Public and Patient Engagement Strategy - Ensuring patients are at the very heart of the decision making process 2018 - 2020 - Central London ...

 
Public and Patient Engagement Strategy - Ensuring patients are at the very heart of the decision making process 2018 - 2020 - Central London ...
Public and Patient
Engagement Strategy
Ensuring patients are at the very heart
of the decision making process.

2018 – 2020
Public and Patient Engagement Strategy - Ensuring patients are at the very heart of the decision making process 2018 - 2020 - Central London ...
2   PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020
Public and Patient Engagement Strategy - Ensuring patients are at the very heart of the decision making process 2018 - 2020 - Central London ...
1. Introduction

Central London Community Healthcare                   support for people through every stage
NHS Trust (CLCH) provides more than                   of their lives from health visiting for
70 different community healthcare                     new-born babies through to community
services in London and Hertfordshire.                 nursing and palliative care for people
We employ approximately 3,500 staff                   towards the end of their lives.
who care for more than two million
patients with over 10 million patient                 We provide a broad range of services
contacts per year. We help people to                  in ten different London boroughs plus
stay well, manage their own health                    specialist sexual health and respiratory
and avoid unnecessary trips to, or long               services in Hertfordshire as shown in
stays in, hospital. We provide care and               the picture below.

 PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020                                              3
Public and Patient Engagement Strategy - Ensuring patients are at the very heart of the decision making process 2018 - 2020 - Central London ...
Our range of services includes:

        dult community nursing including
       A                                                   Specialist services including delivering
       district nursing, community matrons                  care for people living with diabetes,
       and case management.                                 heart failure, Parkinson’s and lung
                                                            disease, homeless health services,
        hildren and family services including
       C                                                    community dental services, sexual
       health visiting, school nursing,                     health and contraceptive services and
       community nursing, speech and                        psychological therapies.
       language therapy, blood disorders
       and occupational therapy.                           Walk-in and urgent care centres
                                                            providing care for over 226,000 people
        nd of life care supporting people
       E                                                    with minor illnesses and injuries and
       to make decisions and receive the                    providing a range of health advice and
       care they need at the end of their                   information.
       life. Specialist Palliative care is also
       provided at the Pembridge Hospice.                Many of our services are open seven-days-
                                                         a-week and our community nursing and
       L ong-term condition management                  inpatient rehabilitation and palliative care
        supporting people with complex                   units offer 24 hour care.
        ongoing health needs caused by
        disability or chronic illness.

        ehabilitation and therapies
       R
       including physiotherapy, occupational
       therapy, foot care, speech and
       language therapy and osteopathy.

4   PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020
Public and Patient Engagement Strategy - Ensuring patients are at the very heart of the decision making process 2018 - 2020 - Central London ...
Our vision: Great care closer to home

Our mission: Working together to give
children a better start and adults greater
independence

Our Values:
       Quality: We put quality at
       the heart of everything we do.

       Relationships: We value our
       relationships with others.

       Delivery: We deliver services
       we are proud of.

       Community: We make a positive
       difference in our communities.

PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020   5
Public and Patient Engagement Strategy - Ensuring patients are at the very heart of the decision making process 2018 - 2020 - Central London ...
We are a high performing trust that put quality of care at the heart of everything we
    do. Our most recent CQC inspection took place in September 2017. During the visit, we
    hosted a team of 28 CQC inspectors and specialist advisors, who assessed four of our core
    services: Children’s; Adults; Inpatient and End of life care. The team visited 17 sites, in six
    boroughs, where they talked to over 150 staff, carers, patients and service users about their
    experience of CLCH and shadowed staff on their visits to observe the care that our staff
    provide. They also reviewed our documentation and patient notes, evaluated our systems
    and processes and assessed the environment in which we provide care. Following the
    inspection, we were pleased to receive an overall Good rating.

    The Trust operates in four Sustainability             We will continue to work with each of the
    and Transformation Partnerships (STPs)                STP areas to ensure that we “develop a
    areas: North Central London, North                    shared vision with our local community”
    West London, South West London, and                   and to work with our partners to ensure
    Hertfordshire and West Essex.                         that our public and patient’s health and
                                                          care needs are met and ensure that our
    The STPs bring organisations together to              patient’s voices are heard as part of any
    take collective responsibility and to plan            transformation to care.
    improvements. Working within these STPs
    is a complex challenge however, we have
    the potential to provide a facilitative and
    supportive role in making change locally;
    building on our track record as a high
    quality community services provider and
    one with the reach and infrastructure to
    support others.

6    PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020
Public and Patient Engagement Strategy - Ensuring patients are at the very heart of the decision making process 2018 - 2020 - Central London ...
Thank you very much for
                                                                                all your help, support and
                                                                                advice over the years.

