Improving patient experience – lessons learnt as an Intern
18 August 2016
Charlotte Beames explores why efforts to improve quality have mixed success, concluding that improvement projects need to involve patients early and often.
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I have just completed a summer internship with The Point of Care Foundation during which I was able to see the theory aspect of my degree in Global Health and Social Medicine come to life in practice. I have learnt and experienced a whole variety of different things over the past couple of months which I will definitely take back with me for my third year of study. But I would also like to share a few things I have learnt about improving the patient experience of care with you here.
Co-producing Services with Patients
“Co-production” is a word I have heard a lot recently; and a word which indeed should be used frequently in a healthcare setting. A key message of the Foundation’s work is that by improving staff experience, patient experience can also be significantly improved. However it is not just about staff engagement; it is also important that patients are involved in improvement projects through co-production, for example in Experience Based Co-Design (EBCD).
At the HOPE Network meeting in July we heard from Ceinwen Giles, David Gilbert and Alison Cameron about what being a patient leader entails and about each of their own experiences of a “dramatic fall from grace”. They defined patient leadership as having three components – having experienced a life-changing illness or injury or having a long-term condition; a desire to push for change in patient care; and readiness to work in collaboration with healthcare staff. It is important that staff recognise that patient leadership is therefore an active role, not just a feedback mechanism, and consider ways to co-produce services with patients.
The Importance of How
Perhaps more importantly, I have gained significant insight into the vital role of communication in improving the patient experience of care through co-production. Communication is more than just what you say; it is what you hear, what you do and how you react. The CLAHRC Northwest London Summer Collaborative Learning event touched on numerous interesting concepts surrounding this topic; for example the ladder of participation which has 3 levels – “doing to (manipulation), doing for (informing), and doing with (co-production)”. These levels represent various types of communication and collaboration, with co-production being the ideal aspiration.
Timing is everything
It is critical to involve patients from the outset in any improvement projects. If the patient voice is not listened to during the initial planning stages then changes which have been identified may not be the ones that are most needed to improve patient experience.
Within this realm of “how”, it is important to consider the removal of hierarchies in the collaboration between patients and staff. There have been numerous references to “power” having been the elephant in the room in this situation. There can be a lack of clarity about what a patient’s role consists of when working alongside healthcare staff. However patients need to be confident that they are bringing their own expertise and experience, rather than trying to represent all patient voices. It is also crucial to consider that change can be seen as a threat to security by both staff and patients which can result in emotional resistance preventing the needed change. Therefore it is vital that roles are clearly defined and this process is managed effectively to ensure that all participants feel they have a meaningful voice.
An analogy to highlight the importance of good communication in QI particularly grabbed my attention at the CLAHRC event. This was the idea of communication in QI being compared to Chinese Whispers, in the sense that there will be ripple effects, and improvements may be interpreted in a very different way to how they were originally conceived. Therefore if you communicate poorly, there is a real danger that the changes will have the inverse effect and will actually cause more suffering to patients.
All improvement is change but not all change is an improvement
All of the above is vitally important, but it is important because it all significantly contributes to change. However we are not just looking for any change, the aim is for valued change. I have absorbed a lot of information over the past few weeks surrounding how to gain this “valued change”, yet the strongest message has evidently been patient involvement from the outset.
It is when patients and healthcare staff work together, with the removal of any hierarchies that improvement can occur – the change will after all impact on the patients’ experience of care, so why not involve them in decisions on the type of change needed and how this will happen?
When staff and patients alike become colleagues, valued change will follow. This should then link hand in hand with another of The Point of Care Foundation’s messages which I referred to earlier – improving staff experience will subsequently improve patient experience. With both staff and patients working in collaboration it should follow that both feel more valued and capable of positively impacting the patient experience of care.