1. National DRS Patient Feedback
Introduction
The idea of looking at patient feedback came after our Clinical Governance team provided our DRS team with a communications session last year. I was in discussion with them following the session and the topic of patient feedback came up. They mentioned that a couple of departments were using various tools to gather such information.
Angela Ellingford 2010

2. Clinical Governance Team
Better Together, Scotland’s Patient Experience programme
Patients carers and staff as partners
Experiences
Improvement
Sharing best practice
They mentioned the Better Together project.
Programme to support and equip staff with tools and techniques to improve Service quality.
Website to share good practice
It fits with methodology of small tests of change which will improvement Services at the frontline.
Encourages patient centred activity is the key drive for improving quality of the patient experience.

3. It’s our Health Service A guide to involvement 2005
‘Patient’s expertise is gained not from colleges and formal learning, but from the 24 hour, day in day out, experiences of needing to use services for personal support’
Why should patient centred activity work… and why should we involve patients.
Here is a quotation taken from Its our Health Service and the essence here is that we can learn from patients who have had first hand experience of the NHS.

4. Benefits of involving people:
awareness of how Service is actually experienced
helping to improve communication between patients and staff
opportunities to improve Service and avoid mistakes
So what are the benefits of involving people/patients include:
Patients have an understanding of how the service is actually experienced
Helping to improve communication between patients and staff
Opportunities to improve the service and avoid mistakes

5. Being Nice Patient & Public Involvement Patient Information
Patient Participation
Public Involvement
Patient/Public Feedback
Patient experience
Volunteering
Patient Focus and Public Involvement is now part of the clinical governance model and it is one of the jigsaw model segments which our Clinical Governance team use.
Patient involvement is not new in DRS, take patient information for example, the National leaflet on DRS Screening, this was produced mainly by the service Managers but it was focused on the patient and it went to patient groups for comment and amendment prior to going to print.
It is now used as one of our methods of communication with patients.

6. Model for Improvement
Any form of patient involvement must lead to demonstratable benefits to them.
Using this Model for Improvement, the aim becomes one of generating patient-inspired Plan-Do-Study-Act. You start off by planning what you are going to do, you then carry out the plan, you then analyse the results and act on what you have learned.

7. ‘Plan’ - How can we gather information?
Various techniques
brief questionnaires
complaints
focus groups
interviews
patient forum
patient stories
There are a number of methods of achieving how we gather information
Brief questionnaires/ comment cards
Complaints
Focus Groups
Interviews
Patient Forums
Currently NHS Tayside use Patient Stories fairly extensive

8. ‘Plan’ – Method Brief questionnaires simple/inexpensive
responses anonymous, more likely to be honest
visible comment cards on display board
opportunity for feedback
opportunity for improvement and reinforcement of good practice
We decided to use brief questionnaires
simple/inexpensive
responses anonymous, more likely to be a true reflection of what people think
We decided to produce visible comment cards which we would display on boards in our waiting room
opportunity for feedback
opportunity for improvement and reinforcement of good practice

9. ‘Plan’ - Questions (Please be as specific and honest as possible)
If you could change one thing about your visit to the Diabetic Screening Service, what would it be?
(Please be as specific and honest as possible)
What was good about your recent visit to the Diabetic Screening Service ?
(Please be as specific and honest as possible)
What was not so good about your recent visit to the Diabetic Screening Service?
(Please be as specific and honest as possible)
Any further comments
(Please be as specific and honest as possible)
How would you mark our department out of ten:
Plan
We called our questionnaire how are we doing
What was good about the service
Not so good
If you could change something what would it be
Any further comments
Marks out of 10

10. ‘DO’ - How we collected information
Ask Screeners to ask patient (especially when dilating) if they would answer a few questions
Decided to gather information from hospital sites independently to mobile unit sites
Remember we wanted to do this on a small scale and therefore decided to survey patients at two hospital-based sites, Ninewells and Perth Royal Infirmary. I asked the Screeners to select around 5 patients per week at random per week. Those patients who had just been dilated were a target because they had time on their hands.
We carried out our information gathering on the mobile units during Spring-Summer time when the weather tends to be better. We try not to use the mobile vehicles from January to March when the weather is more inclement

