We know that exceptional patient and customer experience is based on a rigorous and continual focus on both clinical quality and safety, and on patient and resident engagement and feedback.
Care UK is focused on providing services that not only achieve the highest clinical quality but also receive top customer satisfaction ratings. We measure our achievement of quality and patient experience through a range of outcome indicators and key performance indicators (KPIs), which we benchmark against other providers where published information is available.
All our services are developing a consistent, structured methodology to ensure that the voice of the patient and customer is listened to and informs the way in which we run and develop individual hospitals and care homes.
We have a strong track record, achieving sector-leading ratings for both service quality and patient satisfaction metrics. Our healthcare services have a proven record of positive clinical outcomes and significantly higher scores than the top 20 percent of NHS hospitals on several service quality and patient satisfaction metrics. We publish a detailed Quality Account for health services and uniquely have published a similar account for our social care services.
Increasing patient satisfaction and cutting hospital stay times in Bristol
We know that patient feedback is key to improving and enhancing patient experience. At Emersons Green NHS Treatment Centre in Bristol, feedback showed that patients preferred to spend as little time as clinically possible recovering in hospital.
An Enhanced Recovery Programme pilot explored how an average four-day hospital stay, following a full knee replacement, could be cut by giving patients a more active role in their own recovery and enabling them to be rehabilitated in their own homes. The pilot found that if patients understood the process prior to the operation, and could be up and out of bed within a few hours of their operation, they would be confident of their ability to walk the following day. The new process means that almost 80 percent of patients are quickly mobile, compared to 20 percent previously.
Physiotherapy has a vital role in the programme. Patients spend two days in hospital undertaking two or three physiotherapy sessions a day before going home with planned physio sessions, making use of our unique Pocket Physio mobile app (which contains videos of how to carry out exercises) and supported by access to a 24-hour helpline.
As a result, the average stay has been cut from four to around two days. Reported pain levels fell to 0.89 (on a patient’s measure of their pain from 0 to ten with ten being the highest) and patient satisfaction percentages are in the high nineties. As well as enhancing the patient experience the new protocol means that the centre can now carry out more surgeries per year and bed capacity is freed up. The pilot was later replicated successfully at our Shepton Mallet NHS Treatment Centre and the programme has now been fully adopted by both centres. We now plan to roll the programme out across our treatment centres nationwide.
Shared learning improves the patient experience in Southampton
The range of services we provide gives us a unique opportunity to share knowledge, skills and facilities across different specialisms, creating practical, more joined-up services within existing relationships with commissioners and communities.
Feedback from our patient user forum led us to use our care home dementia environment expertise to carry out an environmental audit at Southampton NHS Treatment Centre. The clinical team were keen that people living with dementia would not feel confused or stressed by visits to the centre. The audit, carried out by our head of dementia services, led to clearer signage and a better use of colour and contrast to help people move around the waiting and examination area.
Colleagues within the centre also undertook the experiential training programme developed in our residential and nursing homes. During the training they were given direct experience of the dramatic effect that dementia and frailty can have on the senses: special glasses blurred their vision, headphones delivered white noise and gloves restricted the movement of fingers. They were also fed food they could not see, drank tea from a plastic training beaker and were asked several questions in quick succession without having enough time to think of replies. These experiences have given them an insight into how some patients experience life.
Giving residents a voice
Our engagement commitment extends across all of our social care services and NHS facilities. Our commitment to promoting wellbeing in those living with dementia, as well as our ongoing investment in the fabric of our care homes was reflected in the high levels of satisfaction achieved in the first ever independent survey of care home residents’ views of their care.
The survey asked more than 20,000 residents in 1,055 care homes across the UK to rate their home under four headings - Staff and Care, Quality of Life, Home Comforts, and Choice and Having a Say – scoring them out of 1,000. The aggregated score then formed an overall performance rating (OPR).
Care UK homes were well represented throughout the top quarter of the survey, but most importantly home managers are able to use the feedback generated to further improve the service they offer.
