Patient Experience: Why does it matter?

Sarah DickieNurse Consultant

What is Patient Experience?

• How the patient journey (and the dynamic, associated human interactions and emotional response) is experienced and interpreted by an individual

• 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 Scotland

• Focused on detailed patient experience

• Useful at both local and the national level

Better Together

• Year 1 and 2:• Acute Care (Inpatient)• Primary Care (GP

Services)• 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 ward

• 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 (86%)

Quality Patient Care

Safe & Effective Patient Experience

Clarity about purpose

“what happens to me”

Clinical Outcome

Explanation of procedure/risks

involved

Choices offered/ patient/carer engagement

- Understanding aftercare/self care - Compliance assured - Lifestyle change - Where to get help

Admission/ Referral

Assessment/ Treatment

Intervention/ Treatment

Discharge Plan/ Exit System

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

Approach

Role of the healthcare professional

What has been done to patient

Impact on patient

Expectations

Anxiety

Empathy /Engagement

Negative Responses

“They [NHS24] go through the same

routine – she wanted somebody

to talk to – you just give them the same

information time after time after

time.”

Pre-Arrival Arrival @ A&E Triage by Nurse Consultation Testing/ Treatment

Decision to Refer/

Discharge/ Admit

Transfer/ Discharge

Ward 3E

Reception

Waiting Room

Cubicle/Trolley

Excited

Desperate

Lucky Fortunate

Over your head

Confused Not happy Put up with it Worried Not sure

Understood Comfortable

The average length of wait from arrival to

seeing the Triage Nurse was

11 minutes.

The average length of wait from the Triage Nurse to seeing a doctor

was 24 minutes.

Positive Responses

Map Key

Patient Identified Touchpoints

Expressed Emotion A&E Survey Results (Interim) A&E Survey – Comments Patient Interview Quotes

Not Ignored

Pleased Calming

Confident

“When you go into reception and my husband had to give my name and that, and you sit for the triage nurse, well there was a wee bit of a

wait so I had to go back out because I couldnae breathe, so I had to go out and get fresh air and wait till they came for me . . . I

couldnae breathe, I was just desperate for somebody to let me breathe.”

“If you asked questions they

answered you, they told you, what they did, they kept you informed as they

went along.”

“I can say that the nurses on this ward last night were exceptional, I mean, they

couldnae do enough for you.”

“ADOC had phoned down but when we got down there nobody had got the phone call, well, so they said, so

my husband had to go through it all again and then we had to go through it all

again [at triage].

“The only thing I have against it [A&E] was that it was that long to wait to come up to the

ward. 7 o’clock I came up here and it was twenty past 10 before I got a bed . . . fair

enough, they’re busy, you cannae help that.”

“When you get your breakfast and they say ‘do you want tea’, you get

your tea before you start your breakfast, lunch is the same and

probably the evening. . . you get your tea cold when you’re ready to take it and if you ask for another cup they

don’t have time.”

“If you ask they tell you and I’m one of those folk that asks. I got a whole

lot of pills this morning and I thought no way that I’m taking them

– I want to know whit they’re for. So I managed to reject 2 of them.”

“I was left waiting downstairs from probably, from what I can recall, and I wasnae happy about it, probably before 6 in the morning, maybe even earlier than that, probably 5 in the morning. Nobody asked me, came and

asked me, and I shouted for somebody, and I shouted and I shouted and eventually I got a wee toty lassie and she says I’ll fix you up.”

“I was at the renal clinic yesterday and they sent me from there to get a heart trace done, they told me to go home and get some clothes and come back, and she gave me a letter to by-pass A&E. So I went to A&E and I

spent from quarter to 2, maybe 2 o’clock till quarter to 8 when I got brought here [3E] last night. They say there was no record of a doctor

saying I was being transferred but I gave them the letter and I still spent 6 hours there [at A&E]. But they did say it was a busy day because Ayr

Hospital was shutting.”

“There is really nothing you can do about it [the wait for a bed]. You’ve just got 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 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.”

“The nurses did try and said they’re just waiting on beds, there’s no

beds, and that was the biggest problem.”

“You can understand, I mean, I’ve been through A&E before and it’s never took that

long. I think they did say, the nurses did explain that Ayr Hospital is shut and

everything is coming here, so, we’re taking everything, there was even folk sitting in

corridors on chairs and whit no, it was just like something out of casualty it was [laugh].”

“I had been waiting for an

outpatient appointment but I was progressively getting worse and

he [GP] wanted me to come in.”

“After my x-ray I had to wait for a wee while because they were very,

very busy downstairs, just to come to the ward, and then once a bed

became free I came up here [3E].”

“I think I was lucky downstairs at A&E because they weren’t busy. They were busy in the cubicles but actually sitting

waiting wisnae busy.”

“No sooner was I in when the nurse came and checked my heart and then the doctor

came and done his bit and asked all his questions . . . I was quite pleased with the doctor, he was very nice, very calming, as I was a bit excited about coming in.”

“Then the doctor came and went through all the procedure again, actually similar

to what I got in A&E, and just told me all that was wrong, what he thought was

wrong with me. All this time my daughter was in the waiting room and I asked him would he explain it all to my daughter cause sometimes it goes over your head when you’re not feeling too good, so eh, he did, he came in and my

daughter had came in by that time, and he came back and explained it all to her, so, she was very pleased with that. It lets her

know as well as me what’s really wrong.”