Our Trust Strategy                                    The Trust Quality Strategy, ‘Simply the
Our Trust Strategy was refreshed in                   Best, Every Time’ aims to support the
2016/17 to make sure it was aligned                   delivery of outstanding care to all of our
to the national direction for the NHS as              patients. This strategy provides a plan for
set out in the Five Year Forward View                 how we as a Trust are going to organise
and being taken forward through local                 and develop to improve the services
Sustainability and Transformation Plans               we deliver over the coming three years.
(STPs). Looking ahead, we wish to                     As part of the strategy, there are six
focus more on developing integrated                   campaigns, each with enabling strategies
community services, working closely with              and key objectives. The first campaign
physical and mental health providers,                 is ‘Positive Patient Experience’ and the
social care and the voluntary sector. In this         key objective and outcomes have been
way, we can bring greater benefits to the             reflected in this strategy in order to ensure
patients, families and communities facing             that staff, patients and stakeholders
increasingly complex health conditions.               understand how this strategy fits together
                                                      with the Quality strategy.
One of our key objectives in the strategy
is our wish to put greater emphasis
on planned and integrated services
that meet specific local needs through
multi-disciplinary services delivered
in collaboration with our partners. In
order to do this, we recognise and are
committed to co-designing our services
with patients and partners.

 PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020                                                     7
Public and Patient Engagement Strategy - Ensuring patients are at the very heart of the decision making process 2018 - 2020 - Central London ...
2.     ow have we developed
      H
      our Strategy

2.1 Evaluation of our current situation              The Trust has exceeded 90% for people
In order to develop our strategy for 2018             rating their overall experience as good
to 2020, we have evaluated our current                or excellent for the whole year
situation. This enables us to identify where
we need to focus and what we need to                 There has been continued improvement
build on to continuously improve our                  to the Friends and Family test Score
patient experience and engagement.                    with the Trust ending the 2017/18 year
                                                      on 94%.
2.1.1 Patient and Public Engagement
Key Performance Indicators (KPIs)                    100% of complaints have been
Looking at the current position on patient            responded to within 25 days
experience, the following results from key
patient experience performance indicators            The proportion of patients’ concerns
include:                                              (PALS) responded to within 5 working
                                                      days is over 95% and rarely falls below
  T he Trust continues to collect between            100%.
   2500 -3500 pieces of feedback from
   patients every month                              The numbers of complaints have fallen
                                                      since last year.
  T he proportion of patients whose care
   was explained in an understandable             The overall performance against each of the
   way has been over 92% for the whole            Patient Experience performance indicators
   of 2017/18                                     throughout 2017/18 has been exceptional.
                                                  However, the National and Trust target of
  T he proportion of patients who felt           95% of patients recommending the Trust
   they were treated with both dignity            through the Friends and Family test (FFT)
   and respect has been above 95%                 has not been achieved in some services.
   for the whole of 2017/18                       A number of actions have been taken to
                                                  improve this and will continue to be a key
  T he proportion of patients who were           priority for 2018/19.
   involved in planning their care has been
   above 85% throughout the whole of
   2017/18

 8                        PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020
Public and Patient Engagement Strategy - Ensuring patients are at the very heart of the decision making process 2018 - 2020 - Central London ...
2.1.2 Complaints                                      to focus on these areas in 2018 using
A total of 98 formal complaints were                  a co-design approach to engage our
received by the Trust during 2017/2018,               patients in establishing actions that we
which is a decrease of 28% from last year             can take to continue to try to improve
where 137 complaints were received.                   their experience.

The top three themes from complaints                  2.1.3 Patient Stories
remain the same as the previous year                  Patient stories enable the patient to
with complainants being unhappy                       tell staff their own story about their
with aspects of their clinical treatment,             experience of care. They are undertaken
attitude of staff (also taken to mean                 through an interview process and the
staff being rude) delays and/ or process              story is either written or developed
regarding appointments. The category                  through the use of video or pictures. A
‘All aspects of clinical care’ covers a wide          programme of patient stories collection
spectrum of complaints. In 33 individual              is in place throughout the Trust and
cases, complainants reported that their               each service have targets to ensure that
assessment / diagnosis were not thorough              they collect stories in order to hear the
enough and felt that they did not receive             voice of their patients and continue
the treatment that they believed was                  to listen and improve the service
required or expected. Staff attitude can              provided. Patient stories are routinely
often be the complainant’s perception of              presented at the Patient Experience
the way they were addressed or treated by             Co-ordinating Council, Trust Board,
staff. When describing their perception of            and other Trust Forums alongside the
staff; rudeness, insensitivity and a general          Quality Stakeholder Reference Groups
lack of concern were the most common                  which serves as one of our many forums
themes identified.                                    for engaging with public and patient
                                                      representatives.
Whilst the top three themes align with
those from other provider Trusts, they                The Patient Experience team collate
have remained the same since 2016/17.                 all of the stories each year into an
Therefore, they have been a topic of                  annual report with the purpose of
discussion with our patients and the                  understanding key themes that have
public to ensure we are doing all that we             emerged. The Trust wide analysis of
can to address them. We will continue                 patient stories collected in 2017/18

 PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020                                               9
Public and Patient Engagement Strategy - Ensuring patients are at the very heart of the decision making process 2018 - 2020 - Central London ...
provides a clearer understanding of our              Working together staff, patients and
     patients experience and the key aspects              carers ‘walk around’ a chosen site
     of care that is important to them.                   providing structured feedback on
     The comments extracted highlight                     how welcoming, safe, caring and well
     the significance that service users                  organised they experienced the services.
     place on care that is compassionate                  This approach offers patients and
     and effective, and also explained in a               members the opportunity to participate
     way that is meaningful to them and                   in a meaningful engagement activity
     involves the patient/family. The key                 which makes a difference to the quality
     themes throughout both the positive                  of healthcare services for our patient
     and negative comments relate to                      population whilst offering staff and
     communication and continuity of                      managers the opportunity to consider
     care. Within the positive comments,                  their services from a new and often
     there are numerous comments relating                 surprising perspective, to instil the
     to staff being courteous, polite,                    process of continuous improvement and
     confident and smooth transition                      to work with stakeholders to promote
     between services. However, areas for                 the co-production model.
     improvement refer to the need for
     staff to be more flexible and clear, and             The Trust aims to undertake monthly
     for care to be explained clearly when                15 step challenge visits to our services
     patients are discharged from one                     where a team of patients, members
     service to another in a language that                and directors, identify improvements
     people understand.                                   that will enhance patient experience.
                                                          In 2017/2018 we undertook 7 new
     2.1.4 15 Steps Challenge                             visits, where a total of 61 actions
     The 15 Steps Challenge is a tool                     were agreed with each service visited.
     developed by the NHS Institute for                   General feedback from all of the visits
     Innovation and Improvement following                 was extremely positive and staff were
     a mother’s visit to an acute setting                 found to be friendly, professional and
     where she noted:                                     welcoming. The majority of actions
                                                          related to estate and actions such
     “I can tell what kind of care my                     as improved signposting, a need for
     daughter is going to get within                      more storage areas or a need for more
     15 steps of walking on to a ward”                    information. As a result of each visit,

10   PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020
‘Thank you for all that you do. Your
service, kindness help and support
is not unnoticed.’
Stoma care patient

action plans were developed with the                  Nursing teams focusing on patient’s
service and monitored by the Patient                  involvement in care with the aim being:
Experience Team.
                                                      “We will always support patients,
In line with the new NHS England                      relatives and carers to be involved in the
guidance (The Fifteen Steps Challenge:                planning and delivery of their care”
Quality from a patients perspective;
Community care in a patient’s own home,               As a result of listening and working with
2017) we will be reviewing our approach               patients and staff, a new location specific
to 15 step challenge visits to ensure                 service leaflet has been developed to
that all our patients’ voices are heard.              provide consistent and clear information
For example, how we undertake these                   about the service to patients. A script was
challenges for housebound patients.                   produced for each member of the Single
                                                      point of access team and the nursing
2.1.5 Co-Design Events                                staff to make sure that the initial contact
Always Events                                         with the patient was concise, clear and
Always Events are an Institute for                    ensured that the patient felt involved in
Healthcare Improvement (IHI) initiative.              the care they would be receiving. This
They are aspects of the patient experience            has been supported with a training video
that are so important to patients, their              developed and including one of our
relatives and carers, that health care                patient representatives and community
providers must aim to perform them                    staff. As a result of these actions, there
consistently for every individual, every time         has been a significant improvement to the
they have contact with a healthcare service.          proportion of patients that feel that they
The Always Events methodology requires                have been involved in the decision making
genuine partnerships between patients,                about their care across the community
service users, care partners, and clinicians.         nursing teams.
This partnership is the foundation for
co-designing and implementing reliable                The Trust is one of only three Trusts
care processes that hold promise for                  in the country who have successfully
transforming care experiences.                        implemented Always Events and
                                                      are committed to the continued
The Trust has successfully implemented its            implementation of these in the future.
first Always event across all Community

 PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020                                                 11
Co-Design                                             administration staff, clarity of information
     The Trust has used co-design as an                    for patients regarding the services and
     approach to improve patient experience and            effective signposting for patients. In
     to engage with patients for service changes.          addition, public Wi-Fi is now available
     Some examples are outlined below:                     across each of the centres and specific
                                                           child friendly areas were created in two
     Improving patients experience of waiting              of the services. Patient satisfaction has
     times in the Walk-in Centres                          continued to improve across all sites
     In 2016/17, the Trust received a number               and patients have reported a 12.4%
     of concerns raised by patients about their            improvement in their experience of
     experience of waiting times in the Walk-in            waiting times.
     Centres. In order to understand what our
     patients experience was and understand                Continence Transformation
     what the true issues were, a co-design                The Procurement and the Transformation
     approach was used. Throughout the                     teams were reviewing the continence
     project a number of observational visits              service, in particular standardising the
     took place at each centre, with staff                 provider of pads across the Trust. It was
     and patients being interviewed about                  imperative that our patients were involved
     waiting times and their overall experience            from the outset of this project to help
     of working in and using these services.               identify and implement service level
     Video comprising selected interview                   improvements. Therefore, a number of
     footage, along with other patient and                 open engagement events for parents/
     staff feedback was developed and a                    public/carers/relatives were held as well as
     co-design event was also held with staff              a number of product testing events. Letters
     and patients to present back the stories              were also written to a sample of patients
     collected and establish what would                    in each borough who received continence
     improve patient experience.                           products asking them to complete a
                                                           questionnaire feeding back on their
     The event provided an opportunity to                  experience of using their current products.
     collectively agree on the priorities for
     improvement and how this would be                     Using the patient and carer feedback
     achieved. As a result, a number of actions            received through the targeted continence
     were taken including the development                  service user engagement, a new provider
     of training and competencies for                      was agreed upon and commissioned.

12    PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020
Each service user has now been informed               to ensure they are always considering
of the changes to the provider and patient            what is important for our patients with
feedback relating to the continence                   dementia.
service continues to be monitored and
reported on.

