VOICES
EXPERIENCE OF CARE
Patient feedback is welcomed as a vital part of continuous service improvement. There are already many ways to gather information on patients’ and carers’ experiences in the community, and this month the NHS Friends and Family Test will be implemented by all NHS community nursing service providers. Gathering feedback in the community can be more challenging than in a hospital environment, where there is often a discrete episode of care. In the community, patients have longer-term, more individual engagement with services, so the way feedback is gathered needs to be sensitive to this. Community nursing providers are working to agree a common set of patient-reported experience measures (PREMs). These will help us to understand patients’ experiences of care, and facilitate the identification and comparison of themes and trends. Many service providers and commissioners have dedicated websites to respond to feedback. The ‘you said, we did, we will’ approach adopted by many is a transparent and public-facing way of demonstrating how feedback has informed service development. Patient stories can also be a powerful way of gathering feedback, but we should be mindful of the quote from Albert Einstein: ‘Everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted.’ Above all else, we must always prioritise what counts for patients in what we measure. Crystal Oldman is chief executive of the Queen’s Nursing Institute @CrystalOldman
JOHN HOULIHAN
Gathering feedback in the community can be challenging, says Crystal Oldman
Implementing change Cultural change starts with the team and is not always easy. Jocelyn Cornwell offers important advice The team at the Point of Care Foundation has almost a decade’s experience in helping clinical and non-clinical staff use insights from patient feedback, and from their own observations of care, to change the culture of services and improve the patient experience. Using patient feedback to drive cultural change in the NHS is a challenging undertaking. If you are serious about it, be prepared to enter the difficult and sensitive territory of challenging the values, beliefs, attitudes and behaviours of staff and managers. Cultural change only occurs when a team is prepared to start with itself, not the patients. Most teams think the place to start is with technical questions about the quality of data, or how to collect it, but they really need to begin with themselves: who is ‘the team’ that will do the work? Do members share common goals? Who has the time to make change happen? Reflect on your own and your colleagues’ experiences of other change
programmes before you begin, as these will shape reactions to this one. How do people feel about change? Are they enthusiastic about it? Has their previous experience left them sceptical or even exhausted? You cannot change the way people feel about past experiences, but it is better to acknowledge negative feelings than to ignore them.
‘CULTURAL CHANGE ONLY OCCURS WHEN A TEAM IS PREPARED TO START WITH ITSELF’ If some colleagues are reluctant, do not let it stop the work altogether. Start instead with the people who are keen to participate, get some results then go back to the others. It is easier to persuade critics and sceptics when you have something to show them. It is always easier to push water downhill. Appreciative enquiry creates more energy for change than starting
24 february 25 from :: volRCNi.com 29 no 26by :: 2015 STANDARD Downloaded ${individualUser.displayName} on Nov 18, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
STUDENT EXPERIENCES IN THE REAL WORLD OF NURSING
Patient shadowing
Try not to reinvent the wheel. There are tried and tested effective methods of using patient experiences to drive change, including experience-based co-design which focuses on the most important issues to patients. If you want staff to put themselves in patients’ shoes, offer opportunities for them to do so, such as patient shadowing. The technical side of collecting and using feedback can be tricky, but it is the least of the problems. Start by involving patients in the work if possible, and access all the patient feedback available for the service you are interested in. Look at complaints, compliments, surveys and all the qualitative data you can lay your hands on and, wherever possible, get analytical help to make sense of data that comes from different sources. Patients can tell you a great deal that will be helpful in changing the culture of services, but the process of making changes is not easy, and it is not linear. Real change is a messy, human business. The hardest part is not actually listening to and learning from patients, but getting the team to communicate well and work together. Jocelyn Cornwell is chief executive of the Point of Care Foundation and visiting professor in the Department of Medicine at Imperial College, London @JocelynCornwell
Starting out
A PATIENT WITH PARKINSON’S TAUGHT ME THE IMPORTANCE OF LISTENING In my first year of nurse training, I undertook a six-week placement at St Mark’s Community Hospital in Maidenhead, Berkshire. One patient I helped to care for, whom I will call John, had learning difficulties and had been diagnosed with Parkinson’s disease. He visited the hospital every other week for speech and language therapy, but was frustrated at his lack of progress. John was in the end stages of Parkinson’s disease and was receiving palliative care, but he was determined to carry on with his therapy. He told me he did not want to just ‘give up on conversations’ and that it was disheartening when people could not be bothered to listen to him because they could not understand him. He said he enjoyed coming to the hospital because the nurses and therapists listened to what he had to say. After talking to John, and other patients at St Mark’s who were receiving palliative care, I embarked upon a project looking at how feedback from patients can be used to address individual care needs. My project involved creating care plans for patients with terminal illness, which could be adapted to suit individual needs as the condition progressed. For example, a care plan for a patient like John would need to cover the following: Control of physical symptoms, such as muscle weakness and lack of bladder control. We need to ensure that the patient is not in distress and that there is no loss of dignity. Cognitive problems, such as confusion, hallucinations and
