PEN Awards Webinar series 2 of 6
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PEN, Patient Experience Network, NHS IQ, NHS Improving Quality, Ruth Evans, Patient Experience, Lesly Goodman, Samina Allie, Rachel White, NHS England, Midlands and Lancashire CSU, Black Country Partnerships NHS Foundation Trust, Using insight across a health system to improve care, What's the story with storytelling within the NHS, Digital story telling workshops
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PEN Awards Webinar series 2 of 6
- 1. #PENNA2015 #PatExp What’s working well in patient experience? PEN Awards Webinar Series 13th October, 12 - 1pm 20th October, 12 - 1pm 27th October, 12 - 1pm 3rd November, 12 - 1pm #PENNA2015 #PatExp
- 2. patientexperiencenetwork.org #PENNA2015 #PatExp RUTH EVANS Managing Director Patient Experience Network WELCOME What’s working well in patient experience? PEN Awards Webinar Series
- 3. patientexperiencenetwork.org #PENNA2015 #PatExp Webinar content – 6th October 2015 Welcome and introduction • Ruth Evans - PEN Launch of the Winning Principles and overarching Framework • Samina Allie - Black Country Partnerships NHS Foundation Trust Digital story telling workshops – Innovative use of Technology/ Social Media • Lesley Goodburn - Midlands and Lancashire CSU Using insight across a health system to improve care - Commissioning for patient experience • Rachel White - NHS England What's the story with storytelling within the NHS – Strengthening the Foundation Questions
- 4. patientexperiencenetwork.org #PENNA2015 #PatExp Welcome to the UK’s leading awards event that recognises Patient Experience excellence Wednesday 11 March 2015 patientexperiencenetwork.org PEN National Awards 2014 Re:thinking the experience LET’S CELEBRATE A YEAR OF SUCCESS
- 5. patientexperiencenetwork.org #PENNA2015 #PatExp Intention and Outlook • Passion and determination • The most successful initiatives are driven by an individual or team with a firm belief in what they are doing, and the need to invest time and money to make it happen and bring about change. • Broadening perspectives • A key milestone for success is supporting and educating fellow professionals to look beyond their own situations and embrace and adapt work going on elsewhere. • Keeping it simple • Making initiatives easy for people to understand and adopt is crucial. Clear communication, posting results and evidencing improvements encourages engagement and continuation with projects.
- 6. patientexperiencenetwork.org #PENNA2015 #PatExp Organisational Support • Culture • Creating a culture where everyone is engaged in patient experience and understands the role they have to play in improving it is vital to success. All successful initiatives are delivered by teams, not individuals. • Management • Senior level support is often key to the success of a project. The best results are seen where improving patient experience is encouraged and prioritised by management. • Leadership • Clinical and senior management leadership, particularly in the form of empowering staff to identify, develop and implement changes is key to sustainable improvement.
- 7. patientexperiencenetwork.org #PENNA2015 #PatExp Evidence & Impact • Financial impact • It is clear that positive patient experience pays dividends, and our most successful entries demonstrate how time and financial investment in well thought out projects can yield an excellent return. • Building professional relationships • Working in partnership with teams within and outside your organisation, as well as with volunteers and other groups is key to ensuring ongoing success in spreading and embedding positive practice. • Spread and sustainability • Evidencing sustainability and transferability are key to success. Demonstrating how initiatives have been or could be adapted provides an opportunity to share and embed successful practices.
