iWGC symposium 2016 slide deck

.org
iWGC National Symposium
The King’s Fund
21st June 2016
Building Fantastic Staff Morale
Improving Quality
Reducing Costs

.org
Welcome
Dr Neil Bacon
Founder & CEO iWGC

.org
How does being rated and reviewed online affect
the attitudes, behaviour and communication of
Doctors?
“Patients value time and explanation, some
elements of the trust management want numbers
processed and pathways turned around. Quality is
what I and the patient want and the feedback from
iWGC reinforces this...” – Anesthetist

.orgDoes patient experience matter?
“... the weight of evidence across different areas of healthcare
indicates that patient experience is clinically important...that
patients can be used as partners in identifying poor and unsafe
practice and help enhance effectiveness and safety.
Clinicians should resist sidelining patient experience measures as
too subjective or mood-orientated, divorced from the ‘real’
clinical work of measuring and delivering patient safety and
clinical effectiveness.”
Doyle, Cathal, Laura Lennox, and Derek Bell. "A systematic review of evidence on the links between patient
experience and clinical safety and effectiveness." BMJ open 3.1 (2013): e001570.

.org
But what do doctors think?
• Is patient experience important?
• Does getting feedback make any
difference?
• Do doctors like being “rated and
reviewed”?

.org
72% learned something from the reviews
“...I learned what
matters to patients…”
Yes
No

.orgWhat do you like, or find especially
helpful about your patients
reviewing you online?
Improves morale
Affirms my competence to myself
Affirms my competence to others -
patients and colleagues
Highlights areas for improvement

.org77% reported improved morale
0 20 40 60 80
Yes
No

.orgWould you recommend collecting
patient feedback to other doctors?
0
10
20
30
40
50
60
70
80
90
Yes No

.orgHas collecting real time feedback
from your patients been…
Better than I thought it
would be
Neutral- What I expected
Worse than what I thought
it would be

.org
12
Is the feedback positive or negative?
of respondents said that the majority of feedback
received was positive

.org
• All doctors with more than five pieces of feedback on iWGC were
surveyed.
• Response rate 29% 75/258
• N= 75
Method

.orgAs a patient, would you want to
read reviews about your hospital
or doctor if helpful?
0
20
40
60
80
100
120
Yes No
“How to Choose a Doctor or Surgeon”, Gresham College lecture by Professor Martin Elliot
17th February 2016

THE 21STC CLINICIAN
IWANTGREATCARE
7TH NATIONAL SYMPOSIUM
KINGS FUND
JUNE 2016
@Nadeem_Moghal
Executive Medical Director
@BHRUT_hospitals

IWGC & ME
• 2008
– Signed up & then what?
• 2010
– Stressed service & uncertain quality
– Variable engagement
– Clear message
• 2013
– GEH
• 2015
– In a position to influence Trust policy

PROFESSION
Eliot Freidson (1923-2005)
• Certification
• Autonomy
• Self direction
• (Entitlement)
Ivan Illich (1926-2002)
• Trapping of knowledge
• Impact on society
• Predicted today
What is today’s definition?

IWGC
Continuous, transparent, supported feedback

THE CQC ‘PROBLEM’
• Way too late
• Collected in retrospect
• Not clinician or facility specific
– Who, what, where, why…
• It is what we are measured against
• IWGC will help solve the CQC problem
– Trust problem
– Problem for our patients

WHY IWGC
• Simple
– Three questions
– Narrative
– Easy for patients
• Transparent
– WWW
– Honesty
– Behaviour
• Responsive
– Real time
– Interactive

TRUST
• IWGC partnership launched
• Policy 17/18
– Annual appraisal expectation vs GMC 5 yearly revalidation
– X feedback responses a year
– Supportive mechanisms for negative feedback
• Clinician communication development strategy
• Medical lead for patient experience
• Measures of success
– Individual, Trust & CQC FFT
• Director for Patient Experience?

