Annie Laverty Director of Patient Experience and Quality Improving the Patient Experience The Northumbrian Way Annie Laverty Director of Patient Experience and Quality

Northumbria Healthcare Employing almost 10,000 staff. Largest area of any health trust in England Providing integrated health and social care Three general hospitals and seven community hospitals. Firstly –thought it may be useful to share a little about our organisation.

2013 Systematic review. “patient experience is consistently positively associated with patient safety and clinical effectiveness across a wide range of disease areas, study designs, settings, population groups and outcome measures” “clinicians should resist side-lining patient experience as too subjective or mood orientated, divorced form “real” clinical work of measuring safety and effectiveness”.

Leadership at all levels focused on compassionate care and service improvement

Patients, staff and other key stakeholders actively engaged on quality Performance reviewed at every level Transparency, a cornerstone of our improvement Clinically lead, frontline change

Values in action. Value Based Recruitment : “The nurses are wonderful. You cannot make a nurse, they are a certain kind of person. They do wonders.” The importance of ‘being held in mind.’ (PAWL,1995) “Every day Teresa gives me my tea just how I like it and always with a lovely, big smile. She is so kind with me. ” “ I think this Trust chooses it’s nurses because of how friendly they are.”

Using insights from patients and families to improve care

Responding to patient feedback Feedback from more than 50,000 people every year Measuring what matters most to patients in a variety of ways and at different points of care Right time’ data giving site, specialty, and individual consultant data, externally validated to feed through appraisal system Real time measurement fed back to clinical teams within 24 hours

Health Quality Checkers Team

Individual consultants.

Real time data

What matters most to inpatients. Consistency and coordination of care Treatment with respect and dignity Involvement Doctors Nurses Cleanliness Pain control

Real Time Report – Ward 10 Wansbeck 20 01 2015 100% of patients surveyed would highly recommend this ward to their Family and Friends The baseline data is established on responses patients surveyed in 2014. Number of respondents 12 (60%)

Real Time Data – By Business Unit 2014 No of Patients Surveyed Coor-dination Respect & dignity Involve- ment Doctors Nurses Clean- liness Pain Control Medicines Kindness & Compassion Domain Average Recom- mendation Medicine 3665 9.06 9.90 9.38 9.81 9.78 9.85 9.80 8.34 9.86 9.53 9.41 Surgery 2680 9.20 9.84 9.39 9.75 9.83 9.64 8.62 9.82 9.55 9.51 Children 144 9.23 9.93 9.74 10.00 9.89 8.59 9.69 9.77 Total 6489 9.12 9.88 9.79 8.46 9.54 9.46 16

Commissioning for quality.

Real time improvements (n= 12,000)

Real Time Domain Averages 2014 to date

Real Time Domain Averages 2014

Negative Themes Q1 Negative Themes Q2 Top 3 Positive Themes Q1 Quality of the staff 28% Quality of the care 28% Kind empathetic caring staff 14% Top 3 Positive Themes Q2 Quality of the staff 29% Quality of the care 20% Kind empathetic caring staff 15%

Data that drives Timely Owned Actionable Specific Talked about

September 2014 Results 53% of patients surveyed would highly recommend this ward to their families and friends. 23

Patient Comments Analysis – (August 2014) Total number of individual patient comments: 201 Total number of positive transactional themes: (themes that include the processes we have to deliver care to our patients) 103 47% Total number of positive themes: 219 62% Total number of positive relationship themes: (themes that include the empathy, kindness and compassion we show to our patients) 116 53% Total number of negative themes: 137 38% Total number of negative transactional themes: 70 51% Overall total of positive and negative themes: 356 Total number of negative relationship themes: 67 49%

December 2014 Results

Being open and honest with patients, families and the public

Sharepoint available to all on the intranet

Sustained engagement in making measurable improvements

Staff well being and patient experience Seven staff variables (‘wellbeing bundles’) which are linked to good patient-reported experience. These are: good local (team)/work-group climate perceived organisational support high levels of co-worker support low emotional exhaustion good job satisfaction supervisor support good organisational climate

Strong staff engagement as our foundation. Our Staff Survey Performance Best response 3 years in a row. 2013 - 78% 2012 – 71% 2011 – 75% 2010 – 68% Engagement scores 2013 - 3.88 2012 - 3.79 Acute Average is 3.74 Medical Engagement at the heart of our organisation

Our story of moving the dot. Number of staff believing high quality patient care is the No1 priority of the trust. “You cannot make things happen, but you can create a space in which what you want is more likely to happen.” – Chinese proverb

#6. Celebrating compassion and rewarding staff

Quality Improvement Using our data to drive change

Complaints Improvement Project Phase 1: project planning Defining objectives & scope; focus on Trust-wide complaints process and its outcomes Phase 2: evidence gathering Mapping of the complaints process and analysis of data against metrics Phase 3: stakeholder engagement Focus groups & interviews of all key stakeholder groups, including patients. Phase 4: recommendations Developed and tested with all key stakeholder groups, designed around SMART principles. Post EMT approval of recommendations, full implementation plans will need to be developed. Phase 5: implementation

Our shared purpose Our commitment to dignified and compassionate care for frail older people.

Support for Junior Doctors with QI Free subscription to BMJ Quality improvement programme. Supports meeting FY and ARCP requirements. Learning modules to develop knowledge re QI. Publication in a BMJ Journal!

Key things we have learnt. The benefits of real time reporting at team level. Executive management team support is crucial. Ensure patients & families are part of your improvement team. Focusing on things that matter most has made sense. Investing in improvement has helped. Qualitative feedback appears particularly important. Transparency of reporting matters.

Thanks for listening. Any questions.