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Showing posts with label NHS. Show all posts
Showing posts with label NHS. Show all posts
Monday, 13 December 2010
Smoke alarm to detect poor patient care
Dr Neil Bacon has written a short piece on his personal blog describing how patient experience (the ratings and reviews that patients submit on their doctor and hospital) can act as a “smoke alarm” for patient safety.
Wednesday, 21 July 2010
Putting patients in the driving seat works
Gosh, it’s been an incredibly busy few weeks.
So much for a summer-break, the iWantGreatCare team has been fully occupied helping our existing clients realise all the benefits of real-time, direct patient experience.
One of the fascinating things about enabling organisations to harness patient experience as an outcome metric, is how rapidly it becomes an essential and powerful tool affecting so much of what they do, and how they do it “from ward to board”. This is exciting and satisfying - sort of like letting a genie out of the bottle, but with every one winning (not just the person who gets to make the wish!).
In addition to the Health Secretary Andrew Lansley once again naming iWantGreatCare as an example of patient-centric outcomes which “put patients in the driving seat”, the Department of Health have released their Outcomes document and Health White Paper.
All those who are passionate about high quality care and patients getting the very best treatment, will be delighted by the new focus on outcomes. Most importantly, the measures to be used include those that are reported directly by patients (including experience ratings at a highly detailed level).
This shift from targets to outcomes is long overdue and - if done properly - will benefit every single user and employee of the NHS.
Exciting times.
Thursday, 18 February 2010
NHS monitoring systems
Patient experience - solving the problems of today's failed monitoring systems.
Existing methods of measuring and monitoring NHS quality and safety are repeatedly shown to be slow, insensitive, inaccurate and misleading. The Care Quality Commission relies on expensive, centralised, backward-looking data collection which does not drive the change needed, nor build confidence amongst the public.
After further hospital disasters in Mid-Staffordshire and Basildon (and, we are told, more to come) we need new approaches that actually work and win the support and con?dence of the public, professionals and the media. Harnessing the user-voice to understand patient experience has the ability to:
To deliver this change requires vision, resolve and a willingness to absolute transparency in public services. It will reveal some difficult truths about the variation in quality across the NHS - but ultimately all patients, all staff and all NHS organisations will benefit.
Existing methods of measuring and monitoring NHS quality and safety are repeatedly shown to be slow, insensitive, inaccurate and misleading. The Care Quality Commission relies on expensive, centralised, backward-looking data collection which does not drive the change needed, nor build confidence amongst the public.
After further hospital disasters in Mid-Staffordshire and Basildon (and, we are told, more to come) we need new approaches that actually work and win the support and con?dence of the public, professionals and the media. Harnessing the user-voice to understand patient experience has the ability to:
- reduce costs,
- raise quality,
- empower patients,
- increase safety.
To deliver this change requires vision, resolve and a willingness to absolute transparency in public services. It will reveal some difficult truths about the variation in quality across the NHS - but ultimately all patients, all staff and all NHS organisations will benefit.
Monday, 23 March 2009
Mid Staffordshire - why was nobody listening to the patients?
There are so many ways in which the disaster at Mid Staffordshire hospital should - and must - lead to improvements in patient care, not just locally but across the entire system of the NHS. Whilst politicians and the Department of Health have been quick to claim that it is just an isolated example, the reality is that it reveals an almost total inability of the national monitoring and safety systems to protect the patients who were admitted to the Mid Staffordshire hospital.
The facts are as clear as they are shocking: analysing mortality data for Mid Staffordshire Hospital reveals excess mortality since 2003, yet in the six years since then the Health Care Commission increased the rating for the hospital from Fair to Good and the hospital was given Foundation status - supposedly a marker of excellence in which patients can have complete trust.
To make matters worse, the company monitoring outcomes data only "raised the alarm" in 2007, after they were alerted and asked to look in detail at the mortality information. This would be analogous to an organisation responsible for ensuring airline safety "alerting" the public to problems years after a plane crash that killed 400 people.
So what lessons can be learnt, what changes have to be put in place to ensure that we don't have yet another "one-off" in a few years time, and what role does patient experience have to play in this?