CLINICIAN IN THE 21STC
Measure or be measured
• Growing number of process & outcome indicators
• Performance & quality
• Protocols/bundles of care/NICE/guidelines
• Standardisation
• PREMs, PROMs
• Transparency
• Social media
• Regulation, regulation, regulation
Contracting autonomy & self direction

PATIENTS
• Patient choice
• Patient expectation
• Patient knowledge – Dr Google, NHS Choices…transparency
• Patient reported outcomes
• Patient experience feedback
If you believe the patient can help you deliver safe care…then patients
are part of the team
– Quality improvement – experience & clinical outcomes
– Training & Education
– Research
– Service & organisation development

TRANSACTION – SERVICE - EXPERIENCE

Healthcare staff, you and me, deliver products wrapped
around a service that our patients measure the value of. The
drug, the operation, the dialysis machine are all tangible
measurable instruments we use to affect improvement in lives,
and regardless of the outcome, be it good, bad or indifferent,
the patient will always remember the experience, also
tangible and measurable. If the clinical outcome is poor despite
the very best instruments and technical skills at hand, the ability
to accept that outcome depends on how the individual clinician
and teams deliver the experience. A poor experience wrapped
around a poor, indifferent or even good outcome will leave a
patient unhappy about their care, even when the clinical
outcome was inevitably poor. You and I will then rightly get
consumed by complaints, litigation and concerned regulators; a
preventable waste of resources
Email & Blog June 2016

21STC TRANSPARENCY
• Knowledge is everywhere – increasingly reliably sourced
• Knowledge is being automated – Babylon
• Rating experiences the norm
• Patient choice & expectations changed
• Shared knowledge
• Agreed expectations
• Transparent capabilities
What impact on the sense of profession?

21STC CLINICIAN
Professional
Develop self – ‘directed autonomy’
Develop colleagues – professional duty
Develop teams - patients & carer partners
Develop learning cultures – Qi/Training & Education/Research
Revised definition of our profession?
Continuously improve services & organisations

nadeem.moghal@bhrhospitals.nhs.uk
@Nadeem_Moghal
iwantgreatcare
nadeemmoghal.wordpress.com
LinkedIn
Social media:
-it is where our patients are
-it is where our staff are
-it is where our future staff are
-it is where the critics are
-it is where the experts are
And they are all happy to engage with you
@christiplady

.org
Chief Nurse and Director of Clinical
Standards, First Community Health
& Care
Liz Mouland

‘Pre-approval, professional
autonomy and patient outcomes’
Liz Mouland – Chief Nurse and Director of Clinical Standards

pre-approval
professional autonomy
patient outcomes

trust
people
enterpriseideas
social
community
partnership
talent
business

turn the hierarchy on its’ head
patients and public

Body copy or bullet point goes here

The Happy Manifesto
10 principles
for a happier
workplace

1. trust your people
2. make your people feel good
3. give freedom within clear
guidelines
4. be open and transparent
5. recruit for attitude, train for skill

6. celebrate mistakes
7. community: create mutual benefit
8. love work, get a life
9. select managers who are good at
managing
10. play to your strengths

Pre-approval – the principles
What makes great management?
1. good communication
2. clear vision
3. integrity
4. decisiveness
5. coach/supporter/listener

When did you work at your best?
1. great salary?
2. great communication?
3. real challenge?
4. trusted and given freedom to do your job
your way?

trust and
freedom

freedom to do the job the way you want
•clear boundaries
•no micro-management
•fosters responsibility and ownership/pride in the
job
•mistakes may be made – learn and move on
•increases job motivation
•positive impact on culture

barometer of cultural health
customer feedback
• seek
• study
• synthesise

14,903 reviews
since April
2013
Average score
4.86 out of 5

D Day
Ward Olympics Music in Hospitals
MP visit and Rotary Christmas carol service

MDT led project
• clear boundaries set
• MDT discussed solutions
• partnerships established
• breakfast club
• 5 volunteer Activity Co-ordinators appointed

The team have installed a second
reception desk and employed a second
receptionist who is currently being trained.
They have programmed the voicemail to
start after the 6th ring. This has meant that
people are leaving messages and can be
called back when the line is busy.

Qualitative Data:
Helps us to identify that we are meeting our Values

Improving patient outcomes
letting go
liberates
everyone!

.org
Senior Researcher, Nuffield
Department of Primary Health Care
Sciences
Dr Jeremy Howick

.org
Coffee & refreshment break
30 minutes
Please be re-seated by 12:00 pm

.org
12:00 – 12:30
David Behan
Chief Executive Officer, CQC

82
What do
people tell
us about
their care?
David Behan, Chief Executive
I Want Great Care symposium
21June 2016

CQC purpose and role
Our purpose
We make sure health and social care
services provide people with safe,
effective, compassionate, high-quality
care and we encourage care services
to improve
Our role
We register, monitor, inspect and
regulate services to make sure they
meet fundamental standards of
quality and safety and we publish
what we find, including performance
ratings to help people choose care
83

Raise public awareness
and understanding of
CQC’s role and purpose
Listen to and act on
people’s views and
experiences of care
Engage the public in
how we do our job
High quality information
to support choice
Priorities for engaging the public