- 8. #PENNA2015 #PatExp Questions? 13th October, 12 - 1pm 6th October, 12 - 1pm 20th October, 12 - 1pm 27th October, 12 - 1pm 3rd November, 12 - 1pm #PENNA2015 #PatExp
- 9. patientexperiencenetwork.org Digital story telling workshops Celebrating Success Samina Allie - Black Country Partnerships NHS Foundation Trust @BCPFT
- 10. The Digital Story Telling Project Presented by Samina Allie CPsychol AFBPsS Chartered Principal Counselling Psychologist Black Country Partnership Foundation Trust
- 11. ‘The best way to teach people is by telling a story’ Kenneth Blanchard • Pressures on staff First Phase • Narrative project (Whittall, S. & Allie, S. (2011) ) Second Phase • Digital Story Telling Project Referral Criteria • Clients should be of no risk to selves or others • Group was open to 3 acute wards and Crisis/Home Treatment Team Rationale and Context
- 12. Benefits and Evidence base • Improve communication skills and develop interpersonal skills such as teamwork, critical thought, interpretation of data, analysis of texts and images, synthesis and self-evaluation. • Increase participant confidence • Offer a forum for the discussion and dissemination of individual experiences • Increase literacy, visual and computer skills • Create a level of objectivity for the participant which give the opportunity for personal circumstances to be seen in a more detached light • A powerful advocacy tool • Opportunity to see their own words grow into a completed broadcast quality movie • Create meaning from experience by building connections with prior knowledge • Great fun! • Stories for change: http://storiesforchange.net • Capture wales: www.bbc.co.uk/wales/capturewales • Patient Voices :www.patientvoices.org.uk
- 13. Timescale/Planning • Multistory: Obtained funding • Small window to initiate develop and implement and evaluate the project Structure Story Circle Workshops Showcase
- 14. Impact & Results achieved Comments from Clients • “It’s to tell the world even if we have a mental health problem, we can still tell stories, we are still people. I still have my sense of humour, I’m strong, and I want to preserve nature” • “We’d be encouraged to create our own story but it would allow us to do more than this. We’d learn to use a program and use digital equipment”. • “To help other people if they read my story it might help them. They can’t give up; there is a light at the end of the tunnel. I feel there is life now.”
- 15. Achievements It provided patients with the opportunity to: • Tell their stories in a therapeutic environment • Self reflect on their journey so far • Helped them think about coping strategies It gave the hospital an opportunity to: • Improve service user involvement • Listen to their experiences and reflect on our practice • Use the information to further the work already identified in Star Wards, satisfaction surveys and community meetings. • Provided a resource to develop awareness and training
- 16. Future Plans • Looking at continuing to strengthen relationships with Multi story. • Always looking at other creative means to engage patients so that they feel heard. • To continue to utilise stories as a resource • Training/ Development of staff • Develop awareness http://www.bcpft.nhs.uk/se rvices/creative-projects- gallery/76-creative-projects- and-artwork/235-2011- digital-story-telling-project- mh-adult-inpatient-care
- 17. References/Further Reading Digital story telling project (Narrative project Allie (2011): http://www.bcpft.nhs.uk/services/creative-projects-gallery/76-creative-projects-and- artwork/235-2011-digital-story-telling-project-mh-adult-inpatient-care Duncan, A., Fialko, L., Rowe, A. Samson, G. & Duncan et al, SJ. (2005). Helping Patients to Write Their Own Account of Their Admission to Hospital: How Do They Respond and Can Nursing Staff Help? Proceedings of the British Psychological Society, 13, 170. McIntyre, K., Farrell M. and Savi, A. et al (1989). Inpatient Psychiatric Care: The Patient’s View. British Journal of Medical Psychology, 62, 249- 255 Mehl-Madrona, M. (2007). Introducing Narrative Practices in a Locked, Inpatient Psychiatric Unit. The Permanente Journal, 11(4), 12-20 National Collaborating Centre for Mental Health (2002). Schizophrenia: Full national clinical guideline on core interventions in primary and secondary care. National Institute for Clinical Excellence, London. NHS (2010). Institute for Innovation and Improvement. Available from: http://www.institute.nhs.uk/quality_and_value/productivity_series/productive_ward.html Whittall, S. and Allie, S. (2011) Using Narratives on an Acute Psychiatric Ward. Counselling Psychology Review, Vol. 26, No. 3, September 2011.
