A national Inpatient survey is conducted each year and published on the CQC website. The survey results are benchmarked against all NHS trusts and therefore allow national comparison. Our aim is to achieve year on year improvement on the question which asks patients to rate their overall experience on a scale of 0 – 10 with 10 being “a very good experience”.
In addition each year we target specific areas where patients have told us that experience could be improved. The national inpatient survey results were published too late for us to consider the areas to focus on for next year through our internal and external consultation process so we selected two questions based on the Picker survey – areas where we have worsened significantly compared with last year. Since we agreed these questions the national inpatient survey results have been published. We reviewed the results and confirmed that the areas we had chosen were areas we needed to focus on but we also decided to add a further question where we had not done well – ‘did not always get enough help from staff to eat meals’
In summary the areas we agreed are as follows with targets:
Table 7
National survey results (Picker) – lower scores are better
2014 result*
2015 target*
Overall experience rating ( scored less than 7/10)
13% 12%
Care: Staff contradict each other
37% 30%
Care: More than 5 mins to answer call button
20% 14%
Hospital: did not always get enough help from staff to eat meals
41% 37%
* problem scores – lower scores are better. See glossary for more information on how these are calculated.
The targets chosen are based on previous best performance over the last four years (in the same survey)
As overall experience is already above average compared with other trusts in the Picker survey we want to maintain this performance.
The results from the national inpatient survey and the targets are as follows:
Table 8
National inpatient survey results (CQC) – higher scores are better
2014 result*
2015 target*
Overall experience rating (1) 8.1 8.4
Care: Staff contradict each other (2)
7.7 8.2
Care: More than 5 mins to answer call button (2)
6.0 6.2
Hospital: did not always get enough help from staff to eat meals (2)
6.5 7.9
* Individual responses are converted into scores on a scale from 0-10, with 10 representing the best possible score and 0 the worst (see glossary for further information).
1 Maintain the target from last year 2 Target is last year’s score
APPENDIX 2 QUALITY REPOR T APPENDIX 3 ANNUAL GOVERNANCE ST A TEMENT APPENDIX 4 ANNUAL ACCOUNTS
We know from experience that by including these questions in our real time patient experience survey, performance will improve as ward teams are able to try ways to improve patients’ experience in specific areas and see quickly whether there is an impact.
We also believe that our ‘Home for Lunch’ initiative will help with staff not contradicting each other. This is a system of ‘planning for tomorrow’, where ward staff meet as a multi-disciplinary team (MDT) to review all patients on their ward, establish their progress and ensure that all plans for discharge are in place. Ensuring everyone is clear about patients’ plans and progress also makes for more consistent information being provided to patients and relatives by the members of the MDT.
We have started to look at best practice in other trusts for helping patients with meals and have areas of good practice within the trust that we can learn from. We will use this experience to agree a plan to implement improvement in all areas.
1.2 Outpatient Survey
What success will look like
Last year patients attended 940,000 outpatient appointments and it is important to us that this should be a positive experience. We have been working with clinical teams in a structured programme called the ‘Productive Outpatient
Programme’ (POP). POP works to improve the quality, efficiency and smooth running of clinics and improve the experience of patients who visit us.
We are continuing to work on initiatives that will make the waiting time shorter and each waiting area is being reviewed to ensure that when waits are unavoidable, patients are made as comfortable as possible and kept informed. We have introduced pagers in most outpatient areas to call patients who have impaired hearing, and to allow patients to leave the waiting areas if waits are long.
We have been working with clinic teams to give them tools to understand what patients want and supporting them to develop and test solutions to improve the experience in their services. We have made some improvement in the overall rating of care that patients received but we did not meet the target for the time patients waited. However, we want to do better and have therefore set a higher target. There is no national survey planned this year, and the last data is from 2011 so local surveys are being used to measure how we are doing.
We also want to increase the number of patients that respond to the survey so that we get a better
idea of how we are doing. At present, very small numbers of patients respond to our feedback survey offered on tablets or online. We have trialled alternative ways of providing feedback (e.g. a paper form) and initially want to increase responses to at least 1 per cent while we agree the right system to use. We are also asking patients more frequently about our service so that we can take prompt action.
We have also undertaken further UCLH wide work to improve the booking/contact processes including administration, management on the day, and staff attitudes, all of which are aimed at improving our outpatient experience and efficiency.
Our performance and targets are as follows:
Table 9
Meridian survey results – higher scores are better Question 2014 result (Meridian) 2015 Target (Meridian)
Overall how would you rate the care you received (1)
89% 91%
How long after the stated appointment time did the
appointment start? (2)
69% 74%
(1) Percentage of patients who rated the care as good or better
(2) Percentage of patients who waited less than 30 minutes for appointment to start.
1.3 Cancer Survey
What success will look like
The Trust continues to work to improve the cancer patient experience and we are pleased to note a number of improvements in key areas. We continue to work with our staff and patients to address issues raised by the survey and we have set targets that reflect areas which we feel are particularly important to patients.
We have set our targets based on the results of the National Cancer Patient Experience Survey (NCPES) as follows:
VEY RESUL TS APPENDIX 2 QUALITY REPOR T APPENDIX 3 ANNUAL GOVERNANCE ST A TEMENT APPENDIX 4 ANNUAL ACCOUNTS
Table 10
NCPES Question – higher scores are betterNCPES 2014 result*
2015 target*
Overall how would you rate the care you received (1)
89% 91%
How easy is it for you to contact your Clinical Nurse Specialist (CNS)? (2)
69% 74%
While you were in hospital did the doctors and nurses ask you what name you prefer to be called by? (3)
54% 60%
If your family or someone else close to you wanted to talk to a doctor, did they have enough opportunity to do so? (4)
65% 68%
*The National cancer experience survey is
administered by Quality Health. In that survey the questions have been summarised as the percentage of patients who reported a positive experience. For example, the percentage of patients who said they were given enough information about their condition.
(1) We have chosen a target based on the top 20 per cent trusts.
(2) Contact with a CNS: we have demonstrated that patients now know who their CNS is but we still have a problem with patients being able to contact them. We have based our target on the national average of 73 per cent.
(3) Preferred name: this is still only 54 per cent in the National Cancer Patient Experience Survey (NCPES) and we believe we should be able to improve this number. We have based our target on the national average of 60 per cent.
(4) Family able to talk to a doctor: this is an important component of quality care, and scored 65 per cent in NCPES in 2014. We have based our target on being higher than the national average of 67 per cent. There will be no NCPES in 2015 and so we will monitor our performance against our real time patient survey system Meridian.
To help us improve the overall experience and how we do against the specific questions we will:
Continue to train Clinical Nurse Specialists (CNS) in ‘Holistic Needs Assessment’ (HNA) – a process in which there is general discussion with patients to ensure that their needs are met and their worries and fears are discussed
continue with ‘Sage and Thyme’ (see glossary) training in particular for front line and
administrative staff. This training helps staff to be more able to deal with patients’ anxieties
provide training for ward staff in caring for cancer patients and for senior doctors and nurses in communication skills
provide dedicated administrative support to help CNSs to manage telephone calls so that they can be contacted more easily by patients and more time can be spent with patients and their families. encourage CNS teams to develop generic email addresses for patients to use e.g.
continue with the ‘Cancer CNS Community of Practice’, a meeting of Cancer CNSs, used to share ideas and solutions.
We would like to improve our response rate as we have had less than 100 patients surveyed per month since October. However this is challenging and we are looking at other ways of getting feedback such as focus groups.