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					Patient Experience: Why does it

           Sarah Dickie
         Nurse Consultant
 What is Patient Experience?

• How the patient journey (and the dynamic,
  associated human interactions and emotional
  response) is experienced and interpreted by an
• A subjective measure of a patient's experiences. It
  looks at a care provider's offering from the
  standpoint of the patient's holistic experience
     Why it matters?

Better Health Better Care -Mutuality and
  Patient Centeredness

‘We are determined to put the needs of patients
  at the centre of our health service…and learn
  from patient experience, good and bad, in
  improving how we design and deliver services’

Shared ownership and partnership working
  with patients
    What do Patients want?

• Fast access to a reliable health service
• Effective treatment delivered by professionals
• Participation in decisions & respect
• Clear, comprehensive information and
  support for self care
• Continuity of care

Picker Survey 2007
Quality Strategy

       The three Quality Ambitions

       • Person- centred
       • Safe
       • Effective
Better Together
              • Consistent
                information regularly
                collected across NHS
              • Focused on detailed
                patient experience
              • Useful at both local
                and the national
Better Together
           • Year 1 and 2:
           • Acute Care (Inpatient)
           • Primary Care (GP
           • Disease specific (Long-
             term conditions,
             including Cancer)
       Better Together
Areas which received the lowest levels of
  positive feedback included:-
• Being told how long you would have to wait in
  A&E and knowing who was in charge of the
• Emergency or urgent patients were less likely
  to score their overall admission to hospital
  positively (77%) when compared to those who
  were admitted from a waiting list or planned
                             Quality Patient

   Safe & Effective                              Patient Experience

External ‘process’/journey      Based          Human ‘internal’/experience

                                                        Clarity about
     Admission/                                           purpose
      Referral                                         “what happens
                                                           to me”

   Assessment/                 Anxiety
    Treatment                                         Explanation of
                               Empathy                   involved
     Treatment                                         Choices offered/

 Discharge Plan/
   Exit System
                              of                      - Understanding
                              the                      aftercare/self care
                              healthcare              - Compliance assured
                              professional            - Lifestyle change
                                                      - Where to get help