- 18. patientexperiencenetwork.org Using insight across a health system to improve care Celebrating Success Lesley Goodburn - Midlands and Lancashire CSU @lgoodbu @MLCSU
- 19. 06/10/2015 Insight and Involvement Lesley Goodburn Service Partner – Insight and Involvement
- 20. 20 Midlands and Lancashire CSU www.midlandsandlancashirecsu.nhs.uk
- 21. Insight and Involvement the Journey so Far
- 24. Access and Waiting Clean comfortable place to be Safe high quality care Building closer relationships Better info more choice Miscellaneous Domains of patient experience
- 28. Community Providers Acute Providers Mental Health Providers Independent Providers Voluntary Sector Providers NHS England Area Team CSU
- 29. Patient Experience Social media, media, complaints, PALS, workshops, surveys – any feedback Clinical Effectiveness GP concerns about secondary care and secondary care concerns about GP services Safety - Incidents in primary care Quality
- 30. Implementation and Roll Out
- 31. Completed Implementation • 9 CCGS and 350 GP practices in Staffordshire. Shropshire, Telford and Herefordshire • 3 CCGs in Lancashire and 88 GP practices • NHS England Staffordshire and Shropshire Local Area team • Out of Hours providers – Lancashire • Condition support groups Staffordshire
- 32. Planned Implementation • Health and Well Being Board in Staffordshire inc HealthWatch • 4 CCGs in Lancashire and 250+ GP practices • CCGs in Central midlands and GP practices • Condition support and voluntary sector groups • Care Homes • Discussions about provider implementations across a health economy
- 35. Results • 98% of events rated as severe and above have had follow up action • All events and feedback are reviewed within 30 days • All data is shared across health economies 1200 active users of the system • Over 600 hours per year reviewing the data and setting actions across the CCGs • Data is review at quality subcommittee and formally reported to the CCG board for primary and secondary care • 68% of cases that require action have an action formally recorded • 181 GP practices trained • Over 350 GP practice staff trained • Over 600 members of staff at CCGs trained • Over 150 CSU staff trained • Over 50 NHS England staff trained • Regular qrtly reporting for 12 CCGS by theme and trends • Over 300 individual real-time dashboards and reports • Top ten themes and trend identified
- 36. Results • New system to inform practices when a patient dies in hospital • Changes to referral system for CAHMS • Contract review for WMAS to deal with suspected fractures • Use of locum radiographers to clear backlogs on imaging • Improved discharge reports and communications • Full clinical review of district nursing services • Review of the falls service • Themes and trends feeding into communications and engagement strategy • Review of coding in radiology and pathway • Improvements to the paediatric discharge pathway • Improvements to confidentiality and training on information governance • Plain film reporting has been improved • Standardised format for discharge summaries • Improvements to scripts for 111 service • Contract reviews of 111 and radiography service • Assurance measures for ophthalmology service • Adult protection and safeguarding referrals
- 39. patientexperiencenetwork.org What's the story with storytelling within the NHS Celebrating Success Rachel White - NHS England @ NHSEngland @Rachel3White
- 40. www.england.nhs.uk What’s the story? Strengthening the foundation: Storytelling in the NHS (Midlands and East) NHS England 6th October 2015
- 41. www.england.nhs.uk http://mikequah-arthinks.blogspot.co.uk/2011/08/artists-of-altamira.html http://www.rocketwatcher.com/blog/2009/02/the-importance-of-storytelling-in-marketing.html www.demotix.com- Every picture tells a story & every story paints a picture
- 42. www.england.nhs.uk Huffington Post 2015 Sawubona - I see you "I see your personality. I see your humanity. I see your dignity and respect.“
- 43. www.england.nhs.uk Why did we evaluate? NHS Midlands and East Ambition o Patient Revolution o Review NHS Changes - Legacy considerations National drivers and imperatives
- 44. www.england.nhs.uk • Storytelling process: Associated outcomes • Distributed leadership model • Codesign • Realist Evaluation • Action Learning • Primary and Secondary data sources • Sharing the learning • Systems thinking: Influencing change Approach
- 45. www.england.nhs.uk Pawson and Tilley 2004 Asks not, ‘what works?’ or ‘does this programme work?’ but asks instead what works for whom, in what circumstance, and in what respects, and how?
