The Big Feedback
What people said in The Big Health Conversation
The Big Health Conversation (BHC) was what we called our public and stakeholder consultation in year three of our five year strategy which took place between May and August 2009.
Our goal was to reach out to a representative sample of Sheffield’s population and our efforts notched up nearly one million contacts with people - some people will have been informed in more than one way - eg postcard, listened to the news on the radio, read the newspaper, saw a bus advert etc.
Around 5,000 people were directly asked to take part and 2,243 gave us their views.
The detailed feedback will inform the refresh of our strategy Achieving Balanced Health 3, due out in November - and we’ll be letting people know about it shortly after.
The Big Health Conversation asked four questions:
- How should we decide what and what not to spend NHS money on?
- How can we improve the healthcare experience for patients?
- How can we improve the safety of patients?
- How can we measure the success of patient treatment?
The headline feedback
- Measures that help to prevent and educate, cost effectiveness, transparency and the ongoing need to involve patients and the public in decision making process were seen as key issues to addressing how to decide what and what not to spend NHS money on.
- More personalised services that meet the individual needs of patients, better information to manage own care, communication between patients and healthcare staff, the physical environment and the questioned necessity of some out patient appointments were seen as the key issues to addressing how to improve the healthcare experience for patients.
- Cleanliness, shared information for all health professionals to access, better security and training and developing staff were all seen as the key issues to addressing how to improve the safety of patients.
- Patient feedback mechanisms, more sophisticated evaluations and measuring the quality of life (not just clinical outcomes) were seen as the key issues to addressing how to measure the success of patient treatment.
The detailed feedback - what Sheffield people said
These are the wider themes that emerged from the consultation:
How should we decide what and what not to spend money on?
A young person told us: "Ask us to vote!"
"Do things like this (a new mums group) that are cheap, easy to run and reduce need for patients to use health visitors for some stuff that simple support from other new mums offers."
"Spend on things that will improve people’s lives."
"Spend in areas that will benefit the greatest number of patients."
- Measures that facilitate prevention and education – people should take some personal responsibility for their own health, and there should be better education and research into prevention rather than cure.
- Greater involvement in decision making and involving the public more - the need to involve patients and the public in the decision making process by listening to their views and experiences and to encourage inclusiveness was emphasised. Connected to this, it was suggested that greater public transparency about treatment costs would focus attention on what is important.
- Cost effectiveness - cost effectiveness was identified as an important criterion for making spending decisions. Choices about spending NHS money should reflect the benefit that patients get from treatment and we should be able to compare the cost benefits of different options.
- Holistic care - decisions should be made on whether services were directed towards improving the care of the ‘whole person’, rather than finding a cure for a specific problem.
- Co-operative negotiation - decision making should involve a more cooperative approach between commissioners, their partners and providers, particularly in view of the tightening economic situation ahead.
- Transparency of process - before decisions are made, greater transparency is needed about current spending patterns. Decisions about future spending need to be made in the context of how money is spent now, and the reasons behind this.
- Impact of transferring care - decisions about spending should take into account that transferring services out of secondary care will increase the burden on carers.
- Organisational priorities - decision making should be shaped by the organisations’ objectives. This would involve prioritising areas where health is poorest and focussing on improved quality of life.
- Balance between different parts of the service - any changes in spending must ensure that the balance between services is correct. This means ensuring there is a balance between hospital care, intermediate care and GPs.
Improving the healthcare experience for patients
One young person told us: “My doctor never speaks to me, he always talks to my mum.”
“They always talk in a language you don’t understand – all big words – why can’t they use everyday words so I can understand them?”
“When my husband was dying in hospital I just wanted someone to come over and give me a cup of tea. I was sat at his bedside for hours and was scared to leave in case something happened to him. It sounds silly, but that would have made a world of difference.”
“Ask people to ‘sign-off’ that they are happy with the treatment they have had.”
- More personalised service - there was strong support for services to be organised to meet the individual needs of patients, rather than for organisational efficiency. More ‘customer care’ was requested, where the patient, and not just their condition was the focus of care.
