How can we bridge the gap between knowledge and practice to deliver good patient experience?

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Whenever we hear about patients' poor experiences, we ask ourselves – if we know what good care looks like, why do we find it so hard to ensure that patients get this sort of care day in, day out? Every day we hear about examples of excellent NHS care and poor NHS care – sometimes from the same hospital on the same day, sometimes even from the same ward.

On the Point of Care programme we have been working with NHS staff and others to identify interventions that could help to address this inconsistency and bridge the gap between knowledge and practice. We have been testing aspects of a methodology called patient and family-centred care (PFCC) – devised by Dr Tony DiGioia from the University of Pittsburgh Medical Center. It is a low-tech approach to improving services, based on the fundamental premise that care givers need to see care through patients' eyes if they are going to improve the patients' experience. As Tony reminded us at a recent event on patient experience, 'no industry has ever survived without considering the needs of its end users'.

It seems so obvious to look at care through the patients' eyes – surely as caregivers we know about our patients' needs and our own services? But as the PFCC method shows, sometimes we see only our part of the bigger picture, and often, it is only the patient or their family that can see the whole situation. The PFCC method involves caregivers shadowing patients so they can truly experience care through the patients' eyes. With this knowledge it is possible to design better health care experiences for patients.

Last week, we heard from Tony at a workshop that brought together leaders in the patient experience field with NHS staff who have been working to improve patients' experiences across a range of care pathways. A number of NHS doctors, nurses and managers at this event told us that shadowing had enabled them to look at care in a different way. How long must a night shift seem to a patient waiting anxiously, without sleep, for the next phase of her clinical assessment; the same shift that flies by for a nurse, who is run off her feet? How baffling must it be for a patient, who is moved from one waiting room to another for no apparent reason with no explanation? What feels like a sense of progress through the system for hospital staff may feel pointless or confusing for a patient.

In Pittsburgh, where PFCC has been in use for more than five years, it has helped to identify examples of duplication and waste – often the greatest frustration for staff. As a result, significant changes in clinical practice and care processes have improved patients' experiences and reduced delays and lengths of stay in hospital.

For the NHS staff at the workshop, the message was clear: simple approaches can achieve rapid and meaningful change for patients. They agreed that patients and frontline staff are the place to begin making improvements. The progress made by their Pittsburgh colleagues galvanised their efforts to make the small changes in care that can make a big difference to patients, challenging the often expressed notion that the system is too hard for frontline staff to change.


Robin Macfarlane

British Senior CitizensParty
Comment date
25 November 2011
Hi, we have been in contact for a few weeks. you asked how can we bridge the gap between PATIENT & Service.I think you already do this but you don't realise it. Keep in touch. Best regards Robin

Ed Macalister-Smith

NHS Buckinghamshire
Comment date
25 November 2011
An interesting programme, thanks Bev.

But as well as front-line staff, it's vital that Boards also engage in this. The failure at Mid Staffs and elsewhere was not just (was not even mostly) a failure at the front line, it was the responsibility of the leadership of the organisation at all levels up to and including the Board. And while you might say that it was also the failure of regional performance managers and of regulators and of commissioners and of other stakeholders (yes to all of those) actually the structure of the NHS that we work with requires Boards to carry the can for what happens in their organisations on their watch.

So how is it that Boards regularly fail to understand what is happening at the front line in their organisations? We await the outcome of the Inquiry...

The conceptual problem with statements about other industries not surviving if they don't consider the needs of the end user is that in the NHS the patient (or carer) ie the end user has very little power, so that model doesn't generally work very well - except in extreme cases. We need another model...

Nigel Edwards commented recently on the development of corporate values, beliefs and ethics in his own personal experience - which was almost zero from the NHS, but a substantial amount for one of his new and part-time roles. (That would be my experience as well). Some Trusts do genuinely inculcate organisational values into new recruits, but so frequently these are actually not the values and behaviours as expressed and lived by senior staff, so they are not believed at the front line.

Keep up the good work, but please don't keep the point-of-care issue just to front-line staff, it needs to be core business for senior teams as well. Ed.

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