- 46. www.england.nhs.uk Research Cycle Hypothesis Data Analysis Theory Testing Data Collection Collaboration, previous knowledge, reflection and learning, informed theory developed and tested. Collaborative learning is the catalyst for action in the region. Area Team leads facilitate response /data returns. Study lead collaborates, reflects, learns from Area Team leads and approach is adapted accordingly. Data analysed, context, mechanism and outcome patterning emerge. Reflective review against original theory. Revision of theorised framework based on study findings. Peer scrutiny of process. Communication of early emerging findings to test response to study findings. Peer scrutiny identifies additional reporting needs to support regional action.
- 48. www.england.nhs.uk What response did we get? . Organisational Type Possible Numbers Response Numbers Evidence Returns Clinical Commissioning Group 61 17 15 Acute Hospital Trust 23 7 4 Community Hospital Trust 9 4 2 Acute Foundation Trust 23 3 2 Mental Health Foundation Trust 11 3 2 Ambulance Trust 3 2 2 NHS England - Region/ATs 1 (+8) 2 1 Commissioning Support Unit N/A 1 1 Regional Total 147 39 29
- 49. www.england.nhs.uk What were the findings? Strand 1 – RE Evaluation Findings Structured storytelling Listening forum Reportable Educational storytelling Learning forum Individual learning & practice development Storytelling at board Reflective time Board development Storytelling forum Story told in person by the storyteller Emotive power
- 50. www.england.nhs.uk Storytelling in the region was impacted by the architectural changes to the NHS CCGs are steaming ahead Staff and Carer stories are an important emerging consideration for storytelling organisations Patient leaders / Volunteers play a critical supporting role Innovative approaches to storytelling are being explored and used. Strand 2 – Regional Mapping Findings
- 51. www.england.nhs.uk Importance of co-design Engage early with participants Ensure clarity about expectations timescales and outputs Communicate effectively Keep people in the loop & maintain engagement Demonstrate progress Important to develop something tangible that people can use Be flexible and adaptable Strand 3 - What did we learn as an organisation?
- 52. www.england.nhs.uk People tell their stories in exactly the same way as we tell stories in our daily life and lots of things are considered to be stories: to name but a few! What else did we learn ? Corridor conversations
- 53. www.england.nhs.uk Final Storytelling Programme Specification
- 54. www.england.nhs.uk Week of action and roadshows: Individual Pledges Publications http://www.england.nhs.uk/mids-east/patient-stories/ Online 6Cs Live Resource Hub http://www.england.nhs.uk/6cs/groups/storytelling/ System Thinking (Open and Honest) : Individual and Organisation stories http://www.england.nhs.uk/ourwork/pe/ohc/ (Midlands and East documentation only) MyNHS https://www.nhs.uk/Service-Search/Performance/Search NHS England : Carer Programme Impact: What’s happening in the next chapter?
- 55. www.england.nhs.uk Vision of Success - System Thinking Operational Support from frontline staff,storytellers, storytelling support staff including patient leaders and communication leads Strategic Support Board & CEO commitment Leadership Support from clinical & Patient leaders & managers Clear Vision and Strategy Create sustain and refresh a visible shared purpose Robust Delivery & Outcome Measurement Take collective responsibility for success Incentivise, Innovate & Improve Develop as a learning organisation, incentivise practice and personal growth. Open and Honest Transparently share outcomes and organisational learning
- 58. www.england.nhs.uk Derbyshire Community Healthcare Services NHS Trust. Derbyshire Health United North Derbyshire CCG Hertfordshire Partnership University NHS Foundation Trust West Hertfordshire Hospitals NHS Trust NHS England , Midlands and East - PE team Helen Brooker, East Anglia AT (Data analysis/peer review) Acknowledgements
- 59. www.england.nhs.uk All narrative is considered to be a story Multitude of ways to tell stories – Societal changes & Technology A refreshed view of storytelling is required All organisations ,departments , levels of an organisation and individuals can benefit from storytelling. Storytelling should not be confined to service improvement, it can and should be used for a multitude of purposes. Storytelling programmes should consider staff and carer stories alongside patient stories. System thinking: Visible and tangible outcomes for the individual, the organisation and the wider NHS system. Take home message from this story!
