Ify Okocha, Medical Director of Oxleas NHS Foundation Trust discusses Oxleas' approach to improving patient experience and creating a culture of continuous improvement.
This presentation was filmed our our sixth annual leadership and management summit on 25 May 2016.
So a good place to start I think is to tell you a bit about Oxleas, we’re not just a mental health trust, we also provide community services. We employ 3,500 staff across maybe 20 or more disciplines. We really work out of four hospitals, one community hospital, two acute and one more hospital the Queen Mary’s Hospital which we own. We provide probably 35% or 40% of services from that site and the rest of the site is of health is where care is provided by a lot of other partners. Acute partners, NHS and non-NHS partners. I'm not aware of any hospital of this nature certainly in England where you have lots of partners coming together and providing care for local people. And we invest in somewhere in the order of £30m to see that this site becomes a real hub of health care.
And that takes me onto this notion of patient experience and we have had a programme in Oxleas for many many years. Because we see this as being absolutely vital particularly where you think about the sort of work we do. We don’t run high tech services, we don’t operate on people, we look after people with chronic conditions, what you and I may call ‘long-term conditions’. So people with schizophrenia, people with bi-polar, with diabetes, with chronic obstructive pulmonary disease, so we use a number of methods to capture information but perhaps the commonest is asking them questions using a questionnaire. And there are six questions that we ask irrespective of where you are across the entire organisation.
The first four questions, those are the things that at every opportunity, at every contact you need to make sure that you leave your patient with no doubt that they have enough information about their care and treatment, they’re involved in decisions about their care and treatment, they’re been treated with dignity and respect and that their carer or family have been supported.
And then we ask two further questions. Has that intervention made a difference to your life? And the last one is would you recommend our services to your friends and family? And what is most important to my mind is that people need to see what we’re doing about the responses.
The other thing that we do particularly in areas where we find that there are challenges, that has a lot of complaints, incidents etc, is that we ask a group we call our research net consisting of users of services to go in ad talk to service users face to face and gather more information than we can get from questionnaires about what’s working well and what’s not working well. And then we work with the teams to try and bring about change to make the differences and to co-produce in terms of how that can be realised.
Talking now about our staff, I think no-one would doubt that staff are absolutely critical and we do everything that we can do in our organisation to make sure that they are in fact the best that they can be, supporting them in every way possible. So supervision is something that needs to take place, making sure people have had annual reviews, for example, making sure that they have access to CPD. But I want to say a bit more about our partnership working with staff because I think that merits special mention.
So we’ve got a partnership team who really can go anywhere in the organisation and speak to anybody. So they have free access to the chief exec, free access to the director, and one of the directors is sat there smiling because we really are frightened of Wendy, she comes in, she tells you what’s working, what’s not working and she demands responses. So every year she runs about 60 focus groups. It doesn’t surprise me therefore that when the King’s Fund, in 2014, published their engagement score, Oxleas was rated number one of several trusts. Of course developing staff is important and so we have a bespoke management development programme for those who are aspiring to be managers or indeed those who are already managers that helps them to develop personal skills for managing and also helps them to be more efficient in leading the services that they manage. And it’s through action learning and mentorship in the workplace that we try and embed these further in practice.
And then they all wanted to get their teeth into something, they wanted to change programmes within their teams, to do things within the organisation and for that we again turned to the King’s Fund to say well can we run a strategic quality improvement project? And from doing that work we found that there were a little over 300 projects, research, audit, service improvements that were being run in the organisation. And the question really for the group which consist of the doctors, senor clinicians and of course the management teams of our five directories was how do these projects align with the organisational goals, how do they align with the directory goals? And through the work that went on overall several months we managed to whittle this down and to have directories think about things that would really make a difference to get us to the position that we are struggling to get to.
But of course you can't do all of this without being in an organisation or an environment that delivers this work to flourish. In terms of governance we have very good systems, but in addition to that I think that the board, certainly the seven years I’ve been there, has really been very keen to make clear that quality is the absolute priority.