The Leeds Teaching Hospitals NHS Trust

Patient Experience Team

Services Responding to Feedback

In the trust we have a Patient Experience meeting that is held every 2 months. At this meeting we hear about some of the amazing work that is taking place to improve our services as a result of patient feedback. These are some of the actions that were taken by different specialties within our hospitals in 2019.

Estates and Facilities - January 2020

The Estates and Facilities (E+F) CSU was represented by the General Manager for Facilities. One of the regular ways in which the CSU worked with members of the public to support improvements was through the PLACE inspections that took place annually to review many aspects of patient environments. PLACE inspections were first introduced nationally in 2012 and required the Trust to work with patient assessors to deliver. The process was reviewed in 2019 when new guidance for implementation was published. The assessments were based on a scoring system and resulted in an action plan. Themes arising from the last inspection included cleanliness, food, issues to do with dementia care and signage.

The E+F team provides patient assessor training to enable the public to effectively contribute to the process. Feedback from the inspections was shared with the patient assessors through a PLACE Lite event. At these events, the opportunity was also taken to work on smaller scale improvements, such as catering menus for Christmas and Boxing day.

One of the challenges the CSU had was ensuring that the patient assessors were representative of the wider community. 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 received largely positive feedback from the Friends and Family Test (FFT), which was reviewed monthly to check for any comments relating to E+F related activities, e.g. food, cleaning, and interactions with CSU staff. In December 2019, there were no negative issues raised by members of the public. Recognising that transport was often an area of concern for patients (although services were provided by an external company), it was reported that there were 18 positive feedback comments in December 2019 relating to the transport services.

The E+F CSU has been utilising the Leeds Improvement Method to identify projects aimed at improving experience for patients and reducing waste. Patients had raised the beverage round that occurred at 14.00hrs as requiring improvement as it was often late. They have also provided feedback about the food that was offered at that time, which had helped the team review their ordering. Chocolate muffins were less popular for example than a yogurt. As a result of the feedback, a revised beverage round was being tested.  

The Patient Environment Team received lists from Matrons detailing what they need fixing across the Trust such as notice boards, paint, etc. and these lists were often influenced by patient feedback received at ward level.  There were currently two teams set up at the LGI and SJUH who are responsible for ward maintenance.

The service collected feedback from around 3000 patients a month about food and catering. Examples of feedback they received included that the chilli was too spicy, sandwiches were too hard and the pies were too big. Also, patients who were in hospital for a long time were often frustrated when the same choices appeared on menus.  It can be very difficult to address patient preferences and to support menu planning, however to assist with this the team hold meal tasting sessions with members of the public to assess acceptability of menu items. 

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Outpatients - November 2019

Outpatients’ CSU has previously received feedback on its environments through a programme of work that was undertaken over 18 months in collaboration with Healthwatch Leeds. They continue to make changes to address the findings from that initiative. 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. This has significantly improved communication, however it was acknowledged that getting this information right for all patients can be challenging, as in some cases up to 20 specialities may be holding clinics in each area at any given time. The electronic solution being progressed allows medical staff to input when patient appointments should have been and when they actually went ahead. This is then displayed in the waiting area to improve access to information about expected delays.
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.  
Refurbishments are taking place in clinics across the Trust. Improvements have been made to Seacroft outpatient area, with the addition of new chairs and linoleum to replace carpets.
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, is almost at completion 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.
Patient pathways for phlebotomy have been reviewed to reduce known delays following consistent feedback from patients about the amount of time spent waiting for blood tests.  Phlebotomists now start work at an earlier time in the day, which has resulted in positive feedback from patients experiencing an improved service.  
Changes have been made to the way outpatient appointments are booked following a number of PALS raising concerns that patients were struggling to get through to the Referral and Booking Service (RBS). In the last 12 months a number of changes have been made to improve this, including GP’s directly referring to RBS. RBS follow up GP referrals by aiming to contact and agree an appointment time with the patient within 72hrs of referral receipt. Since this change has been made, PALS concerns relating to this issue have significantly dropped. This is partly due to the new system freeing up the service phone lines, meaning that patients are finding it much easier to contact the department when they need to. A new rota of working until 20.00 has also been introduced, meaning that opening hours are more accessible to working people
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.
The CSU recognised it was important for them to undertake some work that considered children’s outpatient experiences. This is because, although the outpatient clinics are predominantly adult based, there are 3 services for children operating within them. The CSU will be collaborating with Children’s CSU on this.
Steps have been taken across the CSU to improve visual displays that show the feedback patients have provided and what actions have been taken in response.  
 Outpatients November 2019 v2

Cardio-Respiratory - September 2019  

The CSU provided feedback to showcase how they have listened to their patients and how they are improving their services. The group was informed about the Interstitial Lung Disease (ILD) service and the support group that is currently running for patients. The success of the group has been dependant on nurses and doctors working with patients to promote it and suggesting they may like to attend. It has provided patients with the ability to meet with others who are suffering with the same illness.
The Cardiology CSU showcased the admission process within their department and described how it has improved in recent months. In response to feedback about difficulty getting through on the phone to check if a bed is available, the nurse in charge is now telephoning patients’ prior to their appointment, to provide this information directly. Nurses in the CSU are additionally making a concerted effort to communicate with all patients who are awaiting surgery. . This is in response to feedback that suggested patients were frustrated by not receiving updates from passing staff about whether an ICU bed was available. Patients reported that being told nurses didn’t know the answer to that question was much better than not being told anything at all. As a result, nurses are now ensuring patients are regularly updated with the current position of ICU bed availability, regardless of whether a bed is available.
J06 is a ward for young adults with Cystic Fibrosis. It was reported that the ward has 12 single rooms where inpatients stay and this can lead to patients feeling isolated and alone. In response to this feedback, a new initiative has been put in place by the CSU to support patients and create an uplifting environment. The CSU has introduced games, DVD’s, and art therapy activities to the area. One particular patient, as a result of this, has painted 12 pictures which will be placed in each of the rooms. This work is a great example of the value the unit place on the experience of their patients and showcases the efforts that have taken place to improve the hospital experience.  
 Cardio Resp September 2019 v2CARDIO 2 v2

