When Monitor asked foundation trusts to take part in a pilot project on patient experience, Norfolk and Norwich University Hospitals trust was keen to get involved. Chris says, “We want to do as much as we can to ensure our patients have a good experience of our services. This was an opportunity to really understand the patient experience and look at ways to make it even better.”
The process began in November 2008. “We selected emergency services for the pilot because it is a large, high-pressure area”, says Chris. “We wanted to capitalise on the support we received for the pilot, and then iron out any wrinkles before we implemented the same process in other service lines.”
A half-time project lead took the work forward, collecting a range of information about patient experience. Some came from existing sources such as the Dr Foster Patient Experience Tracker, complaints the trust had received and feedback from the Patient Advice and Liaison Service. New information was also collected through surveys, one-to-one interviews and focus groups with staff and patients. The information was analysed and key messages were identified, highlighting areas that were working well and those where improvements could be made.
The findings were fed back to service-line staff at a “mirror workshop”. One of the materials produced for the workshop, a DVD in which patients gave their views about what was important to them, proved to be a particularly powerful way of bringing issues to life.
Staff from all disciplines within the service line attended the mirror workshop. “We planned it well in advance so everyone could put it in their diaries; for the right level of engagement it was important that the right people were around the table,” says Chris.
The final stage in the process was the development of an action plan to address areas for improvement, with implementation monitored by a steering group. “Some of the actions involved investing in the hospital environment,” says Chris. “But many focused on the way we organise ourselves and communicate with each another. For example we’ve structured shift handovers in a different way to improve communication, which will ultimately benefit patients.”
The work has secured a commitment at all levels of the trust to improving patient experience. “It has focused the Board’s attention, bringing patient experience towards the top of their agenda,” says Chris. “Their buy-in is vital to secure support to implement the actions.”
Positive feedback at the mirror workshop, improved communication and the sense of a shared goal have also contributed to higher staff morale. Chris says, “If you’ve got staff who talk to each other and support each other, they’ll be much happier and they’ll pass on that positivity to patients.”
The process has also brought about better relationships between management and service-line staff. “Feedback from staff in the emergency services review showed a desire for the executive team to be more visible, rather than just visiting when there was a problem, and this is now happening.” says Chris.
Although evidence of the benefits to patients is anecdotal at this early stage, informal feedback has been positive, and the trust hopes to do some follow up work to measure the impact of the process on patient experience.
Chris advises other trusts embarking on the same journey to be realistic about what’s involved. “It doesn’t have to be hugely expensive, but there are resource implications,” she says. These include project management time, time for staff to get involved in interviews and workshops, and funds to put together supporting materials, such as DVDs or posters.
Making sure a structure is in place to ensure the action plans are followed through is also vital. “It’s really important that you don’t just do the project and then go,” says Chris. “If people go to a lot of trouble and nothing happens they’re going to walk away. There needs to be a mechanism in place to sign off the action plan and to ensure that implementation takes place.”
Since the pilot took place, the process has been repeated in cardiology and urology and is currently underway in stroke services. The trust is putting together a timetable to implement the process across all service lines. Chris says, “We should never assume we know what patients want, the knowledge we have gained is invaluable to us, both now and for the future.”