- 60. www.england.nhs.uk Look for the story that makes the person Source unknown
- 61. www.england.nhs.uk NHS England Nursing Directorate, Patient Experience Team Leadership Support Manager Rachel White Email: Rachel.white3@nhs.net Mobile: 07795637771 Twitter: @rachel3white Web: www.england.nhs.uk Thank You!
- 62. #PENNA2015 #PatExp Questions? 13th October, 12 - 1pm 20th October, 12 - 1pm 27th October, 12 - 1pm 3rd November, 12 - 1pm #PENNA2015 #PatExp
- 63. #PENNA2015 #PatExp Thank you 13th October, 12 - 1pm 20th October, 12 - 1pm 27th October, 12 - 1pm 3rd November, 12 - 1pm #PENNA2015 #PatExp
- 64. #PENNA2015 #PatExp What’s working well in patient experience? PEN Awards Webinar Series 29th September, 12 - 1pm 13th October, 12 - 1pm 6th October, 12 - 1pm 20th October, 12 - 1pm 27th October, 12 - 1pm 3rd November, 12 - 1pm #PENNA2015 #PatExp
Hinweis der Redaktion
- I would like to talk to you about a project that was initiated at a psychiatric hospital where inpatients were supported to record and share their own stories using digital technology about the things that are important to them in their lives. We belong to the Black Country Mental Health Foundation Trust which caters for a diverse multicultural community. Hallam Street Psychiatric Hospital is a 54 bedded unit consisting of 3 ‘Houses’. Each ‘House’ or ward has 18 beds, consisting of 9 male beds and 9 female beds. We give intensive 24-hour in-patient care to people who need more support than we can give them in the community. Nurses, Psychologists, Occupational therapists, and Psychiatrists are the staff that help people on their journey towards recovery. We also have a Home treatment/ Crisis team on site whose patients were also involved in the project. Through a series of innovative workshops, creative practitioners worked closely with patients to enable them to script and devise their own digital story. A digital story is a short film that tells a personal story using computer-based tools usually containing a mixture of images, text, recorded audio narration, video clips and music.
- In the busy world of inpatient mental health and staffing pressures listening to clients talk can be seen as a low priority. This project bore out of an earlier initiative 'the narrative project' to determine whether the process of creating a narrative impacted upon therapeutic relationships between staff and clients and whether narratives could improve client’s insight. The process also improved staff confidence in their skills and increased client satisfaction of their care. The digital story telling project was the second phase to this project as a means to creatively engage a marginalised client group. As a psychologist I explore what sense people make of their journey and the prospect of people learning to use new tools to support this process excited me. I contacted Multistory; a charitable organisation in Sandwell that deliver creative projects. We felt that the process would add value to and benefit our service and extend the therapeutic value of narrative work in a creative way.