What has been done to                                 Impact on patient
Crosshouse Hospital Front Door – Patient Experience Map
Positive Responses                                                                                                                                                                                                                                                                                                                    82.1% were completely or                    82.1% were completely or very
                                                                                                                                                                                                                                                                                                                                       very satisfied with their                  satisfied overall with the service
  42.9% sought advice from their                                                                                                                                  “It wasn’t that long [wait for the doctor] but it felt longer             Everyone was very professional              “They talked me through what
                                                                                                                                                                                                                                                                                                                                            length of wait                            they received from A&E
        family or friends                                                                                                                                          because I was worried about what was going on. But it                    with an understanding and caring                   would happen.”
                                                                                                                                                                   wasn’t that long at all, and then the doctor came in and                            approach.
  25.0% sought advice from their                                                                                                                                  examined me and he answered every question that I had
               GP                                                                                                                                                              for him which was quite good.”                                                                                                                        64.3% felt the reason for their tests         “I can say that the nurses on this ward
                                                                                                                                                                                                                                                                                                                                    or treatment had been fully explained         last night were exceptional, I mean, they
                                                                                                                                                                                                                                                                                          “I was kept up-to-date and I                                                                  couldnae do enough for you.”
     3.6% sought advice from
                                                     92.9% found the receptionist to be                                                                                                                                                                                                     was checked regularly.”                 67.9% felt they had been treated with
                                                         friendly and welcoming                                                                                    “Everything was just flowing actually,                  “It was done very nicely and quickly with the
                                                                                                                                                                   everything was just fine, there were no                minimum of fuss, and that was good wasn’t it –                                                                 dignity, respect, care and
     3.6% sought advice from a                                                                                                                                                  problems.”                                                no hovering.”                                                                                          compassion
                                                      75% felt treated with dignity and                  We felt that the nurse practitioner did an
          general website                                                                              exceptionally careful and good job on my leg
                                                                   respect                                                                                                                                                                                                                 “If you ask questions they
                                                                                                       which had a deep cut and torn skin after a fall.                                                                                                                                                                                                                            “Then the doctor came and went through
     14.3% sought advice from                                                                                                                                                                                                                                                             answer them. Everybody is                                                                 all the procedure again, actually similar
                                                    75% were able to speak without any                 Also, there were 2 medical students who were              “No sooner was I in when the nurse came                   “They took me                  “They were very                                                           92.3% understood what they had to
     elsewhere (first aider etc)                                                                                                                                                                                                                                                                 that friendly.”                                                                  to what I got in A&E, and just told me all
                                                              interruptions                                observing the procedure, and she was                  and checked my heart and then the doctor              through to where the             interested in you, in                                                            do when they got home
                                                                                                       excellent in the way she explained everything                                                                                                                                                                                                                                  that was wrong, what he thought was
                                                                                                                                                                  came and done his bit and asked all his                doctors and nurses             me, which made you
   25.0% didn’t seek any advice                                                                                           to them.                                                                                                                                                                                                     80.8% felt that their condition,                 wrong with me. All this time my
                                                    67.9% felt their hospital record was                                                                         questions . . . I was quite pleased with the             see you and they                feel confident in
                                                                                                                                                                                                                                                                                        Staff were very courteous and                  illness or injury had been fully             daughter was in the waiting room and I
                                                      accessed without any problem                                                                                doctor, he was very nice, very calming,               couldnae have been                 what they were
                                                                                                                                                                                                                                                                                               understanding.                                      explained                        asked him would he explain it all to my
                                                                                                                                                                  as I was a bit excited about coming in.”               nicer. Everything                    saying.”
                                                                                                                                                                                                                                                                                                                                                                                    daughter cause sometimes it goes over
     71.4% made the decision                                                                                                                                                                                           was done quite quick                                                                                                                                          your head when you’re not feeling too
                                                                                                         I was seen very quickly and the nurse and                                                                       except there was a                                                                                           76.9% were confident that they
   themselves to present at A&E                                                                                                                                                                                                                                                                                                                                                     good, so eh, he did, he came in and my
                                                                                                        doctor explained everything to me, and put                                                                     wee wait to get up to                                                                                              could manage at home
                                                    I was brought in by ambulance and I                 me at ease with my minor injury, as I felt I                                                                                                        “If you asked                                                                                                         daughter had came in by that time, and he
                                                                                                                                                                   Not Ignored                  Confident                the ward, but that                                                  You are very helpful.
  14.3% had the decision made by                                                                                                                                                                                                                           questions they                                                                                                          came back and explained it all to her, so,
                                                          was seen straight away.                       was taking up precious time that could have                                                                        was all really, I
     a family member or friend                                                                                                                                                                                                                          answered you, they                                                                                                        she was very pleased with that. It lets her
                                                                                                       went on somebody else, at a very busy time of                                                                   mean, I had my x-ray
                                                                                                         day. Thank you very much for your help.
                                                                                                                                                                                                                                                        told you, what they                                                                                                             know as well as me what’s really
   10.7% were advised to attend                                                                                                                                                                                          done in, in fact, a             did, they kept you                                                                                                                         wrong.”
                                                                                                                                                                     Pleased                    Calming                                                                                   “If I had any questions they              Was told to attend Ayr Hospital Eye
          by their GP                                                                                                                                                                                                  minute – it was hard               informed as they                 always answered it as best                  Clinic once discharged from
                                                  “I think I was lucky downstairs at A&E                                                                                                                                    to believe.”                    went along.”                 they could, you know what I                Crosshouse where they were able to
  3.6% were advised by someone                    because they weren’t busy. They were
                                                  busy in the cubicles but actually sitting                                                                                                                                                                                              mean, so it was quite good.”               diagnose the problem with my eye.
        else (not listed).                                                                                              Understood                                       Lucky                  Fortunate                                                                                                                                                                                          Comfortable
                                                           waiting wisnae busy.”

       Pre-Arrival                                    Arrival @ A&E                                            Triage by Nurse                                            Consultation                                                 Testing/                                          Decision to                                         Transfer/                                           Ward 3E
                                                                                                                                                                                                                                      Treatment                                          Discharge/
                                                                                              The average                                       The average length
               Excited                                                                       length of wait                                      of wait from the                                                                                                                          Admit
                                                                                            from arrival to                                      Triage Nurse to
                                                                                           seeing the Triage                                     seeing a doctor
                                                                                               Nurse was                                               was                                                                                                                                                                                                                              “When you get your breakfast and
   “They [NHS24] go                                                                           11 minutes.                                          24 minutes.                                                                                                                                                                                                                         they say ‘do you want tea’, you get
    through the same                                                                                                                                                                                                                                                                                                                                                                      your tea before you start your
       routine – she                                                                                                                                                                                                                                                                                                                                                                     breakfast, lunch is the same and
    wanted somebody                                                                                                                                                                                                                                                                                                                                                                   probably the evening. . . you get your
   to talk to – you just
   give them the same
                                       Reception                                    Waiting Room                                                                                                                                  Cubicle/Trolley                                                                                                                                     tea cold when you’re ready to take it
                                                                                                                                                                                                                                                                                                                                                                                       and if you ask for another cup they
    information time                                                                                                                                                                                                                                                                                                                                                                            don’t have time.”
     after time after
          time.”                                                                                Desperate                                                                Not happy                 Put up with it                     Over your head                Worried                    Not sure                  Confused

