Acting Together!
Louder than words!
Overall Report
Prepared by
Contents
1.0
Executive Summary
4
1.1 Overall Themes
5
1.2 Specific actions/opportunities
7
1.3 Conclusions
9
1.4 Recommendations
10
2.0
Background
12
3.0
Aims and objectives
14
3.1Overall
14
3.2 Staff interviews
14
3.3 The Listening Event
14
4.0
Methodology
16
4.1 Staff Interviews
16
4.2 The Listening Event
16
4.3 Follow Up Activities
17
5.0
Listening Event Overview
19
5.1 Introductions
20
5.2 Interactive Voting
20
5.3 Breakout Sessions
20
5.4 Conclusions and Final Thoughts
20
6.0
6.1
2
Contents
Outcomes: Interactive Voting
22
Current Experience
22
6.2 GOSH’S Listening Ability
23
6.3 GOSH’S Ability to Respond
23
6.4 Importance of Introducing a Commitment
24
6.5 Effect of introducing a Commitment in GOSH
25
6.6 Impact of the Listening Event on creating a change in GOSH
26
7.0
Outcomes: Young People
28
7.1 Promises, Promises
28
7.2 Empowerment
29
7.3 Resilence
31
7.4 Voice and Influence
31
8.0
Outcomes: Adult Stakeholders
34
8.1 The Patient Experience – What GOSH is doing well
34
8.2 The Patient Experience – Aspects GOSH can improve upon
26
8.3 The Patient Experience - Suggested improvments
39
8.4 The Commitment – What is involved?
42
8.5 The Commitment – What should it contain?
47
8.6 Barriers to implementation
49
8.7 Implementation of the Commitment
50
8.8 Values and Culture
52
9.0
Conclusions
54
9.1 The Listening Day
54
9.2 The Commitment
54
9.3 GOSH
54
9.4 Recommendations
54
3
1.0 Executive Summary
1.0executive summary
1.0
Executive
Summary
This is a summary of the views from
both the Listening Event (adults
and young people) and the staff
interviews that preceded the event
and highlights the overall themes
emerging from the consultation as
well as the most frequently mentioned
aspects which emanated for all
strands of the consultation. The
summary also provides conclusions and
recommendations.
1.1Overall Themes
1.1.1 The GOSH Patient/Family
Experience
Firstly it is important to state the
vast majority (85%) of all those that
attended the Listening Event felt that
the day itself would lead to positive
change in the GOSH patient/family
experience. There were many positive aspects
identified with the current GOSH
patient/family experience, with
most individuals who were involved
providing examples of why they felt
it was a good experience. Many of
these were based on the staff working
at GOSH and there was a widespread
recognition of the importance
the staff play in the patient/family
experience at the hospital and how
well staff contribute currently to the
experience in their nature, knowledge
and attitude/behaviour. However,
there are still messages emerging from
the consultation which require careful
consideration, including two issues in
particular:
•
The results of the interactive voting
held at the Listening Event showed
that almost 75% rated the patient/
family experience as good or excellent;
however a quarter of attendees rated
it as fair of poor.
•
A common theme from both the
staff interviews and the Listening
Event was the perceived imbalance
that exists between the current
GOSH clinical experience and the
non-clinical experience of how the
hospital provides a service. The clinical
experience is considered excellent in
all aspects and the task is to raise the
patient/family experience to the same
perceived standard.
1.1.2
The Commitment
There is widespread support for and
belief in the concept of a Commitment
from all stakeholders involved in this
consultation as they all see it as a
means of improving the GOSH patient/
family experience for all concerned. The interactive voting results indicated
that 9 out every 10 attendees thought
the idea of introducing a Commitment
was either ‘fairly or very important’.
Staff interviews, in addition to showing
strong support to the Commitment, also
validated the change from that of a
Promise to a Commitment as many felt
that a ‘Promise’ is an overused term
that has been bankrupted (mainly
by politicians) and is something that
can be broken, which defeats the
objective.
5
1.0 Executive Summary
In terms of what the Commitment
should be or contain, key messages
and suggestions were provided from
the Listening Event. It must:
•
Be multi-disciplined, representative,
understood, bought into, owned by all,
communicated to all and not just a tick
box exercise,
•
Be binding and measurable,
•
Be all inclusive yet be flexible, diverse,
believable and honest,
•
Be based on values and not just
actions,
•
Contain key words such as: strive,
endeavour, respect, openness,
courtesy, dedication, listening, flexible,
understanding, inclusive, honesty,
respectful, and diversity.
Finally and maybe MOST importantly
is the need for the Commitment to
be a shared Commitment and that
in addition to GOSH committing to
the families, carers and patients;
these service users must also commit
something to GOSH, e.g. have a
respectful attitude to staff and arrive
on time or ensure cancellations are
communicated.
1.0 Executive Summary
1.1.3Implementation
1.1.4
Four key issues were raised with regards
the successful implementation of the
Commitment:
There are very two important messages
for senior management that need
to be taken on board and absorbed
which came from the young people
involved in the consultation. 1.
2.
Both staff and family representatives
pointed out that many of the changes
necessary to improve the patient/
family experience are small things such
as the attitude of staff, for example a
smiling receptionist; improved signage
which is more user-friendly; better
management and therefore service/
choice at both The Lagoon and the
shop.
3.
That the only way for a Commitment
to work is for it to be both topdown (in terms of ‘Commitment to
the Commitment’!) and bottomup in terms of staff empowerment
and responsibility for enacting the
Commitment. The senior management
Commitment needs to both recognise
and address the fact that many staff
are ‘initiative weary’ with a small but
significant sense of cynicism from some.
4.
6
It will involve a wide variety of tasks,
many of these being ‘tangible’ such
as ensuring sufficient and effective
resources that cover factors such as
staff, facilities and systems. However,
patients, family members and staff
all pointed out that for its successful
implementation it is imperative that
GOSH recognises the importance of
and addresses the ‘soft’ issues. These
include such aspects as the need
to recognise the emotional energy
required by staff to address family
anxiety and time to play with patients. However, perhaps top of the list of the
softer issues is that of the GOSH culture
and the need for it to embrace and
raise the importance of the patient/
family experience to the same level as
it holds the clinical experience in. It must include measurement of
the impact of the Commitment on
all relevant parties - staff, patients,
families/carers and other key
stakeholders.
1.
Patients/Young People
They likened the implementation of the
Commitment to a leap of faith and the
plea from these young people to the
management of GOSH was ‘just go
for it’ and jump (they compared it to
the space jump of Felix Baumgartner)
and not to spend hours planning to
account for every eventuality but
instead to just get on with it. They felt it
is better to make meaningful and real
changes (and mistakes) than to talk
and do nothing. 1.2Specific Actions/
Opportunities
In addition to the overall issues, there
were four key action areas:
1.2.1
The Fabric
The overall design of the hospital was
mentioned frequently and the need for
it to be designed around young people
rather (as several stated) them having
to fit into a fabric that was designed
by/for adults. Examples of this included
the provision of children’s toilets and
the type of products that are sold in the
shop and how it is run. Other aspects of the fabric mentioned
included the reception, with some
noting that the entrance should be
the start of a Disney style experience
for young people and the importance
that this matched the expectation
and standards of other aspects of the
hospital. Other suggestions to enhance
the reception service included the
need to redesign the height of desks so
reception staff have level eye contact
with arrivals, the need to enhance the
waiting area for taxis/lifts and provide
activities for those waiting.
2.
From their perspective the overall
need is for GOSH to recognise that
the development and roll out the
Commitment is a three way process
involving staff, families/carers and
patients and not just a process
between staff and family/carers. For
this to occur they felt it is essential that
patients (along with their families/
carers) are empowered and are given
an active and definite role.
7
1.0 Executive Summary
Signage was mentioned by many
across all three strands of the
consultation and the need to enhance
both the design and language
used whilst also providing signage/
information systems to make journeys
around the site easier.
The Lagoon attracted much criticism
in terms of food variety, quality and
price together with organisational issues
such as extending the times that food
is available and the detrimental effect
which two controlling organisations can
have on the service1. Similar criticism
was aimed at the shop with young
people stating the need for a task force
to redesign the shop and its stock.
