Experiencing culture

The five millionth piece of feedback has been gathered from the Friends and Family Test (FFT).

Surveys, FFT, patient opinion websites, patient and carer feedback all play a part in helping us see care from the perspective of patients, their families and carers.

I want to focus on three areas where I think there is more for us to do to make the most of all of this insight and improve patients’ experience of care.

Are we focusing on what matters most to patients? Patients tell us two of the most important points that matter are communication and compassion, two of the 6Cs. If we are excellent at these, patients are safer and report better clinical outcomes. That is why the National Quality Board has published a narrative on what makes a good experience of care, to ensure we focus consistently on the quality of the interactions between patient, carer and health professional.

This important publication identifies the eight main ingredients of a good experience on which we all need to focus our efforts, with examples from across England showing how nurses are delivering them.

We also need to consider the experiences of vulnerable patients – for example, children, people with a sensory impairment, those with a learning disability, dementia or frail older people.

Patient groups tell us that vulnerable patients may have poorer experiences of care, and surveys back this up. A report for Signhealth showed that people who are born deaf feel alienated from the NHS because we do not make sign interpreting services available as often as needed. Older people, by contrast, may be reluctant to share poor experiences in feedback forms.

Nurses across the NHS have found imaginative ways to overcome such challenges. A feedback app developed by Birmingham Children’s Hospital is an excellent way to engage children and young people. By asking ‘What could have been better?’ rather than ‘How was it for you?’ we can successfully encourage people to be more frank.

Such initiatives often remain restricted to particular services. Eye clinics, for example, usually have excellent signage for people with visual impairments, but the same signage may not be deployed in the rest of the hospital, even though visually impaired people may use any of the services provided.

The challenge, and the opportunity, is to replicate what already works across a whole organisation. Where that has been done, patients report significant improvements in their care experience. NHS England is consulting on a new accessible information standard, which will be mandatory for all organisations providing NHS services.

It is often said that you cannot have happy patients without happy staff. The Staff Survey and the Friends and Family Test for staff are vital parts of our efforts to improve patient experience, but we need to do more to bring together patient and staff feedback. For example, there is usually a direct correlation between the experiences of BME (black and minority ethnic) staff and those of BME patients.

We need to be able to engage, listen and respond to staff. That means delivering a culture in which all staff feel encouraged and supported to speak up about their concerns and to demonstrate that concerns are listened to and action taken.  We must also support reflective practice through such initiatives as Schwartz Rounds, so that staff have the opportunity to share their experiences of delivering care.

Ultimately, the best guarantee of a good patient experience is culture. We are working hard to provide compassionate care more consistently and inclusively, and know we have more to do. The message patients, their families and carers are sending us is, ‘Do more of what works’ and ask ‘what matters to us’.

Jane Cummings

Professor Jane Cummings is the Chief Nursing Officer for England and Executive Director at NHS England.

Jane specialised in emergency care and has held a wide variety of roles across the NHS including Director of Commissioning, Director of Nursing and Deputy Chief Executive.

In February 2004, she became the national lead for emergency care agreeing and implementing the 98% operational standard. She has also worked as the nursing advisor for emergency care. In January 2005, she was appointed as the National Implementation Director for ‘Choice’ and ‘Choose and Book’.

Jane moved to NHS North West in November 2007 where she held executive responsibility for the professional leadership of nursing, quality, performance as well as QIPP, commissioning and for a time Deputy Chief Executive Officer. In October 2011, she was appointed to the role of Chief Nurse for the North of England SHA Cluster.

She was appointed as Chief Nursing Officer for England in March 2012 and started full time in June 2012. Jane is the professional lead for all nurses and midwives in England (with the exception of public health) and published the ‘6Cs’ and ‘Compassion in Practice’ in December 2012, followed by publishing the ‘Leading Change, Adding Value’ framework in May 2016.

Jane has executive oversight of maternity, patient experience, learning disability and, in January 2016, became executive lead for Patient and Public Participation.

She was awarded Doctorates by Edge Hill University and by Bucks New University, and she is a visiting professor at Kingston University and St George’s University, London.

She is also Director and trustee for Macmillan Cancer Support and a clinical Ambassador for the Over the Wall Children’s Charity where she volunteers as a nurse providing care for children affected by serious illnesses.

Follow Jane on Twitter: @JaneMCummings.

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