agenda item 4.1 2 november 2016 health board report ...cwmtaf.wales/docs/board_papers/2016-2017/02...

Patient Experience Initiatives of 13 University Health Board Meeting 2 November 2016

AGENDA ITEM 4.1

2 November 2016

Health Board Report

PATIENT EXPERIENCE INITIATIVES

Executive Lead: Lynda Williams, Director of Nursing, Midwifery and

Patient Services

Author: Kathryn Doughton, Patient Experience Manager

Contact Details for further information: Kathryn Doughton, 01443 728581 or email [email protected]

Purpose of the Health Board Report

This paper informs the Board of the current Patient Experience activities undertaken across Cwm Taf University Health Board (CTUHB) for Quarter

One applying the All Wales Framework for Assuring Service User Experience and the NHS Wales Health and Care Standards.

Governance

Link to Health

Board Strategic Objective(s)

This report supports the Board’s Strategic direction

and its commitment to the triple aim to improve patient experience, reduce inequalities and maximise

the use of resources.

Supporting

evidence

CTUHB Quality Strategy and Delivery Plan

Safe Care Compassionate Care Together for Health

All Wales Framework for Assuring Service User

Experience NHS Wales Health and Care Standards

Listening & learning to improve the experience of care Health & Care Standards 2015

Engagement – Who has been involved in this work?

Cwm Taf University Health Board is committed to embedding a culture of

engagement and learning from service user feedback. A collaborative approach with internal and external stakeholders is fundamental to ensure

patient experience is embedded across the Health Board.

Health Board Resolution (insert √) To;

APPROVE ENDORSE DISCUSS √ NOTE √

mailto:[email protected]


Recommendation The Board is asked to;

DISCUSS and NOTE progress to date.

Summarise the Impact of the Health Board Report

Equality and

diversity

There are no specific equality and diversity

implications of this report. However, ensuring arrangements are in place to capture and

respond appropriately to patient experience will only help to ensure the Board meets its statutory

duty in relation to equality and diversity.

Legal implications There are no known legal implications of this

report.

Population Health There are no specific population health implications of this report.

Quality, Safety & Patient Experience

Ensuring the organisation captures feedback from patients in a reactive and pro

active way and use feedback to influence services provided by the Board will impact

positively on improving the quality, safety &

patient experience.

Resources There are no specific resource implications of this

report. However, it should be noted that the patient experience agenda is overseen by one

senior manager as part of a broader role.

Risks and Assurance There are no specific risks or assurance issues identified within the report. Implementing

arrangements to capture and act on the patient experience will help mitigate risks

and provide assurance to the Board.

Health & Care

Standards

Access to the Standards can be obtained from

the following link. www.wales.nhs.uk/siteplus/documents/1064/Eas

y%20Read%20Standards%20FINAL%20December%202010.pdf

This work related primarily to Standard 5, Patient Experience.

Workforce There are no specific workforce implications of this report.

Freedom of

information status Open available for the website

http://www.wales.nhs.uk/siteplus/documents/1064/Easy%20Read%20Standards%20FINAL%20December%202010.pdf




PATIENT EXPERIENCE INITIATIVES

1. SITUATION / PURPOSE OF REPORT

The purpose of this report is to update the Board on patient experience activities undertaken in quarter one April - June 2016.

The University Health Board (UHB) has a wide range of systems and processes

in place to support a better understanding of patient experience. This report provides an overview of those mechanisms and also highlights some of the

improvements made.

2. BACKGROUND / INTRODUCTION

The Health Board’s Patient Experience Strategy sets out our commitment to

ensuring that patient’s views are heard and acted upon to further improve the

quality of care provided. This is based on a national approach; “Framework for Assuring Service User Experience” (WG December 2015) See table 1.

Real Time Service users should be given the

opportunities to give feedback

(e.g. surveys) whilst in our care so

that action can be taken to resolve

issues

Retrospective In-depth feedback should be

sought from service users after

they have left our care to allow

more detailed analysis of issues.

This can incorporate quality of life

and Patient Reported

Outcomes/Experience measures

(PROMS/PREMS)

Proactive/Reactive A range of opportunities should be

made available to

users/families/carers to provide

feedback at any time to

demonstrate that feedback is

welcomed. This can include paper

and online methods, text and

social media

Balancing Narrative feedback adds balance

to survey based feedback.

Sources include concerns and

compliments, clinical incidents,

patient stories, third party surveys

such as Community Health Council

and Voluntary Organisations

Table 1: Framework for Assuring Service User Experience

Assurance & Governance Framework

It is important to note that the Board has several assurance and scrutiny processes in place that ensure all incidents, complaints and claims are reviewed

and where feasible inform learning and improvements across the UHB.