Most importantly, everybody working in healthcare has to listen intently and continuously to the patients. If patient-centric care means anything, and is to be more than just a politically correct buzz-word, it means continuous, detailed and open listening to the voices, experiences and opinion of patients. Patients, their families and carers in Staffordshire had been complaining loudly from 2003 about the shocking state of their hospital and their voices were ignored completely. The Trust itself appears to have dismissed them, and the Healthcare Commission has no system to track and monitor the level of complaints made about a hospital - until the patients themselves complains to the HCC. There is extensive evidence that the perceptions of patients and their experience is an accurate marker of quality standards in hospitals - yet the NHS does not harness what is probably the most accurate, early system of detecting poor quality healthcare: the voices of those using the service. One can only speculate how many lives would have been saved if the NHS systematically incorporated real-time collection and monitoring of patient experience as part of safety and monitoring systems.
"Insanity: doing the same thing over and over again and expecting different results." Albert Einstein
Rather than listen in real-time to the public, the HCC requires patients to be dead before their "experience" activates the systems and alerts. One doesn't need medical training to realise that this might be somewhat too late! However, not only is this a patently ridiculous way to protect patients (akin to a smoke-detector that only goes off months after the house has burnt to the ground), but it also lacks the sensitivity necessary to improve quality across the NHS. As anyone who has worked in a hospital will tell you, things can be very bad indeed before mortality rates increase.
Continuous, real-time, granular monitoring of patient experience has the unique ability to solve some of these problems and greatly increase the sensitivity, accuracy and timeliness of systems put in place to monitor quality and safety of the NHS. We need to make it easy for patients and their carers to not only record their experience, but to ensure this invaluable information is analysed in real-time and provided to Trusts (and the regulators and monitors) in a fully open, transparent way. At the simplest level, all Trusts (primary, acute and mental health) should be required to display the number of complaints they have received, standardised to the number of patients they see, on the front page of their website. Even such a simple thing would help inform the choice that patients now "enjoy", whilst perhaps concentrating the mind of the management. (Perhaps Monitor might even be tempted to look at that number when coming to their decisions?)
The experience of patients has to be a metric and tool that the board and management of Trusts use in the same way that they use data about infection rates: a critical, sensitive and core metric of quality. Perhaps then we might actually get closer to a truly patient-centric NHS.
The facts are as clear as they are shocking: analysing mortality data for Mid Staffordshire Hospital reveals excess mortality since 2003, yet in the six years since then the Health Care Commission increased the rating for the hospital from Fair to Good and the hospital was given Foundation status - supposedly a marker of excellence in which patients can have complete trust.To make matters worse, the company monitoring outcomes data only "raised the alarm" in 2007, after they were alerted and asked to look in detail at the mortality information. This would be analogous to an organisation responsible for ensuring airline safety "alerting" the public to problems years after a plane crash that killed 400 people.
So what lessons can be learnt, what changes have to be put in place to ensure that we don't have yet another "one-off" in a few years time, and what role does patient experience have to play in this?
Most importantly, everybody working in healthcare has to listen intently and continuously to the patients. If patient-centric care means anything, and is to be more than just a politically correct buzz-word, it means continuous, detailed and open listening to the voices, experiences and opinion of patients. Patients, their families and carers in Staffordshire had been complaining loudly from 2003 about the shocking state of their hospital and their voices were ignored completely. The Trust itself appears to have dismissed them, and the Healthcare Commission has no system to track and monitor the level of complaints made about a hospital - until the patients themselves complains to the HCC. There is extensive evidence that the perceptions of patients and their experience is an accurate marker of quality standards in hospitals - yet the NHS does not harness what is probably the most accurate, early system of detecting poor quality healthcare: the voices of those using the service. One can only speculate how many lives would have been saved if the NHS systematically incorporated real-time collection and monitoring of patient experience as part of safety and monitoring systems.
"Insanity: doing the same thing over and over again and expecting different results." Albert Einstein
Rather than listen in real-time to the public, the HCC requires patients to be dead before their "experience" activates the systems and alerts. One doesn't need medical training to realise that this might be somewhat too late! However, not only is this a patently ridiculous way to protect patients (akin to a smoke-detector that only goes off months after the house has burnt to the ground), but it also lacks the sensitivity necessary to improve quality across the NHS. As anyone who has worked in a hospital will tell you, things can be very bad indeed before mortality rates increase.
