1. 1
This document sets out a number of improvements that will be implemented
in 2016/17 for ensuring that all patients receive compassionate care and that
the patient’s voice sits at the heart of the improvement programme.
May 2016
Patient Engagement
and Experience Strategy
Deborah Kelly - Deputy Chief Nurse
Paula Lloyd Knight - Head Patient Experience
3. 3
1.0 Introduction
1.1 The Trust’s Quality Improvement Plan ‘Safe
and Compassionate’ is the principal vehicle for
driving quality improvement across the Trust.
The plan outlines a range of improvements
that are not just a response to the Care Quality
Commission’s (CQC) Inspection report of May
2015; it also includes the actions that staff feel
are necessary to provide the communities we
serve with safe, effective, compassionate and
high quality care.
1.2 The Patient Engagement and Experience
Strategy should be read and understood
within the context of the wider improvement
objectives set out in ‘Safe and Compassionate’.
This document will outline in more detail the
step-change required to realise the ambitions
around patient engagement and experience
and will serve as the foundation for sustained
improvements in this area.
1.3 All staff at Barts Health are committed
to delivering compassionate care resulting in
a positive patient experience. In doing so our
vision is to build a new dynamic collaboration
with the community we serve. We aim to
improve the way we engage local patients and
citizens around their health care needs. This
strategy reinforces our commitment to safe and
compassionate care across the Trust, working
together with our patients and partners.
1.4 This strategy sets out a number of
improvements that will be implemented in
2016/17 to ensure that all patients receive
compassionate care and that the patients’ voice
sits at the heart of the improvement programme.
In developing the strategy, we engaged a wide
range of stakeholders and co-designed principles
and improvements that will enable the Trust to
achieve the goals we have set ourselves.
2.0 Principles underpinning patient
engagement and experience
improvements
2.1 Barts Health will ensure that our patients,
carers and the communities we serve are:
• at the heart of everything we do
• supported to proactively engage and
contribute to decisions that impact on
their care
• engaged in a dynamic way which reflects the
diverse needs of our communities
• offer support to better understand and access
organisational systems to inform and shape
our services.
2.2 Barts Health will:
• develop a culture which proactively takes steps
to build collaborative relationships
• invest in resources to support and develop
effective and meaningful patient engagement
and involvement
• share good practice: learning from patients,
listening and valuing contributions of patients,
demonstrating the impact of involvement
• develop engagement and involvement
pathways which are inclusive
• build collaborative relationships with external
partners including Clinical Commisioning
Groups (CCGs), Healthwatch and community
groups thereby facilitating a voice and
feedback mechanism for patients in the
community when issues are brought to
Trust forums.
4. 4
3.0 Our commitment
3.1 To deliver care compassionately and give a
positive patient experience requires proficient
staff with not only the right values and
behaviours but also with the right knowledge,
skills and competence to deliver high quality
care with compassion. Our staff need to be
resilient with an advanced level of listening skills
to enter into a meaningful discussion about the
holistic care our patients need.
3.2 We will harness our staff’s enthusiasm and
focus our attention on what matters most to
patients and their families – high quality, safe,
effective personalised care.
3.3 We will work to ensure that equality and
inclusion is embedded in the way we deliver the
patient engagement and experience strategy
through consistency in collection of diversity
monitoring information, working with the
Business Intelligence Unit, Public Health and
Strategy Teams and working collaboratively with
the Equality and Inclusion team.
3.4 Everyone working at Barts Health has a
common goal: to make sure the care we provide
is as good as it can be. We want patients to
have access to high quality care when they
need it; we want our staff to feel valued and
supported at all times and we want our local
community and partner organisations to be
confident in Barts Health as a provider of
excellent care and an employer of choice.
3.5 We will work to ensure equality and
inclusion principles are embedded in the
delivery of the patient engagement and
experience strategy.
4.0 Key areas for improvement
4.1 In order for the Trust to deliver against
this commitment we need to develop
an organisational culture around patient
engagement and experience. This strategy
sets out a number of changes and proposals
that have been co-designed with patients and
key stakeholders within the context of four
improvement areas outlined above.
