Category: Scheme best addressing Choice for Patients
Name: David Ainsworth
Job Title: Service Improvement Manager
Organisation: Southern Derbyshire Acute Hospitals NHS Trust
Email: david.ainsworth@sdah-tr.trent.nhs.uk
Telephone: 01332 347141 ext 4073 or 09570 473 099
Key team: David Ainsworth - SIM, Rachael Murfin - Quality Development Manager, Mark Sibbering - Consultant Breast Surgeon
Title: Organisational learning through patient diaries
Patient and public involvement is at the forefront of service improvement, with a much greater emphasis on gaining patient feedback to influence service redesign.
The traditional approach of patient questionnaires to evaluate satisfaction was recognised as a limited resource.
The agenda and response is driven by the content of questions and may not truly reflect matters that concern patients. Questionnaires are reliant on a retrospective opinion that may cloud the response and be further muddied by the experience on discharge. for example if the patient experiences a poor discharge, this may well be reflected in their overall response to the questions.
Having performed patient questionnaires at Derby it was decided there was a need for a more reflective, qualitative and reliable method of gaining patient feedback.
A patient diary was designed that could be completed during each stage of the patients journey. We hoped patients would be able to complete it at the time of experiencing the service and that they would be able to reflect how it felt to be a person going through the healthcare system.
The diary asked the patient to reflect their feelings and experience around key stages such as the outpatient experience, arrival to the ward, going to and from theatre, communicating the outcome of surgery and going home.
A trial was set up with a breast surgeon and diaries were sent out with appointment letters asking for volunteers to complete and return them. The response rate was 45%, which was higher than previous surveys.
The PALS service was involved to provide support to staff and patients during the completion of diaries and clinical staff involved in providing the care were kept up to date with any progress.
The findings were analysed and it soon became apparent some common emerging themes were appearing throughout the returned diaries. One example of such a theme was an issue around catering services. This came at a crucial time in external contracts ending and new ones being established. This meant that the contractual agreement was directly influenced by patient feedback in the diaries and additions were made to the contract.
Another example of feedback was around noise at night due to new admissions. A ward changed practice and organised the top half of the ward to be empty so admissions could go directly there and reduced noise throughout the rest of the ward.
There was no resistance from clinical staff during the completion of patient diaries.
There are some staff who question to what degree do you make change on the findings of one diary, being the view of one person and not necessarily the general experience. The response has always been that changes can be made with the common themes as this is the general experience of most respondents. Clinical staff felt more reassured about this process.
It became surprisingly apparent that patients found it therapeutic to complete their feelings whilst going through the journey of healthcare. It was clear patients were reflecting their emotions into words. One lady whilst waiting to go for her operation wrote; "I am sitting looking at my breast, wondering what it will be like without it, it is obviously like saying goodbye to a very feminine part of me, but then I think I would rather be minus a breast than minus a leg."
The diary concept has been accepted by the Trust as a recognised method for patient feedback. They have rolled out to other services including gynaecology, paediatrics, midwifery and mental health.
It is clear they can be used with any client group and in any setting. The group of patients dictates the level of support and communication required during the completion phase. For example to gather feedback from ethnic minority groups the help of interpreters is useful, people with special needs may require help of PALS officers and opportunities for combined child and parent held diaries whereby the child can draw a picture of how they feel and the parent can reflect their feeling as a carer.
Patient diaries allow for collaborative feedback to many services, a patient experiencing cancer care across oncology, surgery and imaging, as an example, could complete one diary of their experience and provide many services a true picture of the whole patient journey.
The diaries have proved to be an excellent communication tool to clinical staff and also in providing teaching and awareness to medical and nursing students around issues of how it feels to be a person not a condition. The school of nursing have adopted the diaries and added a presentation to the curriculum for this year’s student nurses.
A presentation was also completed at the Modernisation conference on involving users and carers and since then many hospitals have adopted the concept and used the template that was devised at Derby.