Dementia Engagement Project
The Dementia Engagement project
‘Engaging people with dementia and
their carers as partners in training and
education’ used an experience based
co-design methodology to gather
information that is meaningful to people
which could then be used to support
more effective training for staff.

A series of open action group meetings
took place in order to explore the critical
issues as identified by people with
dementia and their carers. The feedback
was then transcribed and a detailed
analysis of themes was undertaken in
order to establish key areas that are
important to people living with dementia
and their carers. The analysis from the
co-design sessions was then fed back
to the core group of 16 people, all of
whom live with dementia or are family
members of someone with dementia in
order to validate the findings. From the
engagement work undertaken throughout
the project, a film has now been
developed by our patients. This is being
used in training for front line nursing staff

 PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020                                             13
2.2 Engaging Patients and staff in                   Strengthening our reputation as a high
     the design of our Strategy                           quality provider and building confidence
     Patient engagement is achieved by                    for patients, their families and carers, and
     employing a whole systems approach                   the local community will help the Trust to
     to collecting, analysing, listening,                 deliver its strategic objectives.
     using and learning from feedback. It
     is important to see patient feedback                 To ensure that this strategy accurately
     in the context of the development                    reflects the needs of our patients, there
     of integrated care models, service                   have been a number of engagement
     improvement and an increased focus on                events with patients and staff. These
     empowering patients to fully participate             events have helped shape the Strategy
     in decisions about care and treatment.               and agree the three key objectives.

                                                          At each of the engagement events, the
                                                          feedback received centred on engaging
                                                          with existing community networks,
                                                          building relationships with community
                                                          leaders. Our patients also want to be
                                                          assured that we are using their feedback
                                                          to make positive change, and that we are
                                                          asking the right questions to enable these
                                                          service level changes.

                                                          Each of the key themes have been have
                                                          been reflected in the new 2018-2020
                                                          objectives and outcome measures.

14   PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020
‘We really appreciate and feel blessed
to have your support with their care.’
Patient accessing assistive
communication services

2.3 Patient Experience improvement                      T he Trust gives all staff and
framework self-assessment                                our patients the opportunity to
The Trust has used the Patient                           contribute and act on ideas for
Experience Improvement Framework                         quality improvement namely through
(NHS Improvement, June 2018) to                          the Shared Governance methodology
assess its current position in relation to
patient experience and to determine                     The Trust Friends and Family Test
the objectives for the next three years.                 scores have improved significantly
The framework brings together the                        over the 2017/18 year.
factors which need to be present in an
organisation which is truly focused on                The areas where the Trust could improve
the needs of its patients and uses best               which have helped steer the focus of
evidence from a range of different reviews            this Strategy include:
and guidance.
                                                        T he Trust has made great progress in
Following the self-assessment, it is                     ensuring that patients and service users
evident that there are numerous areas                    are being involved in the design stage
where the Trust continues to deliver to an               of any service change and we have
outstanding level which include:                         evidence where we have demonstrated
                                                         excellent examples of co-production.
  T he Trust has now implemented the                    However, there is still plenty of work
   new patient feedback software which                   to be done to ensure that patients
   has enabled a greater ability to collect              are involved in every service change
   real time patient feedback                            delivered within the Trust.

  T he Trust delivers an accessible user-              The Trust has continued to work
   friendly complaints process with the                  hard on ensuring patients and their
   complaints team working hard to ensure                families are involved as much as
   the process and awareness of how to                   they would wish to be in their care
   raise a concern or make a complaint is                and understand what is expected in
   known and promoted through the PALS                   relation to their care. However, there
   and complaints surgeries                              is still work to be done to be sure
                                                         that all of our patients not only feel
                                                         involved but also have their care and
                                                         expectations explained to them in an
                                                         understandable way.

 PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020                                                 15
3. Our             strategy for 2018 – 2020

The Trust’s previous Public and Patient           3.1 Our strategy objectives
Engagement strategy was agreed in March
2016 with a focus on the collection of            3.1.1 We will change staff behaviours
patient feedback and what, as a Trust             and care to improve the experience of
we do with that information. The Trust            our patients
has significantly increased the amount            Whilst there has been significant progress
of feedback collected from patients and           to embed and build our capacity to
have successfully delivered against each of       hear the voices of people who use our
the objectives of the 2016-2018 strategy          services there is always more to do. We
with patient feedback driving service             will continue to focus on strengthening
improvements and a co-design approach             the methods used to gain patient and
to service improvement now evident across         public feedback, the core communication
many work streams. However, we need to            channels we use to engage with our
build on these achievements and ensure            patients and the public and improve how
that co-design and working in partnership         feedback is used to inform and influence
with our patients to transform services and       service delivery and patient care. The table
improve care and experience is embedded           below outlines the methods that we will
into the way that we do things.                   use to do this.

Our new PPE strategy will therefore
aim to build upon the successes of our              Involvement of patients     
                                                                                Patient Reported Experience Measures
previous strategy with a key focus on               in the decision making      (PREMs)
                                                    process about their own
ensuring patients are at the very heart                                         Patient Advise and Liaison Service (PALS)
                                                    treatment and care.
of the decision making process. We will
                                                                                Self-Management and Support Groups
also make sure we are clear and ask the
right questions before engaging with our                                        Volunteering
patients in order to make sure that it is
meaningful to everyone.                             Engaging patients and       
                                                                                Capturing   patients detailed experiences
                                                    the public in ongoing       through trust wide engagement initiatives
                                                    service delivery            i.e. patient stories
Recognising our patient feedback from
the engagement events, we will engage                                           
                                                                                Patient Experience surveys
                                                                                and comment cards
with existing networks to engage with our
patients and the public reducing avoidable                                      15 step challenge visits
journeys for our patients. In addition,
                                                                                
                                                                                Review of wider feedback from key
we will aim to support borough based                                            stakeholders i.e. Healthwatch
engagement and co-design events to
ensure that the learning and actions taken
are relevant to the local community.

