Real feedback for real change (NToW90)

Background
The value of seeking patients' views about the care that they receive has become increasingly recognised as health and social care providers strive to deliver a more 'patient-centric' service. This project was created to examine feedback from patients receiving care in their own home from community nurses. The methodology used was designed to assess the patient's views about the appointment rather than the outcomes from the care or treatment and so it was described as Person Related Experience Monitoring (PREM's).

Aims/Objectives
The aims of the project were to evaluate:

• Real time feedback from patients about the care they received in their own home
• Feedback from the nursing staff about the care that they were able to deliver.

By evaluating the feedback from both patients and nursing staff, it was hoped that the following objectives would be achieved:

• Improve patient experience
• Create an active voice for the patient
• Provide an evidence base of the quality of the work of North East Lincs CTP to stakeholders
• Develop a baseline to facilitate the measurement of future service improvement
• Provide feedback to staff
• Improve staff morale
• Be ahead of the game in responding to the Government's public engagement agenda.

What happened?
A series of questions were collated in the form of a survey which included questions about the care the patient felt they had received during their appointment. The questions ranged from "How long did your appointment last?" to "Did the nurse talk to you in the way you'd expect?"

Following a visit from the nurse, a random selection of the patients who had confirmed that they were willing to participate in the survey were telephoned by a third-party call centre, (The Campaign Company). These calls were made either the same day or the day following the appointment. During the telephone calls the patients were asked about the service they had received. The patients had already been assured that their feedback would be anonymous so that they would feel able to give honest responses.

The Campaign Company also contacted the nursing staff to ask them for their feedback on the same appointments. These were known as Carer/Clinician Related Experience Measures (CREM's). This process allowed the CREM's results to be compared with the PREM's results.

The questions for staff included examples such as "Were you able to give the patient any instructions about managing their own care or treatment?"

Outcomes
Although it wasn't possible to achieve the number of calls initially aimed for (due to a combination of staff sickness and increased caseloads), the project team were still able to learn a great deal from the project. The interviews revealed useful statistics about how patients felt about their appointment such as:

• 80% said the care was 'excellent'
• 100% were happy with the way the nurse spoke to them.

Much of the feedback from the patients suggested that they would prefer a more accurate indication of the time that the nurse would be arriving for the appointment. The nurses also said that they would like to be able to contact patients more easily when on-route. As a direct result of this feedback every community nurse and home care provider was issued with a mobile phone.

Impact on workforce development and how you can use the learning
For this project to succeed it was important that the nurses were committed to the project. This was achieved by including the nurses in the planning and development of the survey.

It was also important that the survey process was explained correctly to the patients. The nurses therefore described the nature of the survey to the patients during the appointment and asked the patient if they would be willing to participate. Much of the feedback suggested that the patients could see the benefit of the survey and were happy to take part.

The project team found that because the pilot ran at the busiest time of year it was difficult for the nurses to undertake the additional paperwork created. This should be considered in similar projects in the future.

It is key that the momentum of a project such as this is maintained with good communication about the progress of the project in order to increase staff morale. Without adequate communication, the staff involved can begin to see the additional work as a burden.

Other issues which would need to be addressed in a longer-term project include:

• Data sharing, data transfer and security
• Testing and refining the survey questions
• Training for call handlers
• How to avoid the same patient being surveyed multiple times following repeat appointments
• How to ensure a good cross-section of patients of different ages
• How to reach patients in care homes.