These include the need to:
• establish robust governance structures
to monitor and embed strategies for
improving patient experience throughout the
organisation with patients fully involved at all
levels of the structures
• more effectively and responsively listen to
patient feedback – strengthening the way we
listen and respond to our patients and their
concerns
• develop the capacity and capability for staff
and patients to be heard – creating pathways
for patients to be involved at all levels of the
organisation
• refresh improvement goals set out in
‘Safe and Compassionate’ around patient
experience – providing opportunities
for patients to be at the heart of our
improvement plans.
5.0 Governance and leadership
How will we achieve our goals?
5.1 There is a need to strengthen the
systems and governance to support a
proactive programme of work that enables
the organisation to listen and respond to the
experience of patients.
Clear governance and leadership which has
patients embedded within it is vital for the
cultural change required throughout the
organisation. The new organisational structure
will be established at three levels illustrated in
diagram 1.
5. 5
Trust Level Governance
Hospital Patient
Experience Committees
- Monthly meetings
Hospital Engagement
- Patient Panel
- Patient Forum
(Patient and public engagement)
(Healthwatch and patient panel
representatives)
Collective 1:1
with CEO, Chair
and Healthwatch
Chairs
Patient Experience
Committee
- Assurance Group
Trust Wide
Patient Forum
- Open house event
showcasing ‘You said,
We Did’Monthly
meetings
Newham
University
Hospital
The Royal
London Hospital
St Bartholomew’s
Hospital
Whipps Cross
University
Hospital
Clinical Support
Services
Collective 1:1
Meeting with local
Healthwatch Chairs
Open Site Patient
Forums
- Shaping services
Site level ‘You Said,
We Did’ events
Trust Quality Assurance and Improvement Committee
Quarterly
meetings
4 12
times
a year
2
times
a year
2
Quarterly
meetings
4
12
Trust Board
Hospital Patient Panels
part of the strategic governance arrangements at each site
Monthly
meetings
12
There will be strong site governance arrangements
through the creation of Compassionate Care
and Patient Experience Groups at site level.
These will include Patient Panel members and
Healthwatch representatives to ensure local
issues are captured and acted upon.
Patient Panels are an essential part of those
arrangements having a clear role within the
governance arrangements for ensuring we
are delivering our commitments for improved
patient experience and open engagement. Work
is being progressed to revitalise and reframe
these to strengthen local arrangements.
We will establish a Trust wide Patient Experience
Committee reporting to the Quality Assurance
and Improvement Committee. Patient
Panel Chairs will be members together with
Healthwatch.
Patient Engagement and Experience Governance ArrangementDiagram 1
6. 6
6.0 Listening and responding to
patient feedback
How will we achieve our goals?
National patient surveys
6.1 Feedback through national surveys is a
crucial source of patient feedback. In recent
years Barts Health has performed poorly in
this area, specifically, the Inpatient, Maternity,
Cancer, Emergency Care and Outpatients
surveys. This strategy aims to outline a set
of core objectives that will contribute to
improvements in these areas, but we recognise
that a more comprehensive response is required
to address the concerns raised. The Trust’s Safe
and Compassionate Improvement plan outlines a
number of steps that are being taken to improve
the experience of patients in some of the areas
outlined above. In 2016/17 we will be working
with these services to strengthen existing plans
and undertake further analysis to identify themes
that will better place the Trust to create the
culture of caring that is required. It is proposed
that the patient experience improvement plans
for the key areas mentioned will be monitored
through the Patient Experience Committee.
It should also be noted that these will be aligned
to work being undertaken to enhance the
experience of staff and respond to feedback
from the staff survey.
6.2 Real time patient feedback
Compassion will be evidenced through
observation of care and through patient and
family feedback. Patients are the receivers of
the care and the ones who should decide if
the care they receive is compassionate and
meeting their needs.
We will implement iWantGreatCare, a new
platform for collating and analysing Friends
and Family information and real time patient
feedback at ward and service level.
We will use equality data from iWantGreatCare
and patient experience surveys to address
patient experience issues and set goals to reduce
inequity of experience.
Through this vehicle we will improve our Friends
and Family Test (FFT) response rates by engaging
our clinical staff through a staff engagement
programme and by providing access to a
dedicated website for our patients to rate
our services.
iWantGreatCare will also enable us to undertake
local patient surveys around the key compassion
questions from the National Patients Survey.
We have already implemented a new model
of site based complaints management and
will use the learning from our complaints and
Patient Advice and Liaison Service feedback as
an opportunity to change how we deliver care,
7. 7
We will know we are successful
when we see:
• improvements in all national patient
surveys results:
of complaints are
acknowledged in
3 working days
95% 80%of complaints are
responded to within
25 working days.
