Access QI Collaborative Learning Session 2: Understanding your system: the service user and provider experience

The Access QI collaborative is a partnership between Healthcare Improvement Scotland (HIS) and NHS Education for Scotland (NES), with support from the national Centre for Sustainable Delivery (CfSD). The collaborative is currently helping Gynaecology, Urology, Ear, Nose and Throat (ENT) and other elective care services across Scotland use quality improvement (QI) methods to sustainably and affordably improve waiting times.

At the previous learning session in September 2022, the collaborative teams began learning how to understand their systems, identify system constraints, and decide where to focus their improvement efforts. To continue the improvement journey, the teams came together again virtually in November 2022 for a second learning session about understanding your system, this time with a focus on the experiences of service users and providers.

Sharing learning

To begin the session, a participant from NHS Borders’ MSK physiotherapy team shared insights and learning from his team’s experience of developing a process map after the previous learning session. After mapping their pathway and looking at service data, the team have identified areas with room for improvement, and have begun to discuss potential change ideas that will address them. They hope to create an opt-in system that will reduce the number of patients who do not attend, and also adjust some referral processes to shorten the waiting time for routine appointments. He reflected that the right data, an engaged team, and achievable actions to take forward have all helped set their improvement project up for success.

“On reflection, the timing of applying process mapping is very important, particularly relative to the team’s state of readiness. Because if they’re feeling that they’re taking control, they’re initiating the change, there’s going to be a lot more engagement with it.” - Participant from NHS Borders

Collecting and utilising experience data

Next, the teams were introduced to the main topic of the day: capturing staff and service user experience data, and using it to better understand your system.

There are many useful tools and techniques that can enable services to collect experience data. To make use of information that may already be available, a team could browse Care Opinion for any relevant patient feedback. Any complaints and incidents received by a service can also provide great opportunities for learning and improvement.

There are many other tools that can be used to collect new patient experience data and make improvements informed by service user feedback. These include interviews, focus groups, the Care Experience Improvement Model (CEIM), patient journey mapping, and empathy mapping.

Empathy mapping can help us understand a group of people and communicate our understanding with others. The map template contains a series of questions about people’s thoughts, feelings, motivations, and behaviours, and can help a service better understand how their patients might experience a care pathway. While other tools focus more on facts and hard data, empathy mapping enables a team to think creatively about individual patients’ care experiences and view them from a different perspective.

To further explore this tool, each team went into a breakout room to begin working through an empathy map for a service user in their pathway. Afterwards, they returned to the main group and each team shared what they talked about:

• One team reflected that they were “putting patients into a system that isn’t responsive to them,” in that patients are sometimes being told to call or email another service that may not reply to their query.
• Another team reported that because they are looking to improve treatment time guarantees, it might be difficult to use empathy mapping for a patient’s entire journey. They felt they might benefit from alternative tools such as interviews or questionnaires to collect feedback about parts of the patient journey, like having a diagnostic procedure or being admitted to a ward.
• A different team noted that the biggest ‘pains’ for their patients are logistical issues, like how to get to the clinic and how or where to park their cars. Because many patients find it difficult to attend, they talked about ways they might reduce the need for patients to attend in person, such as telephone appointments.
• One team discussed patients who need support but are resistant to being helped. They considered what an individual might be seeing, hearing, thinking, and feeling throughout their care experience that might cause them to decline that support.

The importance of looking into staff members’ experiences was discussed next. Staff experience data can be collected in many of the same ways as patient feedback. It can be as simple as asking staff what went well for them that day, what could have gone better, and what would they do differently. When staff are happy in their work, the quality of patient care is likely to improve.

The session then touched on different ways to make sense of experience data once it has been collected. Coding data into themes that come up multiple times, such as problems with travelling to the hospital, can help pinpoint some of the larger issues patients or staff face. The themed data can be inserted into a Pareto chart for a visual representation. A run chart can be used to display a particular measure, with notations added to tell the story of the data. For example, staff felt happier at work one week because they were fully staffed and patients were discharged on time.

Next steps

To close out the session, the teams took a few minutes in their breakout rooms to discuss which methods or tools they would use to collect staff and patient experience data, and how they would go about collecting it over the coming weeks and months. They teams shared their plans with each other in the chat box. Their ideas included:

• Using validated questionnaires to collect staff and patient feedback over the same 1 week period.
• Asking their board’s Information Governance team for permission to email feedback forms to patients.
• Develop an anonymised electronic survey for administrative, medical, and nursing staff to complete.
• Capture staff experience data through a focus group, with a focus on bottlenecks in diagnostics.
• Promote the use of Care Opinion.
• Meet with local advocacy groups for people with certain health conditions to learn more about their needs and wants.

The Access QI collaborative’s next learning session will take place in February 2023 and will focus on the theory of change, change ideas, and measurement.