16                        PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020
We use co-design as
                                                                                   an approach to improve
                                                                                   patient experience

3.1.2 We will aim to make sure that our               Engaging patients and          
                                                                                     Transforming care pathways in
patients are involved in all decisions                the public in the decision     partnership with patients i.e.
                                                      making process when            Experience Based Co-Design
about their care and the service/s they
                                                      making changes to
are using                                             services or transforming       
                                                                                     Experts through experience panels –
We will continue to seek to build greater             care pathways                  consulting on proposed service changes
confidence in the quality, safety and                                                
                                                                                     Working closely with Healthwatch
experience of health services ensuring                                               and other key stakeholders
that resources are invested in a way that
                                                                                     Always Events
delivers optimal health outcomes. We
will do this by continuing to embed the               Engaging patients and the      
                                                                                     Quality Stakeholder Reference Groups
co-design methodology and putting the                 public in organisational       (QSRGs)
patient at the forefront of the decision              decision-making
                                                                                     Formal Public consultations
making process.
                                                                                     Shared Governance – Quality Councils
3.1.3 We will aim to make sure that                                                  Focused engagement/ listening events
we engage with all of our patients,
with a specific objective of engaging
communities who are less frequently
heard
We also want to build patients confidence
in the accessibility and responsiveness of
our services working with patients and the
public to ensure they are able to influence
health services to meet their needs. In
order to do this, our strategy will be to
ensure that we work in partnership with
our patients. The table to the right outlines
methods that we will use to do this.

 PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020                                                                           17
3.2 Our approach to patient                           So that patients can be empowered to
and public engagement                                  take more ownership of their health
Patient and public engagement is an                    and make informed choices about their
approach that puts the people at the heart             care and treatment, leading to better
of care to improve service quality. It can             health outcomes
be considered to be made up of four key
groups of activities:                                 T o develop improved patient perception
                                                       of the services we provide, and increased
  Involving people in decisions about their           trust and confidence in the NHS
   own treatment and care
                                                   3.2.2 How will we engage people?
  E ngaging people in on-going service            The Trust will follow the 4Pi framework.
   delivery                                        This is a framework that established some
                                                   basic principles to encourage people to
  E ngaging people in making changes to           think of involvement in terms of principles,
   services or re-designing care pathways          purpose, presence, process and impact
                                                   (4Pi). It has been designed to help services
  E ngaging people in organisational              meet their statutory obligations and ensure
   decision-making                                 everyone involved in the engagement
                                                   process feels the benefit and can see the
3.2.1 Why do we engage people?                     impact they have had on high quality
  To enable staff to have a greater               healthcare. The 4Pi model comprises of:
   understanding of what their patients
   want, so they can focus on what matters         Principles: Meaningful and inclusive
                                                   involvement starts with a commitment to
  T o increase patient and staff satisfaction     shared principles and values.
   – happy patients lead to happy staff, and
   vice versa                                      Purpose: People need a reason to get
                                                   involved. The purpose of involvement
  T o reduced complaints; increase                needs to be clear and communicated to
   compliments and increase interest               everyone involved in the activity, as well as
   in our services                                 the wider organisation.

  T o ensure that services are designed           Presence: The Trust would like to see a
   and delivered to meet people’s needs            diversity of service users and carers involved
   and aspirations                                 at all levels and at all stages of a project or
                                                   organisation. The people who are involved
                                                   need to reflect the nature and purpose of
                                                   the involvement.

18                         PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020
Process: The process of involvement needs             consultation or project being developed.
to be carefully planned to make sure that
service users and carers can make the best            Who we include in our stakeholder
possible contribution.                                map will very much depend on their
                                                      concern or interest in what we are doing.
Impact: For involvement to be meaningful,             Typically, our list will include:
it needs to make a difference to the lives or
the experiences of service users and carers.            Customers: those that acquire and
                                                         use the organisation’s services
3.2.3 Identifying our stakeholders
Identifying our stakeholders is one of the first        Collaborators: those with whom
steps in all of the Trusts engagement work.              the organisation works to develop
It helps establish groups with a concern or              and deliver services
interest in what we are trying to change/
improve/transform, showing the Trust who                Commissioners: those that pay the
needs to be reached and ultimately, give our             organisation to deliver our services
work direction and focus.
                                                        Consumers: those who are served
The Health and Social Care Act 2012 says                 by our patients and the public: i.e.,
that each NHS organisation has a duty                    families, friends, carers
to involve people in decisions about their
health care and to consult and involve                  Champions: those who believe in
people when planning or changing                         and will actively promote each of
commissioned health services. Identifying                our projects
our key stakeholders ensures that we are
fully engaging with everyone who needs to               Competitors: those working in the
be involved, meeting these legal duties.                 same geographical area who offer
                                                         similar or alternative services
Researching stakeholders is vital and we
will often need to call upon experts in a             The Trust provides services to a diverse
particular network to help consider fully             population across a number of different
who to engage with. Before each piece                 boroughs; therefore the divisional Quality
of engagement work we will identify our               Stakeholder Reference Group (QSRG) will
stakeholders by considering who will be               be a forum where borough based Patient
affected in the service transformation,               Experience engagement will be discussed.

 PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020                                                19
4. Delivering                                      the Strategy

4.1. Outcome Measures                                               4.2 Framework for Improvement
In order to deliver the strategy, a number                          CLCH has a framework for improvement
of outcome measures have been developed                             (shown below) which outlines our
as outlined in Appendix 1. In order to                              methodology for continuous improvement.
achieve these, a detailed action plan will                          This is supported by the continuous
be developed by the Patient Experience                              improvement strategy, led by the Director
team in conjunction with staff across the                           of Improvement.
Trust and monitored at the Trust Patient
Experience Coordinating Committee.

Fig 2 A Framework for Improvement

                                                                             S E E IT

                                  A   LIT Y                                                                                  15
                                                                                                                                   STE
                               QU                                           HEAR IT!                                                     PC
                          ON                                  • Engage patients (e.g. listening
                                                                                                                                               HA
                     HT                                          events, patient stories)                                                           LL
                                                                                                                                                          E
                IG                                            • Engage staff (e.g. Shared Governance,

                                                                                                                                                          NG
           L

                                                                 Continuous Improvement)
       OT

                                                                                                                                                                  E
                                                              • Capture data on quality
      SP

                          EVALUATE IT!                                                                                       ANALYSE IT!
            •E
              nsure changes are implemented
                                                                     SIMPLY THE BEST,                             • Review patient & staff feedback,
             and achieve desired results                               EVERY TIME                                    complaints, incidents, PALs,
            •S
              hare widely & celebrate success                      4 Better outcomes                               surveillance and quality data
                                                                    4 Better experiences                         • Identify issues, themes and trends
                                                                    4 Better use of resources
                                                                                                                                                                         S
  BA

                                                                                                                                                                      AY

                                                 CHANGE IT!                                         DISCUSS IT!
     CK

                                                                                                                                                                  ID

                                     • Quality Action Teams                               • Clinical supervision
                                                                                                                                                                  FR

                                     • Shared Governance Councils                         • Team/service meetings
       TO

                                     • Continuous Improvement                             • Shared Governance Councils
                                                                                                                                                              AL

                                     • Divisional action plans                            • Divisional Boards
          TH

            E                                                                                                                                                 I
                                                                                                                                                          C

                                                                                          • Executive Leadership Team
                FL                                                                                                                                    IN
                     OO                                                                                                                            CL
                           R

                                                              V IS A B L E L E A D E R S H I P

20                               PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020
4.3 Shared Governance
CLCH is using a model of shared
governance. Shared governance Quality
Councils bring front line staff and patients
together to make decisions related
to the delivery of care. One council
in each division will focus on patient
experience with the chairs feeding into
the coordinating council for their division,
led by the Divisional Director of Nursing
and Therapies (DDNT), and also into
the Patient Experience Co-ordinating
Committee (the Trust wide coordinating
council for the Positive Patient Experience
quality campaign), creating a community
of learning across the organisation. The
councils will be integral to the delivery of
the PPE strategy.

‘I have been able to say
and influence change’
Shared governance patient
representative

 PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020   21
5. Implementation                                          of the strategy
In order to ensure that all staff are               patients with clarity about what should
engaged with the best practice principles           happen for every person, every time they
for patient and public engagement and               encounter our teams in the Trust. This will
understand what it means for them, a clear          aim to ensure that people are involved in
communication plan will be developed                decisions about their treatment, engaged
and led by the Head of Patient Experience           in making changes to services and
and each of the Divisional Directors of             increase patient satisfaction.
Nursing and Therapies. This will include a
short summary of the Patient and Public             The Trust provides services to a diverse
Engagement Strategy and its objectives,             population across a number of different
the key priorities and how these can be             boroughs, therefore the divisional Quality
implemented into practice by everyone.              Stakeholder Reference Group (QSRG) will
                                                    be a forum where borough based Patient
Practical Always Events will continue               Experience engagement will be monitored
to be developed to provide staff and                and discussed.

6. Reporting                            and Communicating
The Patient Experience Coordinating                 quarterly to the Quality Committee outlining
Committee chaired by the Director of Nursing        the progress being made.
and Therapies (Patient Experience and
Education) is responsible for the monitoring        Progress on the strategy will be fed
and implementation of the Patient and Public        through the Shared Governance quality
Engagement Strategy. In order to monitor            councils focusing on Campaign 1; A
this, the forum receives monthly divisional         Positive Patient Experience.
reports outlining performance of PREMs,
patient stories, feedback and learning and          It is essential that this strategy is
updates on engagement work taking place.            communicated as widely as possible to our
In addition, an action plan will be developed       stakeholders and importantly our patients
to ensure specific objectives within the            and staff. Therefore, the Patient Experience
strategy are achieved. This will be led by the      team will be developing a quarterly newsletter
Head of Patient experience and monitored            outlining key work being undertaken and
at the Trust Patient Experience Coordinating        sharing patient and staff stories.
Council (PECC).
                                                    Ongoing involvement in the strategy is
A set of quality key patient and public             key to its success and it is expected that by
engagement outcomes and measures will               incorporating the outcomes throughout
continue to be monitored from front line to         the divisions, the strategy will maintain the
board and a progress update will be provided        energy and enthusiasm with which it has
as part of the Quality report presented             been driven to date.