3. ASSESSMENT / GOVERNANCE AND RISK ISSUES

REAL TIME

Below is a summary of activities currently undertaken across CTUHB which

demonstrates compliance with the All Wales Framework for Assuring Service User Experience, the White Paper – Listening and learning to improve the

experience of care and the new NHS Wales Health and Care Standards.

Health & Care Standards Monthly Audit RAG

%

Throughout your stay/attendance, how often did you feel that you and those that care

for you were given full information about your care in a way that you could

understand?

95

Throughout your stay, how often did you feel that we kept you informed of any delays

in appointment times?

92

Throughout your stay/attendance, how often did you feel that you were treated with

dignity and respect?

98

Throughout your stay/attendance, how often did you feel that you were given the

privacy that you need?

98

Throughout your stay/attendance, how often did you feel that when you called us that

we responded in a timely manner?

95

Throughout your stay/attendance, how often did you feel that the clinical area was

kept clean, tidy and not cluttered?

99

Throughout your stay/attendance, how often did you feel that you were made to feel

safe?

98

Throughout your stay/attendance, how often did you feel that you were given help to

be as independent as you can and wish to be?

99

Throughout your stay, how often did you feel that you were able to get enough rest

and sleep?

82

Throughout your stay, how often did you feel that you were made to feel comfortable? 98

Throughout your stay/attendance, how often did you feel that you were, as far as

possible, kept free from pain?

97

Throughout your stay, how often did you feel that your personal hygiene needs were

met?

98

Throughout your stay, how often did you feel that you were given help with feeding

and drinking if you needed this?

99

Throughout your stay/attendance, how often did you feel that you were provided with

fresh drinking water and plenty of drinks when you need them?

97

Throughout your stay, how often did you feel that you were provided with nutritious

food and snacks?

95


As a member of staff I was apprehensive about being a patient but the

staff on ward 8 treated me with care and compassion and they were

caring and attentive to all patients on the ward

All staff were motivated, and enthusiastic and dedicated to their job

I was very surprised at how hard the nurses and staff work and the care

I have been given

The Staff in PCH are absolutely fabulous and amazing, my daughter has

been in and out of lots of hospitals and we have always been treated so

well at PCH

Staff were friendly/professional

Shared a sense of humour which made the experience positive.

Commitment, communication and engagement abilities of all the staff

were excellent

It was explained what was happening and what results I was waiting for.

Every member of staff was caring and professional

“This is me Leaflet” completed and available at bedside

“Drink a drop” campaign is promoted widely

Any issues or concerns are dealt with at source

Patients were very complimentary about the treatment they received

Nursing staff are extremely busy

Patient extremely complimentary about the food choices

Ward environment was clean

Health & Care Standards Monthly Audit RAG

%

Throughout your stay, how often did you feel that you were given help, if required, to

make sure that your mouth, teeth and gums were kept clean and healthy?

97

Throughout your stay/attendance, how often did you feel that if you needed help to

use the toilet that we responded quickly and discreetly?

96

Throughout your stay/attendance, how often did you feel that you were given help to

look after your skin to prevent you from getting pressure sores?

97

Using a scale of 1-10, where 1 is very bad and 10 is excellent, how would you rate

your overall experience?

92

Key Themes from User Experience Survey

PROACTIVE

Community Health Council (CHC) - Monitoring Visit 1

Activity: CHC undertook an unannounced visit throughout May and June 2016 at various

times of the day to Ward 19, Royal Glamorgan Hospital. The Ward is an acute medical ward which cares for patients with acute medical conditions such as

respiratory.

Outcome of Inspection:



Activity: CHC undertook an unannounced visit throughout May and June 2016 at various

times of the day to Accident & Emergency Department at the Royal Glamorgan

Hospital.


CTUHB Response: Area is checked and cleared daily Mon-Fri by the grounds and gardens

team, however we do not operate this service on weekends. Whilst we provide an above average number of car parking spaces at

Royal Glamorgan Hospital that would normally be in the specification for a hospital of this category and size, at peak times demand can often exceed

availability. The Triage Nurse identifies patients who are diabetic and records this

information on the A&E card. The Triage Nurse will undertake a blood sugar reading where appropriate

and escalate if there is any abnormality for relevant intervention to the

responsible registered nurse within the allocated clinical area.

Majors Area The catering department provide meals at breakfast, mid morning,

lunchtime, mid afternoon and early evening. There is also a supply of sandwiches left for the night time period.

Access to water fountain is available within the A&E department.

Minors Area Refreshments are available via the catering department throughout the

daytime.