Parent accommodation was another
area mentioned frequently, especially
by adult attendees at the event and
staff during the interviews who raised
several issues including, its availability
and accessibility, especially for fathers. The hospital wards also attracted
wide spread feedback including
the provision of parent facilities such
as chairs, sleeping provision in high
dependency wards and the need for
enhanced ward reception facilities. Staff also noted the need to modernise
wards identified by several as “not
good enough”.
1.2.2HR
A variety of key HR issues were raised
that could impact in a positive way on
the patient/family experience if they
could be implemented including the
following:
•
To address (and to be seen to) the issue
of underperforming/poor quality staff
1.0 Executive Summary
•
To expand anxiety management
training for all key staff, including
clinicians
•
To focus more on team building
as opposed to just training and
development
•
The need to improve the
communication skills and attitude
of consultants and clinicians when
dealing with patients and families/
carers
•
To assess how good receptionist staff
are at enhancing the patient/family
experience and what to do if they are
not up the performance required.
1.2.3Communications
Communication with families and
patients attracted the largest
frequency of comments across all
respondent types. These covered
not only changes to outgoing
communications, but also the need
to improve the way GOSH listens (and
responds) to families and patients. They
also covered both generic aspects,
such as the need to understand and
manage the expectations of families/
carers better as well as specific issues
such as ensuring that post-discharge
information includes contact numbers.
One communication area that
attracted many staff and family
comments related to clinics and
outpatients, and the need for effective
communications regarding not only
appointments and named contacts
but also how changes to either date/
time or personnel were communicated
effectively.
Although this is no longer the case, (that two organisations are involved in the running of The Lagoon)
the perception still remains that this is the current set-up.
1.2.4Organisation
1.3.2
As with the feedback on
communications, some of the
suggested actions were generic, such
as the need to improve co-ordination
across perceived ‘silo services’ in
complex pathways and the need for
systems to empower patients and
give them definite role/tasks including
to give young people voice and
influence.
There is overwhelming support for
the idea of a Commitment and that
it will lead to positive change in the
family/patient/staff experience if
implemented effectively.
Others were more specific, for example
to make sure that appointment
setting is administered to include the
convenience of families/carers and
NOT just for GOSH practicalities, e.g.
to take into account journey times,
cheaper travel and so forth and that
where possible, to group appointments
when the patient is in a complex
pathway to avoid multiple visits/
appointments.
1.3Conclusions
1.3.1
The Listening Day
The vast majority attending the
Listening Event felt it would lead to
positive change in the patient/family
experience at GOSH. Young people
demonstrated an interest in and a
willingness to become involved, as did
staff and family members.
The Commitment
1.3.3GOSH
Whilst all recognise the GOSH clinical
experience is excellent there is a
belief that currently the patient/family
experience is not and therefore the
challenge is to improve it so that it is
comparable to the clinical experience. Part of the task is to change the GOSH
culture and thinking so that it equally
embraces both.
There are a series of issues identified
that need to be addressed if the
challenge of improving the patient/
family experience is to be realised
and a culture change can become a
reality. A number of these are broad
generic issues that include the culture
whilst many are specific.
The issues cover both hard/tangible
issues but equally soft issues such as
handling anxiety. The more tangible
issues relate to four key areas; the
fabric, communications, human
resources and organisation. Whilst
some are major challenges such as the
design of the fabric, many could be
described as minor or ‘quick fixes’ such
as the smiling receptionist.
1
8
9
1.0 Executive Summary
1.4
Recommendations
The primary recommendation is
for GOSH to embrace the findings
of this consultation and commit to
improving the current family/patient/
staff experience to a level that is
comparable to the clinical experience. To achieve this there is a need to
‘Commit to the Commitment’ and
this will require systems, processes and
resources to both develop it (and
ensure that it relevant, believable and
achievable), implement it and measure
it.
For this to be done effectively it is
essential that it not only embraces and
empowers all staff but families/carers
and patients and a significant aspect
of the challenge is to create a role for
young people with this process.
The systems and process will need to
prioritise the multitude of issues arising,
the two key measures being ‘ease of
implementation’ and ‘level of impact’
focusing on those that score ‘easy/
high’ rather than ‘difficult/low’.
Finally there will be a need to
monitor and measure progress of the
Commitment’s implementation and
to assess if it is having a meaningful,
positive impact and how to identify and
address barriers to its implementation or
impact where they exist. 10
2.0
BACKGROUND
2.0BACKGROUND
2.0BACKGROUND
Great Ormond Street Hospital (GOSH)
has three priority areas that form part
of its vision and strategic plan and they
are as follows:
•
Safety - to reduce all harm to zero
•
Effectiveness - to demonstrate clinical
outcomes
•
Experience - to deliver an excellent
experience
GOSH aims to consistently deliver an
excellent experience for their service
users - patients, family and referrers. The hospital seeks to provide the
best possible services to patients and
their families who come from diverse
backgrounds and from all parts of
the UK and abroad. GOSH therefore
need many ways to find out about,
and improve patient and family
experience, and they currently do this
best by involving and engaging their
patients, their families and members
in shaping health care at GOSH that
is appropriate to their needs, and by
making best use of the knowledge and
skills of their staff.
The GOSH patient experience is multifactorial and is a shared endeavour
between patients, their carers/families,
clinicians and other staff at GOSH. In
order to improve services there was
a need to begin a process whereby
the interests and needs and desires of
patients and families are supported by
the behaviours, the capacities, and
competencies of staff. Internally the
hospital had talked of some form of
Commitment which was shorthand for
motivating a major cultural change
that involves agreed actions by
everyone connected with GOSH.
12
As further context, communications
between patients, families, staff and
local services underpins every activity
at GOSH. Improving the provision
of timely, relevant, and easy to
understand information and advice is
a continuing goal in ensuring a positive
experience. This is critical for families
who have children with rare or complex
conditions. GOSH also recognises that there needs
to be greater understanding and
sensitivity in dealing with patients who
have a special need and their families. There needs to be a more sensitive and
holistic regard for patients, and systems
and processes need to be adapted
to identify and better support patients
and their families who have special
needs. This was also a key driver for the
event and subsequent Commitment. Great Ormond Street Hospital NHS
Hospital Foundation Trust commissioned
SMSR Ltd an independent research
company to plan, facilitate and deliver
a Listening Event which would enable
the hospital to discuss and to better
understand the current patient and
family experience and start the process
of engaging stakeholders on the
concept of a GOSH Commitment. It was agreed from the outset that this
consultation would evolve and adapt
over the lead-up to the event and
in addition to the event itself, SMSR
Ltd carry out an additional layer of
research with staff prior to the event to
ensure there was as much reach and
input as possible and to give staff an
opportunity to have a voice from the
very start of the process.
3.0
AIMS AND
OBJECTIVES
3.0 Aims and Objectives
3.0AIMS AND OBJECTIVES
3.1Overall
•
The main aim of the Listening Event and
the staff interviews was to explore and
generate feedback on developing
a set of actions and behaviours,
rather than empty promises and
platitudes, that all GOSH stakeholders
– but critically patients, their families
and staff, can share, motivate, and
implement to ensure an excellent
experience for all. Underlying this was
an aim to better understand these
stakeholders’ current evaluation and
perception of the patient experience. 3.3The Listening
Event
•
To gather perceptions of the positive
and negative aspects of the current
patient/family experience
•
To understand what a Commitment
should entail/look like
•
Identify the key priorities/challenges to
be addressed
The key objectives of the engagement
exercise were as follows:
•
Assess the level of support for the
proposed Commitment and reasons
for this
3.2Staff Interviews
•
Assess the levels of belief for a
proposed Commitment
•
To understand how the Commitment
can be implemented successfully
•
14
To understand how the Commitment
can be implemented successfully
To gather perceptions of the positive
and negative aspects of the current
patient/family experience
•
To understand how patient/family
experience has changed over time
•
Identify any gaps/shortfalls in the
current experience
•
Identify the perceived challenges/
barriers in making improvements
•
To gather opinion on what constitutes
an excellent patient experience
•
To understand the current
organisational culture
•
Assess the level of support for the
proposed Commitment and reasons
for this
•
To generate ideas on how staff buyin to such a Commitment can be
achieved
The young people were considered the
most important voice of all stakeholders
and to ensure they had the space
and confidence to speak openly and
honestly a separate session was carried
out on the day with this group; the
objectives of this session were slightly
different as was the approach. The
session built around the suggested
“dozen or so heads of agreements/
actions that will be implemented by
everyone at GOSH” and was aimed to
give the young people in attendance
the opportunity to contribute to
their design and provide feedback
on how they could contribute to a
Commitment and change the current
way of thinking and delivering.