• a reduction in complaints
95% of our patients felt they were treated
with dignity and respect.
95% of our patients felt involved enough in
decisions made about them.
95% of our patients felt they received
timely information about their care and
treatment.
95% of our patients tell us they were
treated with kindness and compassion by
the staff looking after them.
95% of our patients tell us they were cared
for in an environment that was clean.
10%
We are in the top for Friends and
Family Test
response rate by
the end of 2016.
harnessing the passion and enthusiasm of staff
to change what they do and how they do it.
All wards and departments will be required to
act on patient feedback in real time. Working
with our staff we will embed the measures
for improvement in our wards and service
areas through ‘You Said, We Did’ programmes
and monitor improvements through our site
governance structures.
All sites will triangulate and analyse patient
feedback from the various sources of
information through a site based reporting
framework, aggregating this to a Trust wide
patient experience report on a monthly basis.
This will be reviewed at the Patient Experience
Committee and Quality Assurance and
Improvement Committee, thereby ensuring
Ward to Board visibility and drive around
improvements required.
8. 8
PatientForum
s
You
Said
W
e
Did
events
Barts M
em
bers
Patients
by
Experience
Volunteering
Patient Panels
7.0 Strengthening patient and public
engagement pathways
How will we achieve our goals?
7.1 Barts Health is committed to building a
new dynamic with patients and the public.
Strengthening our engagement model is a
key priority and we recognise that significant
work is required in this area to build trust and
confidence with the community we serve.
A key principal underpinning our engagement
model is that we must support patients and the
public to proactively engage and contribute to
decisions that impact on the care and services
they receive, with their contributions valued
and respected.
Feedback from patients tells us that we need to
be clearer about the role they can and wish to
play and the support we offer to enable them to
engage more effectively.
In doing so, we must make it easier for patients
and the public to navigate and understand the
different access points and roles they can play
along the engagement pathway.
In 2016/17 we will co-design the engagement
pathway with patients and the public,
describing it in more explicit terms. The Trust
has commissioned The Kings Fund to strengthen
our engagement model through a programme
of development that will be implemented for
staff and patients, better enabling the Trust to
harness their valuable contribution.
Patients and the public have various access
points into the organisation whereby they can
influence and shape improvements.
Models of engagementDiagram 2
Showing the various opportunities
that we will harness in 2016/17.
Patients panels
9. 9
7.2 Proposed engagement opportunities –
Healthwatch and local community groups are
key stakeholders in the engagement model.
This strategy describes how the Trust proposes
to engage through the formal governance
route. Below are the suggested pathways which
patients, carers, the public and communities can
be involved and engage with us.
7.2. 1 Patient Panels – our existing Patient
Panel Chairs have helped us to strengthen the
role of the Patient Panels. In 2016/17 members
will be recruited for each site and provided with
training and support. Panel members will be
part of the site governance arrangements and
play an important role helping sites shape and
improve services for patients. Open recruitment
will take place for panel members. We will
co-design the recruitment and operating model
with the stakeholder reference group and
existing Panel Chairs to ensure that Patient
Panels are representative of the local hospital
population.
7.2. 2 Patient Forums – a monthly Patient
Forum will be established and co-designed
with patients and community groups which
will aim to provide an opportunity for patients,
the public and voluntary sector organisations
to come and talk to us and help shape and
improve our services. Working with the Barts
Health inclusivity team, each of our sites will
host a monthly engagement activity in a way
that fits their population, ensuring that all
communities’ interests are represented.
Each site, working alongside their local
Healthwatch, will develop a model which
supports their local community. Patient Panel
Chairs will provide a monthly report to the
forum on how they have represented their views
and progress on actions being taken forward.
7.2. 3 ‘You Said, We Did’ – sharing what we
have improved is an essential part of patient
and public engagement; each site will host a bi-
annual event to share what has improved. A Trust
wide event will also be held to support learning.
10. 10
We will know we are
successful when:
• a co-designed engagement
model and pathway is in
place and accessible by
patients and the public
• revitalised and reframed
Patient Panels are in place
across all sites
• patient Forums will drive
continuous learning and
improvement
Clinical leaders/senior
managers are trained
in co-design and
patient experience
improvement.