11. ‘Study’ – Results
Results were input into an Excel spreadsheet and the top three responses were highlighted in aspects of good, not so good and changes patient would like

12. NHS Tayside patient comments
‘What was good’
quick and efficient
helpful, courteous staff
put at ease
‘Changes you would like’
improve result letter
dilation
water drinks machine
‘What was not so good’
dilation
duplication of Optician’s test
did not like the mobile van
‘Further comments’
coincide screening and DC appointments
apprehensive but fears were unfounded thanks to staff
keep up the good work
Here are the top three from each of the three areas.

13. Diabetes Eye Screening Patient feedback
Diabetes Eye Screening Patient feedback. What you said, and what we have done about it! Read comments from previous patients and how we have responded to them. If you would like to complete a feedback form, please speak to one of the screening staff. Thank you
The comments were then inserted into a template which I was sent by the Clinical Governance Team starting with this one and the top three comments were printed out and displayed on a board within the patient waiting rooms

14. Good about the Service
What was good about your visit to the Diabetic Eye Screening Service …
You liked our friendly Service.
You said:
We will ensure feedback to all staff.
Our response:
What was good about your visit to the Diabetic Eye Screening Service …
You said:
You said you were put at ease and had the process well explained.
Our response:
We will ensure that this is passed onto the relevant staff group
What a moral boater for your staff to see this displayed in the waiting room

15. Not so good about the Service
What was not so good about your visit to the Diabetic Eye Screening Service …
You said:
I did not like the Mobile Unit especially in bad weather.
Our response:
We are considering more static sites.
What was not so good about your visit to the Diabetic Eye Screening Service …
You said:
Why should I attend the Eye Screening Service as well as my Optician.
Our response:
We are sending an information sheet to all our patients explaining the reasons.
What was not so good about your visit to the Diabetic Eye Screening Service …
You said:
You did not like the dilating drops.
Our response:
Unfortunately, sometimes we cannot take photographs without drops
Some patients mentioned they preferred the static clinic to clinic conducted inside the mobile vans as a result I am now considering more static sites
Dilating drops was a big issue – most of the respondents were dilators
Confusion about the difference between us and the Optometrist. This made me think about what we could do. I brought the problem up with our retinopathy subgroup and it was decided that I should contact the Chairman of the local Optometry Committee and explained that we had decided to send all patients an information sheet explaining the difference and would they like to add anything to the leaflet. Their response was positive but they proceeded to send me a two page document all about Optometry and what they had to offer. The retinopathy subgroup within Tayside then worked on this and eventually a mutually agreed worded leaflet was produced

16. 16

17. Changes to the Service
If you could change one thing about your visit to the Diabetic Eye Screening Service, what would it be …
You said:
The results letter is rather vague.
Our response:
These are Nationally agreed letters which have already been through patient groups, however, we will pass on your comments to the relevant parties.
If you could change one thing about your visit to the Diabetic Eye Screening Service, what would it be …
You said:
Why don’t you provide a water fountain or drinks machine?
Our response:
We are having a water fountain installed.
There were a number of complaints regarding our result letters in that a number of people thought there is not enough information should the patient have been referred to ophthalmology. Although I believe Dr Caroline Styles has addressed this by producing a letter for patients who have been referred.
Anything out of our control was passed onto the relevant staff members such as the Charge Nurse who told me in this case that a water fountain was being installed

18. Any Further Comments Any further comments …
It is good to be seen at the same time as my Diabetic Clinic appointment.
You said:
We try to do our best and coincide our appointments if possible.
Our response:
Any further comments …
I was apprehensive about test but fears unfounded thanks to staff
You said:
Staff are encouraged and ensure patients are fully informed about the procedure.
Our response:
Certainly our Ninewells Hospital patients appreciate that we try our best to fit them in at the same time as their diabetes appointment. It takes us a little more time to provide this service but I think it is worthwhile.

