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Our vision for using patient insight and
feedback in the NHS
RichardAshworth, Chris Branson, Clare Enston and Dan
Wellings
Insight & Feedback Unit
NHS England
What is insight?
What does insight mean?
• Using qualitative and quantitative
data from users to inform what
we do
• Using whatever data sources we
have - not just surveys but a
whole range of feedback
techniques
• Always asking the question, what
do we do with the data?
• Making a difference with data
“The most important
single change in the NHS
in response to this report
would be for it to
become, more than ever
before, a system devoted
to continual learning and
improvement of patient
care, top to bottom and
end to end”
A promise to learn – a
commitment to act
The Berwick Report
• There are a wide range patient data sources
• No one source is better than others
• They all have different strengths and weaknesses, and hence
they have different uses
• Commissioners, providers of services, and policy and support
services canall benefit from using a range of tools
4
Insight comes from many sources
What is the challenge?
98%
1 in 317%
>95%
0.919
R2 = 0.7608
p value = 0.05
123,000
273
10m
4/5 0.783
Methodologies – pros and cons
RobustnessUsability
Balance between local and national
collections – question of ownership
Is data being presented back
appropriately to each audience?
Patients and the public Frontline staff
Managers and
commissioners
Academics
Data presentation
Making it easy…
Presenting data with impact
Surveys
National Patient Experience Surveys
Current National Surveys – feedback from c1.5 million people a year
• GP Patient survey (NHS England, twice a year)
• Community & Mental Health survey (CQC, annual)
• Inpatient survey (CQC, annual)
• A&E survey (CQC, every 3 years)
• Outpatient survey (CQC, every 3 years)
• Maternity survey (CQC, every 3 years)
• National Cancer Patient Experience survey (NHS England, annual)
• VOICES survey of Bereaved People (NHS England, annual)
• Staff survey (NHS England, annual)
• Adult Social Care survey (Department of Health, annual)
FFT…
Is not a survey
• It has different characteristics from national surveys
– FFT is a real-time local feedback tool; putting the patient voice centre-stage in health service improvement.
– FFT and National surveys are complementary sources of Insight
– FFT is a formative measure: it provides data to improve services
– National surveys are summative measures: they provide an accurate picture of relative performance
FFT
• Real-time
• Ward-level / service groupings
• Effective for service improvement
• Can be used as early-warning system
• Not representative, not comparable
National surveys
• Robust, comparable data at Trust level
• Data on a range of issues
• Suitable for performance management
• Not meaningful to front-line staff
• Have not historically changed behaviours
FFT…
Over 10 million responses received acrosshealthcare settings
• The FFT review has clearly demonstrated that the FFT is making a difference to patient experience: 4 out of 5 trusts
said that the FFT has increased emphasis on patient experience.
• The key strengths of the FFT are reported as: its real-time nature, inclusivity, free text comments.
Some examples of service improvements:
• Silent/soft closing bins
• Medication alerts
• Patient preferred name
• Staff introductions
• Transfer of staff
• Menu choices
• Activities
• Parking concessions
• Extended visiting times
• Improved lighting
• Lights out at night
• Timing of medications
• New call bells
• Personal possessions
• Health snacks
• Self medication
• Toilet shelves
• Silent phones
• Staff training
• Towel rails
• Social meal times
• Meet and greet
And asking questions is not the
only way…
Depends what we want to know
Normative
Need Felt Need
Expressed
Need
A&E Design council case study
(ethnography)
Hallsworth M, Berry D, Sallis A, Vlaev I, King D, Darzi A: Stating appointment costs in SMS
reminders reduces missed hospital appointments.(2015: publication pending)
11.1
8.4
0
2
4
6
8
10
12
old message nudge
message
‘DNA’rate %
old message ‘nudge’ message
DH – Leading the nation’s health and
Appt at St Barts Hospital
on Sep 26 at 2.30. To
cancel or rearrange call
the number on your
appointment letter.
