The Patient and Family-centred Care programme is run in partnership with The King’s Fund (building on the Hospital Pathways programme). It’s breaking new ground in improving the experience of care for patients and their families, while also improving the working lives of staff.
Co-clinical lead Dr Joanne Watson, Health Foundation Quality Improvement Fellow and Consultant in Diabetes and Endocrinology at Taunton and Somerset NHS Trust, tells us about the programme and its approach.
About the Patient and Family-centred Care programme
It’s all about culture: taking a fresh look at how we do business in healthcare in the 21st century, and developing exemplary hospitals to spread sustainable improvement. In many ways, I feel it heralds the future: really putting patients at the centre of care and delivering services that are relevant to them and that meet their needs.
The programme involves following the patient journey through a particular area of care and drawing on this learning to improve patient and staff experience. Each of the 11 project teams involved is looking at a different issue, ranging from the dementia care pathway to length of stay, developing self management or finding new tools to capture the patient experience.
Patient shadowing methodology
The programme focuses on patient shadowing – a methodology that involves accompanying the patient through their care experience, from the moment they arrive at reception until they leave the building, including periods in waiting rooms and consultations. The person shadowing records observations, such as how long the person has to wait to be seen, and may ask questions such as: ‘Did you understand what the doctor just said to you?’
Already, the programme is opening up participants’ eyes about the importance of seemingly little things, such as staff wearing a name badge, or knocking on a door before entering. Much of it is about picking up on small things that are so simple to change, but it does also reveal bigger systems changes, such as the need to refer certain patients to a particular ward. It’s not only focusing on areas for improvement – it’s about celebrating the good things too, such as the operating department assistant who lights up the room with jokes and helps everyone to relax.
To establish the baseline from which to quantify any improvement, teams use a range of data to measure the patient experience. These include compliments and complaints, qualitative survey data, focus groups and patient stories.
Guiding teams through improvement
The power of the programme is that it holds your hand through the process of improving the patient experience. It teaches teams to work together as a group to bring about transformations and reliably deliver excellence in patient care, thinking about factors such as leadership and staff engagement. It’s hard, because participants often haven’t been taught to think in this way. But it’s important because if you step back, you realise that many services aren’t meeting people’s needs. No one person can make these changes happen, but because each team also has executive buy-in, it combines the frontline, bottom-up approach with the guiding hand of the executives, who can help with the systems changes.
I am one of two clinical leads for the programme. I first became involved when my team took part in the pilot phase to improve our under-performing stroke service. Through the project our service moved very quickly up the National Stroke Audit, resulting in much higher standards of care. For the current phase I helped design the programme and support the doctors working on the projects. Clinical leadership is an essential part of the approach. There’s something about medical involvement that makes a difference. Without it, the changes just don’t stick.
Power at the frontline
This programme plays to the direction of travel in the NHS mandate – it’s not about command and control, it’s about power at the frontline, and the ability to respond and make changes that are needed to engage people, intellectually and emotionally, to deliver great healthcare.
Five years ago there wasn’t this momentum for change, but now the time is right. I am proud of what we do, and I want the NHS and its ethos to continue – but we do need a shift. If we carry on as we are we’ll always feel frustrated. And the more we really do to put patients at the centre, the better things will be.