Leading change

Nursing staff as a part of a multi-disciplinary team at Aintree University Hospital NHS Foundation Trust identified and addressed unwarranted variation in visiting hours offered to patients and visitors, which was having an impact on patient, carer and staff experience. The nurse leaders have introduced new, flexible visiting hours based on several key factors, initially motivated by feedback received from patients and visitors.

Where to look

Nursing staff gathered information from patient feedback and complaint forms, a divisional engagement event and also through seeking thoughts and feedback from staff. This evidence showed clear unwarranted variation – a distinct difference in visiting hours from ward to ward across the Trust.  Some wards particularly had visiting times which were reported not to be effective for patients, relatives or staff.

The multi-disciplinary team decided to address this unwarranted variation in practice by piloting new visiting hours on two wards whilst working closely with patients, relatives and staff throughout to ensure feedback was adequately captured.

What to change

This lack in consistency of visiting times was proving confusing for patients and relatives, notably if they were being transferred to another ward, which had different visiting hours. Nursing team members in this pilot wanted to get it right for every patient, every time – to take a standardised approach across the hospital on visiting hours.

By identifying this unwarranted variation, the team were able to take steps to address it and to make experiences better; not only for patients, relatives and carers, but for many members of staff too.

How to change

As a result, new ‘core’ visiting hours were introduced across the Trust. The new visiting hours were 1.30pm to 7.30pm and the expected benefits for both staff and patients, which was more patient-focused and demonstrated personalised care tailored to the needs of the patients. The work was implemented as a pilot and gradually rolled out across the Trust.

Adding value

Evidence for the added value in this case study example is derived from patient feedback and is qualitative in nature. It demonstrates that the patients and relatives have been involved in the change and have been asked throughout the various stages about how it is working for them. The trust hopes to identify more quantifiable evidence that the extension of visiting hours has been beneficial.

• Better outcomes – The flexible hours had a by-product of staggering visits to wards. This has allowed staff to have more time to engage with families of patients with long-term conditions to discuss the patient’s ongoing care, daily activity and lifestyle choices to enable the patient to live independently on discharge rather than needing ongoing residential support.
• The 2017 review of the programme covered a range of patients across 30 wards at the Trust. All free-text comments were overwhelmingly positive with regard to existing visiting times. Over 90% of respondents felt that they had access to a relative or carer during their stay in hospital.
• Patient feedback has been closely monitored since the initial audit through the Friends & Family Test (FFT). From August 2016 to July 2017, 31,573 Inpatient discharges were recorded. From all FFT comments received across the 12 months directly linked to the project, only 18 patients responded negatively to the new flexible visiting hours. This equated to 0.05% of patients.
• Better experience – Staff and visitors have reported that the introduction of flexible visiting times has resulted in a better overall experience at the Trust and that patients feel like their needs have been considered and personalised. One example is that car parking spaces are more readily available and there is less congestion making the process much smoother and keeping the patient at the centre of decisions, always. Some quotes include:
  • “I have felt very vulnerable in hospital and being able to have my wife around whenever I have needed has been fantastic. Staff have been very accommodating and I have appreciated their workload when I have made requests for my wife to be with me outside of visiting times.”
  • “Flexible visiting times guarantee the wellbeing of the patient in hospital. I think it is a wonderful idea. We all need support, especially at times like this in hospital. Thank you for the innovation.”
• Better use of resources – The new approach also means that ward managers can work closer with patients, visitors and carers to ensure that visiting hours can be adapted to meet their needs. To quote: “We know that many people work different shift patterns and have other commitments that can sometimes make it difficult to visit. Ward managers now work closely with patients, relatives and carers to arrange visits outside the ‘core’ visiting hours where needed, supporting overall well-being.”

Challenges and lessons learnt for implementation

This new partnership way of working, including patients, carers and staff in decision making has resulted in stronger relationships which is supporting improvements across the care plans, e.g. in planning for discharge.

The introduction of flexible visiting means that visiting now happens at a time convenient for patients, carers, relatives and friends. This helps to reduce the care and quality gap and hard work continues to drive quality improvement at the Trust.

Watch this film about improving patient experience at Aintree Hospital NHS Foundation Trust

Colleagues from Aintree University Hospital NHS Foundation Trust talk about how, by identifying and addressing unwarranted variation, they were able to make positive changes to visiting hours and to patient experience, and how team members led the project.

Find out more

For more information contact:

Anna Morris, Lead Nurse Patient Experience and Engagement: anna.morris@aintree.nhs.uk
Aintree University Hospital NHS Foundation Trust