Appt at St Barts Hospital
on Sep 26 at 2.30. To
cancel or rearrange call
02077673200.
We are expecting you at
St Barts Hospital on Sep
26 at 2.30. 9 out of 10
people attend. Call
02077673200 if you need
to cancel or rearrange.
We are expecting you at
St Barts Hospital on Sep
26 at 2.30. Not attending
costs NHS £160 approx.
Call 02077673200 if you
need to cancel or
rearrange.
Existing message Easy Call Social Norms Specific Costs
11.1
9.8 10
8.4
0
2
4
6
8
10
12
Existing Message Easy call Social Norms Specific Costs
Percentageof
appointmentsthatare
missed
Effect of messageson missed appointments(N = 10,111)
DH – Leading the nation’s health and
Hallsworth M, Berry D, et al: Stating appointment costs in SMS reminders reduces missed hospital appointments. (2015: publication pending)
Making a difference with data…
Guy’s & St Thomas’s - Barbara’s
story
• ‘Barbara’s Story’ commissionedby Guys’ and St Thomas’NHS Trust to help their
staff develop awareness of people with dementia and the care of older people,
and to reinforce trust values
• Script was developed through qualitative research with clinicians and patients
– Allows the team to draw out common themes to be explored in the narrative
– Many of the scenes often actually happened in real life
• It was shown on a regular basis from September2012 to April 2013
– 11,054 clinical and non-clinical staff attended a mandatory training session and
watched the film
– Barbara’s Story was also embedded into the corporate induction programme for
new Trust staff
Communicating patient
experience through film
Barbara’s impact
• Evaluation indicated Barbara’sStory made a lasting impression on staff
o It prompted reflection on their own practice and that of others
o Led to resolutions for improvements
• Strong evidence that the film raised awareness of dementia and, more generally,
patients’experience and their need for help
o It prompted staff to think more broadly about care provision in the Trust
o Not just focus on their own specific practice area and patient group
• Some indication of culture change, particularly staff feeling able to give more time
o Both leadership and teamwork were important factors that influenced
application of learning from Barbara’s Story to practice
o BUT staffing and time available remain constraints to being able to give the time
needed
• A further five films about Barbara have since been made
• Pushing wheelchairs
o As a result of the film porters started pushing wheelchairs as opposedto
pulling them.. this led to Eileen Sills - Chief Nurse to order a whole new set
of wheelchairs that could be more easily pushed rather than pulled.
• Re-configuring reception areas
o Selected receptionareas in the Trust are being reconfigured to direct the
focus on the patient seeking help.
• Infection control
o The infection control policy is being reviewed to take into account
compassionate care. This was prompted by a scene featuring a nurse
sitting on Barbara's bed.
Tangible improvements as a result
of Barbara’s story
Improving the NHS by
understanding those who use it
An Insight & Feedback Strategy
Over the next 2 years…
• Our short-termambition can be stated in a single sentence:
We want everyone to make better use of
the data that is available and ensure that
everyone is represented
• Over the next two years we will support everyone in the system to use
insight and feedbackmore effectively
How we will achieve this
1) Active roles
Encourage everyone in the health system to take active roles in the use of insight
2) Leadership and support
Provide leadership and support in the use of insight across the health system and
encourage local collaboration by establishing a national insight network
3) Bitesize guides
Publish a series of ‘Bitesize Guides’ to insight for commissioners and providers
4) Data presentation
Make insight data easier to access in one place, and work on data presentation
so that it is more impactful, and easier to understand and use
5) Filling gaps
Working together to fill gaps in knowledge so that everyone is represented
The roles of commissioners
and providers
Commissioners
• Review insight needs and population coverage
• Use a range of sources throughout the commissioning cycle
• Address poorer experiences
• Design services basedon patients’ needs
Healthcare providers
• Gather local data to understand performance
• Use FFT to make continuous improvements
• Understand the experiences of both patients and staff
The roles of national bodies and
representative groups
National bodies
• Ensure all patients are listened to and represented fairly
• Ensure experience is treated as a key component of quality
• Understand performance of services andmonitor local
variation
• Ensure improvement plans are in effect