                                                                                                                                                                                                                                                                                                                                                                                       “The meal I got today was atrocious
          “I had an                 “ADOC had phoned down                  “When you go into reception and my husband                    “I was left waiting downstairs from probably,                 “You can understand, I mean, I’ve been                  “After my x-ray I had to wait for a               “The only thing I have against it [A&E] was                            . . . no options at all. It’s take it or
   appointment with a              but when we got down there              had to give my name and that, and you sit for                   from what I can recall, and I wasnae happy               through A&E before and it’s never took that                wee while because they were very,                that it was that long to wait to come up to the                                 more or less leave it.”
     specialist in May              nobody had got the phone               the triage nurse, well there was a wee bit of a                 about it, probably before 6 in the morning,                long. I think they did say, the nurses did              very busy downstairs, just to come to               ward. 7 o’clock I came up here and it was
    and they sent me a              call, well, so they said, so                wait so I had to go back out because I                     maybe even earlier than that, probably 5 in                  explain that Ayr Hospital is shut and                    the ward, and then once a bed                     twenty past 10 before I got a bed . . . fair
    letter saying that it             my husband had to go                  couldnae breathe, so I had to go out and get                   the morning. Nobody asked me, came and                    everything is coming here, so, we’re taking               became free I came up here [3E].”                enough, they’re busy, you cannae help that.”
                                                                                                                                                                                                                                                                                                                                                                                      “If you ask they tell you and I’m one
       was cancelled,              through it all again and then            fresh air and wait till they came for me . . . I             asked me, and I shouted for somebody, and I                  everything, there was even folk sitting in
                                                                                                                                                                                                                                                                                                                                                                                      of those folk that asks. I got a whole
     erm, fair enough.              we had to go through it all               couldnae breathe, I was just desperate for                  shouted and I shouted and eventually I got a               corridors on chairs and whit no, it was just
                                                                                                                                                                                                                                                                                                                                                                                          lot of pills this morning and I
     They said they’d                    again [at triage].                         somebody to let me breathe.”                          wee toty lassie and she says I’ll fix you up.”           like something out of casualty it was [laugh].”
                                                                                                                                                                                                                                                                                                                                                                                      thought no way that I’m taking them
      send me another                                                                                                                                                                                                                                         “I was sitting myself for my x-ray so               “I got seen really quickly, erm, but it was
                                                                                                                                                                                                                                                                                                                                                                                        – I want to know whit they’re for.
        appointment.                                                                                                                                                                                                                                                  it seemed a bit long.”                    quite busy in the period from being seen until
                                                                                                                                                                                                                                                                                                                                                                                       So I managed to reject 2 of them.”
       However, they                The nurse practitioner who stitched my wound and her student could not have been                     “I was at the renal clinic yesterday and they sent me from there to get a                “The nurses did try                                                                   I got moved up here [to 3E].”
        hadn’t and I               more efficient and helpful - they were very nice indeed - excellent. If I had any small              heart trace done, they told me to go home and get some clothes and come                    and said they’re
    phoned up about it                 problem it was going into reception and checking in - I didn't really know the                   back, and she gave me a letter to by-pass A&E. So I went to A&E and I                       just waiting on
   and they said I was             procedure and just sussed it out - maybe someone not so able would be confused. All                     spent from quarter to 2, maybe 2 o’clock till quarter to 8 when I got                   beds, there’s no
     on a list of people                                                                                                                  brought here [3E] last night. They say there was no record of a doctor                  beds, and that was           “There is really nothing you can do about it [the wait for a bed]. You’ve just got
   that had fell behind
                                                         in all I would say thank you to the nurses.
                                                                                                                                         saying I was being transferred but I gave them the letter and I still spent                  the biggest
                                                                                                                                                                                                                                                               to put up with it. Erm, I know that sometimes people come in that are in a worse
                                                                                                                                                                                                                                                                 state than you, you’ve got to wait, but I just felt it was a long, long time to sit
                                                                                                                                                                                                                                                                                                                                                                                  Map Key
     and I still haven’t                                                                                                                 6 hours there [at A&E]. But they did say it was a busy day because Ayr
           heard.”                                                                                                                                                 Hospital was shutting.”                                                                      there. I mean, she told me they’d be happy for me to come in and get admitted
                                                                                                                                                                                                                                                                straight to 3E and I didnae – I spent 6 hours down in A&E. If I had knew that I
                                                                                                                                                                                                                                                                                wouldnae have done it, I’d have stayed at home.”
        “I had been
                                   32.1% were told how long
                                                                                                                                         “I came in at 3 o’clock and             “When we arrived I gave the letter to A&E downstairs and, er,
                                                                                                                                                                                                                                                                                                                                                                             Patient Identified Touchpoints
                                   they should expect to wait
      waiting for an                                                                                                                    the first doctor I seen was at            sat for a little while and then we were conveyed to a little side
         outpatient                53.6% felt they had enough                                                                              half past 4 . . . they just           room downstairs, I’d say in about 20 minutes and that’s not too               Although I am quite happy about the care and attention I received at A&E, I had
    appointment but I               privacy when giving their                                                                             leave you until the doctor               bad is it. And, it just took off from there. I had to wait for a            to ask what my injury consisted of. When I got home I had to ask my daughter                                  Expressed Emotion
    was progressively                        details                                                                                        has time to see you.”                               while in the little side room for a bed.”                       what the nurse had told me to do i.e. seeing the practice nurse which made me
    getting worse and                                                                                                                                                                                                                                                  feel that written details about this should have been given to me.
   he [GP] wanted me                                                                                                                                                                                                                                                                                                                                                         A&E Survey Results (Interim)
       to come in.”
                                                                                                                                         The receptionist, nurse and maxillofacial doctor were               After seeing the nurse practitioner I
                                                                                                                                           all helpful, caring and patient however the initial                had to wait a further 50 minutes                                                                                                                               A&E Survey – Comments
                                                                                                                                          doctor I spoke to did not seem to think that my pain                before being seen by the doctor.                                                               Service was pretty good but waiting
                                                                                                                                                                                                                                                                X-ray waiting times could be
                                                                                                                                          was as bad as I was saying and was condescending                   After that my treatment was prompt
                                                                                                                                                                                                                                                                better or indication of priority                 to see Doctor was too long.
                                                                                                                                            towards me which was annoying and upsetting.                                 and efficient.                                                                                                                                      Patient Interview Quotes
                                                                                                                                                                                                                                                                    cases e.g. head injury.

