Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Identifying Signs of Mental Health Presentation (1).pptx
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
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
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)
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
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