“They were very interested in you, in me, which made you

feel confident in what they were

saying.”

“Everything was just flowing actually, everything was just fine, there were no

problems.”

“I had an appointment with a specialist in May

and they sent me a letter saying that it

was cancelled, erm, fair enough. They said they’d send me another

appointment. However, they

hadn’t and I phoned up about it and they said I was on a list of people

that had fell behind and I still haven’t

heard.”

“When we arrived I gave the letter to A&E downstairs and, er, sat for a little while and then we were conveyed to a little side

room downstairs, I’d say in about 20 minutes and that’s not too bad is it. And, it just took off from there. I had to wait for a

while in the little side room for a bed.”

“It was done very nicely and quickly with the minimum of fuss, and that was good wasn’t it –

no hovering.”

“I came in at 3 o’clock and the first doctor I seen was at

half past 4 . . . they just leave you until the doctor

has time to see you.”

“The meal I got today was atrocious . . . no options at all. It’s take it or

more or less leave it.”

“I got seen really quickly, erm, but it was quite busy in the period from being seen until

I got moved up here [to 3E].”

“They talked me through what would happen.”

“I was kept up-to-date and I was checked regularly.”

“If you ask questions they answer them. Everybody is

that friendly.”

“It wasn’t that long [wait for the doctor] but it felt longer because I was worried about what was going on. But it wasn’t that long at all, and then the doctor came in and examined me and he answered every question that I had

for him which was quite good.”

“I was sitting myself for my x-ray so it seemed a bit long.”

“If I had any questions they always answered it as best

they could, you know what I mean, so it was quite good.”

Everyone was very professional with an understanding and caring

approach.

X-ray waiting times could be better or indication of priority

cases e.g. head injury.

The receptionist, nurse and maxillofacial doctor were all helpful, caring and patient however the initial

doctor I spoke to did not seem to think that my pain was as bad as I was saying and was condescending

towards me which was annoying and upsetting.

We felt that the nurse practitioner did an exceptionally careful and good job on my leg which had a deep cut and torn skin after a fall. Also, there were 2 medical students who were

observing the procedure, and she was excellent in the way she explained everything

to them.

The nurse practitioner who stitched my wound and her student could not have been more efficient and helpful - they were very nice indeed - excellent. If I had any small

problem it was going into reception and checking in - I didn't really know the procedure and just sussed it out - maybe someone not so able would be confused. All

in all I would say thank you to the nurses.

After seeing the nurse practitioner I had to wait a further 50 minutes before being seen by the doctor.

After that my treatment was prompt and efficient.

I was brought in by ambulance and I was seen straight away.

Although I am quite happy about the care and attention I received at A&E, I had to ask what my injury consisted of. When I got home I had to ask my daughter what the nurse had told me to do i.e. seeing the practice nurse which made me

feel that written details about this should have been given to me.

Staff were very courteous and understanding.

Was told to attend Ayr Hospital Eye Clinic once discharged from

Crosshouse where they were able to diagnose the problem with my eye.

You are very helpful.

Service was pretty good but waiting to see Doctor was too long.

Just the distance, to walk to a vacant room, because I had a foot injury. Thank you once again for your

service, very much appreciated.

I was seen very quickly and the nurse and doctor explained everything to me, and put me at ease with my minor injury, as I felt I was taking up precious time that could have

went on somebody else, at a very busy time of day. Thank you very much for your help.

42.9% sought advice from their family or friends

25.0% sought advice from their

GP

3.6% sought advice from NHS24

3.6% sought advice from a

general website

14.3% sought advice from elsewhere (first aider etc)

25.0% didn’t seek any advice

71.4% made the decision

themselves to present at A&E

14.3% had the decision made by a family member or friend

10.7% were advised to attend

by their GP

3.6% were advised by someone else (not listed).

92.9% found the receptionist to be friendly and welcoming

75% felt treated with dignity and

respect

75% were able to speak without any interruptions

67.9% felt their hospital record was

accessed without any problem

32.1% were told how long they should expect to wait

53.6% felt they had enough privacy when giving their

details

82.1% were completely or very satisfied with their

length of wait

64.3% felt the reason for their tests or treatment had been fully explained

67.9% felt they had been treated with

dignity, respect, care and compassion

32.1% found it easy to find where they had to go for tests or treatment

35.7% were told how and when they would receive their results

82.1% were completely or very satisfied overall with the service

they received from A&E

92.3% understood what they had to do when they got home

80.8% felt that their condition, illness or injury had been fully

explained

76.9% were confident that they could manage at home

“They took me through to where the doctors and nurses see you and they

couldnae have been nicer. Everything

was done quite quick except there was a

wee wait to get up to the ward, but that was all really, I

mean, I had my x-ray done in, in fact, a

minute – it was hard to believe.”

Crosshouse Hospital Front Door – Patient Experience Map

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 complete

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

caring• 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

First class care from the ENP, a credit to the

Hospital

Excellent Care. I was very impressed

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 board

You said – We did

YOU SAID WE DID

• Staff kind and caring, excellent care provided

• Waiting times seemed too long

• Lack of communication after being left in a room

• Thank you for this feedback. Passed on to staff and congratulated on their good work

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

• Relatives should be encouraged to accompany the patient. Staff asked 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 CentreEmail: 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