                                                                                                                                          Just the distance, to walk to a vacant room, because I              32.1% found it easy to find where                35.7% were told how and when
                                                                                                                                            had a foot injury. Thank you once again for your                 they had to go for tests or treatment             they would receive their results
Negative Responses                                                                                                                                   service, very much appreciated.
 Transforming Relationships

• Supporting Patients and Carers to engage in
  improving services at local level
• Surveys, Focus groups and patient stories
• Clinical supervision to promote reflection as
  an everyday part of work
• Creating opportunities to support staff in
  driving improvement in patient care
• Patient experience embedded into CPD and
  staff feedback
Patient experience: Trauma Review Clinics

• Data collated Feb 2010 – Feb 2011

• All patients (new & return) attending the
  Tuesday morning Trauma Review clinic are
  offered a patient experience questionnaire to
Patient experience: Trauma Review Clinics

  • 86% of respondents rated the Trauma Review clinic
    as either excellent or very good
     – Patients valued not waiting
     – Patients valued staff who were professional, polite and
  • Areas where patients thought we could do better
     – Information: “provide information updates when clinic’s
       running late”
     – “Make sure their was enough time to ask questions”
Patient Experience: ENP Service

• Data Collection: May 2010
• All patients presenting to Emergency
  Department and seen by an ENP
• N= 734 surveys completed
• Overall patients experience with the ENP
  service was rated excellent across all aspects
  of the service
Patient Experience: ENP Service

        Excellent Care.
     I was very impressed
                                                           First class care from the
                                                              ENP, a credit to the
                            Fast and efficient.
                                Thank you

    Thanks for good
   advice. Everything
  was explained clearly
         to me
                                                  I was very pleased with
                                                    the way I was treated
         You said – We did

• Short survey offered to patients and relatives
  each month
• Collated information displayed on white
           You said – We did
YOU SAID                   WE DID
• Staff kind and caring,   • Thank you for this feedback.
  excellent care           Passed on to staff and congratulated
provided                   on their good work

                       • Staff have been asked to ensure
• Waiting times seemed that patients and relatives are kept
too long               informed and up to date with
                       potential delays to flow

• Lack of                  • Relatives should be encouraged to
communication after        accompany the patient. Staff asked
being left in a room       to provide more communication
 Next steps: Over to You

• What does the patient experience programme
  mean for me and my organisation ?
• Are we delivering the Services we would want
  to receive ?
• What are you going to do that will really make
  the difference to patient experience ?
               Useful links

• Patient Experience Coordination Centre
 Email: Patientexperience@scotland.gsi.gov.uk

• NHS Education for Scotland
  – A framework to support staff development in Patient
    Focus Public involvement www.scot.nhs.uk/pfpi

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