Building patient engagement from the ground up

In September 2009, I arrived to take up my position as head of patient experience at Manchester Mental Health and Social Care Trust. I was charged with putting in place the systems and processes that would help the organisation to listen to people and act on their feedback.

When I came into the post, it became clear quite quickly that I had my work cut out. There was an obvious lack of systems that we expect to see at most trusts, meaning our service users and their families weren’t able to engage in meaningful dialogue about their experiences.

‘We now involve our patients in everything we do, including helping to choose our new chief executive’

The trust did have a monthly patient and carer forum meeting in place, but despite good intentions it had become something of a platform for people to vent their frustrations and dissatisfaction.

Three years on, the trust has just been named the best in the country in eight key areas of the Care Quality Commission’s survey of community mental health service users.

We had the best scores for treating people with respect and dignity (9.7 out of 10), making people feel listened to (9.3), and taking service user views into account (9.0).

The trust also received the highest national scores in helping people to achieve their goals, making sure people know what to do in a crisis and supporting people with mental health problems to address their physical health needs.

Real feedback

So how did we get here in three years?

One of the first things we did was to create separate service user and carer strategies, with the full support of the director of nursing and therapies. We made sure to involve service users and carers in the creation of these strategies, which were important as they allowed for many different levels of involvement.

The potential activities ranged from local activities within teams or wards, such as ward community meetings, to trust-wide opportunities, like helping the trust with large-scale service redesign).

Another key milestone in my time with the trust has been the In My Shoes project, in late 2010 and early 2011, which used video booths, one-to-one written interviews and creative artwork to engage with people.

For the first time, this gave the trust real, qualitative feedback and really brought the user’s experience to life, while also bringing home the therapeutic value of them getting involved in this work.

It was a bit of a risk, particularly given the financial investment required to get the project off the ground, but people loved it and it showed how serious we were as a trust about listening to people and acting on their feedback.

Positive conversations

Another big factor in our move towards better engagement was the introduction of the Commissioning for Quality and Innovation framework in 2009-10. This placed a new dimension on listening to and understanding people’s experiences and improving services, while at the same time allowing the trust to generate additional income.

Even though a good and positive culture was already starting to develop, the potential to attract this additional income as a result of refining our core systems for listening to patients helped us to push this important work forward. It also led directly to the introduction of entry and exit questionnaires, which gives us feedback from 3,000,4,000 people a year.

‘We believe we are at the forefront of NHS organisations in terms of our commitment to capturing patient experience’

What is also working really well is that every quarter we ask service providers what they have been doing locally, how they have responded to feedback and how things have changed. Some of this activity is very simple and straightforward.

For example, on one ward patients told staff that they didn’t like the dinners they were getting on Sundays, so we invited the catering manager from the acute trust providing the service to come and speak to them. Feedback from that ward has improved drastically as a result of this basic conversation.

We now involve our patients in everything that we do, including helping to choose our new chief executive, sitting on interview panels for consultants, in research and development, and in meetings of the trust’s assurance framework.

Patient stories

Most recently, we forged ahead with our qualitative data, by undertaking our “patient stories” project in which service users put together and narrate their experiences as digital stories. These have been used across the trust to give staff an insight into mental illness, as well as one story a month being shown at every meeting of the trust board.

‘We now have a fantastic platform to build on’

We are also extremely proud of the way we used these stories to raise awareness of mental health issues on World Mental Health Day in October, when they were shown on the BBC big screen in Manchester city centre. This also generated some good news coverage in the Manchester Evening News and on BBC Radio Manchester.

What really made me proud was that a couple of patients who saw these personal experiences on the big screen or in media reports have been in touch to say they want to tell their own stories.

It has been an interesting time at the trust. Three years ago, we knew very little about our service users. Now we believe we are at the forefront of NHS organisations in terms of our commitment to capturing patient experience.

Perhaps more importantly, we take pride in analysing and understanding what we are hearing to identify the things we need to do to affect change.

We now have a fantastic platform to build on and I’m looking forward to taking our next steps in this shared journey.

Patrick Cahoon is head of patient experience at Manchester Mental Health and Social Care Trust