Jennie Negus, Deputy Chief Nurse at Homerton Hospital NHS Foundation Trust in Hackney, here describes a new staff-led initiative to re-focus efforts to monitor and improve patient experience. This is one in a series of stories that The Point of Care programme is presenting on the issues that staff face in trying to ensure a positive patient experience. The views given in this article are those of the author and do not necessarily represent the views of The King's Fund.
Our trust has 'enjoyed' the notorious accolade of more than once receiving the lowest national inpatient survey response rate in the country. This is not an achievement we have been proud of. Our scores in the national survey were not good either; we were among the lowest performers in the country, although our scores were not significantly worse than those of other London trusts, and had been gradually improving.
But we wanted to do better. We wanted to get more representative feedback and to capture the good experiences that many patients had told us about unsolicited and anecdotally.
A key method we used to turn things around was 'walk rounds' of the wards.
Previously, we had found 'rounds' to be very useful when pleading for survey responses and inspecting compliance with hygiene code. But we decided to add a bit of 'punch' to the rounds by using the time to collect meaningful information for our data bank.
Matrons and heads of nursing together developed an audit tool with a number of components: assessments of 'calm, clean environment', with 12 measures; 15 measures of 'positive friendly culture', and 12 'culture of safety' measures.
The audit tool also included a section for staff and patient stories which aimed to be as open as possible, but included a couple of questions to use as prompts if necessary.
Our plan was for two teams, each consisting of a director or deputy director with a senior clinical member of staff (matron, head of nursing or nurse consultant), to visit two wards on the first Tuesday of the month. Each ward visit would last an hour and a half and require completion of the audit tool, feedback to the ward sister or charge nurse and a follow-up report.
We asked directors to give up three hours of their time every six months. There was unanimous sign-up to the proposal, and 98 per cent attendance at a meeting for potential participants to discuss logistics – a very strong message in itself. 'First Tuesday', as our initiative was called, started in January 2010 and – except for when snow wrecked plans at the beginning of February – has almost always gone to plan.
I kept a close watch on progress throughout, catching up with the teams to check all was going well. I collated audit forms into short reports for the wards, and the lead director personally wrote to the ward manager thanking them for their welcome and feeding back the main observations.
We carried out a full evaluation after six months by sending a questionnaire to team members, ward sisters and charge nurses.
We found that everyone agreed that seeing senior managers dressed smartly alongside a clinical lead in uniform gave a powerful image that was valued by both staff and patients. Directors who did not have a clinical background found the audit tool particularly useful – it gave them a structure and helped them to find their feet in a largely unfamiliar setting.
Non-clinical directors clearly gained the most on a personal and professional level: they fed back that it put their work into perspective and reminded them that ultimately we are all aiming to provide high-quality care for patients.
Our evaluation showed that ward staff loved the visits; staff in other wards said they were jealous and asked why they had been left out! The sisters and charge nurses enjoyed receiving their 'important visitors' and said they appreciated being asked about their experience. They were both surprised and pleased that a director and senior clinical lead had put effort into finding out what was important to them.
Patients were also impressed by seeing a director and valued the fact that they had 'taken time to come and talk to me'.
Sometimes, the directors acted as trouble shooters in their visits. For example, one made sure that a slamming door that had been repeatedly reported was repaired, another helped out when a patient was worried that her frail husband wouldn’t be able to visit, and a third intervened when the patient told of another patient being rude and aggressive to staff.
The initiative was so successful that staff and directors wanted to roll it out further, and from October 2010 three teams now take part, covering 23 areas, each being visited every three months. We now plan for governors to join the team, and members of our local LINK have also asked to be involved.
'First Tuesday' has been successful on a number of fronts: the image to staff and patients of clinicians and managers working together; a greater understanding and appreciation of the care environment among team members; and valuable quantitative and qualitative data.
But without a shadow of a doubt the most powerful aspect has been hearing the staff and patient stories. Sitting beside a patient, your hand on hers, hearing her story, looking into her face, seeing her anxiety or pain, welcoming her positive words or accepting and apologising for failings is the very core of understanding patient experience.
Jennie Negus – Deputy Chief Nurse
Would it be possible that I receive a copy of your audit tool you use?
Thank you very much,
I have been a 'frontline' nurse/midwife most of my working life and have been happy to remain at ward level working in junior management posts until the age of 60 while simultaneously being a union steward. I felt strongly that the the latter activity was an important sign that I could be a ward leader but still show solidarity with the experiences of staff I managed. I found doing both roles at the same time made me better at both of them. It seemed completely natural and essential to me to stay in touch with staff and patients' 'stories' as Jennie describes them and find it amazing that it appears to be a revelation to her how important this is! I have rarely, during my working life, had managers myself who placed any priority on spending time on the ward and talking to us and the patients and finding out what life was like for those whose core work is holding the patient's hand (as well as juggling answering the phone,attending to other patients' buzzers, giving medications etc). And this work is still relatively poorly rewarded if you are a junior staff nurse or a health care assistant and especially if you work in a care home - a sign that this work is still not truly valued despite Jennie finding it very important to learn from it. But having said all that I'm very glad she did!
I just wonder which Ward might shock them most - though I guess it would be the Geriatric Ward, even if the Ward Staff were superb.