4.0
Methodology
4.0METHODOLOGY
4.0METHODOLOGY
4.0METHODOLOGY
The process consisted of
several stages:
4.1Staff Interviews
To help develop the content for the
Listening Event, it was agreed to hold a
series of semi-structured interviews with
a variety of staff prior to the event. A
topic guide was prepared that covered
their opinion of the current patient/
family experience and their views on
the Commitment to ensure the aims
and objectives were achieved
The GOSH Patient Experience Team
co-ordinated the recruitment exercise. The aim was to engage staff to raise
their awareness about the event and
more importantly gather their views
which would be used to inform the
Listening Event. The desire was to engage with front
line staff and a selection of staff were
invited to take part in a 1:1 interview
with the SMSR Project team. Named
staff from each staff group were
invited to 1:1 interviews via email and
staff were also asked to cascade the
invitation to their colleagues. A list
of dates and time slots were made
available and interested staff selected
their preference. In total 28 staff were
recruited and interviewed at GOSH over
four days (30th and 31st May and 3rd
and 4th June). 16
4.2The Listening
Event
A recruitment plan was drawn up to
ensure a good balance of staff, young
people and families/parents and
other stakeholders attended. It was
always intended that the event would
attract an even split of staff, patients
and families. The target was to recruit
between 50-100 people, in total 87
attended the event.
The event was hosted by Mrs Liz
Morgan, Chief Nurse and Families
Champion, and she wrote personal
invitations to external stakeholders, e.g. HealthWatch Camden, Directors and
Non-Executive Directors. A Councillor
from the Member’s Council who
also helped with the planning of the
event sent out a personal invitation
to Member’s Councillors. The GOSH
Young People’s Forum was invited
by the Patient Experience Team and
families and parents were invited via
targeted emails. The GOSH Charity
also supported the recruitment by
signposting families to the event. Three
volunteers were recruited to call families
and patients who were aged over 11
years and invite them to the event. A
targeted email was sent to Foundation
Trust Members and an invitation and
booking arrangements was placed on
the Trust Website, on the Get Involved
page.
Divisional Directors were requested by
the Pals and PPI Manager to nominate
five staff representing a range of staff
roles from their Directorate. The Chief
Nurse sent a personal invite to the Heads
of Nursing to nominate nursing staff to
attend the event. Posters and flyers
were produced to publicise the event
and an advert was published on the
back of Roundabout, a staff newsletter
which is also extensively read by patients
and families.
were given name badges and colour
coded stickers to signpost them to the
break-out session as part of the overall
event. Young people were separated
from the main group of attendees shortly
after arrival so that the listening process
could be adapted in a way which best
suited the profile of this particular group. The event was held on Saturday 22nd
June 2013 and started at 10.30am and
finished at 2.00pm. Refreshments were
served throughout the day and lunch
was offered at the end of the event.
The adult stakeholder event was held in
Weston House; whilst the young people’s
event took place in the Charles West
Boardroom and on arrival attendees
The profile of attendees was as follows:
Who do you represent at the event?
Response
Number
Percentage
Parents/carer
22
25%
Staff
44
50%
Patient/young
people
16
19%
Other
5
6%
4.3Follow-up Activities
It is recognised that GOSH needs to set
up processes that will use and convert
the consultation outputs into:
•
The Commitment itself,
•
A process to introduce it into the
organisation,
•
A mechanism to evaluate its impact,
•
Take actions to resolve issues identified
by participants on the day
17
5.0 Listening Event Overview
5.0LISTENING EVENT OVERVIEW
For both adults and young people the overview of the day was as follows:
1. Orientate
5.0
Listening
Event
Overview
Map the objectives
at the event and
the strategy
4. Feedback
Stimulate and
suggest strategy
for change
LISTENINg
EVENT
2. Explore
Explore different
perspectives
of GOSH
stakeholders
3. Build
Build domains
through which
to implement a
change within
GOSH
19
5.0 Listening Event Overview
5.1Introductions
The event was facilitated by SMSR’s
lead Health Director, Mrs Kath Lavery,
who formally started the proceedings
explaining to all the structure of the day
and the main aims and objectives, this
preceded introductions by GOSH Chief
Executive, Mr Jan Filochowski and Chief
Nurse, Mrs Liz Morgan. 5.2Interactive
Voting
SMSR utilised their internal ‘Quizdom’
voting software system that gave all
attendees the opportunity to give
their opinion on a number of questions
that fed into the aims and objectives
mentioned earlier. This also acted
as an ice breaker. The software was
used towards the end of the event to
measure any changes in attitude and
to evaluate enjoyment and perceived
value of the day.
5.3Break-out
Sessions
All adult attendees were split into six
mixed groups chaired by an SMSR
trained facilitator (four of which were
GOSH staff who volunteered for the
event in advance). Each group selfappointed a scribe and a presenter. Each session was focused on a specific
topic and lasted 30 minutes, with a 15
minute feedback session to the rest of
the adult audience. All young people were involved in a
separate facilitated programme away
from the adults run by a specialist
20
facilitator experienced in working with
young people. The facilitator was
supported by a cartoonist to produce
both working graphics but also visual
representations of outputs themes/
messages.
The four themes they focused on were:
1.
Promises
2.
Empowerment
3.
Resilience
4.
Voice and Influence
The methodology to address the event
objectives was built on a qualitative
participatory model in which young
people were stimulated to reflect on
the existing culture within GOSH and
challenge the norms through raised
engagement and voice and influence.
5.4Conclusions and
Final Thoughts
Both Event Facilitator and GOSH Chief
Executive gave their final thoughts and
summaries including the next steps of
the process. 6.0
Outcomes:
Interactive
Voting
54%
6.0 Outcomes: Interactive Voting
23%
6.0 Outcomes: interactive voting
18%
5%
6.0Outcomes: interactive voting
How would you rate the current GOSH
patient/family experience?
Good
Fair
Poor
6.2 GOSH’s listening ability
Strongly ag
Agree
Disagree
Strongly dis
Don’t know
6.1 Current experience
8%
4%
3%
5%
Excellent
14%
55%
18%
3%
10%
How good is GOSH at listening to their patients and
family/carers?
55%
54%
18%
14%
10%
3%
23%
18%
5%
Excellent
Good
Fair
55%
Disagree
Strongly
disagree
g
g
3%
6.3 GOSH’s ability to respond
Strongly ag
Agree
Disagree
Strongly dis
Don’t know
9%
46%
18%
3%
10%
How good is GOSH at responding to patient and
family/carer feedback?
46%
10%
18%
9%
Agree
Disagree
Strongly
disagree
3%
Don’t know
/ not sure
Strongly
agree
22
/
18%
14%
Strongly
agree
Don’t know
/ not sure
Around seven out of every ten attendees agreed that GOSH was good at listening
to patients, families and carers, with 14% strongly agreeing that this was the case. It is however, important to note that around a fifth of those who attended the
Listening Event disagreed that GOSH was good at listening to patients, families and
carers.
Poor
Almost a fifth (18%) of attendees rated the current GOSH patient/family experience
as excellent, with a further 54% saying the experience was ‘good’. Although
good
is GOSH
at listening
to their
patientsexperience
and
around aHow
quarter
(23%)
of attendees
said
the current
was fair, only 5%
family/carers?
felt that at present the experience was poor.
4%
5%
8%
3%
0%
Agree
Strongly
agree
The Lagoon
Communica
Patients
Fabric
Families/ca
Clinicians/c
Organisatio
GOSH over
Staff
1
1
4
4
6
9
9
9
18
Agree
Disagree
Strongly
disagree
10%
Don’t know
/ not sure
More than half of attendees agreed that GOSH was good at responding to the
feedback which was received from patients, families and carers however, similar to
the previous question around a fifth (21%) of attendees disagreed that this was the
case. What is good when considering the GOSH experience?
