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Appendix A: Examples of implementation OF PATIENT experience improvements
Making appointment times more patient-centred
[Shetland] In day surgery we followed patients through their entire day. Before, we had quite a traditional approach, so everyone coming in for day surgery had to come in at 8am so, for many of them, there was a lot of waiting around. There is currently no pre-assessment service either so all of that happened on the morning they were admitted. In the future, based on patients' feedback, we are remodelling the service. We will change the system so that not all patients have to come in at 8am.
[Tayside] Patients were telling us it was difficult for them to come in for a 9am appointment if they had a long way to travel. Now we are looking at post codes so we can adjust the appointment times for those who have further to travel.
Giving senior nurses more patient contact
[Grampian] One of our most important projects is called Back to the Floor (based on a project from one of the large London acute NHS trusts). It involves everyone in nurse management. They all do a nursing shift once or twice a month. So now, when they are trying to make changes, they can illustrate effectively with the things they see with own eyes. They all now routinely wear uniform so it's clear to everyone they are all part of the same team. It has reinforced the crucial role that nursing staff have to play in coaching and mentoring staff at ward level, and modelling behaviours. (There was a time when they were seen more as administrators.) It has generated huge enthusiasm among them and it's starting to make a big impact. The feedback has been phenomenal from patients and staff. We don't call it an initiative. The word initiative was been banned: it's the day job.
Language support
[Western Isles] The work we are doing for patients who don't have either English or Gaelic as their first language. We had quite a lot of incidents of poor communication. We are a seafaring community here, the fishermen's co-operative told us that a lot of foreign people, for example Spanish sailors on trawlers, were finding our services difficult to use. So we implemented a different system, put in Language Line.
Re-organising outpatients appointments
[Western Isles] We have done systems changes in outpatients. We realised that we were expecting people to be in different places at once: going for bloods and other tests, etc. So we worked with people in outpatients, deployed staff differently so they helped patients get from A to B and back again.
Flexible dining times
[State Hospitals] We have more flexible dining times. Patients said they wanted somewhere to sit outside when the weather is nice so now we have seats. Patients are now much more actively involved in their treatment planning than they were 5 years ago.
Car parking
[Tayside] Car parking - an emotive subject. We involved service users as part of a group to come up with solutions. We looked at patients coming in for treatments who were unwell, making sure they could park as close as possible and not be penalised financially.
[Golden Jubilee] A patient who had come for an X-ray had great difficulty getting to the department and he said, "Your parking is a bit far away. It was too far for me to walk." Also, he said he expected somebody to meet him with a wheelchair, but no-one did. When I fed this back to the management team, they agreed to have wheelchairs at the entrance but at first they said, "It's only one patient who said it. We don't see anything wrong with the disabled parking." The patient's comment that changed their minds was "You have spaces at the front allocated for the Chief Executive and the surgeon. If that surgeon is fit enough to stand on his feet for 8 hours to perform the operation on me, isn't he more able to walk than me?" Then the disabled parking places were changed.
Improving patient privacy
[Golden Jubilee] A patient who had been to the cath lab complained that the consultant came in after her angio and spoke about what he found. There was no confidentiality because there were only curtains between her and the next patient. Now we have a new unit with separate rooms so patients don't overhear the other patients. In each cubicle there is also an en-suite toilet so patients don't need to walk down the corridor with their gowns flapping open at the back. We also have a policy that patients are offered two gowns so they can put one on over the other.
Supporting people with learning difficulties
[Ayreshire and Arran] We have been working on how learning disabled people use hospital day surgery services. This was partly prompted by a complaint, but also by other factors. The changes were mainly about communication, the way the list was organised to give more time to those patients, consent issues, listening to the carer and involving the carer as a partner.
Improved speed of response to emergency calls
[ NHS24] Our feedback told us that when patients would call with cardiac chest pain, saying they think they're having a heart attack, the call handlers would take their details, then pass them on to a nurse, the nurse would then ask many of the same questions, and keep the patients on the line while they contacted an ambulance to take them to hospital. Then, the average contact time was over 12 minutes, which is a long time if people are having a heart attack. So we trained our call handlers to ask people who presented with chest pain just two or three extra questions, then contact the ambulance directly. Then, the average contact time was reduced to seven minutes. Then, we did an audit with the ambulance service on how appropriate the referrals were: it was over 90%.
[ NHS24] Aspects of the service that have been addressed and improved as a result of survey findings coupled with input from other stakeholders would include an improvement in access times and a reduction in the number of patients that have to be called back.
Improved hand-cleaning
[Dumfries and Galloway] In the patient safety agenda, we realised hand hygiene was not always what it should be so we introduced mandatory hand hygiene training for all staff. Now the hand washing audits have shown an increase in healthcare staff hand washing from 40% to 90-100%.
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