nice guidance and quality standard on patient experience dr sophie staniszewska, chair of nice...

NICE Guidance and Quality NICE Guidance and Quality Standard on Patient Standard on Patient

ExperienceExperience

Dr Sophie StaniszewskaDr Sophie Staniszewska,,Chair of NICE Guidance Development GroupChair of NICE Guidance Development GroupRoyal College of Nursing Research InstituteRoyal College of Nursing Research Institute

School of Health and Social StudiesSchool of Health and Social StudiesUniversity of WarwickUniversity of Warwick

Key initiativesKey initiatives Importance of patient experienceImportance of patient experience Darzi (2008): High quality care for allDarzi (2008): High quality care for all NHS Constitution (2009-2010)NHS Constitution (2009-2010) White Paper: Equity and Excellent: White Paper: Equity and Excellent:

Liberating the NHSLiberating the NHS NICE Guidance – direct referral from NICE Guidance – direct referral from

DHDH

Nature of evidence Nature of evidence NICE Guidelines normally developed NICE Guidelines normally developed

around clinical and economic around clinical and economic evidence evidence

Patient experience has drawn on Patient experience has drawn on patient-based evidence of patient-based evidence of experiencesexperiences

Patient-based evidence can sit Patient-based evidence can sit alongside clinical and economic alongside clinical and economic forms of evidence forms of evidence (Staniszewska et al 2010)(Staniszewska et al 2010)

GuidanceGuidance A set of recommendations focusing on A set of recommendations focusing on

key aspects of patient experiencekey aspects of patient experience Informed by: Informed by: Research evidenceResearch evidence Recommendations in previously Recommendations in previously

published NICE guidelinespublished NICE guidelines National survey data National survey data Synthesised through consensus processSynthesised through consensus process

Quality standard Quality standard QS developed alongside guidanceQS developed alongside guidance QS are set of specific, concise QS are set of specific, concise

statements and associated measures statements and associated measures Aspirational, but achievableAspirational, but achievable Markers of high-quality, cost Markers of high-quality, cost

effective care effective care Derived from best available evidenceDerived from best available evidence

Focus of Guidance Focus of Guidance Directed primarily at clinical staffDirected primarily at clinical staff Patient experience is also affected by Patient experience is also affected by

non-clinical staff such as non-clinical staff such as receptionists, clerical staff and receptionists, clerical staff and domestic staffdomestic staff

Reflects entirety of patient Reflects entirety of patient experienceexperience

NICE Guidance: Key NICE Guidance: Key areas areas

Knowing the patient as an individualKnowing the patient as an individual Essential requirements of care Essential requirements of care Tailoring healthcare services for each Tailoring healthcare services for each

patient patient Continuity of care and relationshipsContinuity of care and relationships Enabling patients to actively Enabling patients to actively

participate in their care participate in their care

Knowing the patient as Knowing the patient as an individual an individual

Patients value healthcare Patients value healthcare professionals acknowledging their professionals acknowledging their individuality individuality

Values, beliefs and circumstances Values, beliefs and circumstances influence expectations, needs and influence expectations, needs and service useservice use

Recognition individuals are living with Recognition individuals are living with condition, so family and broader life condition, so family and broader life need to be taken into account need to be taken into account

Example: Example: Recommendation 1.1.1Recommendation 1.1.1

““Develop an understanding of the Develop an understanding of the patient, including how the condition patient, including how the condition affects the person, and how the affects the person, and how the person’s circumstances and person’s circumstances and experiences affect their condition experiences affect their condition and treatment” and treatment”

Essential requirements Essential requirements of care of care

Patients have needs other than the Patients have needs other than the treatment of a specific health treatment of a specific health conditioncondition

Recognition of potential need for Recognition of potential need for psychological and emotional supportpsychological and emotional support

Importance of meeting fundamental Importance of meeting fundamental needs – nutrition and pain needs – nutrition and pain managementmanagement


Respect for the patient: All staff providing Respect for the patient: All staff providing NHS services should:NHS services should:

Treat patients with respect, kindness, Treat patients with respect, kindness, dignity, compassion, understanding, dignity, compassion, understanding, courtesy and honestycourtesy and honesty

Respect the patient’s right to Respect the patient’s right to confidentialityconfidentiality

Not discuss the patient in their presence Not discuss the patient in their presence without involving them in the discussion without involving them in the discussion

Tailoring healthcare Tailoring healthcare services for each patient services for each patient Patients wish to be seen as Patients wish to be seen as

individuals in the healthcare systemindividuals in the healthcare system Services need to be tailored to Services need to be tailored to

respond to needs, preferences and respond to needs, preferences and values of the patientvalues of the patient

Advice on treatments and care, Advice on treatments and care, including risks and benefits should be including risks and benefits should be individualised as much as possible individualised as much as possible

Example: Example: RecommendationRecommendation 1.3.1 1.3.1

Adopt an individualised approach to Adopt an individualised approach to healthcare services that is tailored to healthcare services that is tailored to the patient’s needs and the patient’s needs and circumstances, taking into account circumstances, taking into account their ability to access services, their ability to access services, personal preferences and coexisting personal preferences and coexisting conditions. Review the patient’s conditions. Review the patient’s needs and circumstances regularlyneeds and circumstances regularly