• Design effective insight-based policy to improve healthcare
Representativegroups
• Be leaders on understanding patient experiences
• Focus on effective communication of patient issues
• Develop collaborative relationships across the system
The role of patients, carers and
the public
• Provide feedback through surveys and at point of care
through the FFT
• Tell us your stories so that we understand experiences
in depth
• Raise a complaint if a service has been unacceptable
• Use insightdata to understand local services
• Hold the system to account
• Become an active participant in healthcare policy,
design and delivery
Where we want to be in 5 years
1) Routine use of insight data
Insight data to be used routinely across all areas of the NHS, from policy-making
and commissioning to service provision and patient decision-making
2) Advances in data collection
More sophisticated, innovative and efficient approach to learning
3) Integrated insight
Have a fully integrated system of insight across care pathways
4) Insight-based commissioning
Use insight to drive quality through outcomes-based commissioning
5) Qualitative data analytics
Learn as much as possible from huge volumes of open text feedback
6) Personalised insight
Patients to use their own data to become partners in their care and treatment
How we’re going to get there
1) Link datasets across healthcare services to understand the full
care pathways of patients
2) Link insight data with medical outcomes data to understand the
relationship between experience and effectiveness
3) Make more efficient use of national surveys by separating core
questions from modular question sets
4) Use electronic data collection methods where this is feasible
5) Attach payments based on outcomes and experiences to
contracts where this makes sense
6) Develop open text data analytics, including analysis of social
media
7) Develop personalised PROMs as part of care
What do you think?
How does our vision for insight and feedback look to you?
34
A few final thoughts
Conclusions and a few thoughts
on local use of insight
• Be very clear on what data is collected for and do not overload a
collection
• Think early on about how data will be translated into change
• Think clearly about audience(s)
• Involve patients as much as possible in the design
• Train people to use the data and show how change can be
made; involve the right people early in the process?
• Numbers without meaning can be dangerous – signal not noise
• Reflect on ownership - engagement
Means nothing if nothing is done
Thank you
england.insight-queries@nhs.net

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Our vision for using patient insight and feedback in the nhs, 12.00, pop up uni, 2 september 2015

  • 1. Our vision for using patient insight and feedback in the NHS RichardAshworth, Chris Branson, Clare Enston and Dan Wellings Insight & Feedback Unit NHS England
  • 3. What does insight mean? • Using qualitative and quantitative data from users to inform what we do • Using whatever data sources we have - not just surveys but a whole range of feedback techniques • Always asking the question, what do we do with the data? • Making a difference with data “The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end” A promise to learn – a commitment to act The Berwick Report
  • 4. • There are a wide range patient data sources • No one source is better than others • They all have different strengths and weaknesses, and hence they have different uses • Commissioners, providers of services, and policy and support services canall benefit from using a range of tools 4 Insight comes from many sources
  • 5. What is the challenge? 98% 1 in 317% >95% 0.919 R2 = 0.7608 p value = 0.05 123,000 273 10m 4/5 0.783
  • 6. Methodologies – pros and cons RobustnessUsability
  • 7. Balance between local and national collections – question of ownership
  • 8. Is data being presented back appropriately to each audience? Patients and the public Frontline staff Managers and commissioners Academics
  • 13. National Patient Experience Surveys Current National Surveys – feedback from c1.5 million people a year • GP Patient survey (NHS England, twice a year) • Community & Mental Health survey (CQC, annual) • Inpatient survey (CQC, annual) • A&E survey (CQC, every 3 years) • Outpatient survey (CQC, every 3 years) • Maternity survey (CQC, every 3 years) • National Cancer Patient Experience survey (NHS England, annual) • VOICES survey of Bereaved People (NHS England, annual) • Staff survey (NHS England, annual) • Adult Social Care survey (Department of Health, annual)