All patients spoken to were pleased with the care they had received

and they had been kept informed regarding what was happening

Cleanliness: the grounds, the approach and entrance to the Accident

and Emergency Department were littered with cans, cigarette ends,

and paper cups.

Parking near to the Accident and Emergency Department: there was

only 1 place free in the night; car parks near to the Accident and

Emergency Department during the daytime visit were full.

Diabetic patient transferred from the Out of Hours Service: we were

told that the patient had informed the triage nurse that they were

diabetic, but it seems that the information was not relayed to other

nursing staff. The patient was anxious about when they would next

eat.


During the Out of Hours period, there is access to sandwiches and hot drinks via the A&E nursing staff.

There is access to a drinks vending machine at the entrance of A&E


Activity:

CHC undertook an unannounced visit throughout May and June 2016 at various times of the day to Accident & Emergency Department at the Prince Charles

Hospital.


CTUHB Response: The seating is designed to reduce the risk that is a real threat from

attendees who are at times prone to violence. Soft mobile chairs are available for patients who require them

There is dedicated number of staff on duty for each shift, which has been benchmarked against other A&E departments of the same size. When

there is a need for more staff to be available to meet patient’s needs, staff from majors and minors give the support required. At other times

extra staff, are rostered in to cover The ‘Tic Tac’ machine used to provide up to date information on waiting

times has been moved and is now situated above the reception desk and

is updated by the receptionist.

Patient Advice & Liaison Service (PALS)

Activity: PALS Care to Share Clinics The PALS team have recently initiated “Care to Share” clinics on various wards

across Royal Glamorgan, and Ysbyty Cwm Rhondda Hospital sites. The clinics are a proactive initiative which provides patients and relatives with an

opportunity to raise any concerns/issues they have around care and treatment with a view to resolving these “on the spot”. There is an opportunity to speak

with the Ward Manager and PALS Officer during the allocated one hour slot.

Seating provision within this Department needs to be reviewed to suit

both the disabled and elderly patients

Resuscitation: There are 4 beds in resuscitation, 3 x adult beds and 1

paediatric bed. We understand that during the day, 2 nurses manage

the 3 adult beds but during the night, the 3 adult beds are managed by

just one nurse

To ensure safe staffing levels, we query whether there should be 2

nurses assigned to resuscitation

The lack of good quality, meaningful information regarding waiting

times in Minor Injuries needs to be addressed


Care to Share Clinic by Directorate & Type

Quarter 1 (1st April 2016 to 30th June 2016)

Ward 1, RGH:

Patient advised that she was more than happy with the care she has

received from the medical and nursing teams on the Ward Patient had been reviewed and further investigations were required,

patients relative advised that her husband did not have to wait long for treatment and was more than happy with the care received

Ward 12, RGH:

Patient and relatives are happy with the care received and are kept up to date with regards to care plan Patient found the staff to be very helpful,

kind and "nothing too much trouble for them").

Relative stated that it makes it easier for her to cope knowing that her husband is happy, well cared

Activity: PALS Informal Complaints

Total Informal

Complaints

Received (PALS)

Total PALS Ongoing Total PALS Closed

147 0 145

Num

ber


Top 3 Directorates/Specialties with the most complaints

Activity: Compliments Received

For quarter 1: 223 compliments were received, in addition, many more cards and messages of thanks are received by wards and departments.

Compliments received by directorate / Specialty

Unit / Location complimented


Example of Compliments Received

RETROSPECTIVE

Parkinson’s Rehabilitation Service, Dewi Sant

Activity: The service has been running for ten years and is evaluated on an annual basis.

The latest evaluation of the service was undertaken in April 2016, a qualitative questionnaire was used to gauge service users and relative’s views on:

Compliments, Complaints and Areas for Improvements.

Compliments Received:

Relatives commended the nursing team and medical staff.

Care on the ward was exemplary; the nurses were tentative and kind.

The doctor on call was very informative and also spoke on a level to

the family that they could easily understand the prognosis.

Relative wished to convey her thanks to Sister Perkins and felt that all

the staff on Ward 15 were truly amazing; nothing was ever too much

trouble. During patient’s last days staff were very supportive and

allowed the family to stay at bedside, day and night.

Observed one of the nurses greeting patients, always had a smile

greeting patients and staff.

Complimentary of hospital radio, patient was able to request a song

from Hospital Radio every evening on air.

Patient had never received a visitor but was visited frequently by

volunteers who collected her requests.

1st class service

The whole team is very welcoming and caring. I look forward to the

days that I spend here. The whole package seems to have improved

since I started. I enjoy the exercises and quizzes.