18
Staff
GOSH overall
9
Organisation
9
Clinicians/clinical
9
Families/carers
6
23
6.0 Outcomes: Interactive Voting
6.0 Outcomes: interactive voting
6.4 Importance of introducing a
Commitment
6.5 Effect of introducing a
Commitment in GOSH
How important is it that GOSH introduces the proposed Commitment?
Response
Before (%)
After (%)
Difference (%)
Very important
78
66
-12
Fairly important
14
23
+9
Not very important
4
6
+2
Not at all important
0
3
+3
4
3
-1
Don’t know / not sure
Around nine out of ten attendees felt it was either very or fairly important for
GOSH to introduce the proposed Commitment. Although the overall proportion
of respondents who felt it was important remained consistent throughout the day,
there was a shift in distribution between very and fairly important (prior to the
break-out sessions more than three quarters of attendees felt the Commitment was
very important whereas, when this question was repeated at the conclusion this
decreased by 12%).
24
How convinced do you feel that a Commitment will make a positive difference
to everyone who comes to or works at GOSH?
Response
Before (%)
After (%)
Difference (%)
Very convinced
19
39
+20
Fairly convinced
43
45
+2
Not very convinced
25
14
-11
Not at all convinced
1
1
0
Don’t know / not sure
11
1
-10
At the start of the event, a little over 60% of attendees felt the Commitment would
make a positive difference to GOSH; with almost a fifth being very convinced that
this would be the case. This rose considerably by the end of the Listening Event,
with more than eight out of ten attendees expressing this opinion. Both at the start and end of the Listening Event, only 1% of attendees were not at
all convinced that the Commitment would make a positive difference to those who
visit and work at GOSH. 25
6.0 Outcomes: Interactive Voting
6.6 Impact of the Listening Event on
creating change in GOSH
How likely do you expect today will lead to positive change
at GOSH?
Response
Before (%)
After (%)
Difference (%)
Will definitely take steps to
bring about positive change
for everyone
21
48
+27
Will probably take steps
to bring about a positive
change for everyone
51
37
-14
Will possibly take steps
to bring about a positive
change for everyone
24
14
-10
Will listen but do nothing
4
1
-3
Just over 70% initially felt that the Listening Event would either definitely or probably
lead to positive change in GOSH; this rose to 85% as a result of attending. Maybe
the most significant change that many who initially said ‘probably change’
switched to ‘definitely change’. 26
7.0
Outcomes:
Young People
7.0 Outcomes: Young People
7.0 Outcomes: Young People
7.0Outcomes: Young People
7.1Promises,
Promises
Promises, promises explored young
people’s confidence in the creation
of the Commitment. It attempted to
explore what a Commitment would
look and feel like for them. The working
definition of the Commitment for the
day was:
Within a complementary appraisal of
the multi-disciplinary workforce within
GOSH amongst the young people, it
was described as:
The main focus was around:
•
Perspective taking
•
Universally accepted
•
Transparency
•
Young people’s equality
“Nurses are great, they are a mix of
doctor and parent, they have their
responsibilities medically but they still
seem to make time for you. Doctors are
good too, just different.”
The discussion led to a Eureka moment
within the cohort that identified Play
Specialists as possessing a quality
that was more prevalent within their
discipline than others – talking directly
to young people. The group reflected
on their relationships with Play Specialists
within GOSH acknowledging,
To create a culture at GOSH where
everyone is equal and young people
are trusted to contribute to what the
hospital experience should be like for
patients – from the moment you walk in,
to the moment you leave.
“They don’t talk to parents first, it is
always about children and that is
great, something that all staff members
could try to do. Nobody beats a Play
Specialist for that.”
The young people defined the three
key variables in this process as being
themselves, families and GOSH staff. They discussed the strengths of this
as a platform on which to build the
Commitment while providing an insight
into the opportunities to develop.
One young person described his
perception of the workforce within
GOSH that was echoed across the
delegates,
“The staff here [GOSH] are great, but
I think it would take everyone to get
involved for this Commitment to work,
from the Chief Exec to the cleaning
staff. As soon as someone doesn’t
keep to the Commitment, no matter
what their job is, it will all fall down.”
28
7.2
Empowerment
This was the theme that underpinned
all of the aspirations of young people
involved in the GOSH Listening Event. As a group of stakeholders in the
hospital it was felt they could
significantly add value to any shared
goal. The discussion generated further
comment and significantly, invited
observations from other young people,
one described,
“If the Commitment is going to be for
everyone at GOSH then we must all
stick to it. If you are in hospital and
feeling low and you smile at someone,
they must realise how important it is to
smile back and that doesn’t matter if
you are a doctor or a cleaner. Children
realise that staff are busy sometimes so
it might be a good idea for everyone
at the hospital knowing a little bit more
about what other people are doing.”
“Being empowered to take ownership
within GOSH” was a central theme of
the Listening Event and young people
described a desire to not just feel
like, but have a genuine stake in any
initiative. Adding substance to the
discussion was the reflection on current
4
practice and possible opportunities
missed (see ‘Marshmallow Challenge’
and learning from trial). Young people
illustrated the discussion by describing
the re-design of the GOSH entrance,
including its shop. One young person provided a poignant
observation that appeared to resonate
with the larger group:
“It would be like getting up for school in
the morning and my Mum saying, ‘put
this uniform on today because you are
going to another school from now on’.
It worries me already what it might be
like”.
While the discussion addressed specific
issues such as the GOSH shop, the
patient experience and transition. There was a wider debate about the
need for a greater level of responsibility
to be discharged to young people in
designing these processes; in short, to
be empowered. It was acknowledged that such a
philosophy would present a firm
challenge to GOSH’s intention of a
Commitment if it was not be become a
universal platitude or demand. Young
people reflected on the challenge
of a cultural shift and demonstrated
their understanding of it needing to be
accountable when driving any change. Naturally the session raised questions
about the potential barriers in this
process. One response was to simply
suggest:
“We could just try it, and then have
some feedback between the staff,
children and their parents to see if it is
working”?
29
7.0 Outcomes: Young People
7.0 Outcomes: Young People
It was also described that young people
at GOSH would benefit from greater
IT connectivity when redesigning the
wards to challenge the already present
feelings of “isolation” and “just being
out of it”.
The GOSH message is clear and
there was a solid understanding and
appreciation of the hospital and the
desire to be involved:
‘Great Ormond Street Hospital (GOSH) is
an international centre of excellence in
child healthcare’.
With regards the shop, “I suppose we
want the shop to sell things we need...
like bandanas for when someone has
lost their hair”. The young person’s
message is clear ...so if any shop should
sell bandanas, it should be the GOSH
shop!
“I guess because we are all here today
it means that our health is okay at the
moment, but when it isn’t, and we are
on a ward it is very different”.
5
Examples of GOSH benefitting from
the young person’s influence would be
for them to greater contribute to the
design of the patient journey with a
focus on both the hospital experience
and transition to University College
London (UCL). A transition when children and young
people move from GOSH to another
hospital, including UCL was placed
under scrutiny:
“I have been at Great Ormond Street
for 12 years and I have come to an age
where I have to leave. It literally feels
like that is it, move to UCL and don’t
have anything to do with the people
you have grown up with at GOSH.
There should be an overlap, an ACTUAL
transition”.
7.3 Resilience
Resilience was a characteristic felt
to be present among young people
within GOSH and a characteristic that
would benefit any mutual Commitment
established within the organisation.
Young people participated in an
exercise to illustrate their ability to
‘prototype’ and demonstrate the
benefit of capacity building through
trial and testing. The ‘Marshmallow
Challenge’ (build a marshmallow
mountain) offered an opportunity to
develop an insight of the strengths
in ‘prototyping’ when working
collaboratively on a new initiative,
read in this instance as the GOSH
Commitment. The ability to ‘learn
through trial’ is a trait often prevalent in
young people. From both the practical
exercise and preceding discussion it
was a sentiment shared by the young
people on the day.
When considering the ‘Marshmallow
Challenge’ in the context of the events
aims, it was commented:
“...so we try it yeah, and if it doesn’t
work, we look at what went wrong
and we try it again...actually, even if it
doesn’t go wrong, we still look at it and
see what we have learnt to make it
better next time”.