- Being spoken to appropriately - part of the personalised service involves patients feeling that they are being spoken to appropriately and in a way that recognised their own language and knowledge levels, and not in a standard predetermined format.
- Provide better written information for patients - groups wanted to receive appropriate written information specifically related to the various points in their treatment pathway, including discharge, aftercare and self management.
- Out patient appointments - hospital out-patient appointments were seen as not always necessary. Inconvenience is caused when patients have to take a day off work for what is seen as a simplistic check up, only to be told during a consultation lasting a few minutes, that they are okay and need to come back in a year.
- Confidence in staff knowledge - healthcare experience would be improved if patients felt confident that staff were properly trained in relation to their specific condition.
- Contribution of volunteers - volunteers could have a greater role in improving patient experience. It was felt that more use could be made of volunteers to carry out routine tasks to improve the quality of the stay in hospital.
- More consistent level of service - concerns were expressed about perceived variation in GP services across the city. Patients reported their experience of some specialist services not being available in some areas of the city and not being as inclusive as they thought they should be.
- Improve the physical environment - suggested improvements included the need to improve the physical access to the hospital site including maintenance of pavements, providing pedestrianised areas, and signage.
- Making the stay more comfortable - improvements in food quality were requested as this contributed to a patient’s recovery. Menu choices should also reflect the needs of different ethnic groups.
- Car parking - poor car parking for visitors at all hospitals was a source of annoyance, and charges were seen as unfair.
- Involve patients in planning services - service planners should listen to patient groups more, especially expert patient groups and to take their views more seriously.
- Patient and visitor behaviour - patients and their visitors should be encouraged to behave more responsibly on the wards.
- Seamless service - the need for a ‘seamless’ continuity of care between different health professionals during a patient’s treatment was suggested, perhaps with one person coordinating the patient journey.
- Better discharge arrangements – patient experience could be improved by discharge arrangements that made better planning for care outside the hospital setting. This would be more likely to avoid readmissions.
Improving the safety of patients
“I’m worried about MRSA and hygiene. Make people aware and educate people on how to use gels etc.”
“Cleanliness should be the number one priority.”
- Cleanliness - preventing infection whilst in hospital should be a priority.
- Security - the importance of strengthening physical security in hospitals and care homes was reported by the groups. Suggestions called for more practical and visible measures.
- Sharing clinical information - patients wanted to feel confident that information about their health was available to all relevant health professionals at any point in the service.
- Training and development of staff and clinicians – updated training on a regular basis with training given to cascade down to staff at all grades.
- Clearer information - clearer communication about taking medication would improve safety. Again this was about the information being presented in a friendly ‘customer-centred’ way
- Physical environment - suggested safety improvements to the physical environment within hospitals included the need to prevent falls by improving pavements and providing better lighting.
- Information about hospital stays - it was felt that more patient information could be provided about how to stay safe in hospital and this could be backed up by campaigns to promote health and safety in the hospital environment.
- Risks - making better use of the experience of expert patient groups could help to identify areas of risk in specific situations relating to their condition. Risks were also regarded as increasing when hospitals are short staffed, or use inexperienced staff.
- Risk from discharge plans - it was felt that patients were sometimes discharged too early, which put them at greater risk, and could lead to readmission.
Measuring the success of patient treatment
“Ask us what we think, patients know.”
Most people we spoke to said they wanted their feedback ‘to be anonymous’ or ‘done by someone independent’. They didn’t want to ‘hand back information to a member of staff’.
"By keeping in contact and having a chat with people (about their treatment).”
- Provide patient feedback mechanisms - the importance of providing patients with processes to give feedback on their experience at various stages of their treatment was frequently mentioned. This also included asking family and carers and some consideration was given to developing patient advocates.
- More sophisticated evaluations - the groups also supported the need for more formal research-type processes, such as independent surveys, to quantitatively monitor the effectiveness of treatments.
- Quality of life outcome measures - ‘Success’ should be defined as more than just the clinical outcome. It should also include more quality of life indicators.
- Patient/public involvement in design of measures - full use should be made of patient/carer experience in designing success criteria. Patients/carers should be consulted more in providing feedback on the design of proposed outcome measures.
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