NICE Guidance and Quality Standard on Patient Experience Dr Sophie Staniszewska, Chair of NICE Guidance Development Group Royal College of Nursing Research Institute School of Health and Social Studies University of Warwick

Key initiatives Importance of patient experience Darzi (2008): High quality care for all NHS Constitution (2009-2010) White Paper: Equity and Excellent: Liberating the NHS NICE Guidance – direct referral from DH

Nature of evidence NICE Guidelines normally developed around clinical and economic evidence Patient experience has drawn on patient-based evidence of experiences Patient-based evidence can sit alongside clinical and economic forms of evidence (Staniszewska et al 2010)

Guidance A set of recommendations focusing on key aspects of patient experience Informed by: Research evidence Recommendations in previously published NICE guidelines National survey data Synthesised through consensus process

Quality standard QS developed alongside guidance QS are set of specific, concise statements and associated measures Aspirational, but achievable Markers of high-quality, cost effective care Derived from best available evidence

Focus of Guidance Directed primarily at clinical staff Patient experience is also affected by non-clinical staff such as receptionists, clerical staff and domestic staff Reflects entirety of patient experience

NICE Guidance: Key areas Knowing the patient as an individual Essential requirements of care Tailoring healthcare services for each patient Continuity of care and relationships Enabling patients to actively participate in their care

Knowing the patient as an individual Patients value healthcare professionals acknowledging their individuality Values, beliefs and circumstances influence expectations, needs and service use Recognition individuals are living with condition, so family and broader life need to be taken into account

Example: Recommendation 1.1.1 “Develop an understanding of the patient, including how the condition affects the person, and how the person’s circumstances and experiences affect their condition and treatment”

Essential requirements of care Patients have needs other than the treatment of a specific health condition Recognition of potential need for psychological and emotional support Importance of meeting fundamental needs – nutrition and pain management

Example: Recommendation 1.2.1 Respect for the patient: All staff providing NHS services should: Treat patients with respect, kindness, dignity, compassion, understanding, courtesy and honesty Respect the patient’s right to confidentiality Not discuss the patient in their presence without involving them in the discussion

Tailoring healthcare services for each patient Patients wish to be seen as individuals in the healthcare system Services need to be tailored to respond to needs, preferences and values of the patient Advice on treatments and care, including risks and benefits should be individualised as much as possible

Example: Recommendation 1.3.1 Adopt an individualised approach to healthcare services that is tailored to the patient’s needs and circumstances, taking into account their ability to access services, personal preferences and coexisting conditions. Review the patient’s needs and circumstances regularly

Continuity of care and relationships Continuity and consistency of care and establishing trusting, empathetic and reliable relationships with competent and insightful healthcare professionals is key to patients receiving effective, appropriate care

Example: Recommendation 1.4.1 Assess each patient’s requirements for continuity of care and how that requirement will be met. This may involve the patient seeing the same healthcare professional throughout a single episode of care, or ensuring continuity within a healthcare team

Enabling patients to actively participate in their care Many patients wish to be active participants in their own healthcare, and to be involved in creating and managing their health strategy and use of services. Self-care and self-management are particularly important for people with long-term conditions

Example: Recommendation 1.5.4 Establish the most effective way of communicating with each patient and explore ways to improve communication. Examples include using pictures, symbols, large print, Braille, different languages, sign language, communication aids, or involving an interpreter, a patient advocate or a family member

Examples of quality statements 1. Patients are treated with dignity, kindness, compassion, courtesy, respect, understanding and honesty 2. Patients experience effective interactions with staff who have demonstrated competency in relevant communication skills 3. Patients are introduced to all healthcare professionals involved in their care, and are made aware of the roles and responsibilities of the members of the healthcare team

Examples of quality statements 4. Patients have opportunities to discuss their health beliefs, concerns and preferences to inform their individualised care 5. Patients are supported by healthcare professionals to understand relevant treatment options, including benefits, risks and potential consequences

Examples of quality statements 6. Patients are actively involved in shared decision making and supported by healthcare professionals to make fully informed choices about investigations, treatment and care that reflect what is important to them 12. Patients experience coordinated care with clear and accurate information exchange between relevant health and social care professionals

Implementation Translating guidance into practice offers considerable challenges Uneven progress relates to complexity of process, with change required at many different levels and depends on range of factors that influence uptake Even more challenging for complex guidance

Implementation support NICE encourages commissioners in a range of ways: One of the factors used to judge tenders Ask providers to evidence of systems for collecting and using patient information Audit of local practice Collection of information across whole service pathway

Implementation evidence-base Implementation strategy needs to draw on implementation evidence-base Draw on existing frameworks eg. PARIHS Promoting Action on Research Implementation in Health Services Research Implementation is function of nature of evidence, context of implementation and way in which process if facilitated Core thinking could inform implementation strategies

Implementation “Support for commissioners and others using NICE Guidance and Quality Standard on patient experiences in NHS services” available on NICE website http://www.nice.org.uk/media/AA2/92/NICESupportForCommissionersAndOthersUsingThePatientExperienceQS.pdf Staff training and development resources

NICE Guidance Taken together, the NICE Guidance and Quality Standard captures the essence of good patient experience Implementation will ensure healthcare services are acceptable and appropriate Contribute to ensuring all people using NHS have the best possible experience of care

Contact sophie.staniszewska@warwick.ac.uk Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick