"Patient Opinion" brings balance to the forces of healthcare scrutiny, feedback and improvement

We're pleased to bring you our first guest blog of 2016 from Ian Reeves, Geriatrician, Glasgow, which brings his perspective of the complementary role Patient Opinion can play in scrutiny and improvement activity.   We'd love to hear your views too so please, if you have the time, comment and share too.  Thanks

A long time ago in a ward far far away….

Scotland has a healthcare scrutiny process run by a pretty positive and progressive organisation called Healthcare Improvement Scotland (HIS). As well as scrutiny and inspection, they are the engine that powers a world renowned process of improvement in patient care called the Scottish Patient Safety Programme. They are much more than just the quick labelling of organisations as failing by the big stick of the CQC in England.

However, healthcare scrutiny is complex, and HIS still have a limited toolbox of methodologies, which doesn’t take simultaneous account of other forms of feedback, such as Patient Opinion.

In general, we tolerate this, levels of disagreement are low. Although they are limited in limited in scope, HIS reports are a reasonable commentary on the care our patients receive. They provide positive comments where care is good, and highlight areas where improvement is still needed.

But what happens when you have significant conflicting evidence, a disturbance in the force of healthcare scrutiny?

Ward 56 at Queen Elizabeth University Hospital in Glasgow is a ward for the rehabilitation of patients who have suffered a stroke. I declare a conflict of interest here, I used to work in it.

I also help monitor our Board responses to Patient Opinion, so it was interesting to see an awakening of three positive stories about the care in ward 56 posted on Patient Opinion earlier this year. Here they are:

Posted by govanman5 (as the patient),

I have nothing but praise for the amazing angels on ward 56

I suffered a minor stroke and was admitted to 56 after spending the night in 1c. The difference between the two wards is unbelievable. Friendly staff in 56 and disdainful staff in 1c in my opinion.

I was greeted by 2 nurses, and nothing was a bother to them (even my constant use of the patient call system). They answered me everytime with a smile (and kept me smiling with their chat)

So thank you ward 56

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Posted by praise for 56 (as a relative),

My elderly relative was a patient in ward 56 for over a month. I can’t say enough about the wonderful staff in this ward.

Always smiling and cheery. Patient care was fantastic.

The only complaint I have is about other relatives. Rude is one word that springs to mind, they spoke to all the staff as if they were dirt on their shoes. I even heard a relative calling the staff slaves!

Also visiting time. I thought the 2 visitors to each bed rule was still in place? Well obviously not as sometimes there was no chairs for visitors because some patients had 6 visitors round them!

Again, nothing but praise for ward 56 staff who work short-staffed. Night shift only 4 or 5 staff on! Dayshift 6 or 7.

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Posted by Friend544 (as the patient),

The standard of care from all staff on Ward 56 has been superb. The levels of cleanliness are exceptional. Would like to get regular updates on progress without feeling encroaching on staff duties.

Parking throughout the hospital is abysmal. Why are patient and visitors allowed to stand smoking beside large signs which declare smoking to be banned?

The Wi-Fi signal is too weak to use any equipment in the ward.

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HIS made an unannounced visit to QEUH, including ward 56 in October 2015, and there was a significant difference in their findings, and these Patient Opinion stories.

The report findings included the observation that ward 56 was short staffed, and that patients’ nutritional needs were not being adequately assessed or monitored. This report was released in December 2015, and was duly noted by the national (scottish) press. This was despite specific information provided by the health board that the patient wasn’t ‘starved’.

Making the front page of the newspapers and seeing TV cameras outside your door is never a good for staff morale,

and the media pack had their day, gnawing on a tasty healthcare story bone.

The press headlines were:

The case was more complex, but this clinical subtlety was apparently missed by the HIS team, and the press drew their own rather sensationalised conclusion. The press reports didn’t mention the fact that the ward was short staffed.

The family of the patient, weren’t concerned, the clinical team weren’t ‘starving’ a patient. This subtlety was lost in the scramble for a good headline. Clearly if a patient was being starved were this would be a genuine GMC/NMC issue, and you would rightly expect a formal enquiry. There isn’t one planned. There doesn’t need to be. The GGC Health Board internal discussion can be seen in the paper in the links at the end.

I’m left struggling to reconcile the conflicting evidence and outcome from these different sources. Is the ward as good as the Patient Opinion stories? Is the ward as bad as the press stories? Or is the truth — as usual — more complex and subtle.

Patient Opinion stories are shared with staff, and posted on our walls in a similar way to our thank you cards. Here’s a word cloud made from the stories in the thank you cards from one of our wards.

                                Word cloud from contents of thank you cards

These cards and Patient Opinion stories can help to provide positive support for staff, and reassurance for other patients and relatives, that the press reports aren’t a universal and unstoppable ‘truth’.

I’ve read the Patient Opinion stories again, since the press reports came out. I needed another look at them, and I found they put the press reports into perspective.

Scrutiny of healthcare services is needed, but it can be brutal and clumsy. The damage to staff confidence and morale is considerable.

Don Berwick from IHI recently concluded that in ‘Era Three' we will need to stop excess measurement, this story is a good illustration to support this premise.

http://www.hhnmag.com/articles/6798-don-berwick-offers-health-care-9-steps-to-transform-health-care

I have concluded that we need both good and bad, Dark and Light sides of the healthcare scrutiny ‘force’, to keep both in balance.

In the case of Ward 56, the ‘First Order’ of healthcare scrutiny was balanced by the ‘Resistance’ of Patient Opinion.

@iangarethreeves

These views are my own and not in any way related to my work with any healthcare or healthcare scrutiny organisations.

HIS Care of older people inspection reports

Stories about Ward 56 on Patient Opinion

Scottish Patient Safety Programme