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Patient Experience Toolkit to improve care

A Yorkshire Patient Experience toolkit has been devised to help frontline staff gather and use patient feedback about their experience. Developed by Claire Marsh and her colleagues, it provides a six-step tool, tested in six different departments for a year, with support from academic staff.

This study took place in three phases: qualitative research, toolbox development and lastly a review of the latter.

Issues

This study showed that organisations collect large quantities of indicators about patients’ experiences but that, without an organisational framework, it was difficult to use them, to respond to requests and to put forward improvements.

Three issues were highlighted:

  • Who owns the Patient Experience?

The concept of a Patient Experience is very broad: it refers to a continuum of care received by a patient, not just their appointments with individual clinicians. In this respect, it falls within the remit of all the people with whom the patient is in contact. Consistent and coherent communications between these groups are therefore of great importance.

  • What types of feedback should frontline staff use?

There are many tools to measure and understand the patient experience (questionnaires, complaints, quality surveys, etc.), each with its own pros and cons.

  • How can narrative feedback be used to drive the implementation of improvements?

This involves using interviews or observations with patients and staff to trigger discussions about revising and improving services. Participants are then regularly brought together to review and reflect on progress. Assessments show the effectiveness of this approach thanks to its highly participative nature but that it is resource-hungry, which can represent an obstacle to implementing it.

Developing and testing the toolbox

This was based on the action and research learning framework for organisational change by Coghlan et Brannick (2014).

To do this, academic staff arranged interviews and group discussions with staff and patient representatives at regular intervals to decide on the basic ingredients of a successful process, drawing lessons from what worked and what didn’t work and responding to the issues identified above. This approach enables potential solutions to be studied through iterative cycles, allowing clinicians to learn what works best for them in practice and academic staff to collect and share theoretical knowledge.

This resulted in a six-step toolbox (the Yorkshire PET):  CollaborationGathering feedback – Making sense Team priorities – Making a changeReview.

Main lessons learned 
  • Collaboration is vital: experience has shown the limitations of a lack of existing arrangements for working as a team and, conversely, how easy it was to progress with projects if a team approach was already in existence. 
  • Frontline teams wanted more details of what the tool offered, so they arranged more specific interviews with patients.
  • The results were more a reflection of the emotional needs of patients and their families. The project team observed that it was difficult to present this type of complex, emotionally-rich commentary to frontline staff.
  • Small-scale trials can help to implement improvements.
  • It is not always straightforward to measure the impact of improvements.
Conclusion

While staff need a detailed narrative commentary that reveals patients’ needs rather than statistical or historical trends, this raises questions about the current emphasis on data gathering. It also appeared important that patients’ relational feedback – for example, the expression of feelings – be kept intact and not converted into numbers or notes.

Furthermore, the independent review which also took place in parallel with the development of this toolbox showed the need for qualified facilitators to support the teams throughout the six steps, particularly to manage the more emotional comments or for some more technical aspects, such as analysing feedback. Overall, it was found that the toolbox was not a document that frontline staff could “take off the shelf” and use, but more of a guide for support staff: for example, those responsible for improving quality or for the Patient Experience.

The toolbox’s six-step process may appear deceptively simple because it does not require any complex systems for managing data or analysing statistics. However, it does require a people-based process of collaboration, discussion, listening, identifying issues, reflection and empathy.