Findings suggest there is no single best way to collect or use PREM data for QI, but they do suggest some key points to consider when planning such an approach. For instance, formal training is recommended, as a lack of expertise in QI and confidence in interpreting patient experience data effectively may continue to be a barrier to a successful shift towards a more patient-centred healthcare service. In the context of QI, more attention is required on how patient experience data will be used to inform changes to practice and, in turn, measure any impact these changes may have on patient experience.
Key findings from report
Local reporting on complaints is inconsistent and inaccessible
All hospital trusts are reporting to NHS Digital on the numbers of complaints they receive; however, only a minority of trusts report any more meaningful data at a local level.
Analysis shows just 1 in 8 hospitals trusts (12%) are demonstrating that they are compliant with the statutory regulations when it comes reporting on complaints.
Staff are not empowered to communicate with the public on complaints:
All hospitals must produce an annual statutory complaints report but they are only required to make it available to people upon request. Yet we found that hospital complaints staff were often not aware of the reports or who could access them.
Reporting focuses on counting complaints and not demonstrating learning:
Only 38% of trusts make public any information on the changes they’ve made in response to complaints.
Much of this reporting is still only high-level, telling us little detail about what has changed and only stating that “improvements were made”.
Wrong tooth extraction has been clearly designated as a 'never event' since April 2015. However, in 2016/17, wrong tooth extraction topped the charts as being the most frequently occurring never event based on NHS England’s data.
What can we do to mitigate these incidents?
Based on both practical experience and research evidence, BAOS advises that the main methods for mitigation of errors are:
learning from mistakes – including investigation and root cause analysis
engaging the clinical team when developing 'correct site surgery' policies
utilising the LocSSIPs template and guidelines from NHS England/RCS England
developing a correct site surgery checklist that is appropriate for your clinical environment
providing training for staff on the use of the checklist
ensuring that the checklist is being used correctly through active audits of the processes involved
supporting the clinical team throughout the process and not taking punitive action when incidents do occur.
Vanessa Sweeney, Deputy Chief Nurse and Head of Nursing – Surgery and Cancer Board at University College London Hospitals NHS FT decided to share a example of positive feedback from a patient with staff. The impact on the staff was immediate and Vanessa decided to share their reaction with the patient who provided the feedback.
The letter she sent, and the patient’s response are reproduced here:
Thank you for your kind and thoughtful letter, it has been shared widely with the teams and the named individuals and has had such a positive impact.
I’m the head of nursing for the Surgery and Cancer Board and the wards and departments where you received care. I’m also one of the four deputy chief nurses for UCLH and one of my responsibilities is to lead the trust-wide Sisters Forum. It is attended by more than 40 senior nurses and midwives every month who lead wards and departments across our various sites. Last week I took your letter to this forum and shared it with the sisters and charge nurses. I removed your name but kept the details about the staff. I read your letter verbatim and then gave the sisters and charge nurses the opportunity in groups to discuss in more detail. I asked them to think about the words you used, the impact of care, their reflections and how it will influence their practice. Your letter had a very powerful impact on us as a group and really made us think about how we pay attention to compliments but especially the detail of your experience and what really matters. I should also share that this large room of ward sisters were so moved by your kindness, compassion and thoughtfulness for others.
We are now making this a regular feature of our Trust Sisters Forum and will be introducing this to the Matrons Forum – sharing a compliment letter and paying attention to the narrative, what matters most to a person.
Thank you again for taking the time to write this letter and by doing so, having such a wide lasting impact on the teams, individuals and now senior nurses from across UCLH. We have taken a lot from it and will have a lasting impact on the care we give.
The patient replied:
Thank you so much for your email and feedback. As a family we were truly moved on hearing what impact the compliment has had. My son said – “really uplifting”. I would just like to add that if you ever need any input from a user of your services please do not hesitate to contact me again
There are calls for greater use of ‘soft’ intelligence around quality and safety.
Little research examines the challenges and opportunities soft data present.
This study in the English NHS found clinicians and managers saw utility in soft data.
Dominant approaches to interpretation risked obscuring their greatest value.
Soft data might better be used to disrupt understanding and challenge consensus.