Listening and learning – putting engagement into practice
We are continually developing flexible and convenient ways to capture what our patients think. Throughout the country, at our NHS Treatment Centres, Clinical Assessment & Treatment Services (CATS) and doctors’ surgeries, managers analyse their monthly satisfaction surveys to ensure that their service listens to patients and maintains the highest possible standards. These may be written on a card that is then placed into a box in reception or, increasingly, electronic surveys make it quicker and easier for patients to have their say.
Patient forums have full access to survey results, along with any responses of complaint or praise, to assure the integrity of the process and ensure that patients’ input is taken and acted upon. Many services also hold more detailed annual surveys to allow for more questions about quality, dignity, care and new service or facility provision. This commitment to patient participation is a clear contribution to the consistently high Patient Led Assessment of Care Environment (PLACE) scores achieved by services.
PLACE inspections cover a very broad range of issues, including privacy and dignity, cleanliness, food quality and general décor and maintenance of the building. The inspection team is led by trained patients, sometimes members of the patient forum, and their assessment places patients’ views at the centre of the review. We are delighted to see that so many comments from assessors praised not only the quality of the environment but the exceptional attitude of our teams who went out of their way to improve the patients’ comfort and experience.
We use the information we gain from our formal and informal patient interactions to monitor our performance, improve the day-to-day working of our services and create flexible services that fulfil patients’ needs in convenient and accessible locations.
We have also worked hard to capture any data from complaints and concerns, as well as compliments. In 2013 we implemented a Datix Risk Management System to help us track our progress. Our service line quality governance managers monitor the use of the system for all sites and provide a month end report which reviews the number of complaints received and the reasons for these complaints. This reporting provides the basis for improvement at site level. One initiative we have implemented, as a result of feedback, is a redesign of the patient pathway in order to reduce waiting times in clinics. As a result of this and other strategies one centre has a complaint rate of 0.44 percent, with most others having a level of 0.08 percent or below.
Improved pharmacy access
Listening to patients and service users helps to bring about practical changes and innovations. We’ve extended surgery and pharmacy opening hours to allow people who work full-time to pick up their prescriptions immediately after evening appointments and, as the direct result of a patient survey and forum, we’ve made information more accessible through foreign languages and electronic consultation.
Using patient feedback to create a new clinic in North East London
Patient feedback has also led to the creation of a number of new services – such as a wound care clinic at our North East London NHS Treatment Centre, where medical colleagues received formal and informal feedback from minor procedure patients that they were finding it increasingly hard to get GP or community nurse appointments for post-procedural wound dressing. While some GPs were happy to change dressings they were only able to offer appointments four or five days after the operation because of pressure on their resources. We generally recommend that dressings are changed two days after minor procedures. As a result of the feedback, the treatment centre’s medical and administrative teams worked together to create a new wound management clinic that changes the dressing of anyone who has had treatment at the centre.
The feedback from patients has been very positive. They know they are going to have clean dressings in good time, which helps to reduce greatly the risk of infection and complication and, because the service is specialised and on site, they do not need to take a long time out of their day to have their dressings changed.
One-stop services in Rochdale and Southampton
Patient feedback forms have also led to the creation of a one-stop occuloplastic service at our Rochdale Ophthalmology Clinical Assessment & Treatment Service (CATS).
The service has a regular clinic that deals with small operations, such as cyst and wart removal. Traditionally, the patient would visit the consultant and then be given an appointment for the procedure. The overwhelming and consistent feedback from our patients was that they did not want to have to make two trips.
The team spent time working through the logistics with the medical and administrative teams and came to the conclusion that, in the majority of cases, two trips could be avoided. Now the service writes to patients to tell them about their appointment, explaining that, if it is suitable, we may be able to operate on the day and they should be accompanied by a friend or relative to the appointment.
The results have been a great success with patients reporting that they can be in and out in no time and they really appreciate the professionalism and the speed.
We know people always worry to some extent when they have to have a procedure and, thanks to listening to our patients, we have been able to greatly reduce the stress and the inconvenience of treatment.