100
= Patient
Leader,
Clinical Leader
or Senior
Manager
• We have:
patient leaders who have
accessed a programme
of support in co-design
and patient experience
improvement
100
7.2. 4 Patients by Experience – patients
have a vast amount of knowledge about their
condition and are perfectly placed to support us
in identifying areas to be improved. Patients by
Experience recognises this and provides a range
of condition specific groups that patients can
join to help support improvements. A mapping
exercise will take place during 2016 looking at
patient engagement activity. During 2016/17
we will work with these groups to ensure they
are linked to wider support and development
programmes.
7.2. 5 Barts Health Member – membership is
open to anyone interested in becoming a Barts
Health Friend. Our membership programme is
currently being strengthened; we are working on
providing new opportunities for our members to
get more involved in shaping our services.
7.2. 6 Volunteering – the Volunteering
Services are also undergoing a transformation
programme with the number of volunteer
opportunities growing. We have a range of roles
and our volunteers play a crucial role in helping
the trust to deliver high quality care. In 2016/17
we will work to ensure that we capture their
experience and insight and incorporate these
into the quality improvement programme.
7.2. 7 Engagement opportunities
coordination – work will need to take place
to provide a coordinated engagement pathway
which is easily accessed and navigated by
patients and the public.
7.3 Supporting a learning organisation
The work being progressed with The King’s Fund
to develop our patient and staff leaders is aimed
at supporting us to establish more dynamic
and progressive relationship with our patients.
Empowered patients require a responsive culture
with engaged staff.
11. 11
8.0 Improvement priorities in
patient experience
How will we achieve these goals?
8.1 Our strategy sets ambitious goals to embed
a culture of caring and compassion and ensure
that patients can receive high standards of
patient-centred care. In doing so, we will ensure
staff protect our most vulnerable groups and
deliver care to patients that is coordinated and
planned to respect their choices.
Nurse Establishment
8.2 The Nurse Establishment was reviewed in
2015/16 and a further review will be undertaken
for 2016/17 to ensure that the appropriate skill
mix and staffing levels are in place to meet the
care needs of patients.
Fundamentals of care
8.3 In 2015/16 a range of improvements
were made to ensure staff were always caring
and compassionate and treating patients with
dignity and respect at all times. These will
need to be sustained in 2016/17. The Trust will
continue monitoring and auditing the quality
and practice around the Fundamentals of Care,
setting improvement goals for sites and services
where compliance against standards are not
met. This will include review of personalised care
plans and observation of care.
Enhanced 1:1 care
8.4 The Trust will implement a programme of
work across all sites to enhance 1:1 care for
our most vulnerable patients. This will involve
engaging with carers and relatives to devise
joint care plans, patient information, and flexible
visiting times and revised risk assessments.
We will also develop and implement a Trust
wide welcoming policy with improved/flexible
visiting times.
End of life
8.5 The quality of care for patients at the end
of their life and the support we provide to their
families is a key priority in the Trust’s ‘Safe and
Compassionate’ Improvement plan. We are
committed to ensuring that each person is seen
as an individual and is supported to access the
care they need. In doing so, we will maximise
their comfort and well-being and ensure that
their care is coordinated across acute and
community settings. In doing so we will:
• work with national and regional teams
around the ‘Transform programme for End
of Life’
• ensure that clinical and nursing staff are
trained in identifying and making appropriate
decisions for patients at the end of their life
• families and carers are involved in decisions
and have access to the support they need
• ensure wards and services have systems in
place for flagging patients identified as end
of life
• embed the use of the Compassionate
Care Plan (CCP) for the dying patient and
Advanced Care Plans (ACP) for patients
identified as being at the end of their life
• site based audits will be undertaken around
use of CCPs ACP
• establish Link Nurses on all wards with
advanced knowledge and skills around care of
the dying and end of life care needs.
• monitor and review complaints and feedback
from patients.
Learning disabilities
8.6 The Trust will strengthen its approach to
responding to the needs of patients with a
learning disability in 2016/17 through:
• the development of a Learning
Disabilities Strategy
12. 12
• 90 per cent will have a Hospital Passport
within 24 hours of being admitted to hospital
• we will ensure that staff are trained in
responding to the specific care needs of this
vulnerable group of patients, proactively
identifying patients on admission and working
with Community Learning Disabilities Teams
to better prepare and support patients prior
to admission
• we will undertake weekly audits around
compliance
• we will implement a range of initiatives
to improve the experience of carers. This will
include joint care planning, flexible visiting
hours.