- Digital storytelling provides opportunities for people to speak, to be heard and to share their stories with others. In digital storytelling the equipment and technology used is basic and accessible, as people’s familiarity and skills in using technology differs from person to person. Therefore the main emphasis of this process is on the narrative rather than the use of technology, but the approach can be adapted in accordance with the specific needs and skills of the participants. Its flexibility comes from the fact that, in order to elaborate a digital story, participants can use a range of tools from the simplest form such as their voice and existing photographs to more complicated ones using film or animations. *** talk through benefits / evidence base
- The project team consisted of myself; Karl Greenwood and Matt white an artist external both to the trust and Multistory. We ran a series of workshops with patients to enable them to script and devise their own unique story. The workshops complimented and aligned themselves well with the existing narrative project. There are a number of factors to take into account when working on a story; the complexity of the story and scripting it, the availability of visual materials such as photos and film, the personal needs and skills of the individual taking part, the literacy skills of the patient; confidence and anxiety issues with the patients, conflicting commitments for the patient as well people being discharged from the hospital and not attending sessions. We managed to deliver 8 full day sessions in the hospital working with patients on a rolling basis, setting up hourly or two-hourly sessions after each session until the story was complete. At the end of each session an evaluation meeting took place with each patient and also the permissions to use the story were discussed in order for the hospital and Multistory to be able to show the story in public forums such as online and for educational purposes. In collaboration with Multistory I coordinated the showcase event where these very poignant stories were shown to patients, carers, staff, management and family were also invited to the event.
- Our project has been successful in engaging both clients and staff and has made a significant impact on the therapeutic milieu on the wards. We have had a similar project published in the Counselling Psychologist review and we have created poster presentations for the ward as a means of disseminating the results and findings and these have been discussed in both community meetings, reflective practice forums and in trust meetings.
- We continue to support staff through reflective practice to think about the importance of the patient narrative and encourage staff members to listen to the patient journey. We have utilised the DVD of digital stories in mental health awareness training and support staff to develop their confidence to ask different questions creatively. The digital stories were also placed on our trust website and generated a great deal of interest amongst colleagues in other areas in the trust who have wanted to share ideas. This project has already had a profound impact on the trust, its staff and patients. It has contributed to staff training and has encouraged practitioners to continue to focus on the patient narrative. Some clients who participated found the process so therapeutic that it changed the way they engaged with the system. Developing such a strong partnership with an external agency was a very new experience for us however it proved so rewarding and has highlighted that forging partnerships with external services despite the challenges can bring many rewards and learning opportunities and we hope to foster continued working partnerships.
- We are hardwired for storytelling, it is in our DNA. We story tell as a way of communicating the story of our lives and as a way of guiding others . Storytelling is as old as time.
- The Patient Revolution as part of five ambitions were agreed at the NHS Midlands and East board meeting on 24th November 2011. Action: Build on the value and learning from listening to patient stories at the cluster boards of West Midlands, East of England and East Midlands SHA’s and encouraging patient stories in all public board meetings across the Midlands and East. Review of the use of patient stories across the SHA Cluster – this was undertaken 2012 and a report was produced. Continued drivers: Compassion in Practice Dec 2012: Implementation plans 2013. Local Action: Use a story at every board meeting. One year On report: The importance of storytelling and the role stories can play in learning from people’s experiences. Keogh review
- Works on the principle of understanding the context in which the patient story programme is working and operating. Examines the relationship between the mechanisms and processes that are in place how they are utilised by whom and under what circumstances.
- Strand 1 Detailed findings can be found in the full report
- Strand 2 - mapping against the 2012 patient revolution review
- Strand 3 – NHS England organisational learning
- By pictures, film , on paper, on tape etc etc
- Not to be viewed in a linear fashion. Green - the things we are quite good at Amber - the things we could do better at Red – the things we need to get a lot better at
- Study Outputs: Part one - the study findings has been published along with storytelling programme framework Part two - currently being written will include resources that could be used as a possible improvement / storytelling evaluation framework Regional week of action - Partnership WebEx’s, press release, events, personal pledges, publications Project work – toolkit / resource hub . Developments being led by the ATs alongside local strategic partners Website – reports and details about the week of action.
- System thinking is needed. Open ,transparent and collaborative ways of working.
- Storytelling house of care wrapped around the storyteller achieving person centred outcomes for individuals staff, patient and carers
- Working Principles & Future Challenges