22                          PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020
7. Conclusion                                         9. References

High quality care and good patient                    https://improvement.nhs.uk/
experience is everyone’s business. Evidence           documents/2885/Patient_experience_
from patient feedback suggests that the               improvement_framework_full_
Trust provides a good patient experience              publication.pdf
however; we should continue to strive                 NHSE Patient Experience improvement
to be outstanding. Patient and public                 framework
engagement is paramount in order
to improve the quality of the services                http://engagementcycle.org/
provided and ensure that the care delivered           InHealth associates website – meaningful
meets their needs. Delivering against the             engagement for maximum impact.
objectives and priorities in this strategy will
support the Trust to do this better.                  https://www.england.nhs.uk/
                                                      integratedcare/stps/view-stps/
                                                      NHS England STP overview

8. Appendices                                         https://www.england.nhs.uk/wp-
                                                      content/uploads/2016/12/always-events-
                                                      toolkit-v6.pdf
                                                      NHS England Always Event Toolkit
Appendix 1: Patient and Public
Engagement Strategy Key outcomes                      https://www.england.nhs.uk/wp-
and measures                                          content/uploads/2017/11/15-steps-
                                                      community.pdf
Appendix 2: Existing Patient Experience               NHS 15 Steps Challenge Community
monitoring channels                                   Services Guidance.

                                                                              ‘You were brilliant and
                                                                              provided all the correct
                                                                              equipment for my Mum’
                                                                              Barnet Integrated Care

 PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020                                                      23
Appendix 1              	
                         Outcomes and Measures

Objectives:

   e will change staff behaviours
  W                                               e will aim to make sure that our
                                                 W                                                e will aim to make sure that we
                                                                                                 W
  and care to improve the experience             patients are involved in all decisions          engage with all of our patients,
  of our patients.                               about their care and the service/s              with a specific objective of
                                                 they are using.                                 engaging communities who are
                                                                                                 less frequently heard.

 Key Outcomes                   Measures of Success 2018-2019                            Measures of Success 2019-2020

 Service developments and       92% or above of proportion of patients whose             95% or above of proportion of patients whose
 plans of care co-designed      care was explained in an understandable way.             care was explained in an understandable way.
 with patients and service
                                90% of proportion of patients who were involved          92% or above proportion of patients
 users
                                in planning their care.                                  who were involved in planning their care.
                                The use of co-design will be evaluated across the        All service improvement projects will
                                organisation.                                            be supported through co-design.
                                Evaluation from patient feedback of their                Patients will be members of the Quality
                                involvement in the Quality Council.                      Councils in each division.

 Patient stories and diaries    Evaluation of Always Events and their impact             Always Events to become integral to Quality
 used across pathways to        on patient experience.                                   Councils as a method used to improve patient
 identify touch points and                                                               experience.
                                Quality Councils to start leading on the
 `Always Events’
                                development of Always Events with local                  Evaluation of Always Events and their impact
                                implementation.                                          on patient experience.
                                Thematic analysis of previous year’s stories with        Thematic analysis of previous year’s
                                shared learnin.                                          stories with shared learning.
                                Continued use of patient stories by all services         Continued use of patient stories
                                and shared at Divisional and Trust forums.               shared at Divisional and Trust forums.
                                Continue to implement patient diaries/innovative         Evaluation of the use of patient diaries/
                                approaches to patient stories into identified services   innovative approaches to patient stories and
                                                                                         their impact on patient experience.

 Patient feedback used to       Patient feedback will be integral to the review and      Patient feedback will be integral to the review
 inform staff training          development of education and training.                   and development of education and training.
                                Evaluate how patient feedback has influenced             Evaluate the use of patient stories as part of
                                training and education.                                  learning from serious incident reviews.
                                Continue to implement the use of patient stories as      Patient stories and feedback will be integral to
                                part of learning from serious incident reviews.          the learning from serious incident reviews.

24                             PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020
Patient stories and
                                                                                      feedback will be integral
                                                                                      to the learning from
                                                                                      serious incident reviews.

Key Outcomes                        Measures of Success 2018-2019                     Measures of Success 2019-2020

The patient voice is integral to    Implement 15 step challenge visits                Evaluate the impact of 15 steps challenges
each key service change.            across less frequently heard patient              on the overall patient experience.
                                    groups (housebound).
                                                                                      Review impact and learning from
                                    Deliver borough based quarterly                   2018-19 quarterly projects on the
                                    co-design initiatives.                            overall Patient Experience.
                                    Patient representatives are involved in each of   Borough based engagement is embedded
                                    the key ‘CLCH way’ transformation priorities.     across the trust
                                                                                      The patient voice is embedded into each
                                                                                      of the key transformational work streams.

Comprehensive trust wide            Work with community leaders to establish how      Establish working relationships with
engagement networks are built       our communities wish to work with us.             community leaders and key community
and used to engage all patient                                                        groups.
                                    Work with healthcare providers, VCS and local
groups.
                                    authorities to ensure all communities across      Gaps in engagement are monitored with
                                    each STP are mapped and are engaged.              an action plan in place to address any
                                                                                      outstanding gaps.
                                    Complete community and demographic
                                    mapping exercise and develop action plan to       Audit engagement activities against
                                    address any gaps.                                 the community and demographic
                                                                                      action plan.