Oncology - July 2019

Radiotherapy, who treat around 500 patients every day, employ several strategies to gather patient feedback and engagement. A Patient /Carer and Public Involvement group has been set up. Patients and staff are now actively co-designing the new MRI-suite. Soon patients will be offering feedback with regards to the Radiotherapy Mask experience, an often challenging procedure.
Inside the treatment room, there is now a better selection of music to choose from. Through a successful public appeal, patients have sent in their own photo’s of Yorkshire, which are shown on the treatment room TV screens.
The calming artwork, selected by patients and staff, continues in the form of large pieces of Wall Art (depicting scenes of Yorkshire countryside and coasts) on walls and inside other smaller waiting rooms. Information screens in the waiting areas show slides about skin care advice, special events and other support services available. These screens also display waiting times for all treatment machines, and - as requested by patients - there is a rolling news feed too.
Privacy & dignity walk-arounds continue to take place: staff and a patient and/or carer will look at various aspects of the department, so improvements can be implemented from suggestions made. A Dementia Expert was recently involved in tailoring a walk-around to make it more specific to that condition. Future work will include something similar for Learning Disabilities & Autism patients. New Radiotherapy Patient Information leaflets are always reviewed first by a group of patients; a Patient Reader Group (set up by Leeds CCG) is also currently reviewing the generic literature contained in all leaflets.
A large service evaluation project called ‘AIRPoRT’ is exploring the information needs of radical lung cancer patients at the end of radiotherapy treatment.
Patient /carer interviews will inform a future questionnaire, which will be given to a larger group of patients. This will influence local and potentially national practice with regards to information provision.
 ONC 2 v2Oncology 2019 v2

Emergency and Specialty Medicine - May 2019

The CSU described a number of activities which have taken place in the last year to improve patient experience as a result of feedback.
Ward J28 introduced a process where the ward sister makes contact with families a week after they have experienced bereavement. This was introduced as a result of feedback which described how abandoned a family had felt when their relative died on the ward. Since introducing the initiative there have been no more similar complaints raised.
The team also described that they have frequent visits from PAT dogs in a number of their wards and departments and that they are taking part in a project alongside the patient experience team, to obtain the views of carers. 
Much work has been concentrated in HIV services, which have been working with the Organisation ‘Skyline’ to train people with HIV as peer supporters to the newly diagnosed. The service has also introduced a regular newsletter and initiated a process to improve the opportunity for patients to see the same doctor or nurse on their visits, if this is what they would prefer.
The CSU are working alongside the Trust Lead for Learning Disabilities & Autism to prepare ahead of time when it is known that the department is going to be caring for an autistic person who requires additional support.
 ESM May 2019 v3ESM 2 v2

Abdominal Medicine & Surgery - March 2019

The CSU explained how they have acted on the feedback given by a patient with complex needs. They described how staff have regular meetings with the patient, carers and community staff and have a better understanding of her needs.  As a result of this a care plan has been agreed and changes have been made that have improved the experience of the care the lady receives.
Examples were also given of positive and negative FFT feedback and the actions taken to date in response. This has included setting up a work stream on discharging patients before midday; increasing the number of non-medical prescribers; daily board rounds with Matrons; and recruitment drives.
The group were briefed on various other successful initiatives introduced as a result of feedback, which included a “chill out” zone for liver transplant patients called “The Cabin”, the Bexley Boutique with clothes and shoes for patients to support dignity and independence as well as a refurbished relatives room on ward J91.
They also shared plans for future improvements such as having a PAT dog visit the ward, increasing the number of volunteers and creating a space that doubles as both a mini-gym, and a place to celebrate the transplant games. The CSU plan to display patient feedback in the department with examples of “you said, we did” as well as giving transplant patients WiFi call devices so they can leave their beds but be alerted when they need to be seen by a health professional.
 AMS 2 v2AMS March 2019 v2

Women's CSU - January 2019

The CSU has a strong relationship with the Maternity Voice Partnership (MVP) group in Leeds. The MVP is a group of maternity stakeholders who ensure that the voices of families accessing maternity services are heard.
The MVP have supported numerous events within the CSU. One of these being last years ‘Whose Shoes’ engagement event that focused on bereavement in maternity services.   This event provided a safe platform for families and other stakeholders to share their experiences and highlighted the importance of the use of appropriate language and relationships and continuity with staff. This has resulted in the CSU ensuring staff received addition training on bereavement and the use of appropriate language.
Additionally, where appropriate, families now receive early support contact from the bereavement midwife. The MVP hold monthly ‘Walking the Patch’ visits to the maternity unit, visiting a different clinical area each month. They speak with women and their families to gather feedback about their experiences which is then fed back the same morning to the team leaders monthly meeting. This feedback provides real-time evaluation of services. Recent changes as a result of this includes reviewing the Induction of Labour patient information leaflets and patient information boards to ensure consistent information is provided to service users.
 Womens Jan 2019