“I like the idea that you don’t spend
forever planning it, it is about just trying
something and learning rather than
getting the perfect plan first time”.
7.4 Voice and
Influence
The working group of young people was
asked to consider the subject of Voice
and Influence which was referenced
as; ‘If being empowered will give you
the chance to make changes at Great
Ormond Street, Voice and Influence is
about giving you a chance to say what
those changes would be’.
The group having previously suggested
specific changes within GOSH,
discussed the importance again of a
holistic approach to patient care. A
key message was summarised by one
attendee as follows:
“I wonder if staff understand what
children think is important about making
their time in hospital better?”
The young people discussed that
sometimes it is the ‘little things’ that are
important to patients, “like having a say
about the menu” or “if it says couscous,
it should be couscous and not pasta”.
30
31
7.0 Outcomes: Young People
As young people were given an
opportunity to provide feedback
to other GOSH stakeholders they
demonstrated a willingness to exercise
both their Voice and Influence and
the opportunity and support to be
empowered. There are distinct
similarities in both the young people’s
summary of the day and their
feedback to the wider audience and
central to this is the need to have a
greater influence in the hospital. The
mechanics of this would require:
It was suggested:
“...because it is the little things, that
sometimes makes it harder to be
listened to because they don’t sound
important to a staff member”.
•
An increased dialogue between
patients and staff
•
Young people to be accountable
for their increased capacity in either
consultation or decision making
processes
•
Trust between stakeholders
•
Commitment to a cultural change and
the time-frames required to implement
this.
The suggested benefits of
empowerment of young people are:
32
•
A peerless approach to a young person
led patient experience
•
A genuine improvement in the patient
experience for children and young
people at GOSH
•
Increased self-esteem for children and
young people
•
Improved outcomes for Great Ormond
Street Hospital
2
2
8.0
Outcomes:
ADULT
STAKEHOLDERS
8.0 Outcomes: Adult Stakeholders
8.0 Outcomes: Adult Stakeholders
8.0Outcomes: adult stakeholders
8.1.4
What is good when considering the GOSH experience?
18
GOSH overall
9
Organisation
9
Clinicians/clinical
9
6
Families/carers
Fabric
4
Patients
4
Communications
1
The Lagoon
1
It is important to recognise that most of the staff interviewed prior to the event
felt GOSH had improved over time and these improvements were expected to
continue as there is now a greater focus on improvement (with many noting the
positive changes since Jan Filochowski’s appointment as Chief Executive). 8.1.1
Staff (18 )
By far the most positive comments
were made with regard to staff; with
many comments expressed about
them being, “positive”, “friendly” and
“committed”.
34
This was also a very strong message
to emanate from the staff interviews
as the GOSH staff was considered to
be the most important factor in what
is good about the patient/family
experience. Staff across all service
areas were often cited as “care
focused”, “understanding”, “caring”
and “committed”. Interviewees also
identified positive changes regarding
the positive impact of the contribution
of volunteers within the hospital.
Organisation (9)
The positive elements mentioned with
regards to organisation included a
variety of aspects from responding to
emergencies, co-ordination to planning
and access.
8.1The Patient Experience –
What GOSH is Doing Well
Staff
8.1.3
Clinical/Clinicians (9)
Attendees were positive when
describing the expertise and the quality
of care; the clinicians and clinical
aspects of GOSH were also seen as
being at the ‘cutting edge’. The clinical
experience is however perceived as
being of a higher quality than the
patient/family experience and there is a
need to create a balance between the
two elements. The message from the staff interviews
was also very positive as clinical
staff were cited as “world class” and
“experts” and generally held in very
high esteem. The majority of staff felt
very proud to have such knowledge
and expertise within the hospital and
certainly did not take it for granted,
recognising achievements both in
delivery and research.
8.1.2 GOSH overall (9)
8.1.5
The comments made covered a variety
of topics relating to GOSH’s global
reputation/brand, it being forward
looking and its care. There was also
recognition at both the event and from
the staff interviews that expectation
played a significant part in how patients
and in particular families then felt about
their experience. The comments which were provided
covered a range of topics relating
to support, tailoring the service to
meet individual needs and being
acknowledged by staff.
Families/Carers (6)
8.1.6
Patients (4)
Perhaps surprisingly only four comments
were made with regard to the patient
however, as the majority referred to the
child being at the centre of everything
it may be that this was overlooked as
many assumed that it was ‘a given’. 8.1.7
Fabric (4)
Specific reference was made to
everything being under one roof, the
new buildings, the activity centre and
parental accommodation on the ICU. Staff reinforced a number of these
comments in the interviews leading up
to the event as certain aspects were
noted as being positive, including the
new buildings within and around the
hospital, the parent’s accommodation
and the hospital having a child friendly
environment. 8.1.8
The Lagoon (1)
One comment was made regarding the
range of food available in The Lagoon.
8.1.9
Communications (1)
The only comment which was noted
was that there are some good
communications with families however,
this was demonstrated inconsistently. One issue raised by staff at the Listening
Event and as part of the interviews
that the Board may wish to address is
the perception that GOSH has “lots of
money”!
35
8.0 Outcomes: Adult Stakeholders
Communications
1
The Lagoon
1
8.0 Outcomes: Adult Stakeholders
8.2 The Patient Experience –
Aspects GOSH Can Improve Upon
1
2
3
5
5
5
9
13
17
8.2.1
Fabric (17)
This topic attracted the largest number
of negative comments; the issues
mentioned included:
What is not so good when considering the GOSH experience?
17
Fabric
13
Communications
9
Organisation
Treatments
5
GOSH overall
5
The Lagoon
5
2
Families/carers
Patients
2
2
2
2
3
6
1
How could the GOSH experience be improved?
Communications
O
i
ti
The shop
•
Parking
•
Accommodation
•
Signage
•
Parental facilities
•
Lack of privacy
Staff (as part of the initial interview
process) were also critical of the shop
especially around the shop opening
times (particularly the wrong opening
times) and the confusion from all
about when it was meant to be
open. Staff were also critical of the
signage within the hospital describing
it as “ineffective”, “confusing” and
“complicated”.
3
Clinicians
•
6
6
There was criticism of some of the
wards from the staff interviews, with
feedback on factors such as the lack
of facilities and provision for children
within a children’s hospital (for example
“the lack of smaller, child sized toilets
for young people”) and certain wards
appearing shabby and dated and in
some cases described as “oppressive”
or “embarrassing”.
Feedback at the staff interviews also
included issues such as bottlenecks
throughout the hospital and paperwork
on wards/in consulting rooms were
mentioned as problems within GOSH
that could be easily rectified and were
issues that gave an instant negative
perception of the hospital.
36
8.2.2
Communications (13)
Overall, communications attracted
the second highest number of
negative comments at the Listening
Event, with aspects of both internal
communications and communications
with patients/families being criticised. When considering communications with
patients/families the issues included
both general issues such as “being kept
in the dark” and “not good listeners”
and more specific problems including
failing to communicate test results and
the way patients/families were received
by the reception staff. Within GOSH
the cross-department communications
were mentioned as requiring
improvement.
8.2.3
Organisation (10)
When considering the organisation
within GOSH, many of the comments
made referred to specific issues such
as the member of staff being unaware
of the case history at follow-up
appointments and leaving ‘When a
Child Dies’ file in open view of patients/
families. A lack of team co-ordination
was also identified, with an example
being that a patient can be called
back up to three times in one week.
A wide range of staff issues were
raised as part of the staff interviews
including some reception staff being
unprofessional or unfriendly or both,
the need to manage volunteers better
(especially the younger volunteers) and
clinical staff not keeping to time. Interviewees also identified aspects of
the hospital as areas for improvement,
which included safety, opportunity for
internal reporting and feedback and
follow-up.
37
8.0 Outcomes: Adult Stakeholders
8.2.4
GOSH overall (5)
Most of these comments related to the
fact that due to the power of its brand
and worldwide reputation, there was
sense of “arrogance” and “we know
best”. The second comment, is that
GOSH is treatment focused and not
‘every day’ focused which can impact
on issues that families see as important
to them.
