Always Events Thematic analysis

Steps Collect data Analyse data to identify themes Agree on Always Events Step 4 Does Always Event fulfil criteria? Step 5 Design Quality Improvement project based on Always Event

Questionnaire What do you feel is so important that it should ALWAYS happen when you have contact with __________________? (name of unit/department) 1 2 3

Number of responses needed Data saturation

Combines responses “All staff should be polite and pleasant towards patients” “Prefer to see same GP every time and if given bloods want to know exactly what the results are...” “Someone shows genuine concern for any matter that I present with” “That I can get through on the phone to reception quickly.” “The appreciation by reception staff that patients (more often than not) actually do need some consultation with someone whom they find approachable and whose diagnoses and judgement they trust” “I want the correct treatment for my problem” “That we are able to access a doctor or practice nurse ‘on the day’ for important problems...” “It matters a lot to me that I receive good care which I do, as this allows me to continue working and doing the many things I do” “Being treated as an individual – not next in line, but don’t feel this is a problem” “That you can ask the GP anything you need to and to understand what they say because they are saying it using words and language you understand. That they talk to you, not look at the book or computer…” “It should be friendly and efficient and I should always be No.1” “It [care] is given to me by people who are properly qualified and understand my needs” “I feel that when I leave the surgery that I have had a positive outcome e.g. any questions that I had have been answered and even more importantly that I have been listened to” “The ability to book appointments in advance with a GP of my choice and at a time convenient to me” “That I should be able to see the nurse/doctor I always see and have confidence in...” Read and re- read data – immerse yourself in data

Code responses “All staff should be polite and pleasant towards patients” “Prefer to see same GP every time and if given bloods want to know exactly what the results are...” “Someone shows genuine concern for any matter that I present with” “That I can get through on the phone to reception quickly.” “The appreciation by reception staff that patients (more often than not) actually do need some consultation with someone whom they find approachable and whose diagnoses and judgement they trust” “I want the correct treatment for my problem” “That we are able to access a doctor or practice nurse ‘on the day’ for important problems...” “It matters a lot to me that I receive good care which I do, as this allows me to continue working and doing the many things I do” “Being treated as an individual – not next in line, but don’t feel this is a problem” “That you can ask the GP anything you need to and to understand what they say because they are saying it using words and language you understand. That they talk to you, not look at the book or computer…” “It should be friendly and efficient and I should always be No.1” “It [care] is given to me by people who are properly qualified and understand my needs” “I feel that when I leave the surgery that I have had a positive outcome e.g. any questions that I had have been answered and even more importantly that I have been listened to” “The ability to book appointments in advance with a GP of my choice and at a time convenient to me” “That I should be able to see the nurse/doctor I always see and have confidence in...” 2nd person - agreement

Arrange in themes “It should be friendly and efficient and I should always be No.1” “All staff should be polite and pleasant towards patients” “Being treated as an individual – not next in line, but don’t feel this is a problem” “Someone shows genuine concern for any matter that I present with” “I want the correct treatment for my problem” “It [care] is given to me by people who are properly qualified and understand my needs” “It matters a lot to me that I receive good care which I do, as this allows me to continue working and doing the many things I do” “That you can ask the GP anything you need to and to understand what they say because they are saying it using words and language you understand. That they talk to you, not look at the book or computer…” “The appreciation by reception staff that patients (more often than not) actually do need some consultation with someone whom they find approachable and whose diagnoses and judgement they trust” “I feel that when I leave the surgery that I have had a positive outcome e.g. any questions that I had have been answered and even more importantly that I have been listened to” “That I can get through on the phone to reception quickly.” “The ability to book appointments in advance with a GP of my choice and at a time convenient to me” “That we are able to access a doctor or practice nurse ‘on the day’ for important problems...” “Prefer to see same GP every time and if given bloods want to know exactly what the results are...” “That I should be able to see the nurse/doctor I always see and have confidence in...”

Themes - example Access to, and continuity of, healthcare “That I can get through on the phone to reception quickly.” “The ability to book appointments in advance with a GP of my choice and at a time convenient to me” “Prefer to see same GP every time and if given bloods want to know exactly what the results are...”

Create Always Events Generate Always Event that summarises theme (or part of the theme) and uses the patient’s own words Candidate Always Event: “I want to be able to get through on the telephone to reception quickly”

Does candidate Always Event fit the criteria? Always Event Criteria: 1. Is any healthcare interaction, process or outcome that is judged by patients, carers or relatives to be a highly important determinant of care quality and experience 2. Is unambiguous and specific to enable reliable measurement 3. Is consistently deliverable to applicable patient groups by all relevant health care organisations, teams and individuals; AND 4. Is feasible as part of routine health care delivery

Design Quality Improvement Project Always Event: “I want to be able to get through on the telephone to reception quickly” Measure: Patients will speak to a member of staff within two minutes of phoning. (Practice has electronic call handling system) Standard (target) 90% of patients will speak to a member of staff within two minutes of calling.

Team involvement Discussion with frontline staff Agreement on measure and standard (target) Discussion regarding how to interrogate call handling system to collect data Agreement to look at weekly data (could easily use much smaller sample sizes)

Baseline data collection In one week: 1168 calls 561 (48%) answered within 2 minutes

Implement change Discussed handling of calls : House visits Prescription requests Test results Streamed to appropriate caller – alteration to call handling system

2nd data collection 1232 calls 690 calls (56%) answered within 2 minutes

Change Busiest at 8:30am to 10:00am on Monday, Tuesday and Wednesday One staff member agreed to change hours

3rd data collection 1067 calls 898 calls (84%) answered within 2 minutes

Implement change Online appointment booking

4th data collection 1221 calls 1050 calls (86%) answered within 2 minutes

Presentation of data Standard = 90%

Your turn! Review your responses from patients Assign codes to quotes Identify one theme from your data Generate a candidate Always Event within that theme Apply the criteria (in packs) to determine if it is an Always Event

Going forward NES project support Evaluation BMJ Quality licences Publication

BMJ Quality Platform http://quality.bmj.com/

BMJ Quality Resources

BMJ Quality Improvement Reports http://qir.bmj.com/