Services Responding to Feedback
Outpatients - November 2019
Outpatients CSU received feedback on its environment through a programme of work that was undertaken over 18 months in collaboration with Healthwatch Leeds. One of the most common issues raised by patients is being unaware of how long clinic waiting time is likely to be. There is an electronic solution currently being sought to improve this, however until that is in place it was reported that nurses and receptionists are expected to verbally inform patients of the delay upon arrival to clinic. A number of clinics have a white board to make patients aware of the wait times which they add next to the doctor’s name. Some have a clock to visually show the time they are running behind.
Another common feedback theme in outpatient environments is lack of access to refreshments. In response, the CSU provide access to drinking water for people. In most areas water jugs are available and topped up throughout the day, although renal services have access to plumbed drinking water. Hot drinks are specifically made available for patients waiting for transport and people who have been waiting for longer periods of time for an appointment. Additionally it was reported that hot drinks will be made for anyone who requests one.
In response to feedback about poor access to up to date reading material, the CSU have liaised with an external company that provide 30 magazines for 14 clinic areas, covering a range of topics. Magazines are made available to patients one month before publication. There is no charge for this service. Company related advertisements associated with this arrangement are reviewed by the CSU lead team prior to being given authorisation that they are appropriate for a hospital environment and for the Trust.
In the renal outpatient clinic, a Tree of Life has been implemented. The Tree of Life is a way for renal transplant patients to thank department staff involved in their transplant journey and was created in response to feedback from people who said this is what they wanted to be able to do. Patients leave a message that is subsequently transformed into a wood and metal leaf to be placed on the tree.
FFT feedback is collected in the CSU and work continues to make it easier for patients to leave comments associated with a particular area, so that the CSU can target improvements accordingly. A significant piece of work, supported by the Trust IT and Patient Experience teams, has recently been completed to deliver this capability. An example of FFT feedback often received relates to patients reporting they are unhappy with the long distances they have to walk between departments. In response, the CSU are working with orthopaedics to identify, in advance of an appointment, if patients need an x-ray as part of their visit. If so, patients will be asked to attend x-ray prior to reporting at clinic, which will reduce the requirement for them to go back and forth between the two areas.
Phlebotomy services are taking part in a leading for care programme and as part of this are filming a video of their service to provide better information for patients of what to expect when attending the department. The patient information leaflets for the service are also being revised.
Customer service training has been introduced for all CSU receptionists and staff that are required as part of their role to regularly speak to people on the phone. This initiative has been introduced to provide support to staff in improving their communication, in response to feedback received through PALS and complaints.
Estates and Facilities - January 2020
The Estates and Facilities (E+F) CSU shared how they regularly worked with members of the public to support improvements. One such example was through the PLACE (Patient Led Assessment of the Care Environment) inspections that took place annually to review many aspects of a patient’s environment.
PLACE was introduced in 2013 and supports the need for every NHS patient to be cared for with dignity in a clean and safe environment. A PLACE assessment provides an opportunity for improvement through the clear message, directly from patients, about how the environment or services might be changed or enhanced. PLACE underwent a national review, which started in 2018 and the question set / guidance has been significantly refined and revised. As the changes have been extensive, it is important to note that the results of the 2019 assessments will not be comparable to earlier collections (2018 for example).
The NHS provides patient assessor training to enable the public to effectively contribute to the process. Feedback from the inspections was shared with the patient assessors and PLACE Lite events are planned for 2020. This enables the Trust to keep in touch with patient assessors more regularly, rather than annually. In the run up to the 2019 Christmas holidays, many of the patient representatives were invited to Chapel Allerton to taste / sample the 2019 Christmas menu, which was very well received.
One of the challenges the CSU had was ensuring that the patient assessors were representative of the community of Leeds, so that the Trust receives feedback from the community it serves. They were particularly seeking the views of younger people and were considering engaging with colleges and universities to achieve this. Healthwatch Leeds had a number of youth volunteers and expressed an interest in exploring whether their volunteers might be able to support the programme. The CSU was also keen to get support from patients and staff, who could also represent LGBTQ+ & BME communities / networks.
The Patient Environment Team engage and work collaboratively and proactively with Matrons / Sisters throughout the year to detail what estates works need carrying out, to maintain / improve the physical environment for our patients, staff and visitors. This work is also influenced by patient feedback received at ward level. There are currently two E&F teams set up at the LGI and SJUH who are specifically responsible for resolving issues at a ward / department levels, that have a specific PLACE focus / influence.
The CSU receives largely positive feedback from the Friends and Family Test (FFT), which is reviewed monthly to check for any comments relating to activities such as food, cleaning, and interactions with staff (Porters & Ward House Keepers)
Internal feedback is collected from around 3000 patients a month regarding catering services (Patient Satisfaction Surveys). Examples of feedback received included the taste, texture and portion size of the food served, along with appearance. Patients who are in hospital for a long stay can see some repetition as the menu is rotated on a 2 week cycle. Where this occurs, the E&F team can support discussions with individual patients to expand the menu choice wherever possible. If food quality is highlighted by patients, then the E&F catering team will review the food item specifically and discuss this with the manufacturer.
