Students, using Care Opinion, as ‘agents of change’ Plymouth University Pam Nelmes, Kim Young, Ray Jones, Rebecca Baines

Synopsis @PlymUni have used Care Opinion across spectrum: intercalated urgent care and emergency care, undergraduate nurses, to postgraduate researchers in mental health Aim: not only to understand patient perspective but be ‘agents of change’ transforming services spreading patient centred approach helping patients better use online feedback Ray Jones

Urgent and Emergency Care Care (Patient) Opinion has been included as a resource in a UK intercalated course in Urgent and Emergency Care (UEC) since 2013 Methodology – in designing our unique BSc (Hons) intercalated programme we considered guiding principles aligned to professional values (i.e. GMC) focusing on person centred care, experience of UEC, patient focused outcomes, patient safety and collegiate engagement that incorporates feedback into a cycle of evaluation and improvement Methods – Care Opinion (CO) is utilised as a core resource/tool with a range of methods (tools/strategies/techniques) employed including: Social Media i.e. Twitter and engagement in online chats #fhecpu Webinars: seeking engagement at distance with interaction online (i.e. polls) Individual CO accounts: enabling students to engage, freely determine value and set up own reporting/alerting system Integration throughout the academic year enabled through teaching and learning activities linked to patient experience/feedback Assessment: encouraged and valued (formative and summative) UEC Programme LO – our Methodological Stance - the guiding principles and justification for inclusion of Care (Patient) Opinion The ability to use credible techniques of analysis and enquiry to promote high quality, person-centred care Ability to monitor the provision of care to promote effective outcomes and patient Safety Facilitate the development of self and others through collegiate engagement in learning activities incorporating feedback into a cycle of evaluation and improvement

Urgent and Emergency Care Care (Patient) Opinion: What have UEC Students learnt from this? Enhanced appreciation of patients perspective Opportunity to compare our (clinician) experience with that of our patients Understanding that patient ‘problems’ are less about ‘care’ and more about wider systems/processes (illustrating value at service level) How this empowers patients/others to improve care and clinical practice How feedback adds value to professional development and careers How quickly learning from stories can be applied to practice and used to inform Quality Improvement Projects (QIP) How patient stories prompt reflection leading to action planning How to gather local (or National) feedback specific to Urgent and Emergency Care services. Impact of feedback on individuals, teams and culture Value of this illustrated through teaching, assessment and feedback

Urgent and Emergency Care Care (Patient) Opinion: What ideas have students offered to improve? Clarify/emphasise the value of the student account (over and above ‘normal access) Develop a CO App – making this service more accessible Focus on/explore the value of CO to QIP Develop a students ‘space’ on CO i.e. patients sharing their stories focused on how a student ‘clerked’ the patient Produce a monthly/bi-monthly reports of key themes Enable students to learn how to respond to feedback/stories posted Raise profile of CO with medical schools, encouraging inclusion in medical curricula Develop the evidence base supporting CO – particularly evidence of impact on patient experience/care Illustrate value to professional registration and revalidation Emphasise the process of moderation and rationale i.e. ethical/legal

Plymouth University Undergraduate Pre-Registration Nursing Programme All nursing students are linked to Care Opinion Care Opinion is introduced into the first module in year 1 Huge numbers – over 450 per year Scheduled webinars in years’ 1 , 2, 3 – work well James asks students to vote in polls – students like to do this! Students queries are addressed - Q and As Kim Young

Plymouth University Undergraduate Pre-Registration Nursing Programme Care Opinion activity is linked to our WPE innovation across the 3 years’ of the Programme Students’ WPE work incorporates learning and ‘listening’ to the patient voice

Plymouth University Undergraduate Pre-Registration Nursing Programme Optional exercise 2nd years Tried getting students to review entries on Patient Opinion for local hospitals This engaged them – eg one Trust was more likely to respond to patient stories than other But we could not see how to embed this as a ‘repeat’ in the curriculum Ray Jones

Plymouth University Undergraduate Pre-Registration Nursing Programme Probably more hopeful way of getting students to be ‘agents of change’ is to get them to show family members, Care Opinion as one of a number of ‘ehealth’ websites. This was offered as an option in October 2016 and Ray Jones Toni Page

Discussion and demonstration of digital health 93 first year adult nursing students discussed and demonstrated digital health to an older relative, friend, or neighbour as part of their digital professionalism assessment. A secondary analysis was completed of students reflective logs.

Citizen Contacts as part of Wider Patient Engagement in the Nursing Curriculum (Toni Page PhD Project) To explore the feasibility of all nursing students visiting individuals living with one or more long-term condition(s), in a non-clinical setting, as part of the nursing curriculum. The project aims to be mutually beneficial to both students and citizen contacts, providing the chance for: Students to learn from the community, and Students to help the community (in using and learning about using the Internet for health).

Students will not provide clinical information. Nursing students in pairs visit citizen contacts twice in a non-clinical setting. Each student visit two citizens. Each visit provides students chance to hear the citizen contacts ‘story’ and learn from it and Signpost for citizen good ehealth website including CareOpinion The second visit summarises first visit and explores what has happened or changed since. Students will not provide clinical information.

Plymouth University Undergraduate Pre-Registration Nursing Programme Finally we encourage students to review patient feedback before going on placements – hoping that not only to orientate to that placement, but students also to tell placement mentors about Care Opinion and can bring patient stories to their attention.

PhD Mental Health – Care Opinion can: Show us what service users value in their healthcare experiences Identify areas for improvement Lead to beneficial change However, this can only realistically be achieved if someone is listening and responds. In collaboration with a mental health patient research partner we developed a response framework outlining how to satisfactorily respond to patient feedback from the mental health community in an online environment.

PhD Mental Health – Here’s how we did it Methods – four interrelated stages: Systematic search of published stories about adult mental health services or experiences in the South West of England (Jan2005-Jan2017) Thematic analysis of a representative sample (20%, n=37) in collaboration with a patient-research partner to identify factors likely to influence patient response satisfaction; Discussion and validation of identified factors with a wider patient-carer stakeholder group (n=12), leading to the co-production of a best-practice response framework Quality appraisal of identified responses using the developed framework framework.

PhD Mental Health – This is what it looks like Have you explained your role? What you’re responsible for etc.? Are you responding within 7 days? If not, have you apologised and explained why there is a delay? Have you explained why you in particular are responding? Have you identified your role? Introductions Have you provided your name in the title of your response? Have you provided a photo of yourself? Have you named the story provider? Explanations Have you thanked the story provider for taking the time to provide their feedback? If negative, have you apologised and reassured the provider that you are there to help and listen?** If positive, have you offered to pass the feedback on?* Thanks & apologies Have you offered to make contact with the story provider at a later date to check how they’re getting on? Have you made this clear? ** Have you uniquely tailored your response? Have you provided more than one contact option? Not everyone likes the phone.** Have you provided: contact details opening times and a named person for these services?** Have you directed the story provider to other relevant services and explained that services purpose?** Content   Have you signed off your response in a polite manner? Would you be satisfied receiving this response? Sign-off Speed of response Signposting

Have you provided your name in the title of your response? Introductions Have you provided your name in the title of your response? Have you provided a photo of yourself? Have you named the story provider? Explanations Have you explained your role? What you’re responsible for etc.? Have you explained why you in particular are responding? Have you identified your role? Speed of response Are you responding within 7 days? If not, have you apologised and explained why there is a delay?   Thanks & apologies Have you thanked the story provider for taking the time to provide their feedback? If negative, have you apologised and reassured the provider that you are there to help and listen?** If positive, have you offered to pass the feedback on?* Content Have you offered to make contact with the story provider at a later date to check how they’re getting on? Have you made this clear? ** Have you uniquely tailored your response? Signposting Have you provided more than one contact option? Not everyone likes the phone.** Have you provided: contact details opening times and a named person for these services?** Have you directed the story provider to other relevant services and explained that services purpose?** Sign-off   Have you signed off your response in a polite manner? Would you be satisfied receiving this response? * Only applicable to positive/mixed stories ** only applicable to negative/mixed stories

Named the story provider Directed and explained signposted services** PhD Mental Health – This is how current responses compare Explained role 0% (n=0/183)   Responded within 7 days 66.1% (n=121/183) Explained why they are responding Identified role 64.5% (n=118/183) Introductions Provided name in title 58.5% (n=107/183) Provided a picture 2.7% (n=5/183) Named the story provider 27.9% (n=51/183) Explanations Thanked story provider 71% (n=130/183) Apologised if negative ?** Apology 73.6% (n=104/141) Offered to pass positive feedback on* 74.1% (n=40/54) Thanks & apologies offered to make contact with story provider at a later date ** 7.1% (n=10/141) Uniquely tailored response   76.5% (N=140/183) provided more than one contact option** 66.6% (n=94/141) provided: contact details opening times and a named person?** 5.7% (n=8/141) Directed and explained signposted services** Directed 92.2% (n=130/141) and explained 0.71% (n=1/141) Content signed off response in a polite manner 59% (n=108/183) Sign-off Speed of response Signposting

Named the story provider Directed and explained signposted services** PhD Mental Health – This is how current responses compare Introductions Provided a picture 2.7% (n=5/183) Provided name in title 58.5% (n=107/183) Named the story provider 27.9% (n=51/183)   Explanations Identified role   64.5% (n=118/183) Explained role 0% (n=0/183)   Explained why they are responding   0% (n=0/183) Speed of response   Responded within 7 days 66.1% (n=121/183)   Thanks & apologies Thanked story provider 71% (n=130/183) Offered to pass positive feedback on* 74.1% (n=40/54)   Apologised if negative ?** Apology 73.6% (n=104/141) Content Uniquely tailored response   76.5% (N=140/183)   offered to make contact with story provider at a later date ** 7.1% (n=10/141) Signposting Directed and explained signposted services** Directed 92.2% (n=130/141) and explained 0.71% (n=1/141)   provided: contact details opening times and a named person?** 5.7% (n=8/141) provided more than one contact option** 66.6% (n=94/141) Sign-off   signed off response in a polite manner 59% (n=108/183)    

PhD Mental Health – So what It is hoped that organisations, practitioners and potentially students will use the framework to: enhance the quality of feedback responses identify systemic strengths and weaknesses improve the perceived responsiveness of healthcare services and providers And learn to effectively listen to, learn from and respond well to the patient voice

Conclusion We have shown how we have gradually found more and more used of Care Opinion, in emergency care, in nursing, and in mental health. We would like to get it spread to medicine, dentistry, the other health professions – we’re working on it. We have shown how Care Opinion can be one of the central tools in our aim of our students being agents of change Pam Nelmes and Kim Young