One-stop shop cataract service in Bristol
In a similar vein, the team at Emersons Green NHS Treatment Centre in Bristol has developed a one-stop cataract service that enables the majority of surgeries to be carried out in just one morning. For example, if the patient arrives at 8am for a full pre-assessment and consent verification, the procedure can then be carried out with, in most cases, the patient being discharged before 11am.
The initiative was driven by the ophthalmology and nursing teams and was developed in response to patient feedback. It also gives the advantage of enabling more procedures and so reduces waiting lists in the area.
Patient feedback on the service has been excellent and satisfaction levels are also very high, with people electing to have their second eye done at the centre and reporting that they would recommend the service to friends and relatives.
Advice and information on request
The teams within our care homes work hard to support residents’ families. Feedback told us that families were frequently unable to access both clinical and financial information from authoritative, convenient sources. External dementia support groups providing information and signposting tended not to be available outside working hours.
Across the country, homes are providing additional support for families with a range of free seminars designed to give advice and information. National dementia expert James Wilson lectures in Mental Health at Southampton University and specialises in the effects of the condition; he has joined with our own experts to give weekend and evening talks. Feedback forms from attendees have been extremely positive. People tell us they are grateful for the insights and delighted to learn they are supported and not alone.
We have also partnered with financial advisers and care fees specialists to deliver a series of talks on how to plan for your or a loved one’s future care and again feedback forms tell us people are reassured to have access to expert, independent advice.
Assuring quality and safety
Ensuring the highest quality of care and safety for our patients and clients, and for our own people, is at the heart of all our health and social care services.We achieve this by keeping robust systems and reporting structures in place and auditing our services regularly.
Our integrated governance system operates at every level, from the Board to clinical leaders, and covers all services. We liaise with external professional bodies such as the Royal College of Nursing and the Care Quality Commission in England, as well as the Care Inspectorate in Scotland and the Care and Social Services Inspectorate in Wales, to ensure that our care is maintained at the highest level, with clinical leaders working on practical ways to protect patient safety.
Examples of this can be seen in the extremely low level of infections in our hospital settings. Our record on venous thromboembolism (VTE) is also consistently strong – following National Institute for Clinical Excellence (NICE) guidance that patients should be assessed for VTE risk.
We take part regularly in both national and local audits. In 2012-13, we participated in two national audits, with 100 percent of eligible patients taking part, and we held 18 local clinical audits for ISTCs and 14 for CATS, all of which are reviewed at Board level, and which bring together national best practice guidelines and input from professional bodies and institutions, providing benchmarking.
Our own audits, such as those to ensure that we comply with the World Health Organisation’s (WHO) surgical safety checklist, have been improved with a second layer of checks using direct observation and rolled out across all our surgical services. We target 100 percent compliance, because we consider this such a vital aspect of patient safety, and back up our processes with detailed clinical documentation audits.
We are upgrading the systems we use for what might be considered standard tasks, such as creating duty rotas – we now use an electronic rostering system to ensure that we can demonstrate compliance with quality guidelines on the numbers of suitably qualified professionals to meet all patient needs. This means that senior clinical colleagues can focus on their vital role of patient care across all our ISTCs and CATS, while the rotas, including working hours, requests for leave and other variables, are created to reflect and respond to patients’ needs.
Maintaining best practice often brings about practical solutions which have widespread benefits. The need to cut Inadvertent Perioperative Hypothermia (IPH) was the starting point for practical and innovative solutions pioneered at the North East London NHS Treatment Centre. IPH causes a range of postoperative problems, prolonging recovery and causing longer hospital stays.
Simple steps, such as warming intravenous fluids before use, having thermometers in all theatres and using an insulating sheet called Mediwrap before and after operations, brought the number of patients suffering IPH down to 4.3 percent, as against the Royal College of Anaesthetists’ target of less than 5 percent.
A combination of such clinical leadership and a base of effective training creates a robust and effective approach to care – we invest in learning at all levels, including introducing e-learning for almost all essential skills so that our people can access information wherever they are.