8.2.7
Clinicians (3)
The comments made were mostly
associated with the attitude of clinicians
towards families; these attendees felt
that they portrayed themselves as
arrogant and lacked empathy. The
staff interviews also raised criticisms of
consultant’s attitudes to both staff and
patients, with some describing them as
“detached” and “arrogant”.
8.0 Outcomes: Adult Stakeholders
8.3 The Patient Experience Suggested Improvements
After considering the positive and negative aspects of the GOSH experience,
attendees were asked to deliberate how the experience could be improved. Again
comments were grouped into themes and the graph below shows the frequency
that each comment was made:
How could the GOSH experience be improved?
8.2.5
Treatments (5)
The comments with regards to things
which were not so good about
treatment related to support and follow
up/transition.
8.2.6
The Lagoon (5)
Although a previous positive comment
mentioned the range of foods available
at The Lagoon, negative comments
were made regarding the poor quality
of the food, it being too expensive
and the fact there have been two
competing organisations occupying the
same space (an issue which was also
criticised in staff interviews).
During the staff interviews the catering
(The Lagoon) attracted a lot of criticism
with regard to the quality and the
choice of food offered representing
poor value for money. Staff attitude
and understanding of the family and
patient situation was also criticised in
relation to The Lagoon. 38
8.2.8
Families/Carers (2)
Issues were mentioned with how GOSH
deals with families’ high levels of
anxieties and expectations.
Communications
6
Organisation
6
3
The Lagoon
8.2.9
Patients (1)
GOSH overall
2
Clinicians
2
Staff
2
Fabric
2
One comment was made suggesting
there is an identified need to address a
possible fear of patients leaving GOSH. 8.3.1
Communications (6)
There were two key improvements
which emerged with regard to the
communication throughout the
GOSH experience; the pathway
communications (including discharge)
and the need to address language
barriers. The increased use of
technology as a method for accessing
information was discussed and in order
to address this, the development of
a GOSH app which could provide
information was recommended.
As part of the interview process
staff were also very vocal about
how communication could lead to
various improvements with some
specific suggestions including: more
engagement generally with parents/
children (particularly to talk and listen
more); better information at the previsit stage and on arrival, as well as
better information provision on being
discharged from the hospital; and
more general health promotion as
this was seen as an area that is often
overlooked.
39
8.0 Outcomes: Adult Stakeholders
Other separate comments, included:
“A better more customer focused
concierge service throughout the
hospital.”
“Better use and promotion of Pals from
non-Pals staff.”
“Need to focus on the smaller things
such as increasing the number of
television channels and number of
televisions”
Several staff also commented on the
slowness of information from the top
down and across the organisation. Many agreed that there was also
a need for better links between
‘departmental silos’ and more parent
networks.
8.3.2
Organisation (6)
The second most frequently
mentioned suggestion was around
improvements to the organisation
within GOSH. Comments across all
adult stakeholders at the event and
from the staff interviews related to a
need for improvements from a family/
patient perspective, including the level
of support (in a variety of areas) for
inducting families into the pathway and
in terms of providing information on who
the patient will be seeing in advance of
their appointment. Improvements were
also suggested within the organisation
including transition management
arrangements and early evening ward
access.
40
This message was also clear from
the staff interviews as there were
many aspects of the organisational
structure which were considered to be
important for an excellent experience
for example, the speed of getting an
appointment and ensuring the patient/
family is seen by the correct person and
can been seen by multiple services/
departments in one day. Many staff
members commented that the hospital
must take a more customer focused
approach to patients and families to
ensure the softer elements are provided
One specific staff issue raised at the
interview stage of the consultation was
the need for an increased focus on
team building as opposed to training
and development.
One department that was mentioned
frequently as part of the staff interviews,
especially by those who work within
the department, was outpatients as it
was considered to be a good example
of a department that focused on the
convenience of the clinicians and
GOSH rather than the families, which
many felt needed changing.
8.3.3
The Lagoon (3)
The quality of the food available at
The Lagoon was mentioned as a
negative part of the GOSH experience
and therefore it follows that the food
quality was mentioned as a suggested
improvement. There was also a need to
enhance the menu and advertise any
specialist food which is available (for
example foods which are suitable for
specialist diets). It was also felt that the
opening hours should be extended so
that The Lagoon is a 24 hour facility.
8.0 Outcomes: Adult Stakeholders
8.3.4
GOSH overall (2)
Both comments relating to GOSH overall
were about improving the patient/
family experience through increasing
the emphasis on the experience and
through raising it to match the level of
the clinical experience. 8.3.5
Staff (2)
Improvements in staff training were
identified; specifically increased training
for reception staff and further training
for all staff in how to deal with patient/
family anxiety. The main reception waiting area
was mentioned by many at the staff
interviews in terms of a need to improve
the layout and design of the desks and
the need to give staff training in terms
of ‘client handling’, especially around
patient/family anxiety and fear. This
was also mentioned as an issue within
outpatients. The staff factors which were identified
as contributing to a potential excellent
experience covered a variety of
factors, some being ‘hard’ factors such
as having specialist knowledge and
expertise however, most were ‘soft’
factors such as friendly staff who listen
and are supportive, being willing to
go the extra mile and demonstrating
patience.
Nearly all staff as part of the interview
process commented on the importance
of these soft factors in enhancing the
quality of the patient/family experience
and noted that it applied to all staff
including senior clinicians. Further input
included the need for an excellent
experience to include open feedback
from parents and patients to monitor
and manage this. 8.3.6
Clinicians (2)
The quality of clinicians’
communications with families/patients
was mentioned as an improvement, as
was their understanding of anxiety and
how it should be dealt with.
8.3.7
Fabric (2)
Although not permanent, when building
improvements are taking place it
was commented that there is a need
to improve the way disruptions are
managed. Feedback was also given
that more entertainment for patients
was needed, including free Wi-Fi within
the hospital.
Staff (via interviews) strongly felt
improvements were required to aspects
such as signage, outdoor play areas
and the transport waiting areas; a need
for staffed reception areas on all floors
was also identified as a possible option
to reduce bottle necks and anxiety. For
families especially those new to GOSH
it was stated that the layout must seem
bewildering and it was important that
systems are in place to make sure they
can get from A-B and know where you
are going and therefore this is a key
element to an improved experience.
Several staff as part of the interview
process suggested that any future
buildings should be based on the school
model i.e. it is designed around young
people, for young people and maybe
even by young people!
41
8.0 Outcomes: Adult Stakeholders
8.4 The Commitment –
What is Involved?
It is important to recognise there was
almost universal support for such a
concept across attendees at the
Listening Event and from the staff
interviews; with comments such as:
“I’m 100% supportive – it is very
important.”
“In general it’s a good idea.”
“This is vital in taking the hospital in the
right direction.”
“This can only be a good thing for both
families and the staff here.”
“It brings a focus.”
“It’s something that people need to
aspire to it so we can continue to
improve everything.”
There were however a minority of
negative comments made, primarily
from the staff interviews, due to staff being “initiative weary” and a general
sense of cynicism in so far as it being
“management speak”. One also
commented that they had “heard it all
before”.
Interviewees also discussed their
personal opinion and the perceived
benefits and limitations of such a
promise/Commitment; for example:
8.0 Outcomes: Adult Stakeholders
Section A: GOSH
Four key aspects were identified as requiring Commitment from GOSH in order to
improve the experience; the frequency that each was mentioned is shown in the
chart below:
What do GOSH need to commit to?
“What about looking at (and managing)
expectations? Are we supposed to
exceed our families’ expectations?”
“It’s about changing things we can
change so it needs to be realistic.”
11
The experience
10
Communications
“We have the motto ‘child first and
always’ and it must build on this
concept.”
Information provided in this section was
divided into two sections: what GOSH
must do to make such a Commitment
work and what families must do. 14
Values
Organisation
8.4.1
5
Values (14)
Throughout the discussions it emerged
that the Commitment must be based
on values and that there is a need
for a shared vision which is clear
and understood by all. Two key
fundamental values were identified
which must be embedded into the
culture of GOSH and committed to if
the experience is to improve for all:
•
Mutual respect and Commitment is
needed; there must be more ‘we’ and
less ‘us’
•
The child lies at the heart of the GOSH
experience
In additional to the overall values, three
key specific values quoted were:
42
“The need to be tolerant of families’ lack
of understanding and their anxiety.”
“To engender a culture whereby
families feel safe to speak.”
“For GOSH to recognise that fathers
exist.”
Staff that were interviewed leading up
to the event all recognised the primary
focus/responsibility lay with GOSH,
however many pointed out that it was a
“two-way deal” and that parents need
to be equally committed.
“Parents must (and be seen to) ‘do their
bit’, for example we lose money every
time an appointment is not met, so we
need a Commitment from parents.”
43
8.0 Outcomes: Adult Stakeholders
8.4.2
The Patient Experience (11)
The experience was another key
element which GOSH must commit to
for improvements to occur, for example
by making changes which ensure the
patient/family experience is of equal
quality to the clinical one. The focus
on the needs of the family as well,
as the patient, must lie at the core,
which includes specific actions such as
involving families in the knowledge that
they are key to the GOSH experience
and are able to share any clinical
uncertainties.
It is important that any Commitment
is realistic with regard to what can be
done and what changes can occur;
it is of equal importance that such a
Commitment has the same meaning
to all and therefore is not be open to
interpretation. Pathways were mentioned throughout
the discussions and a key part of the
experience is to provide a range of
differing pathway parent/family support
throughout and the recognition that
the total pathway journey includes
transition. Staff who were interviewed prior to the
event felt there were many aspects of
the organisation within GOSH that could
be changed and should be committed
to, to improve the experience. Typical
of the issues raised were to organise
things better to deal with the pure
volume of patients as current demands
can make it difficult to focus on
individuals and the need to create time
to allow staff to enhance the family/
patient experience.
44
8.0 Outcomes: Adult Stakeholders
8.4.3 Communications (10)
Communications are third on the list of
issues that GOSH must commit to and
in addition to general improvements
(including how and when things
are said), specific improvements in
communications included:
There were some generalised
comments (from staff interviews)
when considering how GOSH could
ensure staff commit and maintain to a
Commitment if it were introduced:
“It needs to be realistic.”
“It is important to refresh things,
especially in difficult times, patient
voice is crucial.”
•
Responding to correspondence from
families
“It needs to be both top down and
bottom up.”
“It [the Commitment] should be linked
to staff awards.”
•
Always providing explanations for
delays should they occur
•
Clear explanations of what is
happening throughout the patient
pathway
“Once you get people involved they will
buy-in and there will be no barriers.”
Although staff interviewees felt staff
would be open to a Commitment
being introduced, there were concerns
that other constraints, such as time
and emotional energy, would mean
such a Commitment could not be
accommodated within current
workloads.
•
Providing apologies when it is
appropriate or mistakes have been
made
•
To have anonymous, safe and
continuous ways to provide feedback
•
To listen and to accept that GOSH may
not always be right
8.4.4
Organisation (5)
Various aspects relating to organisation
were mentioned, from more simple
things which much be adhered to such
as both GOSH and families having a
Commitment to be punctual and staff
having a joint Commitment to sort
out issues promptly, to wider issues, for
instance improved co-ordination of
care for complex patients.
“Whilst the promise/Commitment needs
to be focused around the parents, they
must also buy into it and do their bit.”
However, there were also some specific
suggestions as to how GOSH could
ensure staff fulfilled the requirements of
such a Commitment; with training and
management in particular being seen
as key to introduce this into the culture
of GOSH. “GOSH must promote values through
training, development.”
“Jan needs to bang the drum as it
needs management buy-in, in addition
to staff.”
“Staff will say they have no time or
space for this so they need supporting;
they do not value time here.”
“Don’t make it too detailed, we do our
best but there needs to be top level
support behind this.”
“It must become standard in training,
inductions and job adverts.”
A structure which incorporates
greater inclusion of families was also
recommended, with clear protocols
which families can commit to. It was
also commented that this structure
should recognise families as part of the
pathway and therefore should specify
their role.
45
8.0 Outcomes: Adult Stakeholders
8.0 Outcomes: Adult Stakeholders
Section B: Families
It was agreed that families would need to commit to certain actions and values.
Activities
8
It was also commented that families must recognise and be accepting of the
culture of GOSH i.e. a need for better understanding of the pressures of working in a
clinically driven organisation and that staff do care but may not always show this in
a way that parents expect. 8.5 The Commitment –
What Should it Contain?
What do families need to commit to?
8
Activities
Many of the elements to be included within a shared Commitment were discussed
when attendees were asked what GOSH and 5families must commit to in order to
improve
Values the experience for all, however some further information was given when
attendees were asked to specifically describe what a shared Commitment should
include (the responses have been grouped and the frequency which they were
mentioned is shown in the chart below). 8
Activities
5
Values
8.4.5
Key words
Requireme
Underlying
Overall nee
8.4.6
Interviewees (staff interviews)
recognised that anxiety and
expectation were families’ biggest
concern and one member of the
nursing staff noted that they had
undertaken specific anxiety training
and felt that this should be extended to
others within GOSH. 46
What would a shared commitment look like?
5
Overall need
Actions (8)
The break-out groups highlighted key
actions which families must commit
to in order to improve the experience
for all. As mentioned previously, it was
considered to be important that families
are punctual and provide unbiased
feedback and information which is
accurate. Also in order for GOSH to
meet the expectations of families, it was
stated that families must clarify what
their expectations are whilst taking into
consideration the limitations of the NHS. 1
3
4
5
Values (5)
Again, values emerged as an important
influence in improving experience, with
some replicating those which were
mentioned for GOSH (for example
mutual respect and the concept of
‘we’ rather than ‘us’). The majority
of the values which were mentioned
related to the relationship and empathy
which families should have towards
staff:
•
Treat others the way they wish to be
treated and display mutual respect
•
Recognise that ‘we are all in this
together’
•
Recognise that GOSH staff do not have
all of the answers, they are human
•
Value the staff and their role
•
Recognise it’s a two way contract and
therefore to engender respect and
dignity to staff.
4
Underlying values
3
Requirements
Key words
1
47
8.0 Outcomes: Adult Stakeholders
8.5.1
The overall need (5)
Important issues were raised
regarding the overall need for such a
Commitment and the importance of
ensuring it is a genuine Commitment
rather than a ‘tick box’ exercise. The
previous discussions were reinforced as
it was commented that Commitments
are needed from both GOSH and
families and therefore a clear
Commitment for families must be
included.
It was also stated that the Commitment
has to be:
•
Multi-disciplined, representative,
understood, bought into, owned by all
and communicated to all
•
Be binding and measurable
•
All inclusive yet be flexible, diverse,
understandable, believable and honest
8.5.2
Underlying values (4)
Another important aspect when
developing a shared Commitment is the
underlying values; these being identified
as:
•
The actions behind the words being as
important
•
Requires putting yourself in other
people’s shoes
•
Potential cultural and language barriers
must be identified and addressed
•
Acknowledgement that there is fine
line between sympathy and empathy
and that staff have to ensure they are
empathic rather than sympathetic as
this has a negative effect on the patient
and families and could affect the
collective drive towards a Commitment.
8.0 Outcomes: Adult Stakeholders
8.5.4
Many staff interviewees noted the
need for GOSH to change or extend
its culture to embrace the family
experience and were hopeful that the
Commitment would help in this.
To contain key words (1)
Various key words to be included in the Commitment were mentioned during the
discussions, these being:
Another issue raised was the lack of
value placed on emotional energy (by
GOSH) that staff value very highly as
part of their role to the patient and if
they are to fully embrace the family and
commit to their needs then it must be
recognised as a current gap. Staff had
concerns that this important aspect of
the patient experience was in danger of
being forgotten and the Commitment
must recognise this crucial element. 8.5.3
Requirements (3)
The break-out groups identified that
to ensure the Commitment will be
effective, the requirements to achieve it
must be clear and it must be something
which is auditable and therefore
measurable. There is also a need for
transparent systems which are easily
understood.
It was also commented that when
created, the Commitment must have
the same meaning for all with no scope
for individual interpretation. Within the staff interviews a need for
increased openness to patients/families
was identified and for there to be a step
change in how GOSH communicates
with families.
