Designing improvement around the people we care for

What does a ‘listening organisation’ look like? What benefits can it bring to our patients and to our staff? The more we involve patients, the more we make their experience of care better. We can identify the places where the system isn’t working and fix it.

But the problems we uncover may surprise us. When we develop a person-centred approach we often find the things which staff find particularly vexing may not be the things that matter most to the people we care for. We have to be very careful that the ‘solutions’ that make life much easier for us, are also helpful to patients. Knowing we are offering the right care to people is, then, a key part of staff finding satisfaction in their work.

In NHS Wales we’ve recognised that we need to develop our skills and capacity to listen to patients, families and carers. Our latest white paper, The Listening Organisation, looks at the benefits that can be gained from ‘listening’ and suggests some strategic ways we can incorporate learning from the patient experience into our working culture.

In order to listen effectively, we have to know what we’re listening for and what the key issues are to patients when they are reflecting on their experience of care. The white paper borrows three domains identified by the Welsh Government’s National Service User Experience Group as influential on patient experience:

1. First and lasting impressions, including dignity and respect.
2. Receiving care in a safe, supportive, healing environment.
3. Understanding of and involvement in care.

Dignity and respect are difficult to define – they often mean different things to different people. This underlines the importance of listening to learn from individual patients what it means to them. An example included in the white paper shows how very common treatments or procedures which are regarded as routine or simple to staff, are often not regarded in the same way by the patient. For example, one patient on a rehabilitation ward felt profoundly uncomfortable using an everyday device:

'The hoist was so undignified; I felt like a baby in a romper suit. I still squirm when I see others in it.'

Similarly, we can become accustomed to the environments we work in and simply not see them through patients’ eyes. However, patients do make judgements on the quality of their care based on the appearance of the clinical area – a scruffy, untidy, uncared for workplace can reflect badly on the staff. One patient said:

'Nothing could have prepared me for the environment. While on my back on a trolley I noticed there were ceiling tiles falling down. I wondered what my care would be like.'

And, finally, the last domain is the most challenging: how do we involve people in their care? There are a number of specific examples in the white paper of approaches organisations can use, such as shared decision making techniques, and keeping patients informed about what is happening and, importantly, what might not happen (for example if a scan or test has been cancelled).

It is our conviction that organisations exhibiting a genuine willingness to listen will be in a position to provide better care to their patients and will identify ways to improve more quickly. The sooner these organisations begin listening, the sooner the benefits will be felt by both the people of Wales and the people who care for them.

Jan Davies is a director of 1000 Lives Plus, Wales’ national healthcare improvement programme. www.twitter.com/jandavies4