Embedding patient experience in care service development

NHS Improvement publishes 'organisational diagnostic' framework to help senior nurses assess leadership, culture and operational processes

NHS Improvement publishes 'organisational diagnostic' framework to help senior nurses assess leadership, culture and operational processes

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The NHS in England has one million patient contacts every 36 hours. Ensuring that each contact is good is a huge, perhaps impossible, challenge.

But, with good patient experience increasingly seen as an essential part of healthcare, alongside clinical effectiveness and safety, improving it should be seen as a priority, says NHS Improvement.

To help, NHS Improvement has produced a patient experience improvement framework to allow senior leaders to carry out an ‘organisational diagnostic’ to see how well patient experience is embedded in the leadership, culture and operational processes of their organisations.

1 million

Number of patient contacts every 36 hours

(Source: NHS Choices 2016)

NHS Improvement concedes that improving patient experience is not simple. As well as effective leadership and a receptive culture, trusts need a comprehensive approach to collecting, analysing, using and learning from patient feedback.

 A practical guide

NHS Improvement director of nursing Ruth May says she hopes the framework can become a practical guide for board members and senior managers.

It includes 23 characteristics against which leaders can scrutinise their organisation. Alongside each characteristic, there are also suggestions for how improvement can be achieved.

Dr May says it should be an important tool for assessing where a trust is in terms of monitoring and improving patient experience.

‘This is a key part of the journey for trusts in progressing to good and outstanding from a Care Quality Commission perspective, and we hope it will support healthcare providers.’

Ruth May

The characteristics include steps that should be taken in the boardroom, such as having a patient experience strategy and ensuring the organisation takes part in the relevant mandated surveys.

But they also include ones emphasising the importance of front-line staff. Lesley Doherty, who has worked as a director of nursing and hospital chief executive in the NHS, says she believes that these ones are crucial.

‘My general view on patient experience is that it’s down to the staff they come across. If staff attitude is poor then this is more often than not the catalyst for poor patient experience becoming a complaint.’

RCN nurses in management and leadership forum chair Sally Bassett is not surprised by this: ‘It’s probably a reflection of the impact that front-line nurses make; as nurses, our attitude towards a patient and their family is so powerful. The kindness, the touch and sincerity in our communication; it’s what lies at the heart of what it means to be a nurse.’

Are patients happy with the NHS?

The 2017 British Social Attitudes survey shows satisfaction with the NHS is falling.

Some 57% of respondents said they were satisfied, a six percentage point drop in one year.

The four main reasons cited for not being satisfied were: staff shortages, long waiting times, lack of funding and government reforms.

But positives can be found elsewhere. The 2017 Care Quality Commission inpatient satisfaction survey showed that 84% of respondents rated their overall experience as seven or more out of ten and 82% felt they were always treated with dignity and respect.

Meanwhile, the most recent friends-and-family test data has shown a more than 90% approval rating for inpatients, maternity, outpatients and community services. Mental healthcare scored just below 90%.

But she is concerned that improving patient experience will be a challenge as trusts are struggling with financial and recruitment pressures.

The 23 characteristics

  1. There is a patient experience strategy.
  2. Patient experience is embedded in all trust leadership development work.
  3. An identified executive lead is accountable for leading on patient experience.
  4. There is a clear clinical leadership from medical and nursing directors on patient experience improvement.
  5. Development strategy and implementation plans are underpinned by a commitment to improve patient experience.
  6. Board values and celebrates innovation by front-line staff to improve patient experience.
  7. Staff are proud to work for the organisation and speak highly of the culture.
  8. Organisation expresses its commitment to patients through all its communications.
  9. Organisation participates in all mandated surveys, including the national patient survey, friends-and-family test and local surveys.
  10. There is a patient-friendly complaints process that complies with national guidance.
  11. Front-line staff take ownership of, and deal with, issues raised by patients and, only where necessary, refer to others.
  12. Patients are given information about the range of ways they can provide feedback, which might include comment cards, text, kiosks and apps.
  13. Organisation has a systematic way of analysing patient feedback, including complaints.
  14. Organisation produces reports that demonstrate the correlation between improving patient outcomes, safety and experience.
  15. Organisation uses patient experience data effectively to identify and locate deteriorating performance and to act quickly to address the causes.
  16. Patient feedback is routinely considered and acted on by front-line teams and escalated when larger scale service redesign is required.
  17. Staff are supported to share decision-making about care and treatment with patients.
  18. Appraisal process is used to identify training needs to support patient experience improvements.


    Friends and family approval rating for inpatient services in April 2018

  19. All proposals for service change and project initiation are accompanied by evidence of potential impact on patient experience.
  20. Organisation uses quality improvement methods to improve continuously the experience of care.
  21. Patient experience is a key component of the organisation’s annual quality accounts.
  22. Organisation routinely publishes transparent and publicly accessible information about the feedback patients have provided.
  23. Organisation supports a model of co-production and supports patients and staff to deliver this.

Walsall: ‘Be flexible in how you gather information’

Patients who use Walsall Healthcare NHS Trust’s services can give feedback on their experience through a host of avenues, due to efforts made to ensure information is gathered in as many ways as possible.

As well as using the NHS national surveys and the friends-and-family test, the trust also gathers qualitative feedback. This involves the use of focus groups and in-depth interviews with patients. An app for young people who use paediatric services has also been developed with patients’ input.

Front-line teams are supported by a patient-experience team, which is also responsible for self-care management programmes and volunteering.

The material gathered is analysed by the team, who then work closely with departments to implement changes. Any changes are promoted on ‘You Said, We Did’ posters, which are displayed in wards and departments across Walsall Manor Hospital, as well as throughout its community buildings.

Patient experience lead Louise Mabley says: ‘We find that staff are positive about receiving and acting on feedback. They want to listen to our patients and provide the best possible care, and that means responding to the ideas and issues raised.

‘Flexibility is important to us being able to gather information. We don’t just rely on surveys; face-to-face interviews, consultation events and technology can all help provide richer information to work with.’


Find out more about the patient experience improvement framework here


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