Graham Stroke Unit Patient and Family Focus group Author(s): Sinead Stack (OT), Kate Sampson (PT) Supervisor: Helen Crabb Project reference Number: 1754 Year: 2016

Background Graham Stroke Unit Patient and Family Focus Group recommended by Professor Tony Rudd (England’s National Clinical Director of Stroke) following review of Graham Stroke Unit in 2015. Existing patient feedback methods: - Patient/ family questionnaire on discharge - Informal feedback from family/ patients - PALS

Evidence Next Stage Review (DoH 2008) said the NHS must ‘empower patients with greater choice, better information and more control and influence'. Equity and Excellence: Liberating the NHS(DoH 2010) stressed that world-class health care ‘can only be realized by involving patients fully in their own care, with decisions made in partnership with clinicians, rather than by clinicians alone’ Kings fund (2012) suggested ‘involving patients in forums..as part of reforms..co-designing services.’

Evidence Coulter (2012) patient engagement helps deliver the right care, strengthens patients’ ability to manage long-term conditions and improves outcomes. Healthcare Quality Improvement Partnership (HQIP) state that the involvement and engagement of patients, service users and carers in clinical audit is vital and is a marker of high quality audit.

HCIP in Patient & Public Engagement (PPE), PPE in Clinical Audit 2009. Benefits of patient involvement “Expert patients” in their condition Difference in perspective Patient satisfaction, of being listened to Informing services and evaluating if they meet your needs Informing patients of changes to services Greater ownership of services Identify quality markers for patients HCIP in Patient & Public Engagement (PPE), PPE in Clinical Audit 2009.

Objectives for the focus group To provide an opportunity for a broad range of patients, family members, friends and carers to have their say on any aspect of their experience of admission to GSU. To gain detailed feedback on identified priority areas for service development. To identify suitable volunteers to sit on GSU Steering Group. To evaluate the effectiveness of the forum to inform decisions about the format and frequency of future events.

Timeline January 2016 Initial invitation was sent to 18 patient and family members. 12th February 2016 Follow up telephone confirmation regarding attendance Information leaflet sent out to confirmed attendees 22nd February 2016 Second round of invited sent by post 29th February 2016 4th March Questionnaires sent to patients unable to attend 5th March Patient and Family Focus group

Participants Cohort captured between September 2015- March 2016. Sample collected of current and previous patients. Randomized sample of patients selected from database. Target sample of 16-18 people Aimed for 2 groups of 8-9 people

Methodology Consent: written consent at the beginning of focus group & for photographs Data: 2 groups of 6 participants Qualitative data transcribed on flip chart during discussions with participants Analysis: Data collected was reviewed and summerised by the two lead professionals. - Comment cards given to participants at the end of the day Questionnaires collected from those who did not attend

Closing Remarks and Comment cards Format of the day Registration Introductory remarks - Housekeeping Consent Topic selection Group Discussion Theme 1 (20 mins) Group Discussion Theme 2 (20 mins) Closing Remarks and Comment cards BREAK

Communication on the ward Themes Medical care Environment Nursing Care Discharge planning Family support Communication on the ward Activities offered Therapy input

Theme 1- Nursing care Overall nursing care was good Difficulty getting help at certain times of the day e.g. going to the toilet around change of shifts between 8-9pm and 7-9am. Difficulty with getting medication on time Differences in care between staff members Shortages of nursing staff impacted on care and availability of staff Good when nurses nearby Easier when more independent as less dependent on nursing staff

Theme 2- Therapy Input Therapy aided confidence and prepared people to go home Getting ready to go home- home visits, functional tasks helped Patient dependent expectations about amount of therapy Enjoyed doing exercise and leaving ward Individual differences in preference of structure of weekly timetable Rest periods important Distractions and attention affected therapy More information on different types of therapy e.g. booklet/ induction More joint sessions with family ?Barber Groups aided building confidence and opportunity to interact with other stroke survivors Didn’t occur to people what to do in between sessions- no place to go/meet other patients

Discussion Staff shortages on GSU identified by participants and impact on level of care able to be offered More information required for patients & families to induct them onto the ward More focus on joint sessions/ preparation for discharge and self management required in therapy Individual differences in experiences dependent on level of disability Sample was mostly made up of those with low level of physical/cognitive/communication disabilities as transport was not available

Recommendations Liaise with ward manager regarding feedback re: nursing staffing levels Refine induction pack for patients and induction process for patients Increasing self management strategies on the ward e.g. independent activities, exercises Consider communal space for patients to sit to enable peer support Focus group separate for current patients on the ward, and past patients? Changing day of week/ location to enable transport for patients to focus group to capture different levels of disability

Action Plan Present findings to the Stroke Steering Group Kate & Sinead 20th May 2016 Liaise with ward manager regarding feedback re: nursing staffing levels May 2016 Refine induction pack for patients and induction process for patients B7 PT and SLT June 2016 Increasing self management strategies on the ward e.g. independent activities, exercises B6 PT July 2016 Consider communal space for patients to sit to enable peer support B7 PT, OT and SLT August 2016 Present findings to MDT on Graham ward B6 PT and OT Repeat GSU Patient and Family Focus Group B6 OT September 2016

Questions??