85
Inspectors talk with the public before and during
inspections
Regular contact with those who represent the public eg.
Overview and Scrutiny Committees, local HealthWatch
Direct CQC channels including online ‘share your
experience form’, email, phone, and letters
c75% of information received is a concern about care,
25% are positive comments
Analyse comments about services posted on websites
eg. NHS Choices, Patient Opinion, IWantGreatCare
Regular national surveys
How we engage

86
‘Tell us about your care’
www.cqc.org.uk/share-your-experience-finder

87
Monthly
average est.
Yearly est. % of total info
received from
individuals
Adult social care 2055 24,660 68%
Hospitals 720 8,640 24%
Primary Medical
Services
232 2,784 8%
36,084
Between Nov 2014 – October 2015 CQC received:
(Based on assumption that 45% of information received is from individuals)
Who tells us about their care?

Maternity Survey 2015
Inpatient survey 2015
A&E 2014
Community mental health 2014
Recent CQC patient surveys

More women than 2014 said they
were always treated with dignity
and respect during labour and
birth
More women said they were
offered a choice of giving birth in a
midwife led unit or birth centre
More women said they saw the
same midwife at every antenatal
appointment
More women said they felt they
were always given the information
or explanations they needed in
hospital and after the birth
Maternity survey 2015

90
Inpatient survey 2015
Small improvements compared with
2014, 2011 and 2006 survey results
This includes patients’ perceptions of:
quality of communication between
medical professionals and patients
standards of hospital cleanliness
availability of help to eat when
needed
number of nurses on duty
being involved in decisions about
their care and treatment
But results show some answers less
positive on hospital discharge

91
A&E survey 2014
Most patients were positive and most felt
treated with respect and dignity and that
doctors and nurses cared for them
Experiences of discharge improved, but
more improvement needed so patients
have right information when leaving A&E
A&E services need to ensure they are safe,
effective and responsive eg. some patients
arriving by ambulance waited too long and
some waited too long for pain relief
Wide variation in patients' experiences,
between trusts and patient groups. Patients
with mental health conditions or learning
disabilities need more support when in
distress

92
Community mental health 2014
Most staff ‘definitely’ listened to people
receiving services (73%) and ‘always’
treated them with respect and dignity (75%)
Results highlight serious problems with
other aspects of care, suggesting services
are not engaging with people using services
20% feel they have not seen mental health
services often enough to meet their needs
23% have not been told who is in charge of
their care
23% have not agreed what care they will
receive and 26% have not met formally to
discuss how their care is working in 12
months

93
Our partnership with Mumsnet and
Gransnet
Reaching hundreds of thousands of
family carers and women of all ages
In 2014, surveyed the ‘sandwich
generation’ of parents caring for
children under 17 and ageing parents
Carers UK estimate this affects 2.4m
people
Choosing a care home was the most
stressful life event, more than getting
divorced or moving house

94
Our research has confirmed that the public expect us to produce
information about each different service – reflecting their
perspective.
Inspections and ratings at hospital-level are much preferred to
ratings at provider / trust level. But the most meaningful information
is that about particular services or departments.
“I’d say they should have a separate report on each
service. You want to know about our treatment more than the
company who provides it.”
“It is good to have an overall picture, but it needs to relate to
your own individual needs. If you’re elderly, you won’t be
looking at maternity services..” (Male, 70+)
Demand for inspections at the
local level

Ambition
95
95
Our ambition for the next five years:
A more targeted, responsive and collaborative approach to
regulation, so more people get high-quality care

1. Encourage improvement,
innovation and sustainability
in care
2. Deliver an intelligence-driven
approach to regulation
3. Promote a single shared view
of quality
4. Improve our efficiency and
effectiveness
96
Four priorities to achieve our
strategic ambition

97
Reviews of care 2015/16
More to come….
• Integrated care for older
people
• Neonatal care and diabetes
care in the community
• State of Care 2015/16
• Integrated urgent care
• Review of NHS trusts’
investigate deaths

98
People’s involvement in their care –
analysis of findings from thematic
studies and State of Care
Over 50% feel involved with decisions
about their health
People with long term health conditions,
learning disabilities and over 75s are
less likely to be involved compared to
others
Poor involvement is the biggest issue in
monitoring use of the Mental Health Act
in 2014/15
Better care in my hands - May 2016

www.cqc.org.uk
enquiries@cqc.org.uk
@CareQualityComm
David Behan
Chief Executive
99
Thank you

.org
Chief Executive Officer,
Barts Health NHS Trust
Alwen Williams

Staff and patient feedback:
How the patient voice and staff
engagement drives
improvement
Alwen Williams
CEO
Barts Health NHS Trust
21 June 2016

Barts Health overview
• 2.5 million people living in east London rely on our services
• Our local population is the most diverse and deprived in the country, and
growing: in 15 years it is estimated we will have 270,000 more residents –
equivalent to another London borough or a city the size of Southampton
• We operate a wide range of general and specialised acute and community
services across five hospital sites and multiple community locations
• 16,000 staff
• £1.4 billion turnover
• During 2015/16 we:
 delivered over 16,500 babies,
 treated about 167,000 individual
inpatients,
 dealt with more than 455,000 emergency cases, and
 hosted almost 1.5 million outpatient
appointments. All these were record numbers
for the Trust.

