Our vision for using patient insight and

feedback in the NHS Richard Ashworth, Chris Branson, Clare Enston and Dan

Wellings

Insight & Feedback Unit

NHS England

What is insight?

What does insight mean?

• Using qualitative and quantitative

data from users to inform what

we do

• Using whatever data sources we

have - not just surveys but a

whole range of feedback

techniques

• Always asking the question, what

do we do with the data?

• Making a difference with data

“The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end”

A promise to learn – a

commitment to act

The Berwick Report

• There are a wide range patient data sources

• No one source is better than others

• They all have different strengths and weaknesses, and hence

they have different uses

• Commissioners, providers of services, and policy and support

services can all benefit from using a range of tools

4

Insight comes from many sources

What is the challenge?

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Methodologies – pros and cons

Robustness

Usability

Balance between local and national

collections – question of ownership

Is data being presented back

appropriately to each audience?

Patients and the public

Frontline staff

Managers and

commissioners Academics

Data presentation

Making it easy…

Presenting data with impact

Surveys

National Patient Experience Surveys

Current National Surveys – feedback from c1.5 million people a year

• GP Patient survey (NHS England, twice a year)

• Community & Mental Health survey (CQC, annual)

• Inpatient survey (CQC, annual)

• A&E survey (CQC, every 3 years)

• Outpatient survey (CQC, every 3 years)

• Maternity survey (CQC, every 3 years)

• National Cancer Patient Experience survey (NHS England, annual)

• VOICES survey of Bereaved People (NHS England, annual)

• Staff survey (NHS England, annual)

• Adult Social Care survey (Department of Health, annual)

FFT…

Is not a survey

• It has different characteristics from national surveys

– FFT is a real-time local feedback tool; putting the patient voice centre-stage in health service improvement.

– FFT and National surveys are complementary sources of Insight

– FFT is a formative measure: it provides data to improve services

– National surveys are summative measures: they provide an accurate picture of relative performance

FFT

• Real-time

• Ward-level / service groupings

• Effective for service improvement

• Can be used as early-warning system

• Not representative, not comparable

National surveys

• Robust, comparable data at Trust level

• Data on a range of issues

• Suitable for performance management

• Not meaningful to front-line staff

• Have not historically changed behaviours

FFT…

Over 10 million responses received across healthcare settings

• The FFT review has clearly demonstrated that the FFT is making a difference to patient experience: 4 out of 5 trusts

said that the FFT has increased emphasis on patient experience.

• The key strengths of the FFT are reported as: its real-time nature, inclusivity, free text comments.

Some examples of service improvements:

• Silent/soft closing bins

• Medication alerts

• Patient preferred name

• Staff introductions

• Transfer of staff

• Menu choices

• Activities

• Parking concessions

• Extended visiting times

• Improved lighting

• Lights out at night

• Timing of medications

• New call bells

• Personal possessions

• Health snacks

• Self medication

• Toilet shelves

• Silent phones

• Staff training

• Towel rails

• Social meal times

• Meet and greet

And asking questions is not the

only way…

Depends what we want to know

Normative Need

Felt Need

Expressed Need

A&E Design council case study

(ethnography)

Hallsworth M, Berry D, Sallis A, Vlaev I, King D, Darzi A: Stating appointment costs in SMS

reminders reduces missed hospital appointments. (2015: publication pending)

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old message nudgemessage

‘DNA’ rate %

old message ‘nudge’ message

DH – Leading the nation’s health and

care

Appt at St Barts Hospital on Sep 26 at 2.30. To cancel or rearrange call the number on your appointment letter.

Appt at St Barts Hospital on Sep 26 at 2.30. To cancel or rearrange call 02077673200.

We are expecting you at St Barts Hospital on Sep 26 at 2.30. 9 out of 10 people attend. Call 02077673200 if you need to cancel or rearrange.

We are expecting you at St Barts Hospital on Sep 26 at 2.30. Not attending costs NHS £160 approx. Call 02077673200 if you need to cancel or rearrange.

Existing message Easy Call Social Norms Specific Costs

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Effect of messages on missed appointments (N = 10,111)

DH – Leading the nation’s health and

care Hallsworth M, Berry D, et al: Stating appointment costs in SMS reminders reduces missed hospital appointments. (2015: publication pending)

Making a difference with data…

Guy’s & St Thomas’s - Barbara’s

story

• ‘Barbara’s Story’ commissioned by Guys’ and St Thomas’ NHS Trust to help their staff develop awareness of people with dementia and the care of older people, and to reinforce trust values

• Script was developed through qualitative research with clinicians and patients – Allows the team to draw out common themes to be explored in the narrative – Many of the scenes often actually happened in real life

