2. ‘Implement and evaluate the use of a patient
experience blog across all operating theatres at
LTHT in order to promote multi-stakeholder
engagement and assessment of service
provision’
Innovation
3. Engagement of external stakeholders (patients and carers) in discussions around
service provision.
Increase organisational understanding of how improved stakeholder
engagement and communication can drive service improvement.
The planned innovation sits within the context of local and national frameworks
for delivery and review of service improvements.
The innovation looks to build upon existing social networking tools and as such
aims to encourage and streamline the introduction of the associated
implementation within the theatre setting
Review and evaluation will help assess the care needs of patients and carers.
Provide a more holistic approach to engagement, to allow for assessment and
financial planning of future service design – one which is formulated around the
need to meet both the social and economic demands of patients and large scale
NHS organisations.
Benefits
4. ‘There have been concerns that patient-centered care, with its focus on individual needs,
might be at odds with an evidence-based approach, which tends to focus on populations’
(Epstein & Street, 2011)
‘No decision about me, without me’
(DOH, Equity and Excellence, 2010)
‘The case for focusing on patients’ experience and working out how to intervene to improve it is
strong. First, and most important, is a moral and human imperative to protect people when they
are weak and vulnerable; to strive towards recovery and healing; and to ensure the humanity of
care. The need to do so within complex systems and institutions that are under pressure to
increase efficiency and throughput is a fundamental challenge and it is important to find
solutions.’
(King’s Fund, Seeing the Person in the Patient, 2008)
Why is patient centred care important?
5. ‘An idea, service or product, new to the NHS or applied in a way that is new to the NHS, which
significantly improves the quality of health and care wherever it is applied’
(DOH, Innovation, Health and Wealth, Accelerating adoption and diffusion in the
NHS, 2011)
Respect for patient-centred values, preferences, and expressed needs, including: cultural
issues; the dignity, privacy and independence of patients and service users; an awareness of
quality-of-life issues; and shared decision making
Coordination and integration of care across the health and social care system
Information, communication, and education on clinical status, progress, prognosis, and
processes of care in order to facilitate autonomy, self-care and health promotion
Emotional support and alleviation of fear and anxiety about such issues as clinical
status, prognosis, and the impact of illness on patients, their families and their finances
Welcoming the involvement of family and friends, on whom patients and service users
rely, in decision-making and demonstrating awareness and accommodation of their needs as care-
givers.
(DOH, NHS Patient Experience Framework, 2011)
Political
6. ‘ At a critical time when the NHS is facing the biggest challenge in its history - to find £15-
20bn in efficiency savings, the need to improve quality and deliver care more efficiently
has never been greater. Now more than ever NHS teams need to work together to meet the
challenges and opportunities that face us all’
(NHS Institute, 2006)
2007 - £4800 per day to run a standard operating theatre
(HSJ, 2009)
NHS compensation costs £807 million in 2009
(The Guardian, 2009)
‘The capacity to create value through innovation is facilitated by an integrated delivery
system focused on creating value, measuring innovation returns, and receiving market
rewards’ (Paulus et al, 2008)
Economical
7. The Patient Perspective
“Nobody could argue about it because we were talking about making the patient
journey better”
“Telling the patients story has kept the focus in the right place and been a powerful
motivator”
"It's the way patients feel at certain points of their care that leads us to the hard
improvements”
http://www.institute.nhs.uk/qipp/joined_up_care/patient_centred_care.html#sthash.YjJ
se7x8.dpuf
Social
8. Patient-centred care
Consistently deliver high quality, safe care.
Organise around the patient and their carers and focus on meeting their individual needs.
Act with compassion, sensitivity and kindness towards patients, carers and relatives.
What does this mean?
We want to be recognised by our patients, commissioners, peers and staff as being amongst the best
for patient safety, quality, patient engagement and clinical outcomes. Just meeting the minimum
standards is no longer acceptable and our patients, rightly expect the best care possible.
Our quality ambition is to be up there with the highest performing hospitals in the NHS. In some areas,
our performance is comparable to these hospitals but there are others where we can improve and we
want to ensure a consistently high quality standard across everything we do.
We are aware of our responsibility to ensure that every penny of public money invested into our
services is spent wisely and efficiently. We accept that investing in Quality and Patient Experience will
mean eliminating wasteful practices.
(Our Five Year Strategy: Consultation Document, Leeds Teaching Hospitals Trust, 2014)
Local initiatives and why there needed.
LTHT - Patient Centered care.
11. INTRODUCTION GROWTH MATURITY DECLINE
Evaluate and
dissemination of blog
to peers and
organisational review
• Idea for innovation
• Systematic evaluation of
current literature & online
resource
• Why is this needed?
• Focused planning and
design
• Collaboration with external
stakeholders
• Engage with all
stakeholders –
patients/LTHT - publicise
• Implementation and
planned timescales for
review
• Go live
• Review & Feedback to all
users
• Evaluation
• Focus groups
IMPLEMETATION
TIME
Innovation Lifecycle
What did we find?
What were the enablers?