I would like to say the staff are very good and have plenty of patience

with me because I am always late

Staff are very hard working, compassionate and understanding.

Nothing is too much trouble; a phone call to the department reassures

the patient and carer.

Everyone we have had dealings with has been very kind, helpful and

understanding. The staff work well as a team who always have time

for you. It’s because of this that they have made Parkinson’s more

bearable. I have learnt a lot since I started at the clinic.


Compliments Received:

Perhaps more staff could result in more sessions per year also give opportunity to new patients to receive these sessions. New patients only

– so as not too depressed then with more advanced PD patients. Establish Carer awareness meetings – to give an idea of how to handle

certain situations.

Opportunities Identified:

Revisit Carer Awareness and possibility of increasing practical support days

Discuss at next team meeting.

BALANCING

Complaints During quarter 1 (2016/2017) 91 formal complaints were received by the

Health Board- a decrease of 22 from the previous quarter. Compliance with the 30 working day for responding to formal complaints was 30% this quarter.

Work continues to be undertaken to address the issues within the complaints

process and compliance with Putting Things Right response targets. In addition

to the actions identified in the last report, the following improvement work is being implemented:

Development of signposting of complainants to additional support facilities where required, e.g. CRUSE, Macmillan, CTUHB bereavement

services A training programme is being delivered to front line staff to enable and

support them to deal with complaints at source Training programme for concerns team supported by Legal and Risk, ICT,

and Datix Manager

The staff are very supportive and caring and both doctors are very

positive.

The staff are brilliant. They are very supportive. Both Drs are very

good.

Excellent service many thanks to all the staff.

Staff dedicated to help improve the life Parkinson’s sufferers, excellent

service.

Very good always look forward to sessions and staff.

Comfortable, friendly gatherings enjoyed by patients and carers. Lovely

that consultants, doctors and nurses give their time to attending and

supporting (talking specifically about the event).

All staff very helpful and lovely.


Development of Qlik Sense supported by the Performance team to display Key Performance Indicators ward to board

Recording of complaint meetings allowing for the provision of an audio recording to patients to ensure timely responses.

Weekly complaint meetings to address delays and refine processes

Sharing of information with Directorate leads to monitor response times.

Where responses have not been provided, holding letters are sent to complainants to update them on progress with investigations in to their

complaints in line with the timescales identified.

Complaints rarely relate to one aspect of care, however, the top 3 categories for the quarter were:

Treatment error (30) Delays (21)

Communication (20)

Patient Safety Incidents A total of 2614 patient incidents were reported during quarter 1 – this

represents a decrease of 21% compared to quarter 4. A total of 30 serious incidents were reported to the WG – this is an increase of 10 compared to the

previous quarter. This reflects the compliance with the requirement to report

pressure ulcer related incidents and inpatient falls which have resulted in harm.

Three Never Events were reported during the quarter, which relate to; wrong route administration of diamorphine

wrong site surgery – tooth extraction wrong dose methotrexate prescribed and administered (1 dose)

Investigations have been undertaken and action plans developed to address the

learning for all never event incidents reported during the quarter. These will be reported and monitored by the Concerns (Claims, Redress & Serious Incidents)

Panel.

The Health Board continues to have high reporting rates for incidents resulting in no and low harm incidents which is positive indicator of a learning culture.

All incidents are investigated at a level appropriate to the level of harm and

risk. Staff are required to provide the outcome of investigations to patients and/or families on conclusion.

The top reporting categories, which account for 65% of the incidents reported,

have remained relatively unchanged this quarter. However, Health Records related incidents have continued to decrease and no longer feature in the top

reported categories.


0

200

400

600

800

1000

1200

15/16 Q2 15/16 Q3 15/16 Q4 16/17 Q1

Slip, Trip or Fall

Pressure Damage

Admission / Transfer / Discharge

Delays

Communication

The Chart below provides the trend for the top reported categories:

The incidents relating to Admission/Transfer/Discharge reflects the reporting of breaches within the Emerency Care Department (495 reported during quarter

1) which are monitored within the Acute Service Governance Groups.

Trends identified via concerns inform improvement work undertaken within the Health Board through structured consideration at the Quality Steering Group

and inclusion in the quality delivery plan. This includes reducing pressure damage, reducing patient falls resulting in harm and improving care for patients

with dementia.

4. RECOMMENDATION

The Board is asked to;

DISCUSS and NOTE updates, activities and future developments presented in this Patient Experience report.

Freedom of information status

Open

Num

ber

agenda item 4.1 2 november 2016 health board report ...cwmtaf.wales/docs/board_papers/2016-2017/02...

Documents