The scale of our challenge
• Significant quality and finance challenges
• Special measures following CQC reports published in
2015
• The reports highlighted low staff morale / bullying and
harassment
• This year’s staff survey showed signs of improvement
but feedback remains well below the national average
for many indicators
• Traditionally poor results in national patient experience
surveys
• Low Friends and Family Test response rates.

Our response: Safe and compassionate
• Safe and compassionate is our Quality
Improvement Plan (published September
2015)
• Key Priorities: Leadership & organisational
development, safety, compassionate care,
workforce, patient flow, end of life care,
outpatients and medical records
• Staff engagement – culture change : Listening
into Action
• Patient voice – culture change:
Iwantgreatcare as a key component of our
patient engagement and experience strategy

Patient engagement and
experience strategy
• Key priorities:
governance and leadership,
listening and responding to patient feedback,
building capacity,
improvement approach involving patient voice.
• IWGC launched March 2016 - of the 26,823
reviews collected, 18,673 contained a free text
comment.
• Increase in response rates e.g 28% increase in
maternity
• 'You said We did' roll out across the trust

The early results of our new approach

Improving staff experience
Highlights from 2016 Listening in Action (LiA)
staff Pulse Check results show big
improvements in how valued and engaged
staff feel across the Trust.
•10% MORE staff said they would
recommend the Trust to family and
friends.
•10% MORE feel our culture &
organisation supports them to make
improvements for patients
•9% MORE staff said they feel that the
quality and safety of patient care is our
organisation’s top priority.
•9% MORE staff said they felt supported
working in their team/department/service.

Happy staff, happy patients: a case study
Ellen’s story
•Ellen is ward sister on a cardio day case ward at St Bartholomew’s Hospital
which sees around 400 patients a month
•She uses IWGC patient feedback to help her ward create the caring
environment both her patients and staff want
•She goes through the previous day’s feedback with her team at the start of
each day. ‘Happy staff, happy patients’ is Ellen’s mantra

Ellen’s story contd..
•Patients complained about having to stand in a busy corridor outside labs when
waiting for a procedure. The team worked with hospital colleagues to secure a
designated waiting area where patients could feel more comfortable waiting.
•Patients complained about not having enough urinal bottles which the team
were able to address.
•The team reported feeling more empowered by knowing what patients thought
about the care they were providing and how they could make changes.
Highlights for the St Barts Hospital LiA Staff Pulse Check revealed
improvements in how valued and engaged staff feel:
•7% MORE St Barts hospital staff feel that the hospital is providing high
quality services to our patients/service users.
•6% MORE staff feel happy and supported working in their
team/department/service.

Ellen’s story contd..
IWGC May scorecard for Ellen’s Cardio day case ward

Key messages
• Importance of Board and CEO leadership
• Organisational ‘mission'
• Values and behaviours underpinning culture change
• Workforce – improving permanent staffing (recruitment and
retention)
• At scale development of approaches to engage staff and
patients
• A shared leadership culture which connects local leadership,
driving improvement and using staff and patient feedback at
its heart.

.org
Break & lunch buffet
Served in the Edwards Room
Please be re-seated by 13:30 in preparation for the working lunch & panel
discussion

.orgPanel discussion
• Neil Bacon
• Clare Rees
• Liz Mouland
• Jeremy Howick
• Alwen Williams
• Charles Vincent

ORGANISATION STAFF
Morale
Empathy
PATIENT
EXPERENCE
HAPPINESS
FREEDOM
Satisfaction
Clinical
outcome
Development
Courses
V
A
L
U
E

.org
Symposium Feedback link:
www.smartsurvey.co.uk/s/iWGCSy
mposium2016Feedback
Thank you

iWGC symposium 2016 slide deck

Recomendados

Recomendados

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Similar a iWGC symposium 2016 slide deck

Similar a iWGC symposium 2016 slide deck (20)

Último

Último (20)

iWGC symposium 2016 slide deck