  • 14. FFT… Is not a survey • It has different characteristics from national surveys – FFT is a real-time local feedback tool; putting the patient voice centre-stage in health service improvement. – FFT and National surveys are complementary sources of Insight – FFT is a formative measure: it provides data to improve services – National surveys are summative measures: they provide an accurate picture of relative performance FFT • Real-time • Ward-level / service groupings • Effective for service improvement • Can be used as early-warning system • Not representative, not comparable National surveys • Robust, comparable data at Trust level • Data on a range of issues • Suitable for performance management • Not meaningful to front-line staff • Have not historically changed behaviours
  • 15. FFT… Over 10 million responses received acrosshealthcare settings • The FFT review has clearly demonstrated that the FFT is making a difference to patient experience: 4 out of 5 trusts said that the FFT has increased emphasis on patient experience. • The key strengths of the FFT are reported as: its real-time nature, inclusivity, free text comments. Some examples of service improvements: • Silent/soft closing bins • Medication alerts • Patient preferred name • Staff introductions • Transfer of staff • Menu choices • Activities • Parking concessions • Extended visiting times • Improved lighting • Lights out at night • Timing of medications • New call bells • Personal possessions • Health snacks • Self medication • Toilet shelves • Silent phones • Staff training • Towel rails • Social meal times • Meet and greet
  • 16. And asking questions is not the only way…
  • 17. Depends what we want to know Normative Need Felt Need Expressed Need
  • 18. A&E Design council case study (ethnography)
  • 19. Hallsworth M, Berry D, Sallis A, Vlaev I, King D, Darzi A: Stating appointment costs in SMS reminders reduces missed hospital appointments.(2015: publication pending) 11.1 8.4 0 2 4 6 8 10 12 old message nudge message ‘DNA’rate % old message ‘nudge’ message DH – Leading the nation’s health and
  • 20. Appt at St Barts Hospital on Sep 26 at 2.30. To cancel or rearrange call the number on your appointment letter. Appt at St Barts Hospital on Sep 26 at 2.30. To cancel or rearrange call 02077673200. We are expecting you at St Barts Hospital on Sep 26 at 2.30. 9 out of 10 people attend. Call 02077673200 if you need to cancel or rearrange. We are expecting you at St Barts Hospital on Sep 26 at 2.30. Not attending costs NHS £160 approx. Call 02077673200 if you need to cancel or rearrange. Existing message Easy Call Social Norms Specific Costs 11.1 9.8 10 8.4 0 2 4 6 8 10 12 Existing Message Easy call Social Norms Specific Costs Percentageof appointmentsthatare missed Effect of messageson missed appointments(N = 10,111) DH – Leading the nation’s health and Hallsworth M, Berry D, et al: Stating appointment costs in SMS reminders reduces missed hospital appointments. (2015: publication pending)
  • 21. Making a difference with data…
  • 22. Guy’s & St Thomas’s - Barbara’s story
  • 23. • ‘Barbara’s Story’ commissionedby Guys’ and St Thomas’NHS Trust to help their staff develop awareness of people with dementia and the care of older people, and to reinforce trust values • Script was developed through qualitative research with clinicians and patients – Allows the team to draw out common themes to be explored in the narrative – Many of the scenes often actually happened in real life • It was shown on a regular basis from September2012 to April 2013 – 11,054 clinical and non-clinical staff attended a mandatory training session and watched the film – Barbara’s Story was also embedded into the corporate induction programme for new Trust staff Communicating patient experience through film
  • 24. Barbara’s impact • Evaluation indicated Barbara’sStory made a lasting impression on staff o It prompted reflection on their own practice and that of others o Led to resolutions for improvements • Strong evidence that the film raised awareness of dementia and, more generally, patients’experience and their need for help o It prompted staff to think more broadly about care provision in the Trust o Not just focus on their own specific practice area and patient group • Some indication of culture change, particularly staff feeling able to give more time o Both leadership and teamwork were important factors that influenced application of learning from Barbara’s Story to practice o BUT staffing and time available remain constraints to being able to give the time needed • A further five films about Barbara have since been made