memory loss. These symptoms can be traumatic for patients, who may need help coming to terms with them. Medication. Drugs for pain relief and symptom control should be reviewed regularly. Dosages may need to be increased or decreased as the condition progresses to ensure the patient is comfortable. Nurses should hold regular care plan consultations with patients, and liaise with the multidisciplinary team. Allied health professionals, including speech and language therapists, physiotherapists and dietitians are essential to delivering effective care for patients with Parkinson’s disease, and nurses must work closely with them and the medical team. Patients must be kept informed of their care every step of the way and, if they have opinions about how things can be done differently, they must be listened to. They know better than anyone what will and will not help them, and how care could be improved. I learned a valuable lesson on this placement: we have to listen to our patients. If we do not know what they want, how can we meet their needs? I have never forgotten the outstanding care I witnessed at St Mark’s, and the courageous patients I met. This inspired me to enter community nursing on qualifying, and I now work as a community nurse in Marlow, Buckinghamshire. GETTY IMAGES
with problems. Invest time in thinking about and articulating for your colleagues how they and their patients will benefit from the changes. People could find the idea of being confronted with their patients’ views of their service intimidating. The Patient and Family-Centred Care programme offers a step-by-step method of understanding what care experiences are like, and how to make the often small improvements that make a big difference to patients. Some members of one of the teams that joined the programme said that they had dreaded coming to the first meeting because they were sure we would tell them they were not ‘patient-centred enough.’
Clare Troy is a graduate nursing student from the University of West London
On the web http://rcnpublishing.com/r/starting-out. Send your experience, between 500 and 600 words, to [email protected]
NURSING :: vol uses 29 no 26 :: permission. 2015 25 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 18, 2015. For personalfebruary use only. 25 No other without Copyright © 2015 RCNi Ltd. All rights reserved.
EXPERIENCE OF CARE
Patient feedback is welcomed as a vital part of continuous service improvement. There are already many ways to gather information on patients’ and carers’ experiences in the community, and this month the NHS Friends and Family Test will be implemented by all NHS community nursing service providers. Gathering feedback in the community can be more challenging than in a hospital environment, where there is often a discrete episode of care. In the community, patients have longer-term, more individual engagement with services, so the way feedback is gathered needs to be sensitive to this. Community nursing providers are working to agree a common set of patient-reported experience measures (PREMs). These will help us to understand patients’ experiences of care, and facilitate the identification and comparison of themes and trends. Many service providers and commissioners have dedicated websites to respond to feedback. The ‘you said, we did, we will’ approach adopted by many is a transparent and public-facing way of demonstrating how feedback has informed service development. Patient stories can also be a powerful way of gathering feedback, but we should be mindful of the quote from Albert Einstein: ‘Everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted.’ Above all else, we must always prioritise what counts for patients in what we measure. Crystal Oldman is chief executive of the Queen’s Nursing Institute @CrystalOldman
JOHN HOULIHAN
Gathering feedback in the community can be challenging, says Crystal Oldman
Implementing change Cultural change starts with the team and is not always easy. Jocelyn Cornwell offers important advice The team at the Point of Care Foundation has almost a decade’s experience in helping clinical and non-clinical staff use insights from patient feedback, and from their own observations of care, to change the culture of services and improve the patient experience. Using patient feedback to drive cultural change in the NHS is a challenging undertaking. If you are serious about it, be prepared to enter the difficult and sensitive territory of challenging the values, beliefs, attitudes and behaviours of staff and managers. Cultural change only occurs when a team is prepared to start with itself, not the patients. Most teams think the place to start is with technical questions about the quality of data, or how to collect it, but they really need to begin with themselves: who is ‘the team’ that will do the work? Do members share common goals? Who has the time to make change happen? Reflect on your own and your colleagues’ experiences of other change
programmes before you begin, as these will shape reactions to this one. How do people feel about change? Are they enthusiastic about it? Has their previous experience left them sceptical or even exhausted? You cannot change the way people feel about past experiences, but it is better to acknowledge negative feelings than to ignore them.
