How to involve patients in quality improvement

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Our report on Embedding a culture of quality improvement explores the factors that helped five NHS trusts launch and sustain a quality improvement strategy. We spoke with Sara Turle, a patient at Barking, Havering and Redbridge University Hospitals NHS Trust, about her involvement in the Trust's quality improvement work.

How did you first hear about quality improvement at your local hospital trust? 

Having been involved as a volunteer at the trust from early 2015, as part of what was then the Improving Patient Experience Group, doing some collaborative work with cancer services and involved with PLACE [Patient-Led Assessments of the Care Environment] reviews, I was clearly aware that work on quality improvement was happening. Looking back, these first few months for me were crucial preparation and grounding for the partnership that has developed between myself and staff. Building trust was key. 

In August 2015 the trust’s Medical Director first approached me about seriously getting involved in quality improvement work, taking partnership working to a new level. During an early morning phone call, he spoke to me about a weekly Patient Safety Summit (PSS) that was in its infancy and which he would like me to join, where learning from serious incidents took place, improving safety in a safe environment for staff. This was ground-breaking for staff, let alone adding a patient partner into the equation too.

It was at this point that I really saw how serious the trust was about quality improvement. I was understandably a little nervous but excited and inspired by what I was hearing and I was definitely on board.   

How have you been involved in quality improvement?

As a member of the now year-old Patient Partnership Council, I am involved in a diverse range of work including listening to patients about their experiences, assurance groups, film-making and delivering training. These are just a few examples of how I am involved, all the while ensuring quality improvement is at the core of everything I do.

There are, however, two key initiatives to highlight, Patient Safety Summits (PSSs) and The PRIDE Way [Passion, Responsibility, Innovation, Drive, Empowerment] evidence-based quality improvement work that has developed from the trust’s collaboration with the Virginia Mason Institute. With the PSSs, held in both the trust’s hospitals weekly, I have an equal voice with staff in questioning, discussing and drawing lessons from incidents to improve safety for patients. Nothing is held back because I’m there. With our Virginia Mason collaboration, beginning in November 2015, I was asked from the very outset to be part of the sponsor team for the diagnostics work stream.

This has involved not only helping set the boundaries for the work, consider opportunities for improvement within those boundaries, and meeting monthly to review metrics. I have also been part of two five-day intensive Rapid Process Improvement Workshops (RPIWs) where staff from the shop floor are empowered and enabled, through methodology and dedicated time, to find solutions and improvements. I have not stood on the side lines or with anyone holding my hand but have been given a role with the same expectations as anyone else in the group. All our RPIWs have patient partner involvement. 

What benefits have you seen to hospital services as a result of quality improvement work?

Two years on, we have come far. I have seen and am part of a very clear embedding of a quality improvement culture that has been supported from the top of the organisation, been embraced from all levels within the organisational structure and is now developing into a continuous culture and methodology of improvement. 

These factors are utterly crucial, in my view, for sustained quality improvement. To date, more than 425 staff have received training in The PRIDE Way, a mandatory e-learning module for all has launched recently and additional training — The PRIDE Way for Leaders — established too. One of the very real challenges at the start was getting everyone on board. I feel we’re well on track with this.

I have seen more rapid, accurate diagnosis, I have seen safer systems and processes identified and implemented with data to evidence these benefits to patients and I have seen work practices of staff improve as frustrating ‘stones in their shoes’ are identified and eradicated. I have seen so much pride in what is being achieved and I have seen perseverance, innovation and passion to keep improving.

What has patient involvement added to the quality improvement work, and what would have been missing without it?

Patient involvement, as I have described, has brought an understanding, for clinicians, as to what true value is to a patient. Without that, how do they really know what matters most? The voice of a patient with lived personal experiences, heard firsthand, and what that brings, is a priceless commodity. With my work in our PSS, the patient being at the heart of care is never forgotten. Using the first name of patients discussed has been incredibly powerful and fresh, and non-medical environment eyes and ears do bring an added valuable perspective.

Through my presence, it has also helped improve the culture of raising concerns and incidents. My greatest satisfaction now is seeing student nurses and new doctors so actively involved and only last week one student nurse said to me, ‘You ask the questions I want to have answered and by you asking, you’re encouraging me to challenge too.’  

What advice would you give to other trusts about patient involvement in quality improvement?

If you’re new to this as an organisation, it may seem daunting at first but don’t let this put you off. The value seen in partnership working is now at such a point at Barking Havering and Redbridge University Hospitals NHS Trust that staff are requesting patient partners to work with on different initiatives.

To start, I would suggest identifying patients who are already working as volunteers within your organisation. People known to you and your staff. Building on existing partnerships helps both ways. Find your own pace with level of involvement, but keep moving forward.

It is important that you are clear with patient partners about what is involved with any initiative and offer support where needed. 

Trust and mutual respect are key. Change can be unsettling for all. It was important for me that staff recognised that while I would always speak up and say what I thought, I did it appropriately. I challenged but I was a highly proactive cheerleader too. 

Value and invest time in your patient partners. Always remember what they are giving and never underestimate the value of a cup of coffee and a check in about how they are. 

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