We give patients the opportunity    Deliver PALs and Complaints Surgeries across      Evaluate the impact of the PALS and
to tell us about their experience   the Trust.                                        Complaints surgeries on the overall
with our services.                                                                    patient experience.
                                    Review and evaluate the current PREM
                                    questions to establish if they are allowing the   Refresh PREM questions to meet the needs
                                    trust to deliver service level improvements.      of our patients and to allow the feedback to
                                                                                      help shape service improvements.

PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020                                                                                   25
Appendix 2              	
                         Existing channels
The table below outlines the established channels which
the Trust uses to progress and monitor patient experience.

 Channel              Summary                                                                    Audience &              Lead
                                                                                                 frequency

 Trust

 Board Meeting        CLCH’s Board is accountable for providing the highest standards            Monthly                 Trust Secretary
                      of patient experience, quality and safety of services, sound
                      financial management and governance.

 Quality              The role of the Quality Committee is to focus on quality and risk          Monthly                 Non-Executive
 Committee            issues including the clinical agenda to ensure that appropriate                                    Director
                      governance structures, systems and processes are in place across
                      the Trust. A monthly patient experience assurance report and
                      quarterly quality report are presented.

 AGM                  Formal annual corporate event. Linked to public engagement                 Patients & public       CE Office &
                      event and staff awards.                                                                            Communications

 Patient              A forum for innovation, improvement and discussion of patient              Key internal            Director of
 Experience           experience feedback, trends and themes for Divisions and the               staff, patient          Nursing and
 Coordinating         Quality and Learning Team. The forum informs, supports and                 representative,         Therapies (Patient
 Council              monitors divisional engagement and performance of patient                  monthly                 Experience)
                      experience outcomes and provides a forum of key stakeholders
                      to plan, implement and evaluate the Trusts Patient Engagement
                      Strategy within CLCH.

 Divisional Quality   The role of the Divisional Quality Stakeholder Reference Groups            Patients & public       CE Office &
 Stakeholder          (QSRG) are to allow stakeholders in Central London Community                                       Communications
 Reference            Healthcare NHS Trust (CLCH) to provide challenge and input to
 Groups               the Board and other committees to the ongoing cycle of quality
                      improvement. The groups provides a regular forum for staff to
                      share perspectives and consult on new developments and quality
                      related issues across the Trust. It is structured, in particular, around
                      the annual Quality Accounts process, but also looks more broadly
                      at the quality, patient and public perspectives in relation to wider
                      Trust decision making.

 Divisional Quality   Oversight and action planning for all Divisional Quality Metrics           Divisional Directors,   Divisional Director
 Meetings                                                                                        Divisional Directors
                                                                                                 of Nursing and
                                                                                                 Therapies, Managers

 Shared               To deliver the quality strategy objectives we established a new            Shared Governance       Programme
 Governance –         shared governance approach to driving improvement across the               Council members         Manager – Shared
 Quality Councils     trust. This allows frontline staff to drive through the improvements                               Governance
                      they know need to be made.

26                             PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020
Channel                Summary                                                          Audience &          Lead
                                                                                        frequency

Online / digital

Trust website          The main corporate website hosting service information,          All external        Comms / Patient
                       news and key publications.                                                           Experience Team

Health matters         Information and advice – interactive section                     Young people        Children’s Division
website

The Hub                Trust’s intranet, upgraded in 2015 with more use of              Internal            Comms/Patient
                       interactive elements to encourage staff participation and                            Experience
                       networking.                                                                          Facilitator

NHS Choices            FFT and patients feedback Information on the website             All external        Comms

Patient and carers     Digital patient stories and dynamic patient stories              Patients            Patient Experience
videos                                                                                                      Facilitator

Written

Complaints and         Information on how to make a complaint or raise a concern        Patients            Complaints team
PALs leaflets

@CLCH                  Quarterly printed newsletter for members and wider               All external        Comms
                       stakeholders (previously called The NHS in your
                       neighborhood.)

Annual report          Formal corporate publication                                     All external        Comms

Quality account        Formal corporate publication                                     All external        Quality

Board papers and       Routine publication of official documents – hosted on            All external        Various
published strategies   website. Important that quality reflects expectations on a
                       major NHS provider. Media may review to identify issues.

Reports to CCG         Progress and metrics for patient experience in monthly quality   Monthly             Director of Nursing
Quality Groups         reports and quarterly patient experience reports.                                    and Therapies
                                                                                                            (Patient Experience)

Divisional Patient     Divisional PREMs, patient story, 15 Step Challenge, listening    Divisional Teams,   Patient Experience
Experience Reports     event reports.                                                   Monthly             Facilitators

Managers cascade       Monthly briefing to support manager during team meetings.        Internal            Comms
                       Provides key messages for cascade through the Trust/

This Week @CLCH        Weekly news email to all staff                                   Internal            Comms

News / media           A mixture of website announcements and formal press              All external        Comms
releases               releases sent direct to journalists

PUBLIC AND PATIENT ENGAGEMENT STRATEGY 2018 – 2020                                                                                27
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