Feedbackwards and forwards
Odds are your ward already systematically collects information on patients’ experiences and opinions. Your Trust probably has a quality, audit, service improvement etc department and your ward its own methods for finding out how patients feel about being in hospital. From the formal (academic studies, annual surveys, focus groups etc), to the informal (staff asking patients how they feel about one or more aspects of their experience). From pen and paper to touchscreen kiosks and texting, it’s all about getting essential feedback to help make services not only operate effectively but feel comfortable to patients. It looks like ‘net promoter scores’ (see below in the ‘snippets’ section) are going to become used on mental health wards.
While there are very similar issues for patients in general hospitals (eg about whether staff are courteous, empathetic etc), in mental health hospitals patients’ subjective experiences, especially of their relationships with staff, are an inherent part of the treatment and recovery process. Patients who feel understood and respected are much more likely to be open with staff about their emotions and their, often highly traumatic, life stories, making therapeutic interventions possible. Being cared for by skilled, emotionally imaginative staff usually results in patients feeling better about themselves and more confident about coping with life – prerequisites for recovering and being able to return home.
The real benefit of collecting patients’ views depends, of course, on what action is then taken based on this information. (This links in closely with Idea #45 patient involvement.) A nifty example is Bradford District Care Trust , whose systematic collection of feedback through e-feedback (see below in the ‘snippets’ section) showed that 28% of inpatients said they weren’t provided with information about ward routines. So staff and service users produced a flyer with details about the ward including mealtimes and activities which all patients now get on admission. Perfect.
- Service user involvement in various aspects of how the hospital is run is facilitated via the assorted service user and carer groups, as well as complaints and suggestions making an impact. An example of this is the ‘talkback’ box on each ward. At their own leisure service users put suggestions in the box which are in turn looked at fed back to local community meetings. All the suggestions are reviewed by the ward manager and modern matron and fed into ward community meeting as well as being passed to the Trust’s Patient Advice & Liaison Service.
- There is also a monthly PALS talkback newsletter.
- Patients are given a satisfaction questionnaire to complete at discharge. For patients with dementia, their carers and advocates are involved in giving feedback to the ward staff and ward manager.
- Suggestion box, satisfaction surveys.
- Smiley face system – patient tick the corresponding face suited to their experience.
- Unit has a Big Brother style diary room open 24/7.
- All patients given a green, yellow and red ping pong ball before they leave hospital. Green=Positive, Yellow=Neutral, Red=Negative. There are 3 large perspex cylinders next in the reception into which the patient places one ball of their choice. Balls are counted each month.
- Service user and carer groups.
- If a service user has had rapid tranquilization then there is a process for them to write about their experience
- Modern matron visits each patient within a fortnight of them returning home, to learn about their experiences and ensure that they have the support they now need
- Regular focus groups held on the ward which is doubled-up as a therapeutic activity.
- Regular community meetings.
- Discharge questionnaires.
- Modern matron holds a surgery.
Analysing and sharing
- A quality dashboard incorporating service user experience, and outcome indicators.
- Making DVD of patients’ views and basing discussion at Trust Board meeting on this.
- We have recently set up a feedback implementation group (FIG). We seemed to be collecting lots of feedback but not using it. This group looks at feedback and comes up with action plans to make small but positive change.
- Working with the staff on my care plan made me feel like I was taking an active part in my recovery and that my views were valued
- We would talk a lot as a group about rules. It was not normally a dictation but a discussion.
- We used to have ‘special meetings’ if a serious rule was broken. It brought everyone together and helped us to reflect as a group. It wasn’t a condemning affair but more a constructive one.
- When I’m on a section my choices are restricted. So I appreciate the decisions I can make, even the little ones like what time I get up in the morning.
- We were encouraged to speak up and take a stand…it was crucial in creating a culture of honesty and appreciation.
- There was a very clear and supportive process if we didn’t like something to do with our admission. It helped maintain the balance on the ward.
- We were given safe ways to discuss things we were unhappy with or upset about with a complete sense of being ‘heard’.
- We didn’t always get all our demands met as a group but we always had an explanation as to why it wasn’t possible and the chance to discuss this.
- Having a voice on the ward and it being heard makes all the difference.
There are two main issues here: what tools to use to measure patient satisfaction and when and how to use these. Methods range from the informal (and free!) to the complex and sometimes costly. Informal methods are very valuable, and information from these can be fed into quality systems in quite structured ways. For example, ward community meetings usually have a strong element of patient feedback which is passed on to the relevant hospital departments, including the quality team.
Soliciting and analysing complaints used to be a primary measurement method, but happily this is now only one component and many hospitals equally energetically try to secure compliments and suggestions from patients and their families and friends.
There are lots of ‘official’ measurement tools around, including those used in relation to CQC and AIMS. We’re suggesting a few that focus specifically on patients’ experiences and satisfaction.
The Recovery Star
The Recovery Star tool enables staff to support individuals to understand their recovery and plot their progress. As an outcomes tool it enables organisations to measure and assess the effectiveness of the services they deliver.
Core dimensions of the Recovery Star
- Managing mental health
- Physical health & self-care
- Living skills
- Social networks
- Addictive behaviour
- Identity & self-esteem
- Trust & hope
The EBD Approach (Experience Based Design)
How do you measure things like warmth, cheerfulness, and friendliness? The EBD approach (experience based design) is an exciting new way of bringing patients and staff together to share the role of improving care and re-designing services. It is being developed by the NHS Institute for Innovation and Improvement as a way of helping frontline NHS teams make the improvements their patients really want.
While leading global companies have used similar approaches for years, the ebd approach is very new for the NHS. Where it has been used in the health service, it is having amazing results – delivering the sort of care that leave patients feeling safer, happier and more valued, and making staff feel more positive, rewarded and empowered.
DREEM (Developing Recovery Enhancing Environments Measure)
DREEM is an outcome measure and research tool to see how ‘recovery-oriented’ a service is. It is a self-report instrument that gathers information about mental health recovery from people who receive mental health services. The DREEM asks people where they are in their process of mental health recovery and what markers of recovery they are currently experiencing.
Patient-reported outcome measures (PROMs)
PROMs provide a means of gaining an insight into the way patients perceive their health and the impact that treatments or adjustments to lifestyle have on their quality of life. These instruments can be completed by a patient or individual about themselves, or by others on their behalf. The resources available on this website are available free to anyone having an interest in the use, availability and development of PROMs.