• It was shown on a regular basis from September 2012 to April 2013 – 11,054 clinical and non-clinical staff attended a mandatory training session and

watched the film – Barbara’s Story was also embedded into the corporate induction programme for

new Trust staff

Communicating patient

experience through film

Barbara’s impact • Evaluation indicated Barbara’s Story made a lasting impression on staff

o It prompted reflection on their own practice and that of others o Led to resolutions for improvements

• Strong evidence that the film raised awareness of dementia and, more generally,

patients’ experience and their need for help o It prompted staff to think more broadly about care provision in the Trust o Not just focus on their own specific practice area and patient group

• Some indication of culture change, particularly staff feeling able to give more time

o Both leadership and teamwork were important factors that influenced application of learning from Barbara’s Story to practice

o BUT staffing and time available remain constraints to being able to give the time needed

• A further five films about Barbara have since been made

• Pushing wheelchairs o As a result of the film porters started pushing wheelchairs as opposed to

pulling them.. this led to Eileen Sills - Chief Nurse to order a whole new set of wheelchairs that could be more easily pushed rather than pulled.

• Re-configuring reception areas o Selected reception areas in the Trust are being reconfigured to direct the

focus on the patient seeking help.

• Infection control o The infection control policy is being reviewed to take into account

compassionate care. This was prompted by a scene featuring a nurse sitting on Barbara's bed.

Tangible improvements as a result

of Barbara’s story

Improving the NHS by

understanding those who use it

An Insight & Feedback Strategy

Over the next 2 years…

• Our short-term ambition can be stated in a single sentence:

We want everyone to make better use of the data that is available and ensure that everyone is represented

• Over the next two years we will support everyone in the system to use insight and feedback more effectively

How we will achieve this 1) Active roles

Encourage everyone in the health system to take active roles in the use of insight

2) Leadership and support

Provide leadership and support in the use of insight across the health system and encourage local collaboration by establishing a national insight network

3) Bitesize guides

Publish a series of ‘Bitesize Guides’ to insight for commissioners and providers

4) Data presentation

Make insight data easier to access in one place, and work on data presentation so that it is more impactful, and easier to understand and use

5) Filling gaps

Working together to fill gaps in knowledge so that everyone is represented

The roles of commissioners

and providers

Commissioners

• Review insight needs and population coverage

• Use a range of sources throughout the commissioning cycle

• Address poorer experiences

• Design services based on patients’ needs

Healthcare providers

• Gather local data to understand performance

• Use FFT to make continuous improvements

• Understand the experiences of both patients and staff

The roles of national bodies and

representative groups National bodies

• Ensure all patients are listened to and represented fairly

• Ensure experience is treated as a key component of quality

• Understand performance of services and monitor local variation

• Ensure improvement plans are in effect

• Design effective insight-based policy to improve healthcare

Representative groups

• Be leaders on understanding patient experiences

• Focus on effective communication of patient issues

• Develop collaborative relationships across the system

The role of patients, carers and

the public

• Provide feedback through surveys and at point of care through the FFT

• Tell us your stories so that we understand experiences in depth

• Raise a complaint if a service has been unacceptable

• Use insight data to understand local services

• Hold the system to account

• Become an active participant in healthcare policy, design and delivery

Where we want to be in 5 years

1) Routine use of insight data

Insight data to be used routinely across all areas of the NHS, from policy-making and commissioning to service provision and patient decision-making

2) Advances in data collection

More sophisticated, innovative and efficient approach to learning

3) Integrated insight

Have a fully integrated system of insight across care pathways

4) Insight-based commissioning

Use insight to drive quality through outcomes-based commissioning

5) Qualitative data analytics

Learn as much as possible from huge volumes of open text feedback

6) Personalised insight

Patients to use their own data to become partners in their care and treatment

How we’re going to get there

1) Link datasets across healthcare services to understand the full care pathways of patients

2) Link insight data with medical outcomes data to understand the relationship between experience and effectiveness

3) Make more efficient use of national surveys by separating core questions from modular question sets

4) Use electronic data collection methods where this is feasible

5) Attach payments based on outcomes and experiences to contracts where this makes sense

6) Develop open text data analytics, including analysis of social media

7) Develop personalised PROMs as part of care

What do you think?

How does our vision for insight and feedback look to you?

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A few final thoughts

Conclusions and a few thoughts

on local use of insight

• Be very clear on what data is collected for and do not overload a

collection

• Think early on about how data will be translated into change

• Think clearly about audience(s)

• Involve patients as much as possible in the design

• Train people to use the data and show how change can be

made; involve the right people early in the process?

• Numbers without meaning can be dangerous – signal not noise

• Reflect on ownership - engagement

Means nothing if nothing is done

Thank you

england.insight-queries@nhs.net