Continuous, real-time, granular monitoring of patient experience has the unique ability to solve some of these problems and greatly increase the sensitivity, accuracy and timeliness of systems put in place to monitor quality and safety of the NHS. We need to make it easy for patients and their carers to not only record their experience, but to ensure this invaluable information is analysed in real-time and provided to Trusts (and the regulators and monitors) in a fully open, transparent way. At the simplest level, all Trusts (primary, acute and mental health) should be required to display the number of complaints they have received, standardised to the number of patients they see, on the front page of their website. Even such a simple thing would help inform the choice that patients now "enjoy", whilst perhaps concentrating the mind of the management. (Perhaps Monitor might even be tempted to look at that number when coming to their decisions?)
The experience of patients has to be a metric and tool that the board and management of Trusts use in the same way that they use data about infection rates: a critical, sensitive and core metric of quality. Perhaps then we might actually get closer to a truly patient-centric NHS.
Tuesday, 10 March 2009
Gordon Brown embraces web-rating of healthcare
Few of you will have missed this week's announcement that web-based ratings of patient experience will become a mainstay of both delivering truly patient-centric care, and of ensuring patient experience is integral to the assessment of quality in the NHS.
The iWantGreatCare team is naturally delighted by the rapid, widespread recognition of the need to harness patient opinion in this way - having been amongst the first to have given NHS Trusts the ability to realise the many benefits of this path to total quality. As contributors to the Darzi Review in this area it is fantastic to see the principles of how to maximise benefits to both patients and healthcare professionals central in these plans.
The critical next step of course is to truly engage the public, professionals and all NHS Trusts with how such systems can directly improve quality of care, staff-satisfaction and the experience of every single patient in the UK.
Two key principles:
1. For users: Ensuring all data is open, transparent, easy to access and comparative - enabling true choice and maximising pressure on organisations to be excellent
2. For organisations and professionals: Feedback must be granular and real-time. If a patient says care was excellent on Ward 5A then the team there must now promptly. Likewise if three users says the dermatology out-patients is dirty and over-crowded the staff and managers need to know that day, so they can take immediate action - not have to wait six months for a HCC review to tell them that patients are having a poor experience.
Tuesday, 27 January 2009
Ageism in NHS care?
Doctors highlight need for better NHS care for elderly
Ageism in healthcare is in the news after Help the Aged published research showing that many geriatricians consider the NHS to be institutionally ageist:
* More than half the doctors said they themselves would be worried about how the NHS would treat them in old age
Respect, dignity and reducing health inequalities.
Whilst many clinical teams - and their counterparts in social and community care - do a fantastic job, this research will come as little surprise to those who look after the elderly. As patient-centred care gains momentum and a priority across the NHS, with improved systems being put in place to measure and understand the experience of patients, it is vital that such systems truly harness the experience of all our patients - especially those for whom we need to strive hardest. Fully representing the views and experience of elderly patients and other "hard to reach" groups is an area in which iWantGreatCare has special interest and expertise, this new research reminds us all why such focus is so badly needed from all those providing or commissioning care.
Monday, 26 January 2009
NHS constitution 1: meaningful engagement
"PCTs are required to demonstrate that they are proactively leading continuous and meaningful engagement with the public and patients to shape services and improve people's health."
The NHS constitution puts expectations on both patients and those providing healthcare. PCTs are expected to be "proactive" and "meaningful" in their engagement. Of course, these are already competencies required for World Class Commissioning and it is interesting to watch the range of ways in which PCTs are trying to meet (and in some cases exceed) these expectations.
It is clear that "meaningful engagement" is going to require a lot more than a few focus groups and production of a newsletter!
Friday, 9 January 2009
NHS Digital Dreams
"...a policy that emphasises choice needs to put information at its very core"
Although not brand new, it is worth reviewing this HSJ article from August 2007, to see how much progress has been made (or not) in supporting patients in making informed choices over their healthcare.
Is the view of Angela Coulter (former Chief Executive of Picker Europe) that "information on sites such as NHS Choices and NHS Direct online tends be 'didactic, rather old-fashioned and paternalistic' rather than recognising patients' roles in making decisions about their healthcare" a fair view of today's service? Or is the NHS now making the digital dreams of patients reality?
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