Transforming practice: tips for improving patient experience

Comments: 6

Is there anything you could start doing differently right now as a health care professional that might transform your patients' experiences?

The start of a new year is traditionally a time to reflect on how to do things differently in the future, and the smallest things – often easily rectified – can sometimes make the biggest difference to patients because they signal that staff care. Some of the case studies shared at our Point of Care conference last year add weight to this theory, and the stories have some useful and practical tips that can transform practice.

One case study was of a hospital waiting room that had an empty fish tank, which patients singled out as a reason their time spent there was so disheartening. The empty fish tank signalled desolation and an absence of care and attention, setting the tone for patients' experience: foreboding and uninviting.

The staff, however, just hadn't noticed the fish tank. It wasn't that they didn't have time to do something about it or that they were consciously trying to make the waiting room an unwelcoming place. They simply didn't spend much time sitting in the waiting room themselves, so it went unnoticed. By listening to the patients' experiences of the waiting room, staff recognised just how symbolic, and disconcerting, seemingly minor objects in an environment can be.

There are also ways in which a good leader can support staff to take a little time out of their routines to reflect as a team on the experiences of delivering care and, in turn, the quality of patients' experiences.

For example, in a pilot ward at the Edinburgh Napier University and NHS Lothian's collaborative Leadership in Compassionate Care Project, a patient who was asked about his experience in hospital mentioned that his morning cereal was virtually inedible because staff always added too much milk to his bowl.

This small complaint became a learning experience when one of the leaders on the ward decided to address this small and easily fixable problem: the team would allow patients to pour as much or as little milk into their cereal as they wanted (and staff would be on hand to offer assistance as needed).

Nurses were surprised to discover just how much variation there was in patients' preferences for milk in their cereal and came to understand the profound impact on patients of losing their autonomy.

Although this may have been a fairly minor detail in the patients' overall experiences of care, there were broader implications for the delivery of clinically significant aspects of care – with staff realising how often they were unaware of or ignored the 'person in the patient'.

The realisation might not have been possible without good leaders on the ward to recognise and encourage such opportunities for reflection and learning.

These are two real-life examples of how listening to patients can result in changes in practice that improve patients' experiences in hospital. But, more generally, what steps can trusts take to listen to patients? Our conference speakers last year were each asked to give a single practical tip for transforming practice. Here's what they suggested:

At the level of the individual

  • Ask what is the one thing you can do for your patient right now and how you will know when you have done it.
  • Go back and find out whether the board of your organisation invites a patient to each board meeting to share their experience. If not, ask why; if so, ask how this process is being used to inform learning and systems around the hospital.

At the level of the team, unit or department

  • We need to have 'caring conversations' in hospitals among our teams. For this to happen we need to dedicate time and space in the working day to create a multidisciplinary forum for discussing the experience of giving care. Without these conversations, we cannot begin to understand team dynamics and how they impact on patients.
  • Involve patients in some of these caring conversations; this will help to complete the bigger picture.

At the level of the hospital or service

  • Integrate feedback from patients about their experience into governance processes and board meetings.
  • Do not form a committee; instead, start trying to improve patients' experience now. The drive to improve patients' experience may gather momentum through the commitment of teams and individuals dedicated to re-humanising health care and placing the patient at the centre of medical and nursing practice. Teams and individuals also need leaders who affirm compassionate and patient-centred values by modelling them throughout the organisation.

Do you have any more tips for transforming patient experience – or examples to share of when the smallest change has made a profound difference to patient experience? Please let us know by adding your comment below.

See our project: Point of care programme

Comments

#103 Amanda Finlay

Autonomy and nourishment combine at meal times- most of the time as a missed opportunity for positive experiences. 52 years ago as an 8 year old polio patient unable to move and alone in an isolation ward, I asked if my milk could come from the fridge rather than lukewarm and disgusting, and if I could have smaller portions. I suspect my determined mother made this happen, but that responsiveness gave me confidence to feel that I could still make things happen and that the world outside my cubicle was listening to me - both of which helped me to keep going and recover. As a public governor at Oxleas Mental Health Trust I hope to hear those small voices and amplify them as mine was all those years ago.

#104 Alexandra Wyke

In a survey we undertook of patient groups a couple of years ago on Quality of Life one reported obesrvation about how a very small change tro the patient experience sticks in my mind. A lady with rheumatoid arthritis was in great pain. The assumption was that to improve her QoL doctors should up pain relief medication. It took a small local patient group to discover that what the lady missed doing the most was gardening, but was unable to do so because of the bending involved. The group arranged for part of her garden to be elevated. The patient was overjoyed.

Lesson learnt: Sometimes patients needs do not create overwhelming demands on healthcare provision.

#107 Dr Tanya Pelly

I was delighted to see a mention of 'caring conversations' highlighted as a team level initiative that could improve patient care. To make a real impact, however, these 'conversations' must focus on context.

Creating 'space' for these conversations involves more than dedicating the time and engaging all the participants of a multidisciplinary team - it is often more about moving beyond ego and content.

In the traditional medical forum, a 'presentation' (content) given from behind a lectern (ego), has not created connections between teams that improve care.

To create the 'space' for 'caring conversations' it is valuable to have an external party facilitate a forum that focuses on how connection supports care. If that's a patient (or a GP), all the better!

#108 Jane Martin

I belong to a very informal circle of lay people caring for patients with similar conditions in our homes, and we share our experiences of what works and what doesn't through a blogsite. I am sure that busy professionals find too many meetings a burden, perhaps a similar mechanism for exchanging views and expertise could be done inside the hospital and primary care circles?

#110 Michele

I think the availability of more personalised transportation (hospital buses, taxis) for people to access existing services would be a significant improvement. I work in a hospice and am constrained by the limitations of the shared patient transport (which has to deliver and collect from a wide area, meaning many people sit on an uncomfortable bus for up to one hour while their peers are collected & deliverered). My appointments and group sessions are determined by the practical considerations of transport rather than the therapeutic needs of the individual. The Taxicard system is reported by many patients as unreliable and does not seem to adequately address this issue. My patients have reported very poor service from taxi cabs booked through this system.

#684 Neil Clavin
Experience strategist

Its worthwhile to check out some of the challenges commisioned by the Uk Design Council for Health http://www.designcouncil.org.uk/our-work/challenges/Health/

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