‘CULTURAL CHANGE ONLY OCCURS WHEN A TEAM IS PREPARED TO START WITH ITSELF’ If some colleagues are reluctant, do not let it stop the work altogether. Start instead with the people who are keen to participate, get some results then go back to the others. It is easier to persuade critics and sceptics when you have something to show them. It is always easier to push water downhill. Appreciative enquiry creates more energy for change than starting
24 february 25 from :: volRCNi.com 29 no 26by :: 2015 STANDARD Downloaded ${individualUser.displayName} on Nov 18, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
STUDENT EXPERIENCES IN THE REAL WORLD OF NURSING
Patient shadowing
Try not to reinvent the wheel. There are tried and tested effective methods of using patient experiences to drive change, including experience-based co-design which focuses on the most important issues to patients. If you want staff to put themselves in patients’ shoes, offer opportunities for them to do so, such as patient shadowing. The technical side of collecting and using feedback can be tricky, but it is the least of the problems. Start by involving patients in the work if possible, and access all the patient feedback available for the service you are interested in. Look at complaints, compliments, surveys and all the qualitative data you can lay your hands on and, wherever possible, get analytical help to make sense of data that comes from different sources. Patients can tell you a great deal that will be helpful in changing the culture of services, but the process of making changes is not easy, and it is not linear. Real change is a messy, human business. The hardest part is not actually listening to and learning from patients, but getting the team to communicate well and work together. Jocelyn Cornwell is chief executive of the Point of Care Foundation and visiting professor in the Department of Medicine at Imperial College, London @JocelynCornwell
Starting out
A PATIENT WITH PARKINSON’S TAUGHT ME THE IMPORTANCE OF LISTENING In my first year of nurse training, I undertook a six-week placement at St Mark’s Community Hospital in Maidenhead, Berkshire. One patient I helped to care for, whom I will call John, had learning difficulties and had been diagnosed with Parkinson’s disease. He visited the hospital every other week for speech and language therapy, but was frustrated at his lack of progress. John was in the end stages of Parkinson’s disease and was receiving palliative care, but he was determined to carry on with his therapy. He told me he did not want to just ‘give up on conversations’ and that it was disheartening when people could not be bothered to listen to him because they could not understand him. He said he enjoyed coming to the hospital because the nurses and therapists listened to what he had to say. After talking to John, and other patients at St Mark’s who were receiving palliative care, I embarked upon a project looking at how feedback from patients can be used to address individual care needs. My project involved creating care plans for patients with terminal illness, which could be adapted to suit individual needs as the condition progressed. For example, a care plan for a patient like John would need to cover the following: Control of physical symptoms, such as muscle weakness and lack of bladder control. We need to ensure that the patient is not in distress and that there is no loss of dignity. Cognitive problems, such as confusion, hallucinations and
memory loss. These symptoms can be traumatic for patients, who may need help coming to terms with them. Medication. Drugs for pain relief and symptom control should be reviewed regularly. Dosages may need to be increased or decreased as the condition progresses to ensure the patient is comfortable. Nurses should hold regular care plan consultations with patients, and liaise with the multidisciplinary team. Allied health professionals, including speech and language therapists, physiotherapists and dietitians are essential to delivering effective care for patients with Parkinson’s disease, and nurses must work closely with them and the medical team. Patients must be kept informed of their care every step of the way and, if they have opinions about how things can be done differently, they must be listened to. They know better than anyone what will and will not help them, and how care could be improved. I learned a valuable lesson on this placement: we have to listen to our patients. If we do not know what they want, how can we meet their needs? I have never forgotten the outstanding care I witnessed at St Mark’s, and the courageous patients I met. This inspired me to enter community nursing on qualifying, and I now work as a community nurse in Marlow, Buckinghamshire. GETTY IMAGES
with problems. Invest time in thinking about and articulating for your colleagues how they and their patients will benefit from the changes. People could find the idea of being confronted with their patients’ views of their service intimidating. The Patient and Family-Centred Care programme offers a step-by-step method of understanding what care experiences are like, and how to make the often small improvements that make a big difference to patients. Some members of one of the teams that joined the programme said that they had dreaded coming to the first meeting because they were sure we would tell them they were not ‘patient-centred enough.’
Clare Troy is a graduate nursing student from the University of West London
On the web http://rcnpublishing.com/r/starting-out. Send your experience, between 500 and 600 words, to [email protected]
NURSING :: vol uses 29 no 26 :: permission. 2015 25 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 18, 2015. For personalfebruary use only. 25 No other without Copyright © 2015 RCNi Ltd. All rights reserved.
