128. Evidence submitted by Dr John Hyslop
(PPI 11)
Patient Centred Feedback, A Voice for Each Patient
1. To be effective quality management/clinical
governance needs be aligned with the clinical management paradigm
but also with the patient. Quality cannot improve without feedback.
Patients and peers should be able to inform clinical team leaders
of good and bad services.
2. The current feedback/survey tools are
non-specific, post-dated, selective and drip down, rather than
directed to the point of managing service change, the clinical
team leader.
3. The proposal is anonymous electronic
patient feedback via domain portals associated with the Electronic
Health Record. The feedback is specific to that episode of team
service, being identified through Healthspace or Choose and Book.
4. Feedback is a tool to place quality central
to service delivery imbedded where the commissioners' money goes.
The final common denominator closest to patient care delivery
is the clinical team and therefore the emphasis in delivering
all feedback and the quality agenda should be at this dynamic
level.
5. As a benchmarking exercise the patient
perspective can also inform fellow patients, commissioners, and
the Healthcare Commission.
6. Patient complaints generate a lot of
work and consume enormous management and clinical time. This could
be improved by some integration with patient feedback.
7. Human interaction and resolution is led
through dialogue. Feedback formally creates that dialogue where
it might not exist. It is "offer and response" as in
any negotiation and as such engages the patient, the individual,
with the service. That engagement at clinical team level will
influence the good to do better and the bad to change their game,
not least because the dialogue is on the record and cannot be
ignored. Feedback, therefore, is a persuasive tool that permeates
all aspects of service delivery not just as a point of reference
but also as a flag of quality of care.
8. The relationship created is constructive,
gives voice and responsibility to, whilst engaging with, the patient.
9. There are thus benefits for the patient,
the service, each team and subsequent patients.
10. The patient benefits:
Gives each patient a voice, guaranteed
to be heard.
Other patients can review service
choices alongside a feedback graphic.
Engages the individual patient.
Good and poor services can be commented
on.
Individual views can be raised in
an anonymous format without stigmatisation.
Patients would know that their feedback
is on the record to influence service development.
They can become engaged in an active
dialogue to resolve issues.
Values the patient's perspective.
Enhances the patient role beyond
representative "expert patients".
11. The service gains:
A tool to integrate quality, clinical
governance and management into clinical team service delivery.
A Feedback summary, informs PAL's,
team leaders, institutions, the commissioners and the Healthcare
Commission.
The feedback and actions arising
are on the record.
Feedback on services can be audited.
Clinical governance is integrated
with robust evidence at each team level.
The role of patient advocates and
PALS is supported.
Discreet and separate from but informs
critical incident reports and complaints.
Good and poor services will be highlighted
leading to best management through clinical governance.
Issues that might generate complaints
could be actively managed with a timeline of evidence and process.
Norms of service will be determined
(benchmarking).
Clinical team leaders' actions and
response to feedback will be on the record.
Professionals will spend time on
feedback, practice reflection and audit of practice.
Institutions will have a record of
quality, of a benchmarking of services teams and professionals.
Teams will know what patients think
of their service.
Feedback can generate an active engaged
dialogue to resolve issues.
Creates a non-adversarial routine
patient-centred quality initiative to influence service quality,
delivery, professional practice and healthcare commissioning.
Foundations of an evidence-based
constructive complaints system and process.
12. The professional gains:
Professional feedback can be noted
within the appraisal folder informing revalidation.
Complaints should have a feedback
record/timeline for reference.
Past feedback can support responses
to complaints.
Professionals will spend time on
feedback, practice reflection and audit of practice.
Professionals can contribute to resolve
issues and influence local services to improve.
Feedback files are "associated"
with the professional, the team and the institution.
13. The clinical team leader benefits by:
Allows quality to drive the change
agenda.
On the record feedback of good and
poor delivery.
On the record service change response
to feedback.
Helps guide team meetings and service
change planning.
Enables immediate response to issues
or poor service.
Feedback and responses/changes are
on the record with clear justification.
Teams will know how their service
and professionals are perceived.
14. The current mish-mash of delivery of
quality and clinical governance reflect its non-core position
and lack of integration. The positioning of patient feedback as
an anonymous tool at the level of the clinical team leader will
integrate clinical governance into commissioning and delivery.
15. How to take this forward? Briefing papers
confirm it's within the art of the possible from choose and book
episode or healthspace. The concept of patient feedback enjoys
support of the Healthcare Commission, Harry Cayton, Marlene Winfield,
(Head of Public Engagement Connecting for Health), Richard Jeavons,
Monica Clark,(Patient Experience Team), Dame Eve Buckland, and
with passing interest by Sir Michael Rawlins and Professor Paul
Corrigan. But it is not policy, or funded yet. It is likely to
be cheaper and more direct/timely, thus responsive, than current
postal patient "surveys".
16. There are external models of patient
feedback but these are not ubiquitous, contemporaneous, routine,
care episode identified and directed to the relevant clinical
team leader. A Healthspace feedback domain can be all these things.
Dr John Hyslop
Consultant Radiologist, Royal Cornwall Hospital NHS
Trust
21 December 2006
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