Monday 20 July 2009

Transformational power of crowd sourcing and patient choice

Enabling meaningful choice and using this as a driver for improvement from providers.

Patient Choice is not just valuable in its own right as an enabler of patient-centric care, but has the (as yet unfulfilled) potential to drive transformational quality improvement by creating internal NHS competition.

Patients and the public are currently unable to make informed choice and thus cannot exert the pressure required to drive patient-centric change. Nothing currently being delivered in NHS looks capable of changing this.

In the same way that IT-enabled visualisation and understanding of performance for Boards and staff changes culture, so the same will be true for huge numbers of NHS patients. This requires a far more innovative approach than employed to date - but will benefit from the same technologies and understanding employed by many other industries which focus on empowering and supporting users by enabling them to understand realities behind often complex data sets.

Once users understand the huge variance across the NHS, they will exercise choice - and this will create positive pressure for change and improvement across the service.

Existing traditional approaches (doing what we do now in a better way) have failed to harness this potential and will continue to do so.

Is it time to unleash the “armchair auditors”, time to trust the patients and users of the NHS to be the prime judges of the service they pay for, and to fully share this information and opinion in a transparent and open way?

Analysis of - “Understanding what matters” (Department of Health)

iWantGreatCare’s ‘Analysis Of...’ series (1) - 'From Ward to Board'

This is the first post in the ‘Analysis Of...’ series; stuctured commentary on salient publications, conferences and newspaper articles related to patient experience monitoring, analysis and improvement. There will be an ever increasing volume of discussion across many channels in the patient experience space and this series will carefully select out the most relevant, most controversial or the most authoritative and look at them in more detail. The structure for ‘taking a closer look’, and one that will become familiar to readers is Cut it, Dissect it, Digest it, Rate it.

First in the series is a publication from the Department of Health titled Understanding what matters: A guide to using patient feedback to transform services (May 2009). This is a good publication with which to kick off this series since it is recent and topical. It also presents a well written, comprehensive guide to the labyrinth that patient experience can be to some. The publication title is somewhat long winded and for brevity will be referred to as ‘the guide’ from now on...

CUT IT? (i.e. does it ‘cut it’?)– Yes it does. This is a timely piece. The interest in, and activity around, patient experience is rising and many are jumping on this wagon with no clinical background or understanding. The risk of such opportunism is that valid patient experience measurement is not acheived, and the importance and power of unlocking the voice of patients is not given the priority it deserves. There is no time to be wasted with “making it up as you go along” or deploying non-specialised providers for what is a highly specialised area. The impending pressure on budgets, and consequent cuts in services, could have a profound effect on patient experience, and rigorous baseline measurements must be put in place with out delay.

The guide is a comprehensive account, touching on all the main themes in patient experience: capture, analysis, feedback and action. Only one problem with guides – they are like torches in a drawer on a dark night: someone needs to switch them on.

DISSECT IT – The guide notes that patient experience is still very hospital focussed and needs to be widened across PCTs, including community care. Although hospitals may be doing some patient satisfaction surveying and complaints handling, only a few are doing adequate patient experience ‘tracking’. The granularity of the data being collected is at best limited to ward or department level, reducing the ability to use the information to deliver the behaviour and culture changes necessary for sustained improvements. Moreover, patients and carers should be offered simpler means of rating the services they use; tracking experience on hand held pads is far from adequate to collect the detail and quantities of data required. The evidence base suggests that patient perception is mostly influenced by the individual clinician or carer and thus assessing experience at this level is key. Implementing such systems requires clinical engagement as a core component for the success of patient experience performance management programmes.
Case examples throughout the guide provide illustrative detail and meaning and are recommended.

DIGEST IT – The guide touches on the essential principles of patient experience but since it is a guide and not a ‘how to manual’ it does not go into detail. The first issue is the benefits to be gained from excellent monitoring of patient experience. Board directors need to fully understand these principles: business cases and investment papers need to demonstrate the full value justification over time; a business case for patient experience which simply puts forward a ‘plug and play’ type technology acquisition will not work.
Another area not covered in the guide is the importance of local media engagement as part of any patient experience programme. This has to be done to promote and celebrate success within local communities. Brand building for the local NHS can be powerfully worked out of good media engagement.

The guide also warns readers to be conscious of the need to get ethical approval for conducting patient experience research. The ethical issues and consideration of patients is paramount and should always be considered carefully. However, there are effective ways to do this whilst still maintaining momentum and the speed required to deliver rapid benefits in patient experience programmes. iWantGreatCare is particularly interested in research to fully understand the links between patient experience and safety, and patient experience and clinical outcomes. The skill will be to combine this academic base whilst rapidly addressing the new wave of consumer-driven healthcare; doing this now, both for and WITH patients and carers.

RATE IT ****

Wednesday 8 July 2009

Meaningful measurement - time to turn words into actions

Measuring quality - the fundamental first-step in improving quality
The majority of NHS organisations (and individuals) have no accurate and timely way to measure their performance, nor to compare it with other providers.
In contrast to organisations in the commercial sector, whether at board level (exec and non-exec), through management to clinical, front-line staff there is no rigorous, valid way to allow direct, continuous assessment of the quality of care delivered.

The need to measure quality is more urgent than ever before, due to the reorganisation of services that will be required as a result of budgetary pressures post 2011. To be sure that quality is maintained requires it to be measured before, during and after any changes. Without this organisations are deluding themselves if they think they can be confident about quality of service.

Warning - Merely collecting data on clinical outcomes alone is inadequate:
a. In the majority of clinical areas the quality data required is simply unavailable
b. The Mid-Staffordshire disaster shows that current data sets collected are wholly inadequate to accurately monitor service provision with the granularity or timeliness required - Mid-Staffs data was insufficient for the Chief Exec, non-execs, clinical staff, Monitor or the HCC to have visibility of reality
c. Clinical outcomes alone are only half of the equation (quality = outcomes X experience). The NHS cannot understand or assess quality until patient experience is approached with the same seriousness and importance as is monitoring and response to hospital-acquired infection. This requires new thinkning and innovative use of IT driven systems to collect and visualise the data
d. Data itself has little or no value - impact on organisational performance and quality are only realised when the information is accessible, understood and integrated in the systems and processes of the organisation, e.g. enables culture-change. When this is achieved it is proven to deliver improved outcomes, decreased litigation and decreased staff-turnover - all massive clinical and financial benefits to the NHS and patients.

Thus the challenge (and opportunity) is how to provide every NHS (and private-sector) organisation with the insight and understanding required to measure and improve quality. Successfully enabling this will reveal areas of quality excellence, as well as rapidly and accurately identifying areas for improvement.

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