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Improving quality one service at a time: Using people’s experiences to improve community healthcare services

Happy elderly patient talking

Community Healthcare encompasses a huge variety of services. Securing robust, reliable, and representative data to understand and measure patient and service users’ experiences in this setting can become highly complex.

When care services range from district nursing to palliative care and offender health, an intimate knowledge of how to access and measure each group’s experiences is required, particularly as so many of these patient groups are hard to reach. The Health Experiences team at Picker are dedicated to this task, focusing on developing the knowledge and tools required to understand and measure people’s experiences regardless of their care needs or setting.

During 2013 Central London Community Healthcare NHS Trust (CLCH) the largest community healthcare organisation in London, approached us to design and deliver an effective patient experience feedback programme.

“Using the best methods and available technology across professional and patient communities is what Picker do best”

Ian McDowell, Head of PPE, CLCH 2013

The aim:

CLCH provide community healthcare services in four London boroughs across 64 different service delivery units, seeing more than 150,000 people each year in over 160 sites.

Their community healthcare includes an extremely wide-ranging array of services, from paediatric wards to offender health units, from podiatry practices to sexual health clinics.

The aim was to use a range of patient-friendly approaches to enable CLCH to collect high-quality patient experience data across their organisation, supporting staff to act on the intelligence gained to improve care quality.

“Initially a key challenge was to help the trust understand that, collecting experience data through a range of technologies most appropriate for each service user group, would ensure the most robust and representative data. However the trust needed to accept that in doing so they would not be able to reliably compare across services that used different data collection methods. It was agreed, whilst a trust wide overview was important, the focus for CLCH was achieving excellence in the delivery of each and every service, so high quality data at the service level was the top priority. “

Bridget Hopwood, Director of Health Experiences, Picker.

In order to ensure service user groups had access to the most suitable feedback tools, we created a hybrid system of paper, telephone, online and smartphone surveys.

We collected both qualitative and quantitative data, described by CLCH’s CEO James Reilly as:

“…getting the basics right while remaining relentlessly innovative.”

Choosing an approach that is right for the service user has resulted in consistently strong response rates from patients across service delivery units.

With findings uploaded into the trust IT system, staff are able to quickly access, assess and act on intelligence. For example, opportunities to help reduce falls were identified, with the trust introducing “ward deep dives” and creating “patient stories” to better inform staff and patients of the risks and actions to take to avoid them.

Picker were also able to support the trust to harness the power of free-text comments, introducing coding, using a “sentiment analysis” approach to highlight key areas of excellence and those to be improved.

“Some of the low-cost changes are really inspiring. Psychological Services bought sweep second-hand clocks for waiting areas because anxious patients were becoming agitated by ticking second hands. Child-friendly maps and clock faces are being added to appointment letters in Children’s Services to make them more accessible. The Friends and Family Test question is being animated to make it accessible for people with learning disabilities. All of these changes have only been possible due to the high-quality feedback data we are now getting from our patients and service users” Ian McDowell, Head of PPE, CLCH 2013

Picker are proud to continue to support CLCH as they endeavour to deliver the highest quality care for all their patients and service users. We continue to work with a variety of community providers to support their patient and service user initiatives.

Top Tips:

Here are some key tips to effectively understanding and measuring peoples’ experiences of community care services:

  • Ensure a rounded perspective
  • Programmes should be designed to gather feedback directly from each care user group whenever possible. Questions should wherever possible have been cognitively tested with relevant care users. Programmes must also take into account that different care services may require different data collection methods.
  • Be appropriate and engaging
  • The appropriateness of the tools and questions we use significantly affects their potential to collect high-quality experience data. If not appropriate for the audience, respondents may misinterpret the meaning of questions, be unable to give answers, and/or decline to give their feedback.
  • Measure experience over satisfaction
  • As in our work with adults, we have found that research with children and young people must aim to examine experience rather than simply measure satisfaction.
  • Produce actionable results
  • Results must be presented in a format and at a level that is useful to staff. Tables, charts and targets all have their place, but the focus on appropriateness and engagement applies as equally when presenting results to staff as it does when considering mechanisms to collect feedback from patients and service users.

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