What were the barriers?
What could we have
done better?
Adoption of
innovation and
sustainability
12. Force Field Analysis – Barriers & Enablers
Implementation
of patient
experience
online
networking
resource for
LTHT operating
theatres
Driving Forces
National initiatives around patient
centered care
Fits within context of organisational plan
Restraining Forces
Communication
Timescales for development
Driving Forces
Multi stakeholder collaboration
Staff engagement & empowerment
Restraining Forces
Financial constraints
Designing online tools
Driving Forces
Professional development
Demonstrates openness and transparency
Restraining Forces
Governance
Confidentiality
Driving Forces
Escalation to other departments/sites
Demonstrates service improvement
Restraining Forces
Patient access to IT
Multi stakeholder engagement
Driving Forces
(Positive forces for change)
Restraining Forces
(Obstacles to change)
14. Staff Engagement
‘Engaged staff think and act in a positive way about the work they do, the people they
work with and the organisation that they work in’ (NHS Employers, 2013)
17. Enablers
Patient focused implementation
Fits with organisational strategy for improving the patient
experience
Design and implementation of online social networking tools are
already in place
Collaboration equates to sharing of knowledge
Successful implementation could be used by peer departments
Initial implementation cost neutral in terms of blog design
Staff engagement and feedback
Review of current service provision
Online service already used in peer organisations
18. Barriers
Time
Design of online tool
Access to online tools for all patient groups
Financial
Multi-stakeholder Engagement
Site Accessibility and usability
Patient Confidentiality
Staff defamation
Moderation
Data Security
Data Protection
Ability of organisation to respond
Ability to show patients how their feedback was used
This is my innovative idea, via its implementation, I aim to QUOTE SLIDE
The overarching benefits of this planned innovation are as follows QUOTE SLIDE
Patient centered care and the need to involve those accessing NHS services, has become more of a driver in the assessment of the quality of individualised healthcare. However QUOTE SLIDE The publication of the DOH white paper brought the issues of patient choice with its mantra of QUOTE SLIDE backinto the public domain. This innovation, take as its premise, that all patients should expect to have a voice in the care they receive as QUOTE SLIDEAs such I would now like to briefly look at the political, social and economical context for the implementation of a patient focused online resource.
The DOH, Innovation paper of 2011, highlights that new ideas or collaborative innovation should be utilised to improve diffusion and adaptation of innovative models in healthcare QUOTE SLIDEThe NHS Patient Experience Framework of October, 2011 makes specific reference to why involving patients in their care would help patients, carers and organisations who share the complexities of any decision making process to provide and evaluate the values of patient centered care. QUOTE SLIDE The political NHS family and friends initiative currently asks patients to answer questions around – "How likely are you to recommend our ward/A&E department/maternity service to friends and family if they needed similar care or treatment?” These questions albeit well intentioned, do not in my view allow patients to openly feedback on the care they have received.
There are multiple economical challenges within the NHS – QUOTE SLIDE TILL END OF GUARDIANAs discussed in the previous slide, the need to create shared values, would I feel help LTHT assess more openly the demands of patients and enable the organisation to plan and review, what in economical terms is needed.Paulus, highlights this well when saying that QUOTE SLIDE
QUOTE SLIDEIn theatres, across LTHT, how do we understand and evaluate the experiences of patients who use our services?Are we using patient information & experience as a baseline measurement for improvement? Are we developing the right approach, skills and tools to enable us to engage meaningfully with patients and the public?Do we gather and use patient stories as a powerful driver for improvement?Are we ensuring that patients and carers are actively involved in an ongoing and meaningful way in our programme?What are we doing to involve the public and staff in developing the vision?Are we debating some of the difficult options and decisions about service configurations with the public?Are we fully utilizing the potential of technology to engage and involve service users?To answer the above questions simply, no we are not.We need to tell the stories of patients in order to help develop the service and respond to the individual needs of the patient. NEXT SLIDE
Whilst the recently published 5 year strategy highlights we must QUOTE SLIDEIt is my opinion that in order to provide gold standard care for the patients we treat, we must do more to engage and seek out their views.
These few slides demonstrate that using a collaborative methodology……NEEDS WORK!!!!!!