19. What was useful local person responsible for analysis, common trends
cards eye catching
feedback can change as more responses received
includes a score fed back to staff
local person responsible for analysis, common trends
cards eye catching
feedback can change as more responses received
includes a score fed back to staff – we in NHS Tayside scored over 9 out of 10

20. ‘Act’ - What did we do with the feedback
comments reviewed at team meeting
feedback to staff appreciation of value
some things able to modify ie considering more static sites, optometry letter, etc
others not possible ie result letter
comments passed on to appropriate staff outwit the DRS team
In Summary:
comments reviewed at team meeting
feedback to staff appreciation of value
some things able to modify ie considering more static sites, optometry letter, etc
others not possible ie result letter
comments passed on to appropriate staff outwith the DRS team and the appropriate staff were then asked if they could address the issues raised

21. National Feedback discussed all Service Managers
all Health Boards participated
given the same tools and templates
feedback similar with local issues/problems
modifications to their Service
Discussed all Service Managers
We had buy-in from all Health Boards participated
I passed on the same tools I had used
Feedback similar with local issues/problems
Some SM made modifications to their Service

22. National Feedback – What was good about the Service
efficient and prompt service
very reassuring, put mind at ease
staff helpful, professional, polite
staff explained each stage
you get a good laugh
very flexible, staff fitted me in
home visits (optom service)
efficient and prompt service
very reassuring, put mind at ease
staff helpful, professional, polite
staff explained each stage
5th down - you get a good laugh – don’t know what was going on in that service
very flexible, staff fitted me in
home visits (optom service)

23. National Feedback – What was not so good about Service
drops, not being allowed to drive
parking
lack of information
waiting time for results
perhaps more time to ask questions
better signage
having to take time off work
drops, not being allowed to drive
There were a number of local issues such as parking and better signage
lack of information, I am unsure whether the Health Board concern were sending out patient leaflets but this is information which I hope the Service Manager has acted upon this feedback
waiting time for results – again this is another area that the Service Manager would have to address
perhaps more time to ask questions
having to take time off work

24. National Feedback – Changes you would like
not having to have dilating drops
better access/parking
not being informed of result at time of appointment
more flexible appointments after working hours or weekends
having a doctor to answer any questions
not having to have dilating drops
Again some local issues were highlighted such as better access/parking
being informed of result at time of appointment
more flexible appointments after working hours or weekends
having a doctor to answer any questions

25. National Feedback – Further Comments
text message reminder for your appointment
result letter impersonal
eye screening at the same time as diabetic appointment or same time as other health care professional appointments
There were some further comments for local consideration such as:
text message reminder for your appointment. I know that Mike and Neville have been working on the possibility of this happening
result letter impersonal
eye screening at the same time as diab appt or same time as other health care professionals

26. National Feedback – Service Modifications
NHS WI
optometry letter
NHS Highland
telephone numbers as a footer because patients complained not all letters had a contact number
installation background music in reception area
NHS Orkney
new car parking facilities and a hospital project committee has been setup to address hospital signage
Optometry letter
Telephone numbers as a footer because patients complained not all letters had a contact number
Installation background music in reception area

27. National Feedback – Morale Boasters
excellent Service and did not have to wait
thanks to all staff who made my appointment an easy experience
looking forward to next year
I wish all Services could be like this one
keep up the good work
thank you for keeping an EYE on me (pun intended)
if I did not have diabetes I would still like to come because of the staff!
And finally, I thought I would finish on a high give some of the most positive feedback from all the areas. Most areas
excellent Service and did not have to wait
thanks to all staff who made my appointment an easy experience
looking forward to next year
I wish all Services could be like this one
keep up the good work
thank you for keeping an EYE on me (pun intended)
if I did not have diabetes I would still like to come because of the staff!

28. Thank you