1. 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

2. 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

3. 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.’

4. 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.

5. 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.

6. 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.

7. 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

8. 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 people
Aimed for 2 groups of 8-9 people

9. 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

10. 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

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

12. 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

13. 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

14. 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

15. 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

16. 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

17. Questions??