the best possible start harnessing women’s experiences of maternity services
TRANSCRIPT
THE BEST POSSIBLE START
Harnessing Women’s Experiences of Maternity Services
Context: The Healthcare Quality Strategy
3 key quality dimensions: Safe, Clinically Effective & Person-Centred
Improving person-centredness Identified priority areas for action include:
Supporting staff, patients and carers to create partnerships which result in shared decision making
Informing and supporting people to maintain their health and to manage ill health
Improving and embedding patient reported outcomes and experience across all NHS services
Improving the Care Experience
“ It is important to guard against the rise of a measurement industry that detaches caregivers and frontline staff from patients and their experiences by focusing too heavily on quantitative measures and statistical indicators”1
1 King’s Fund Point of Care Programme: Seeing the Person in the Patient (2009)
Instead a range of approaches is needed to gain a better understanding of the care experience and to inform priority areas for improvement.
Improving the Care Experience
Good Practice in Service User Involvement in Maternity Services [SHC, 2010]
Recommendations
o Make better use of ‘static’ timeo Make greater use of familiar technologieso Work more closely with third party providerso Use existing contacts with service users to widen
participationo Involvement opportunities reflect women’s experiences and
preferences
o Provide meaningful feedback (quality of feedback as well as number of tangible improvements)
Using Maternity Service User Experiences - Examples from Practice
Neonatal Jaundice & Phototherapy Treatment – using service user experience to inform the business case for new equipment procurement [NHS Orkney]
Lifestyle Information – service user pre-questionnaire and feedback on the ‘Big Bump’ DVD [NHS Lanarkshire]
Breastfeeding Support Groups – using service user experiences to inform improvements and location choice [Various Health Boards]
“The most important barriers to implementing changes as a result of patient feedback are defensiveness from clinical staff and a lack of a patient-centred culture”
Building on the Experiences of NHS Boards, Patient Perspective Better Together: Scotland’s Patient Experience Programme, Nov 2008
o Listening to the stories of those involved at all levels in health care is essential in overcoming these barriers
o Stories underscore the importance of understanding each person in the wider context of his or her life
o And can offer a less direct call to action – actively involving listeners in co-creation of an idea and giving them space to think
Harnessing Experience
Key Challenges
o How to integrate story work into every day practice in busy local care settings?
o How to develop and personalise approaches?
o How to create a safe and supportive environment that encourages seeking and responding to feedback?
Introducing Emotional Touch points
Touch points are the moments where the user interacts with the service, or aspects of the service
The aim is to identify critical moments that have shaped the experience overall
Service users are invited to identify touch points that identify the best part of the experience or the worst
They can add a touch point if it is missing from the presented ‘care journey’
Users are then invited to pick an emotion (word or image) that best describes how they felt at that point
Introducing Emotional Touch Points
Introducing Emotional Touch Points
The service user is then:
Invited to say why they felt this way Invited to say what could have been different, if appropriate Given the typed up story of the experience to review and change as
required
The approach has been used:
To capture outpatient and community care experiences retrospectively in the context of Experience Based Design [NHSIII; Bate and Robert, 2007]
To gather experiences in ‘real time’ in a diverse range of inpatient care settings [Leadership in Compassionate Care programme, NHS Lothian and Napier University]
Introducing Emotional Touch Points Identified benefits include:
Helping service users to get in touch with their own experience Challenging assumptions about what matters Developing relationships between service users and staff Helping to see positive and negative aspects of experiences Supporting service user and family involvement in service improvements Redressing the power imbalance between interviewer and service user
Dewar B et al (2009): Use of emotional touchpoints as a method of tapping intoThe experience of receiving compassionate care in a hospital setting.
J Research Nursing 15(1) 29-41
Reflecting on Experience
Reflecting on Experience
Focus on both positive and negative experiences at all levels of influence
Focus on experienced reality Vs factual reality
Focus on common and divergent issues
Think about the ‘hidden’ factors influencing the experience at each level, both human and organisational
Reflecting on Experience
Sense-making – individual perceptions e.g. “you’re treated differently because you’re on methadone” Vs “took extra care of me because of my history of depression”
Impact of other service users e.g. feeling bad about being put with mothers actively using drugs in post-natal ward Vs “I forgot how to bath my baby – another patient showed me how”
Interpersonal interaction with staff e.g. “She asked my permission even though I was half out of it ” Vs “she wasn’t bothered about me, I was just told what was to happen”
Reflecting on Experience
Local team / care setting: e.g. antenatal class times, mum not allowed into pre-labour ward during ‘partner’ visits, limited post-natal ward orientation, unable to accommodate visits by Chinese family who worked unsocial hours, unable to obtain halal meat
Interagency working: e.g. sharing out of date information, communication about / management of transitions
Wider context: resource issues, access and waiting times, education, governance, culture
Source of examples:
Equalities in Health. Inequalities Sensitive Practice Initiative. Analysis of the Maternity Services User Engagement Survey. Final Report
Harnessing Experience
There needs to be a strong connection between story and action
Start with the areas of direct influence Recognise areas of good practice and think about how these
could happen more often Try to genuinely understand why negative experiences have
occurred and what could be done to reduce these Pull out key messages and (where necessary) turn into positive
‘best practice’ statements Develop action plans for change Feedback changes made – check responses resonate with
service users
Karen Barrie
National Development Manager (Story Work)
Better Together Programme
Scottish Government
Mobile: 07756 778271