Care of patients with dementia
8.7 The Trust’s Dementia Strategy sets out a
number of key objectives and improvements
for us to deliver against and sustain in 2016/17.
These include:
• strong ownership and leadership for dementia
throughout the Trust
• care is person-centred and individual
• environments that are dementia friendly
• assessment and early identification of
dementia
• supporting people with dementia to be
discharged back home
• staff are skilled and have the time to care
• strong partnership working with people with
dementia, their carers and other agencies.
To achieve these improvements we will:
• strengthen and embed the Dementia and
Delirium Teams at site level
• build on improvements achieved in 2015/16
around the environment, through the creation
of reminiscence areas on older people’s wards
• embed the use of ‘Forget Me Not’ personal
profile. The ‘Forget Me Not’ document aims
to improve communication, interaction and
the whole patient experience. It is suitable
for anyone who may have difficulties
communicating for any reason. All patients
with dementia will have all of these
documents
• increase the number of recruited volunteers
‘Dementia Buddies’ who can provide activities
and opportunities for social engagement
for patients with dementia on the wards.
These offer befriending and promote
hydration for patients who have been
identified by the team
• ensure that the experiences of carers,
captured through the Dementia Carer
Questionnaire, are implemented across the
Trust with feedback used across all hospital
sites to drive improvements
• continue with the training programme for
key staff including junior doctors
• strengthen the role of the Dementia
Champions at ward /service level ensuring
they access the five day Dementia Champion
course available to the Dementia Champions
as well as quarterly update days.
Improved patient experience around
discharge
8.8 Patient Feedback through Friends and
Family and through complaints tell us that more
must be done to ensure that patients and carers
are involved in decisions about their discharge,
but feel that it is sensitive to their care needs.
We will:
• establish a Patient Discharge Improvement
Group to strengthen the Trust wide
guidelines, incorporating informing patient
information discharge packs, timely discharge
procedures and ensuring that routine patient
feedback is captured on discharge
13. 13
• undertake Deep Dive patient-designed
interviews to better understand issues.
Patients will be involved in interpreting results,
planning change in consultation with staff,
and measuring change in practice
• review and spread best practice around
existing discharge initiatives such as ‘Ticket
Home’ at Whipps Cross and ‘Home for Tea’ at
Royal London to ensure a patient engagement
and feedback element in these existing
patient flow initiatives
• we will work with Healthwatch and CCG
Colleagues to identify new ways of working
to support more effective, informed discharge
• embed the new discharge checklist
• all sites will adopt a discharge booklet for
patients and staff will be supported to use
the new tool.
We will know we are successful when:
Nurse
Establishment
Levels are set
in line with nationally
agreed standards.
All patients
are in receipt
of Fundamentals
of Care as set out by the
Care Quality Commisions
(CQC).
An Enhanced Model
of Care for patients
requiring 1:1 care has
been implemented.
All Patients on end of
life pathways have a
personalised Compasionate
Care Plan in place (CCP).
of patients with a
learning disability have
a Patient Passport.
All patients
with a diagnosis of
dementia are offered
‘Forget Me Not’.
in the delivery of dementia
standards with all patients
offered a personalised
care plan.
Improved patient
experience around
discharge
Comprehensive Patient
Experience improvement
plans for Maternity,
Emergency care, Outpatients
and Cancer Services in place.
CQC
90%
We achieve
95%
EOL
Plan
14. 14
9.0 Going forward
9.1 The strategy will be launched through site
based events in March 2016/17.
• all sites will be required to use this
opportunity to review and strengthen existing
arrangements using the Trust Development
Patient Experience Self-Assessment Tool
• work with Communication Team to devise
communication strategy and creation of
public facing document
• we will work with the equality team to ensure
on-going monitoring is aligned to the Equality
and Diversity standards delivery
• while much of the work outlined in this
Strategy is being implemented we will
accelerate and strengthen the programme
through co-development with our patients
and partners
• co-design the operating model for patient
engagement pathways with the patient
reference group
• establish improvement trajectories for
Friends and Family Test/Real Time Patient
Feedback response rates for all sites and
monitor the delivery through a monthly
Patient Experience and Engagement
Assurance Framework.