  • 25. • Pushing wheelchairs o As a result of the film porters started pushing wheelchairs as opposedto pulling them.. this led to Eileen Sills - Chief Nurse to order a whole new set of wheelchairs that could be more easily pushed rather than pulled. • Re-configuring reception areas o Selected receptionareas in the Trust are being reconfigured to direct the focus on the patient seeking help. • Infection control o The infection control policy is being reviewed to take into account compassionate care. This was prompted by a scene featuring a nurse sitting on Barbara's bed. Tangible improvements as a result of Barbara’s story
  • 26. Improving the NHS by understanding those who use it An Insight & Feedback Strategy
  • 27. Over the next 2 years… • Our short-termambition can be stated in a single sentence: We want everyone to make better use of the data that is available and ensure that everyone is represented • Over the next two years we will support everyone in the system to use insight and feedbackmore effectively
  • 28. How we will achieve this 1) Active roles Encourage everyone in the health system to take active roles in the use of insight 2) Leadership and support Provide leadership and support in the use of insight across the health system and encourage local collaboration by establishing a national insight network 3) Bitesize guides Publish a series of ‘Bitesize Guides’ to insight for commissioners and providers 4) Data presentation Make insight data easier to access in one place, and work on data presentation so that it is more impactful, and easier to understand and use 5) Filling gaps Working together to fill gaps in knowledge so that everyone is represented
  • 29. The roles of commissioners and providers Commissioners • Review insight needs and population coverage • Use a range of sources throughout the commissioning cycle • Address poorer experiences • Design services basedon patients’ needs Healthcare providers • Gather local data to understand performance • Use FFT to make continuous improvements • Understand the experiences of both patients and staff
  • 30. The roles of national bodies and representative groups National bodies • Ensure all patients are listened to and represented fairly • Ensure experience is treated as a key component of quality • Understand performance of services andmonitor local variation • Ensure improvement plans are in effect • Design effective insight-based policy to improve healthcare Representativegroups • Be leaders on understanding patient experiences • Focus on effective communication of patient issues • Develop collaborative relationships across the system
  • 31. The role of patients, carers and the public • Provide feedback through surveys and at point of care through the FFT • Tell us your stories so that we understand experiences in depth • Raise a complaint if a service has been unacceptable • Use insightdata to understand local services • Hold the system to account • Become an active participant in healthcare policy, design and delivery
  • 32. Where we want to be in 5 years 1) Routine use of insight data Insight data to be used routinely across all areas of the NHS, from policy-making and commissioning to service provision and patient decision-making 2) Advances in data collection More sophisticated, innovative and efficient approach to learning 3) Integrated insight Have a fully integrated system of insight across care pathways 4) Insight-based commissioning Use insight to drive quality through outcomes-based commissioning 5) Qualitative data analytics Learn as much as possible from huge volumes of open text feedback 6) Personalised insight Patients to use their own data to become partners in their care and treatment
  • 33. How we’re going to get there 1) Link datasets across healthcare services to understand the full care pathways of patients 2) Link insight data with medical outcomes data to understand the relationship between experience and effectiveness 3) Make more efficient use of national surveys by separating core questions from modular question sets 4) Use electronic data collection methods where this is feasible 5) Attach payments based on outcomes and experiences to contracts where this makes sense 6) Develop open text data analytics, including analysis of social media 7) Develop personalised PROMs as part of care
  • 34. What do you think? How does our vision for insight and feedback look to you? 34
  • 35. A few final thoughts
  • 36. Conclusions and a few thoughts on local use of insight • Be very clear on what data is collected for and do not overload a collection • Think early on about how data will be translated into change • Think clearly about audience(s) • Involve patients as much as possible in the design • Train people to use the data and show how change can be made; involve the right people early in the process? • Numbers without meaning can be dangerous – signal not noise • Reflect on ownership - engagement
  • 37. Means nothing if nothing is done