice can be a powerful driver of service improvements. Engaging patients to capture their experiences of using services provides a different lens through which to view familiar challenges. It enables an objective understanding of service strengths and weaknesses − and, crucially, the impact on patients − to be reached by people in a diverse range of roles. In addition, the emotive power of patient testimony promotes common purpose and galvanises action.
‘Each group was required to develop a distinct style of care, tailored to the needs of the patients’
Patient experience was central to an ambitious improvement programme undertaken by the Royal Berkshire Foundation Trust. Gaining patient feedback is routinely practised but the trust wanted to explore innovative ways in which it could be used to further enhance patient experience. By ensuring the patient voice drove both service and staff development, the trust put it to maximum use in improving the quality of care and services.
In 2012, the trust undertook a far-reaching leadership, development and change management initiative to support its four organisational aims of providing:
- the best patient experience;
- the best patient outcomes;
- the best value for money; and
- the best place to work, train and learn.
Under the initiative, clinicians were placed in leadership roles to improve the quality of healthcare and reduce costs. Simultaneously, services were reorganised into three distinct care groups: planned; urgent; and networked care. Each group was required to develop a distinct style of care, tailored to the needs of the patients using its services.
Staff and patients drive improvements
To support the change, 60 clinical leaders and managers participated in a leadership development programme. Involving training and mentoring, it was led by public service improvement specialists, 2020 Delivery, in partnership with patient experience experts Uscreates. The programme was designed to enable the most effective use of patient insight in the development and delivery of service improvements.
‘By revealing the issues that were most important to patients, it enabled a new way of looking at familiar challenges’
To build wide support and ensure staff ownership of the outcomes, patients and staff were intimately involved in the programme’s design and implementation. Patients provided detailed testimony into their experiences of using hospital services; this was done through the approaches that had been deemed most appropriate by participants during the initial workshops. In response, improvements were developed and implemented through frontline, staff-led projects. The focus for each project was established collaboratively by participants, who were equipped to analyse the data collected and use it to support these projects.
The initiative was team based to encourage successful implementation of improvements through the collaboration of a range of players. Participants were organised into nine teams across planned, networked and urgent care services. Evidence was analysed and decisions made collectively within the teams.
Because projects were selected by participants during the initial workshop rather than being preordained, insight gathering approaches were tailored according to participants’ understanding of their service area. This supported effective insight gathering and encouraged engagement with the findings. In addition, developing participants’ knowledge of engagement techniques for future application left a learning footprint.
Insight was gathered after the initial workshops. Detailed transcripts of patient interviews provided a full and in-depth picture of the patient perspective of service use. These were used to develop patient journey maps, highlighting issues and potential improvements at each stage in patients’ interactions with a service. These helped, in turn, to determine which areas the staff-led projects should address.
A fresh perspective
The value of this approach was not in the discovery of entirely new service challenges. In most cases, the findings confirmed what participants suspected was the case but by revealing the issues that were most important to patients, it enabled a new way of looking at these challenges.
‘Don’t be frightened to ask patients. Patients like to be involved and to see that we care about what they think’
Having records of patients’ experiences, captured in their own words, gave the teams confidence that the improvements being implemented addressed the things that truly mattered to patients. Linda Rough, matron for maternity outpatient services, led a project to improve maternity ultrasound services. “Getting patient feedback is brilliant. It keeps you focused on what patients actually want,” she says.
Patients often reported issues that were straightforward to address but could make a significant impact on the quality of their experience. However, these tended to be things that could be missed by improvement approaches that do not involve patient insight in the early planning stages. “Often, patients want the little things changing, and these are doable,” says Ms Rough.
Detailed patient testimony also became a powerful enabler of agreement and action. Patients’ own words are emotionally engaging and the testimonials were as motivating to frontline staff involved in implementing the improvement projects as they were to senior managers. This helped secure the wide stakeholder understanding of project drivers and objectives that was needed to gain buy-in and sustain momentum. It also reduced the possibility of multiple and conflicting interpretations of the evidence, helping teams to agree on the important issues and move forward quickly.
Empowering staff and patients
The frontline staff members on whom many of the improvements depended also directly benefited from the patient testimony. As many patients reported having positive experiences with staff, it provided a boost to morale. More surprisingly, the process of engaging patients may also have benefited their relationship with staff. A formal, structured opportunity for patients to discuss the service they were given at the point it was offered provided an unusual but valued engagement opportunity.
“Don’t be frightened to ask patients what they want and what they think,” advises Ms Rough. “Patients like to be involved and to see that we care about what they think.”
Her team identified that patients were dissatisfied with the current service for maternity ultrasound.
‘Having the patient testimony has really helped us in putting together business cases for the improvements’
“Patients reported that the waiting facilities were inadequate, and they were unhappy with the length of time it took to get through on the phone to make an appointment,” she says. Patient testimony was gathered in the waiting area, both before and after appointments, through in-depth interviews. Linda’s team then initiated a two-week audit of activity passing through the department.
“We wanted to find out whether there was a pattern of increased activity, how long each scan was taking, and whether appointment times were adequate.”
The audit confirmed that extra scans from the antenatal clinic were putting existing appointments under pressure. In response, Linda’s team is implementing a pager system to allow patients to leave the waiting area, eliminating concern that they would miss their appointment if they did so. They are also planning to open a new phone line, with additional clerical staff to operate it at the busiest times, to reduce the time it takes to book an appointment.
“Having the patient testimony has really helped us in putting together business cases for the improvements − it’s what patients truly have said about the state of the scan departments,” says Ms Rough.
Mary Cook is co-founder and director, and Toby Hopwood is communications associate, at Uscreates