Continuity of care and Continuity of care and relationshipsrelationships

Continuity and consistency of care Continuity and consistency of care and establishing trusting, empathetic and establishing trusting, empathetic and reliable relationships with and reliable relationships with competent and insightful healthcare competent and insightful healthcare professionals is key to patients professionals is key to patients receiving effective, appropriate carereceiving effective, appropriate care


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

Enabling patients to Enabling patients to actively participate in actively participate in

their care their care Many patients wish to be active Many patients wish to be active

participants in their own healthcare, participants in their own healthcare, and to be involved in creating and and to be involved in creating and managing their health strategy and managing their health strategy and use of services. Self-care and self-use of services. Self-care and self-management are particularly management are particularly important for people with long-term important for people with long-term conditionsconditions


Establish the most effective way of Establish the most effective way of communicating with each patient and communicating with each patient and explore ways to improve communication. explore ways to improve communication. Examples include using pictures, Examples include using pictures, symbols, large print, Braille, different symbols, large print, Braille, different languages, sign language, languages, sign language, communication aids, or involving an communication aids, or involving an interpreter, a patient advocate or a interpreter, a patient advocate or a family memberfamily member

Examples of quality Examples of quality statementsstatements

1. Patients are treated with dignity, kindness, 1. Patients are treated with dignity, kindness, compassion, courtesy, respect, compassion, courtesy, respect, understanding and honestyunderstanding and honesty

2. Patients experience effective interactions 2. Patients experience effective interactions with staff who have demonstrated with staff who have demonstrated competency in relevant communication competency in relevant communication skillsskills

3. Patients are introduced to all healthcare 3. Patients are introduced to all healthcare professionals involved in their care, and are professionals involved in their care, and are made aware of the roles and responsibilities made aware of the roles and responsibilities of the members of the healthcare team of the members of the healthcare team


4. 4. Patients have opportunities to Patients have opportunities to discuss their health beliefs, concerns discuss their health beliefs, concerns and preferences to inform their and preferences to inform their individualised careindividualised care

5. Patients are supported by 5. Patients are supported by healthcare professionals to healthcare professionals to understand relevant treatment understand relevant treatment options, including benefits, risks and options, including benefits, risks and potential consequencespotential consequences


6. Patients are actively involved in shared 6. Patients are actively involved in shared decision making and supported by decision making and supported by healthcare professionals to make fully healthcare professionals to make fully informed choices about investigations, informed choices about investigations, treatment and care that reflect what is treatment and care that reflect what is important to themimportant to them

12. Patients experience coordinated care 12. Patients experience coordinated care with clear and accurate information with clear and accurate information exchange between relevant health and exchange between relevant health and social care professionalssocial care professionals

Implementation Implementation Translating guidance into practice Translating guidance into practice

offers considerable challengesoffers considerable challenges Uneven progress relates to Uneven progress relates to

complexity of process, with change complexity of process, with change required at many different levels and required at many different levels and depends on range of factors that depends on range of factors that influence uptakeinfluence uptake

Even more challenging for complex Even more challenging for complex guidance guidance

Implementation supportImplementation support NICE encourages commissioners in a NICE encourages commissioners in a

range of ways:range of ways: One of the factors used to judge tendersOne of the factors used to judge tenders Ask providers to evidence of systems for Ask providers to evidence of systems for

collecting and using patient informationcollecting and using patient information Audit of local practiceAudit of local practice Collection of information across whole Collection of information across whole

service pathway service pathway

Implementation Implementation evidence-baseevidence-base

Implementation strategy needs to draw on Implementation strategy needs to draw on implementation evidence-baseimplementation evidence-base

Draw on existing frameworks eg. PARIHS Draw on existing frameworks eg. PARIHS Promoting Action on Research Promoting Action on Research Implementation in Health Services Research Implementation in Health Services Research

Implementation is function of nature of Implementation is function of nature of evidence, context of implementation and evidence, context of implementation and way in which process if facilitatedway in which process if facilitated

Core thinking could inform implementation Core thinking could inform implementation strategies strategies

Implementation Implementation

““Support for commissioners and others Support for commissioners and others using NICE Guidance and Quality using NICE Guidance and Quality Standard on patient experiences in NHS Standard on patient experiences in NHS services” available on NICE website services” available on NICE website

http://www.nice.org.uk/media/AA2/92/NICESupportForCommissionersAndOthersUsingThePatientExperienceQS.pdf

Staff training and development resourcesStaff training and development resources

NICE Guidance NICE Guidance Taken together, the NICE Guidance Taken together, the NICE Guidance

and Quality Standard captures the and Quality Standard captures the essence of good patient experienceessence of good patient experience

Implementation will ensure healthcare Implementation will ensure healthcare services are acceptable and services are acceptable and appropriate appropriate

Contribute to ensuring all people Contribute to ensuring all people using NHS have the best possible using NHS have the best possible experience of care experience of care

ContactContact [email protected] Royal College of Nursing Research Royal College of Nursing Research

Institute, School of Health and Social Institute, School of Health and Social Studies, University of Warwick Studies, University of Warwick

nice guidance and quality standard on patient experience dr sophie staniszewska, chair of nice...

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