NCGCNCGC National Clinical Guideline CentreNational Clinical Guideline Centre

Liz AvitalAssociate Director NCGC

Improving the experience of care for people using adult health services: Developing the NICE Guidance and

Quality Standard.

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Overview• Background of the National Clinical

Guideline Centre (NCGC)• How the Patient experience in adult

NHS services (CG138) guidance was developed.

• Main themes and examples of recommendations and quality statements

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National Clinical Guideline Centre (NCGC)• Formed in April 2009 - merger of 4 national

collaborating centres; Royal Colleges of Physicians, Nursing, General Practitioners and Surgeons

• NCGC develops clinical guidelines on behalf of the National Institute for Health and Clinical Excellence (NICE)

• One of the largest centres in the world developing clinical and cost effective evidence focused on improving patient experience and outcomes

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Clinical Clinical GuidelinesGuidelines

Quality Quality ImprovementImprovement

Primary Primary researchresearch

Evidence Evidence updatesupdates

InternationalInternationalworkwork

NCGC current work programme

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Patient Experience guidance and quality standard

• Commissioned by NICE in 2010 to develop guidance, recommendations and quality standards outlining a level of service that people using adult national health services should expect to receive.

• Guidance for all staff (including non-clinical staff) involved in providing health services, as all interactions can have a profound effect on patient experience of care

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What are NICE guidance and quality standards• Guidance underpin recommendations for the

care of individuals within the NHS (usually population/setting specific).

• Guidance and quality standards outline a level of service that people using adult NHS services should expect to receive

• Has an important role in influencing provision of high quality, effective relevant care

• By design they address variations in practice, optimising care delivery and experience

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Collaborative development of Guidance and Quality Standard • Underpinned by an agreed scope• Driven by a multidisciplinary guideline

development group (GDG);– 10 health professionals – 6 patient representatives

• Supported by a technical team• Consultation with and incorporation of

feedback from stakeholders

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Technical Team

Is comprised of:

GDG Chair Information Scientist Research Fellow Health Economist Project Manager Guideline Lead

Their function:

Undertook evidence reviews / synthesis Presented the evidence to the GDG Wrote the final document.

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Role of the GDG• Attended 7 all day development meetings• Contributed constructively, acknowledging the

equal standing of each group member.• Helped technical team refine and develop review

questions• Considered and debated evidence.• Developed recommendations based on the

evidence and GDG consensus• Helped write the guideline • Debated and prioritised areas for quality standards

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Guidance Development - Sources of evidence

• Review of existing patient experience frameworks• Patient Experience Scoping Study – focused thematic

qualitative overview, identifying key themes• Review of NHS Survey Results• Review of existing NICE guidelines extracting

recommendations related to patient experience• Selected systematic literature reviews for specific

interventions (eg. Decision Aids)

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GDG evidence interpretationGDG evidence interpretation

A powerful combination of :A powerful combination of :• Patients (40% of the group)Patients (40% of the group)• CliniciansClinicians• General PractitionerGeneral Practitioner• Specialist NursesSpecialist Nurses• Allied Health ProfessionalsAllied Health Professionals• Public Health SpecialistsPublic Health Specialists• Academic researchersAcademic researchers• Technical team membersTechnical team members

Rapid synthesis of multiple Rapid synthesis of multiple sources distilling into evidence sources distilling into evidence and consensus shaped and consensus shaped recommendations.recommendations.

These inform the development These inform the development of indicators for measuring of indicators for measuring what ‘quality looks likewhat ‘quality looks like’. ’.

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Identified themesThe following key themes were identifiedwhich underpinned 67 recommendations;1.Knowing the patient as an individual2.Essential requirements of care3.Tailoring healthcare services for each

patient4.Continuity of care and relationships5.Enabling patients to actively

participate in their care.

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1. Knowing the patient as an individual

• Patients appreciate being recognised and treated as individuals by health care providers. It is an essential component of the patient experience.

• Recommendation:Develop an understanding of the patient as an individual, including how the condition affects the person, and how the person’s circumstances and experiences affect their condition and treatment.

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2. Essential requirements of care• Recognition of all aspects of patient needs: respect,

patient concern, nutrition, pain management, personal needs, patient independence , consent and capacity

• Recommendation:All staff involved in providing NHS services should;

• treat patients with respect, kindness, dignity, compassion, understanding, courtesy and honesty

• Respect the patient’s right to confidentiality • Not discuss the patient in their presence without

involving them in the discussion

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3. Tailoring health care services for each patient

• The importance of:– an individualised approach to services taking into account patients

views and preferences– involving family members and carers– Acknowledging the place for feedback and complaints

• For example:Adopt an individualised approach to healthcare services that istailored to the patient's needs and circumstances, taking intoaccount their ability to access services, personal preferences andcoexisting conditions. Review the patient’s needs andcircumstances regularly.

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4. Continuity of care and relationships

• Highlighting the need for appropriate communication enabling continuity of care between service providers. Ensuring continuity of care appreciating the impact this has on the patient.

• Recommendation:Assess each patient’s requirement for continuity of care and how that requirement will be met. This may involve the patient seeing the same healthcare professional throughout a single episode of care, or ensuring continuity within a healthcare team.

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5. Enabling patients to actively participate in their care

• The understanding that patients need and appreciate clear and accurate communication, information, the opportunity for shared decision making.

• The necessity for evidence based patient education programmes

• For example:All staff involved in providing NHS services should have demonstrated competency in relevant communication skills.When discussing decisions about investigations and treatment, do so in a style and manner that enables the patient to express their personal needs and preferences.

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Quality standard

What is a quality standard?

A quality standard defines best practice through 14 specific, concise quality statements, plus measures to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care

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Examples of quality statements• Patients are treated with dignity, kindness,

compassion, courtesy, respect, understanding and honesty

• Patients are made aware that they have the right to choose, accept or decline treatment and these decisions are respected and supported.

• Patients have their physical and psychological needs regularly assessed and addressed, including nutrition, hydration, pain relief, personal hygiene and anxiety.

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To conclude:• Guidance and quality standard are the evidence

and expert consensus base to create sustainable change.

• Produce care that is effective, acceptable and appropriate for patients.

• The generic nature of this guidance makes it internationally transferable and applicable to other healthcare environments.

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NCGC international involvement• Oman Evidence translation and

Utilisation Programme• Collaboration with the Belgium Health

Care Knowledge Centre• International model of support

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NCGC website: www.ncgc.ac.ukNICE website: www.nice.org.uk

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Thank you for listening!

Thank you to the GDG

For more information please contact me:Liz Avital

Liz.Avital@rcplondon.ac.uk