Putting patients at the heart of improving care

Following the final publication of the Francis report into failings at the Mid Staffordshire NHS Foundation Trust, there has been a heightened awareness of the need to improve patient experience across the health service. The scandal has been a significant factor in a major drive to ensure patients’ views are listened to; that care is delivered with compassion and dignity; and that patients are treated as people, not ‘numbers’. Last year, NICE published a quality standard for patient experience, which highlighted 14 key areas that should be adopted as the cornerstones of care (Fig. 1). This highlighted the importance of good communication, treating patients with respect and actively involving them in shared decision making. The NICE quality standard was followed by the recent publication of a plan, by NHS England, confirming its commitment to ‘putting patients at the heart of improving care’. Putting Patients First: the NHS England business plan for 2013/14-2015/16 is a three year plan that will measure how health and care services are performing – with a strong emphasis on making sure feedback from patients, their families and NHS staff is heard and acted upon. The strategy includes an 11-point scorecard for measuring performance of key priorities. The announcement of the plan, coincided with the launch of the NHS ‘Friends and Family Test’, which means that patients will now be asked whether they would recommend hospital wards and A&E departments to their friends and family if they needed similar care or treatment. Patients will have six choices of answer, ranging from ‘extremely likely’ to ‘extremely unlikely’. They will then be invited to answer follow-up questions to give more detail on the reasons for their answer. Results, drilling down to individual wards, will be published on the NHS Choices website, allowing the public to compare patient feedback and make choices about their care. Individual hospitals and wards will be expected to use this real-time feedback, alongside other information, to identify and tackle concerns at an early stage, improve the quality of care they provide, and ensure recognition of the very best care so that best practice can be spread around the health service. The introduction of the Friends and Family Test was a key commitment in Everyone Counts, the planning guidance for the NHS published by NHS England (formerly the NHS Commissioning Board) in December 2012. Over the coming years, NHS England will manage and oversee the rollout of the Friends and Family Test to all NHS-funded services. Maternity services will be next to introduce the question, in October. Jane Cummings, Chief Nursing Officer for England, said: “The Friends and Family test is a really simple way for patients to let us know if we could improve the standard of care we’re giving, and that’s really important. Giving compassionate care is at the heart of what we do and listening to the experiences and feedback of patients is central to NHS values.”

Role of technology

Capturing patient opinion will become increasingly important and technology will have an important role to play in shaping service design in the future. Interactive technology is driving improvement in patient engagement and helping healthcare providers to respond quickly to potential problems. From touch screen kiosks to hand held tablets, the technology is being used to increase patients’ access to information and enable them to leave feedback on services. Showcased at the Department of Health’s recent Healthcare Innovation Expo, Elephant Kiosks’ interactive technology is being used by a number of healthcare providers. Staffordshire and Stoke-on-Trent Partnership NHS Trust, for example, has deployed over 50 handheld devices operating a selection of surveys, which are used in the community by healthcare workers. This ensures that patients in the community have the same opportunities to have their say on services as those that are treated in health centres and hospitals. Managers are able to view real time, online reports at anytime, keeping a daily or weekly track record of patient experience across seven service teams. Bradford District Care Trust has also installed touch screen and handheld technologies to collect patient feedback about specific teams and individuals, relating to performance from the users’ viewpoint. Data is collected in real-time and centrally collated by Elephant Kiosks, and the anonymised data is made available to individual clinicians, teams and wards. Graphical illustrations show how service users score in a number of areas – ranging from quality of food, to how well treatments were explained. The results show that most respondents rate care positively, but where there are trends that deviate from the usual high standards, the Trust can investigate through inspection, audit or evaluation exercises – or rectify the issue immediately if it is straightforward. Touchscreen surveys can also provide instant alerts to staff at healthcare facilities – for example, if a patient leaves feedback about an unclean waiting room, an email can be sent instantly to the senior sister so problems can be dealt with quickly. A new study, undertaken within an NHS Trust in the South East, has further identified the value of encouraging pointof- care feedback through the use of technology. The study concluded that patient satisfaction rates within hospitals could significantly improve if patients are provided with free Wi-Fi access during their hospital visit. The study carried out by social media analysts Trufflenet Health aimed to identify how patients perceived the care and services provided by two of the community hospitals across social media sites. The study found that patients who were able to access Twitter and PatientOpinion.co.uk on their personal handheld devices using the hospital’s free Wi-Fi service gave mainly positive minute-by-minute accounts of their experience within the hospital, enabling the Trust to listen to real-time feedback at the point of care. Key findings arising from the study showed that: