PATIENT, FAMILY AND CARER EXPERIENCE STRATEGY
We are rated as one of the best organisations in the NHS by our patients for several aspects of our
care but there is still much more that we can do. The Patient and Family Experience Strategy is
inextricably linked to our organisation’s core values, Patient and customer focus, Continuous
improvement, Respect, Accountability and is designed to encompass all elements of the patient
journey from outpatients to discharge and community, taking account of the diversity of our patient
population, and delivering equity across the Total Health Journey .Our overarching aim is to be a
listening and learning organisation and to provide patient driven care, asking what matters most to
our patients . Patient and family experience is at the heart of the care that we provide and is a key
measure of patient care.
Our Patient, Family and Carer Experience Strategy is based on our organisation’s core principles
of safe, clean and personal and are centered on our core patient and customer values to ensure
that care, treatment and outcomes are provided to service users and families with due regard to
their age, gender, disability, ethnicity, religion/belief, culture, sexual orientation or gender
reassignment.
Work developed from this patient, family and carer experience strategy will feed into relevant
strategies and policies across the organisation, for example, equality and diversity, safeguarding,
interpretation and translation and dementia strategies. To develop this piece of work a faculty
team will be established to ensure representation from key groups across the organisation.
PATIENT, FAMILY AND CARER EXPERIENCE STRATEGY AIM & OBJECTIVE
PATIENT DRIVEN CARE: WHAT MATTERS MOST TO OUR PATIENTS
To be in the top 20% for patient satisfaction in the NHS and to ensure that wherever
possible the voices of all out patients, including the seldom heard, are included and
listened to.
WHAT HAVE WE DONE TO INFORM THE PATIENT, FAMILY AND CARER EXPERIENCE
STRATEGY?
A number of pieces of work were conducted to feed into this draft strategy, such as:
WHAT MATTERS MOST TO YOU
We listened to our patients and from this have developed six always events. In contrast to the
wellknown “Never Events” that refer to incidents that should never happen in the delivery of care,
patient-experience Always Events are aspects of the patient, family and carer experience that
should always occur when patients interact with health care professionals and the organisation.
DELIVERING THE STRATEGY
In year one a patient, family and carer experience collaborative will be rolled out across the
organisation. The collaborative will test and deliver key pieces of work attached to the
organisation’s always events and will ensure this work clearly links to the Trust staff values
framework and from this develop a patient, family and carer experience change package which will
be adopted throughout the organisation.
Each of the following Always Events are linked to the Values Framework and it is important to note
that whilst the most appropriate key values have been attached to each always event, the
continuous improvement value runs through each always event
Always event 1 - Staff will always communicate with, inform and respect the patient and/or
carers, ensuring appropriate communications methods are in place for diverse groups
Trust Values – customer focus, accountability and Respect
We need to identify the preferred form of communication for the patient or carer and ensure we
support that need.
Introducing yourself and describing the reason you are there;
Address patients by the name that they choose;
Displaying name badge at all times;
Treat patients with the same respect you would wish them to show you;
Encourage patients and families involvement in decision making;
Ensuring appropriate interpretation, translation and other communication methods are available
and accessed in a timely and appropriate manner.
Welcoming and being respectful to those defined by the patient as “family” and/or “carer”.
Work stream 1
a) Teach-back method to be tested and introduced. This will include designing a standard
script which will be used to communicate medication information. Resources such as
picture cards and prompts will be tested to explore the effectiveness of visuals for patient
and carers across acute/OPD and community services.
This will be across all patient groups, ensuring explicit links with the equality and diversity
strategy.
During the patients’ journey within any service, health care staff will educate and discover
(in a non-shaming way) what the patient or family caregiver understood using the teach
back method. The aim is to have patients and families able to teach back in their own
communication:
i. danger signs and symptoms to watch for following discharge from hospital
ii. action steps if signs or symptoms occur
iii. key medications related to diagnosis
iv. management of condition
v. critical self-care activities
vi. follow-up appointments
b) Patients will be provided with all available choice regarding their admission into hospital.
Always event 2 - Patients and/or carers will always know who is in charge of their care
Trust Values – Customer focus, accountability, continuous improvement
Work stream 2
a) The production of a welcome to the ward/OPD and community services leaflet – simple and
easy to read for all patients. Ensure that a range of languages are used and options for
patients with disabilities.
b) Developing a Welcome to the ward/OPD service video – with subtitles, pictorial
representations and different languages uploaded to the Hospedia system and displayed in
OPD . A similar version for community will also be developed which can be accessed by
the Trust website.
The production of a video to welcome patients and their families to the ward/service, will
include:
i. an introduction to the health care team,
ii. an overview of what the patient can expect and the care that they will
receive.
iii. A set of resources that patients and their families/carers can access.
c) The introduction of “face sheets” – These sheets will detail:
i. the members of staff working in that area,
ii. what their role is on the team
iii. what the patient should expect from them.
iv. Photographs, names and numbers.
d) Information regarding staff – what do the different uniforms represent, e.g. matrons – red
uniform, District nurses, navy etc.
Always event 3 - Patients and/or carers are always listened to.
Trust Values – Customer Focus, Accountability
Work stream 3
a) A corporate comments and suggestion book/box provided on each
ward/department/community clinic for patients and relatives to provide instant feedback for
staff. Areas to ensure that patients who require communication support are also provided
with an opportunity to provide feedback.
b) Ward manager ‘surgeries’ a time of day where the ward manager is solely available for
patients and families to discuss specific issues with the ward manager.
c) Quality from a patient’s perspective - Divisions will explore using patient stories and focus
group input from current and former patients/families concentrating on positive and
negative experiences of care suggestions for improvement across acute/OPD and
community settings. The focus groups will be designed to explore ways to improve patient
and family care. When using patient stories use the following acronym to describe how
staff members are expected to respond to patient and family concerns: Hear the Story,
Empathize, Apologize, Respond to the problem, Thank them.
d) Divisions will explore the possibility of implementing service safaris, whereby staff walk
through the patient journey and examine the service from the patients’ perspective. This
will be carried out in collaboration with patients to ensure that the walkrounds are centred
on patient’s needs (This could be rolled out in a similar way to the executive walkrounds, or
The 15 Steps Challenge - a toolkit with a series of questions and prompts to guide staff
through their first impressions of a ward, NHS Institute for Innovation and improvement).
The NHS Institute for Innovation and Improvement 15 step challenge is currently being
developed for mental health and community settings.
e) A patient experience champion in each division/service who will be responsible for
synthesising, analysing and disseminating patient experience data information across each
division. This member of staff does not need to have a clinical background. The patient
and family experience champion will examine the best way to disseminate and act on NHS
national survey information, including doctors and ward-level staff who have no managerial
or strategic roles. This will include, in particular:
i. How information is communicated, including a formal structure of distributing
findings.
ii. Interpreting surveys – how information is displayed and what guidance
and/or training needs to be provided to ensure that information is understood
iii. How action to improve is implemented, monitored and reviewed.
Always event 4 – Patients’ physical, social, spiritual and emotional needs will always be
reviewed and supported appropriately.
Trust Values – Customer Focus, Accountability, Respect
Work stream 4
a) Staff will engage patients as part of their introduction to the ward environment to give a full
explanation of what single sex accommodation means to improve patients’ perception of
this issue. The Hospedia system will be explored to also play a video message to patients
on admission or as soon as possible after admission.
b) Intentional rounding and review. This is a piece of work which has commenced and will
continue. The intentional rounding document is currently being audited across the Trust.
This data will be shown with Harm Free Care data – HAPU, CAUTI, VTE, Falls collected
across all services.
c) A physical, social, spiritual and emotional needs assessment will be developed in
partnership with patients from protected groups, that can be completed by patients and
posted back to the department/service, or a telephone number where information can be
provided, or via an online assessment tool. This can be tested with elective patients, this
will be developed alongside the pre operation assessment pathway but there is scope to
adapt across all acute and community services. Ensuring that staff discuss patients’ needs
being aware of language barriers, taking into consideration cultural needs and
requirements.
d) Personalized Menus – (need pictorial menus and large print) to ensure that patients are
satisfied with their food and that it is meeting their dietary needs, a visit will be made by one
of the catering team to patients who have specific problems with the meals that are
provided in order to identify how best to meet their food needs/preferences.
e) A period of time on the ward known as ‘quiet time’, a planned period of time where no
unnecessary noise is made on the ward. Introduce areas of the ward where particular
attention needs to be paid regarding noise levels, similar to quiet zones on trains. Revisit
and define visiting models as appropriate for different areas, e.g. open visiting times.
Always event 5 – Patients and/or carers will always receive information and education to
facilitate self-care, ensuring that they can be accessed by all patients, where appropriate.
Trust Values – Customer Focus, Accountability,
Work stream 5
a) Develop and implement a comfort and pain relief menu for patients, to be provided with
every pain/comfort assessment across all services. The menu will include three broad
areas: comfort items, comfort action and personal care items:
i. a broad list of pain relief and comfort measures for staff and patients to
discuss,
ii. an option to have a visit from the pain team,
iii. development of a comprehensive pain and comfort plan,
iv. pain scale for patients and staff to work together to assess,
v. pain medications and also other pain relief therapies, such as massage and
movement and comfort strategies such as aromatherapy and will be tailored
to different patient groups.
b) The production of condition specific resources for patients, including online resources,
videos and relevant literature including targeted information at groups where we know
health inequalities exist. Undertake engagement work with groups to improve their access
to health resources.
c) Develop a patients’ carers’ assessment to assess their suitability to care for the patient and
if necessary provide additional advice and support.
d) Patients will be empowered to be involved in their own care through the development of a
patient portal for patients. The patient portal will be developed so that patients can access
their individual patient records online, including tests results. This will help to improve
patients and carers confidence regarding the management of health care needs, improve
the quality of communication, co-ordination and collaboration, and reduce the frequency of
unnecessary re admissions. The focus of the portal will be to ensure that this information is
used across care settings.
e) Develop a set of tools to help patients live well, such as those included on the NHS self
care website:
i. 5 A DAY meal planner
ii. Check your drinking
iii. Are you a healthy weight?
iv. Check your fitness
v. Put your diet to the test
vi. Find out which tests you should be having
vii. Add up what smoking is costing you
viii. Get fitness tips every day
ix. Get support to help you stop smoking
x. Health choices video wall - From planning for long-term care to changing to
a healthier lifestyle, see how people are making active choices about their
health and wellbeing.
http://www.nhs.uk/Planners/Yourhealth/Pages/self-care-week-2011.aspx
Always event 6 - Patients and/or carers will always be included in the discharge process
Customer focus, Accountability, Respect
Work stream 6
a) With the involvement of patients and families providers we will develop a simple item
checklist, such as the SMART Discharge Process (SMART is an acronym for: Signs,
Medications, Appointments, Results, and Talk with me).
b) Develop framework for Trust discharge/transfer of care policy.
c) Develop work with the effective discharge team, such as:
i. Identify a member of staff to co-ordinate the discharge process (taking
account of when staff are off duty).
ii. Patients made aware of their Estimated Date of Discharge /planned
discharge date so that expectations can be manage
iii. All relevant information provided to departments in a timely manner.
iv. Patients to give consent for referrals to other services.
v. Medications prescribed and distributed without delays.
vi. Patients know who to contact if there is a problem e.g. when to contact
specialist team, GP etc. and who is a single point of contact.
vii. Ensure that the above information and systems identify and are provided in
the preferred communication method of the patients, or if appropriate, their
families.
MEASUREMENT
The overarching aim of the patient and family experience strategy is to provide patient driven care,
asking what matters most to our patients, with a key objective - to be in the top 20% for patient
satisfaction in the NHS.
A key part of the measurement strategy will be to design inclusive methods of data collection,
ensuring that ALL patients have an opportunity to provide feedback.
A Patient and Family Monthly Experience Dashboard will be designed to show Trust and divisional
level data across acute, OPD and community services.
Primary outcome measure
Patient and family experience objective (that we are in the top 20% for patient satisfaction in the
NHS). As this will be an annual response. We will have an additional outcome measure of 90% of
patients on collaborative wards will rate their care as ‘good’ or ‘excellent’ by January 2014.
Additional outcome measures
1. Percentage of patients involved in decisions about care and treatment.
2. Percentage of patients given enough privacy when discussing condition or treatment
3. Percentage of patients who found someone on the hospital staff to talk to about their
worries and fears.
4. Percentage of patients who knew about medication side effects to watch for when
returning home.
5. Percentage of patients who knew who to contact if they were worried about their
condition or treatment after they left hospital.
6. Percentage of patients who had single sex accommodation.
7. Percentage of patients who feel that staff have explained results in a way that they can
understand.
8. Percentage of patients who would recommend this hospital/service to family and
friends.
9. Number of patients who had a very good experience (scale from 0-10).
This question is included as The Picker Institute has tested and developed a new overarching
measure of patient experience for use in a wider range of settings. The aim was to identify a single
question that could be meaningfully asked of people from a range of backgrounds to provide
consistent information about experiences of different services).
Process measures
1. Percentage of patients with intentional rounding documentation.
2. Percentage of patients where teach back was used.
3. Percentage of patients receiving medication information.
Initially this data will be collected at a local level via hospedia, there are some issues with relying
on this form of data collection, such as it excludes patients who do not use the hospedia system.
However it is reliable in the sense that it is not collected by an individual and therefore is less likely
to be biased towards the organisation. On balance, it is felt that the Hospedia system will be the
choice of local reporting on this measurement.
The Trust is currently working in partnership with Hospedia and Picker regarding the roll out of the
Hospedia system from the Hope building across the organisation and how we will develop and use
the Patient Experience Tracker (PET) system in the future (this has the potential to be based on inhouse software which will allow us to tailor the questions that are included in the PET). Additionally
other survey methods are currently being redefined to work across community services.
Hospedia/PET and other survey data systems will be:
 Revised to ensure that patients are only asked questions that are relevant and meaningful
and that provide useful information in the service they are attending;
 Reviewed to include and link clinical outcomes, patient reported outcomes and patient
experience.
 Reviewed and co-ordinated so that data can be compared across wards/areas and
community services and over time.
 Designed to reflect ward/specialityOPD and community service priorities for
improving/maintaining patient experiences.
 Designed to clearly identify where ward OPD or community priorities are and are not being
achieved.
 Linked to performance frameworks and processes across all services.
Qualitative data will be collected via patient stories and patient focus groups, this is an area of
development which forms part of Always event 3 - Patients and/or carers are always listened
to. Patient stories are currently collected and prepared for the Board of Directors and Executive
Quality and Safety Committee. These will include a range of patient stories across diverse patient
and carer groups to ensure equal representation of the experience of all our patients/carers and
families across acute, OPD and community services Patient stories should be read out at all
meetings, e.g. ward, community and divisional level meetings. The Quality Improvement intranet
has a patient engagement page which includes information relating to patient stories; this will be
developed as part of the patient and family experience strategy, such as uploading videos of
patient stories on the intranet.
Governance
Measures from the patient, family and carer experience strategy will inform Clinical Assessment
and Accreditation Systems, including the NAAS and CAAS.
Work developed from this patient, family and carer experience strategy will feed into relevant
strategies and policies across the organisation, for example, the equality and diversity and
safeguarding strategies.
Dashboard, patient focus groups and patient stories will be used as a method of measurement in
the performance framework for all disciplines.
Staff value stories should be inextricably linked to patient experience feedback across the 4 values.
Evidence of these stories will be held as a library, as with patient stories to demonstrate staffs
commitment to providing an excellent experience for our patients.
VIEW OF STRATEGY
The following table provides details regarding the links between the always events, work streams and measures for year one.
Objective
PATIENT
DRIVEN
CARE:
WHAT
MATTERS
MOST TO
OUR
PATIENTS
To be in the
top 20% for
patient
satisfaction in
the NHS.
90% of
patients on
collaborative
wards will
rate their care
as ‘good’ or
‘excellent’ by
January
2014.
Always Events
Staff will always
communicate
with, inform and
respect the
patient and/or
carers, ensuring
appropriate
communications
methods are in
place for diverse
groups
Work streams – Year one
PATIENT, FAMILY AND CARER
EXPERIENCE COLLABORATIVE
Design programme for developing teach
back.
Measures
Number of patients receiving teachback method.
Data reporting mechanisms
How reported at ward
Who reported to
level
Learning and
Identified lead
development
Patients will be provided with all available
choice regarding their admission into hospital
Number of patients receiving
information about medication side
effects.
Hospedia and Picker
Identified lead
Patients will report positive length of time on
waiting list.
Number of patients reporting they
had their admission date changed
Hospedia and Picker
Identified lead
Number of patients satisfied with
their length of time on waiting list.
Hospedia and Picker
Identified lead
Number of patients responding
positively to this question (Picker
question). This will be a rolling
question on hospedia (i.e. every 3
months for inpatients).and will be
tested in OPD and community via
PET and patient postcards/online
surveys
Hospedia and Picker
Michele Morgan
Number of patients who are
provided with single sex
accommodation
Number of patients reporting they
have had single sex
accommodation in surveys.
Hospedia and Picker
Michele Morgan
Patient stories (sample of patients)
SCAPE matrons
Corporate Lead
Nurse
Patients will report a positive experience of
inclusion in discussions with healthcare
professionals (picker results report below
national average when patients asked if
doctors talked in front of them as though
patients were not there. Root cause analysis
exercise with a group of staff (medical and
nursing) to understand the different reasons
why inpatients may not feel as involved in
decisions as much as they want to be.
Always Events
PATIENT
DRIVEN
CARE:
WHAT
MATTERS
MOST TO
OUR
PATIENTS
To be in the
top 20% for
patient
satisfaction in
the NHS.
90% of
patients on
collaborative
wards will
rate their care
as ‘good’ or
‘excellent’ by
January
2014.
Work streams – Year one
PATIENT EXPERIENCE COLLABORATIVE
Measures
Data reporting mechanisms
Who responsible for
reporting data
Patients and
carers will
always know
who is in charge
of their care
Patients and
carers are
always listened
to.
Video to welcome patients and their families
to the hospital.
Number of hits to the video on the
website.
Communications team
Who will coordinate data
collection
Identified lead
The production of a welcome to the
ward/opd/Community services leaflet –
Develop as part of Hospedia system and on
line versions.
Number of wards/services who
have up to date welcome
information for patients.
Ward/service manager
Identified lead
Information regarding staff – what do the
different uniforms represent.
Number of wards/services
producing face sheets.
Ward/service manager
Identified lead
The introduction of “face sheets”.
A guide developed to help
matrons/appropriate staff to conduct patient
stories across all inpatient/outpatient and
community services.
Number of patient stories
completed.
SCAPE matrons
Corporate Lead
Nurse
Service safari - walk in the shoes of the
patient - Acute/OPD and Community
services (15 step challenge)
Number of service safaris
conducted.
DDNs
Corporate Lead
Nurse
DDNs
Patient experience champion nominated in
each division.
Number of Trust patient experience
champions
Corporate Lead
Nurse
Corporate comments and suggestion book
box provided on each ward, OPD area and
community service/clinic for patients and
relatives to provide instant feedback for staff.
Number of wards/services with a
comments/suggestion book/box.
Number of comments included and
appropriate action taken.
Patients supported where
appropriate.
Ward/service manager
Identified lead
Number of wards adopting
“surgery” time.
Advocacy support for patients who
may have problems accessing this.
Ward manager
Identified lead
Ward manager ‘surgeries’ a time of day
where the ward manager is solely available
for patients to have an informal chat with the
ward manager.
Always Events
Measures
Data reporting mechanisms
Work streams – Year one
PATIENT EXPERIENCE COLLABORATIVE
PATIENT
DRIVEN
CARE:
WHAT
MATTERS
MOST TO
OUR
PATIENTS
To be in the
top 20% for
patient
satisfaction in
the NHS.
90% of
patients on
collaborative
wards will
rate their care
as ‘good’ or
‘excellent’ by
January
2014.
Patients’
physical, social,
spiritual and
emotional needs
will always be
reviewed.
How reported at ward
level
This is a CQUIN and is
currently in
development
(Proposed measures –
Does patient have an
intentional rounding
document
Has it been completed
in the last hour?)
Hospedia and Picker
Who reported to
Intentional rounding and review.
Number of intentional rounding
documents completed.
Patient responses to intentional
rounding.
Identified lead
Staff engage patients as part of their
introduction to the ward environment and
give explanation of what single sex
accommodation means to improve patients
perception of this issue.
Number of patients receiving single
sex accommodation.
Ward manager
Identified lead
Personalized Menus and Daily dietary visits.
Number of daily dietary visits
requested and answered.
Ward manager
Identified lead
A period of time on the ward known as ‘quiet
time’, a planned period of time where no
unnecessary noise is made on the ward.
Quiet zone in area of the ward/unit.
Number of wards implementing a
reduction in noise strategy in their
area.
Safeguarding team
from isoft records
Identified lead
A physical, social and emotional needs
assessment
Number of patients’ carers who
receive a carer’s assessment
across all services (questions to
determine carers referral needs to
other services currently be added to
admission process in isoft )
Identified lead
PATIENT
DRIVEN
CARE:
WHAT
MATTERS
MOST TO
OUR
PATIENTS
To be in the
top 20% for
patient
satisfaction in
the NHS.
90% of
patients on
collaborative
wards will
rate their care
as ‘good’ or
‘excellent’ by
January
2014.
Always Events
Work streams – Year one
PATIENT EXPERIENCE COLLABORATIVE
Patients and/or
carers will
always receive
information and
education to
facilitate selfcare, ensuring
that they can be
accessed by all
patients
Patients will be empowered to be involved in
their own care through the development of a
patient portal.
The patient portal will be a designed based
on a validated web-based patient selfassessment tool.
Development of patient portal and
associated project measures.
e.g. Number of patients accessing
patient portal.
Condition specific resources
Number of condition specific
resources.
Service managers
Identified lead
Develop as set of healthy living tools.
Number of wards/OPD and
community services developing
pain relief menus.
Ward/service
managers
Identified lead
Discharge planning transformation
team is developing a suite of
measures within this area.
Possible measures: Number of
patients who follow the discharge
process.
Estimated Date of Discharge
Number of patients with a
discharge checklist
NAAS Documents
Corporate Lead
Nurse
Develop and implement a comfort and pain
relief menu for patients, to be provided with
every pain/comfort assessment.
Measures
Data reporting mechanisms
How reported at ward
Who reported to
level
Shine project potential
funding.
The production of condition specific
resources for patients, including online
resources, videos and relevant literature.
Develop a set of tools to help patients live
well, such as those included on the NHS selfcare website.
Patients and
carers will
always be
included in the
discharge
process
Develop a simple checklist for Discharge
Process
Develop work with the effective discharge
team.
Develop a Trust wide framework for
discharge planning