8.6 Barriers to Implementation
The final break-out session was used to identify and reflect upon barriers to
implementing the Commitment. Overall attendees perceived six different types of
barrier to achieving such a Commitment; the barriers and frequency which they
were mentioned are shown in the chart below.
Resources
Communica
Parents
HR
Behavioura
Organisatio
4
4
5
7
11
12
What are the barriers to making it happen?
12
Organisational
11
Behavioural issues
7
HR
5
Parents
Communications
4
Resources
4
6
48
HR
Resources
Parents
Communica
How to do
3
4
4
5
12
How can we make it work?
What to do
How to do it
49
4
12
8.0 Outcomes: Adult Stakeholders
8.6.1
Organisational (12)
Although twelve comments were made
in regards to organisational barriers, the
issues which were raised can be further
divided into macro and micro barriers.
Macro barriers were mentioned
frequently, which included aspects such
as the need for a strategy, to develop
clear priorities and to focus on a few
key issues so as not to initially overwhelm
those involved. Great emphasis was
also placed on getting actions; not just
talking about it!
Micro barriers in contrast covered
a range of practical issues, from a
recurring issue of bureaucracy to
specific aspects such as the limitations
of IT systems. 8.6.2
Behavioural issues (11)
These covered a wide range of
organisational and staff issues including
such things as ‘remote consultants’,
overcoming negativity and the inability
of consultants to sufficiently involve
parents and patients. 8.6.3
HR (7)
Some important issues were noted with
regards to HR and were also factors
which were raised during the staff
interviews. Comments included staff
not being held to account and the lack
of consequences of doing nothing. Other issues referred to lack of training
and having the right skills.
The perceived barriers identified by
families centred on three main issues
and there is a need to train and support
and help manage families to overcome
these issues:
50
•
High expectations and anxiety
•
Lack of openness from the family to
see/understand clinical opinion
•
Unwillingness to speak and contribute,
especially whilst child is being treated.
8.6.5
How can we make it work?
4
What to do
12
How to do it
Communications (4)
A range of communications issues
were discussed when considering
barriers to implementing a Commitment
including cross-team communication,
‘silo problems’ and the wider need for
marketing and communicating positive
change.
8.6.6
8.0 Outcomes: Adult Stakeholders
5
Communications
Parents
4
Resources
4
HR
3
Resources (4)
Concern was expressed regarding the
availability of resources be it staff time
or things such as training, IT, etc. Similar barriers were identified at the
staff interviews with a lack of the right
resources mentioned by many staff as
potentially impacting on the success
of rolling out the Commitment. These
included issues such as restrictions on
budget for free transport for patients
and families, staffing levels and/or
training and the lack of the right IT to
support administration.
8.7Implementation
of the Commitment
In addition to addressing the
aforementioned barriers, the following
factors were stated as being ‘essential’
if the Commitment is to work. There
were overarching comments made
about what needs to be done, as well
as more practical comments discussing
how to do it.
8.7.1
What to do (4)
Creating a clear strategy of what was
required was stated as being essential
if the Commitment is to be successful;
this would include an implantation
map which details the roll out plan and
timelines, together with a statement of
the consequences of doing nothing.
8.7.2
How to do it (12)
The details of how the Commitment will
be introduced so that it is successful
were then divided into two categories;
intangible and tangible issues.
Intangible issues
Overall was the need to change
GOSH’s culture and values to embrace
the family experience and the
need to raise it to that of the clinical
experience. Specific details related
to factors such as complimenting staff
where appropriate, being prepared
to listen, not changing what is already
good, and using volunteers more. A
large turnover of new staff was seen as
creating the opportunity for developing
new values; tackling bad behaviour
was also referred to and the idea of a
staff suggestion scheme was raised.
There was the suggestion that families
need to be more of a consideration
and there was a need to involve,
engage and communicate with the
whole family and share knowledge and
information.
Tangible issues
This also covered a wide spectrum
of issues from overarching ones such
as sharing best practice from other
providers and multi-stakeholder
collaboration (including charities
and medical organisations), to
specifics including outsourcing. Also
included was the need for pathways
to include social and psychological
elements in addition to simply clinical. Communications was also mentioned
again covering the need for effective
feedback, breaking down interdepartmental barriers (staff often
referred to ‘silos’). One suggestion
was monthly staff awards to recognise
positive change.
51
8.0 Outcomes: Adult Stakeholders
8.8 Values and
Culture
A number of discussions that did not
directly relate to the patient/family
experience or the Commitment
(although still relevant to both aspects)
emanated from the staff discussions
and focused on the more cultural
aspects of the organisation and
explored values and developing the
hospital as a whole.
8.8.1Management
Many said that they felt the hospital
has a relatively open culture and
has a positive and accessible style of
management, several said the hospital
does not have power driven people
in place but did warn “it needs to stay
that way and we must be careful we
don’t breed or allow bullies in here.” In
the main staff said they did have the
opportunity to feedback and numerous
staff felt there was a new and important
focus on meetings and training and
personal development was recognised
and encouraged. It was equally
encouraging that staff were cautious
and alert to sustaining this and to be
“on their guard”.
All staff agreed they feel that there
is huge level of understanding at
management and executive levels
and that the hospital will not rest on its
laurels.
All staff were aware of the current
national focus (i.e. Mid staffs) on
poor hospital performance and most
responded favourably and overall there
was a sense that “it couldn’t happen
here” for a variety of reasons (which
bodes well for the Commitment and
staff support).
52
8.8.2
Staff
There was a slight concern from a
number of interviewees that the more
long standing staff (because they may
“become stagnant/complacent”) and
the reliance on bank staff/unqualified
staff posed the biggest concern to
potential issues in the future with one
staff member stating “it was my naivety
and inexperience that led to my turning
a blind eye to one such incident.”
Finally, most interviewees felt GOSH
was open to change which would
lead to improvements in the patient/
family experience however, some felt
there should be more communication
to ensure staff are comfortable making
such suggestions. The use of an independent company
and the Listening Event itself were seen
as significant examples of a hospital
wanting to change and understand
and to listen. Credit was also given
to the new Chief Executive for driving
change and wanting to push for
greater staff, patient and family
engagement. 8.8.3Communications
Many of these are interdependent;
some being organisational issues,
others are staff training issues; others
relate to culture however, all of these
elements require strong and effective
communications. Some specific
examples included:
•
Systems that allow staff and families to
access information when they need it
•
A culture that allows staff to be able to
answer questions and ease concerns
•
A culture and systems that allows
feedback and talking/listening to
people
•
An open and welcoming culture
9.0
CONCLUSIONS
9.0 conclusions
9.0conclusion
9.1The Listening
Day
The vast majority attending the
Listening Event felt it would lead to
positive change within GOSH. Young
people demonstrated an interest in
and a willingness to become involved
as did staff and family members.
9.2The Commitment
There is overwhelming support for
the idea of a Commitment and that
it will lead to positive change in the
family/patient/staff experience if
implemented effectively.
9.3GOSH
Whilst all recognise the GOSH clinical
experience is excellent there is a
belief that currently the patient/family
experience Is not and the challenge is
to develop it so that it is comparable to
the clinical experience. Part of the task
is to change the GOSH culture/thinking
so it equally embraces both.
There are a whole series of issues
identified that need to be addressed if
the challenge of improving the family/
patient experience is to be realised and
54
a culture change can also become a
reality. A number of these are broad
generic issues that include the culture
whilst many are specific. They cover
both hard/tangible issues but equally
soft issues such as handling anxiety. The more tangible issues relate to four
key areas - the fabric, communications,
human resources and organisation. Whilst some are major challenges such
as the design of the fabric, many could
be describes as minor or quick fix’s such
as the smiling receptionist.
9.4
Recommendations
That GOSH embraces the findings
of this consultation and commits to
improving the current family/patient/
staff experience to a level that is
comparable to the clinical experience. To achieve this there is a need to
‘Commit to the Commitment’ and this
will require systems/processes/resources
to both develop it (and ensure that it
relevant, believable and achievable),
implement it and measure it.
For this to be done effectively it is
essential that it not only embraces and
empowers all staff but families/carers
and patients. Part of the challenge is
to create a role for young people with
this process.
W: www.smsr.co.uk
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