The types of innovation utilized in this project, are multiple.Firstly, systemic innovation – As Mulligan highlights, systemic innovation is QUOTE SLIDE. And the use of this methodology can be see as a key driver within the context of this innovation – The Francis Report highlighted a lack of communication which in turn led to poor standards of care. If the MidStaffs trust had listened to what patients, carers and staff where saying then care to patients could have been improved. As such, one of the themes of systemic innovation is for the replacement of target based initiatives with those more based on shared value. A recent report by www.Nesta.org.uk highlights that, QUOTE SLIDEAdditional to the use of systemic innovation I would like to highlight that the use of socio-technical innovation, QUOTE SLIDE I can see a clear link for the use of socio-technical innovation. We can use the implementation of the online resource as a measure for socio-technical innovation as it underpins the need for an understanding of the need for innovation – there currently exists within the context of the operating theatres no such tool – the need for patients voices to be heard and for feedback to be given fits to my mind within a framework for implementation for an initial exploration into the social and technical realm of online blogging.The link here between the systemic and socio-technical models for innovation, can be best expressed by saying that QUOTE SLIDESocio-technical complexityis the result of the combination between social and technical aspects. It occurs in a project when designing, managing or transforming a complex system (e.g. transforming an organization, creating a new business, designing an industrial product, etc). It is especially important in large, innovative or critical projects, involving many individuals and disciplines. Responsible autonomy[edit]Sociotechnical theory was pioneering for its shift in emphasis, a shift towards considering teams or groups as the primary unit of analysis and not the individual. Sociotechnical theory pays particular attention to internal supervision and leadership at the level of the "group" and refers to it as "responsible autonomy".[4] The overriding point seems to be that having the simple ability of individual team members being able to perform their function is not the only predictor of group effectiveness. There are a range of issues in team cohesion research, for example, that are answered by having the regulation and leadership internal to a group or team.[5]These, and other factors, play an integral and parallel role in ensuring successful teamwork which sociotechnical theory exploits. The idea of semi-autonomous groups conveys a number of further advantages. Not least among these, especially in hazardous environments, is the often felt need on the part of people in the organisation for a role in a small primary group. It is argued that such a need arises in cases where the means for effective communication are often somewhat limited. As Carvalho [6] states, this is because "…operators use verbal exchanges to produce continuous, redundant and recursive interactions to successfully construct and maintain individual and mutual awareness…". The immediacy and proximity of trusted team members makes it possible for this to occur. The coevolution of technology and organizations brings with it an expanding array of new possibilities for novel interaction. Responsible autonomy could become more distributed along with the team(s) themselves.The key to responsible autonomy seems to be to design an organization possessing the characteristics of small groups whilst preventing the "silo-thinking" and "stovepipe" neologisms of contemporary management theory. In order to preserve "…intact the loyalties on which the small group [depend]…the system as a whole [needs to contain] its bad in a way that [does] not destroy its good".[4] In practice [7] this requires groups to be responsible for their own internal regulation and supervision, with the primary task of relating the group to the wider system falling explicitly to a group leader. This principle, therefore, describes a strategy for removing more traditional command hierarchies.
Enablers National framework for delivery - The NHS Operating Framework 2012/13 specifically states that the NHS should collect and use patient experience information in real time and use it for service improvements: "NHS organisations must actively seek out, respond positively and improve services in line with patient feedback. This includes acting on complaints, patient comments, local and national surveys and results from 'real time' data techniques” -http://www.institute.nhs.uk/patient experience/guide/the_policy_framework.html#sthash.DyTEnXl5.dpufNHS Outcomes framework – Domain 4 - Ensuring that patients have a positive experience of care – ‘It is now standard practice in healthcare systems worldwide to ask people to provide direct feedback on the quality of their experience, treatment and care. When analysed alongside a range of additional information sources (including complaints and operational data), this information provides local clinicians and managers with intelligence on the quality of local services from the patients’ and service users’ point of view, which means that patient feedback has an important role to play in driving improvements in the quality of service design and delivery’NHS Constitution – ‘no decision about me without me’Section 242 – The statutory duty to involve – consultation with communitiesOrganisational plan – LTHT 5 year plan - The recently published organisational strategy makes implicit reference for the need to involve patients at every stage of their care – We will seek to improve the way we handle our patients’ complaints and concerns ensuring we respond quickly, compassionately and in a transparentway, valuing each complaint as an opportunity to improve. We will acknowledge concerns raised with us immediately and report back on progress within two weeks – the planned innovation will allow an almost instantaneous opportunity to receive and review patient complaints and also the positive stories.Multi stakeholder collaboration – The principles behind this innovation are really very simple. It places a large amount of emphasis on communication, feedback and review. Without the voices of patients and staff, any success will not be seen within the planned framework for both positive and negative assessment and for the primary driver multi stakeholder collaborated change. As such the principle rationale behind the innovation is engagement. (MOVE TO NEXT SLIDE) To make things happen, we need to work with patients and staff to assess service delivery, to assess and plan, deliver and improve. (MOVE BACK TO PREVIOUS SLIDE)The engagement of patients and carers, will be fostered initially through review of the online stories. Initial communication will come from responding to patients and carers using the electronic resource. Future plans would include inviting patients and carers to come and share positive and negative stories with the theatre teams. Specific patient focus groups drawn from those who have responded online will be formulated. We will make these meetings OPEN and TRANSPARANT – Patients will be asked to speak openly about their experiences and will be recompensed for any incurred expense. – SEE BUSINESS PLANTied to patient and carer engagement is staff engagement,
Patient opinion offer a range of annual tariffs outside of the free version. Following negotiation, I was able to agree a price of£2,450 + VAT.This subscription would include access for 5 staff members, monthly reporting, access to our integrated blogging feature and a starter pack of promotional materials.Business planning to agreed by CSU.
I would like to finish with a short video clip highlighting another organisations experiences with patient opinion.