The E+F CSU has started to look at ways the Leeds Improvement Method can support projects that could also improve the experience for patients and reduce waste.
Pharmacy and Medicines Management - March 2020
The Medicines Management and Pharmacy Services CSU have been on an ’improvement journey’ over the past 12-18 months, moving from traditional approaches of seeking patient feedback, to hearing with compassion and understanding the lives experience of patients, to influence and create more patient centered care. In response to patient feedback, examples of improvement initiatives include;
Reducing patient waiting time for medicines in outpatient oncology clinics through a successful collaboration between pharmacy, phlebotomy and Oncology which ensured that blood results were available for doctors at the point of reviewing and prescribing chemo.
Empowering patients and improving experience on Cystic Fibrosis (CF) wards through involving patients in the nurse checking process when administering intravenous antibiotics.
This initiative was also found to promote patient independence and support continuity of care, and was so successful, it has gone on to influence a trial at the LGI site of patients taking their own pain medication.
Reducing asthma and COPD exacerbations and hospital admissions by improving patient inhaler technique. Patients reported a lack of confidence in inhaler use. One patient said “I’m always told I’m using it right and then sent away”. Collaborating with patients and the Respiratory CSU, the pharmacy team created a dedicated service to help people get the most from their inhalers.
The CSU changed their approach to improvement work through Hearing with compassion and understanding the lived experience with medicines. The CSU shared learning from patient and carer focus groups that had been undertaken by three clinical researchers in pharmacy, as part of their research project design. Aligned to the research projects, the focus groups explored; thoughts and feelings of elderly patients about medicines at or after discharge, experiences of parents going home from hospital with babies on medicines, and the impact of technology on medicines use and patient involvement during a hospital stay. The pharmacists involved described being transformed by what they heard from patients and carers. They described how listening with compassion and learning more about the patients lived experience, really enabled them to support patients and carers with achieving what mattered most to them about medicines.
The above work has been complemented by the Me and my medicines campaign, a project initiated and developed by patients of Leeds, now implemented nationally. This campaign focuses on improving the conversations with patients about their medications so that they feel empowered to ask questions. To support this work, the pharmacy team have gone on to collaborate with Leeds City Council Better Conversations project, to provide staff with coaching skills and tools to support patients to get the best from their medicines.
Conversations are occurring about re-purposing the service and the team are challenging themselves to consider what their measures of success should be if they truly put patients at the heart of what they do.
Radiology - November 2020
The Radiology CSU was represented by the Lead Radiographer for Quality and Safety and the Service Manager for Breast Imaging. It was described that one of the challenges the CSU faced was ensuring that FFT data was collected throughout radiology modalities. The CSU have engaged with modalities to look at ways that radiology can overcome the challenges of collecting FFT data and how this information is then used effectively. This has resulted in the CSU developing an improved relationship with the Trust Patient Experience Team. The CSU are appointing FFT champions into modalities and the champion’s role will be to strive to improve public and patient involvement for their area. . It is planned that Patient Experience KPI’s will be agreed within the CSU and that these will be monitored and regularly reported, to provide assurance of performance to the CSU triumvirate.
The department ceased breast screening on 24th March 2020, in line with the national guidance to support the operational response to the Coronavirus pandemic. When services recommenced there was an opportunity for the CSU to review the patient pathway to ensure that patients maintained social distancing and kept safe. The team described how they used patient feedback to learn from a patient’s perspective how they felt when visiting a mobile breast screening van. The team introduced a one way system through the unit and changes were made to ensure patients had an indoor waiting space to wait for their screening appointments to prevent them waiting outside. Patient appointment times were reviewed to prevent queuing and compromising patient safety. Following receipt of a PALS complaint the radiology breast service team described how they reviewed the communication that was provided to patients from the department to look at how this could be improved. Specifically, the breast service introduced a COVID-19 guide with every patient appointment letter. This contains general information about the virus and the measures the unit has taken to keep patients safe. Patients have reported that they feel better informed since this resource has been made available.
The pandemic presented an opportunity to review how the GP X-ray service could be delivered differently. To help reduce the waiting list for an X-ray weekend appointments were introduced on peripheral sites. An audit was carried out looking at feedback from patients attending for an X-ray; results indicated that the additional weekend appointments were very positive for patients, with patients favoring a weekend X-ray service. Patients reported that they felt safer not attending appointments on main hospital sites and that they appreciated the flexibility of weekend attendances.
The team concluded that it was important for them to identify mechanisms that would enable them to receive feedback about the radiology service in ways additional to the FFT. They described how they had engaged with the Patient Experience Team to review other mechanisms for capturing feedback and that they intended to connect with patient groups across the Trust to see how they could assist in supporting this objective.
To find out more information about what our services have done in response to patient feedback, please look at the 'Listening to Our Patients' newsletter which is produced annually: