Creating exceptional patient experience in hip fracture care Aneurin Bevan Health Board

In 2010, the Royal Gwent Hospital was not a good place to be treated if you were an elderly patient admitted with a broken hip. Each year the hospital was treating 400 such patients and the quality of care was in the lowest 25% in the country.

In July 2012, the orthopaedic department began a project to improve standards of care for hip fracture patients.

Their aims were to:

• improve the system of care to deliver the highest quality evidence based treatment possible
• engage staff members to take an active role in quality improvement
• capture and use metrics to guide the improvement effort
• understand the elements of care which matter most from the patient’s and family’s perspective
• deliver the right care, at the right time, in the right place and create an exceptional patient experience.

Lean methodology was used to improve the system of care, Institute for Healthcare Improvement (IHI) methodology was used to produce innovative quality improvements, and the principles of Stacey and Shaw were key to improving the staff experience.

The team used shadowing and in-depth patient interviews to map areas for improvement which patients said were most important. These included: pain, communication, hygiene and dignity, food and staff behaviour.

This fed into the development of a new pathway, which followed the patient from the ambulance through to admission to the ward. This could be expanded to final discharge and beyond.

The project team met weekly to monitor metrics and report on progress. They also organised frequent engagement sessions to encourage participation from all key stakeholders as well as to initiate further innovation.