Care Experience Discovery Conversations

This guide describes the method used for holding care experience discovery conversations within the Care Experience Improvement Model (CEIM) approach.

Listening to feedback to improve care and support

Enabling people to have positive experiences of care, treatment and support is an essential component of delivering good person-centred health or social care services, alongside effectiveness and safety.  Doing this at care or support delivery level requires effective leadership and a person-centred culture and values. It also requires health and social care teams to adopt a systematic approach to meaningfully collecting, analysing, learning from and acting on feedback to support quality improvement. The Care Experience Improvement Model is an approach that can enable teams to do this successfully.

Approaches used to gather feedback about health and social care services are often focused on what matters to a service, rather than what matters to the people that the service is designed to support. This can make it difficult to give honest feedback when asked explicit questions about quality or about what could have made things better. Often, people can also find it difficult to make value judgements that require an understanding of how services should work, or without having had different experiences on which to draw a comparison.  They may also be reluctant to do so because of fear that it may impact on their care or support.

Many of these approaches rely on using a survey questionnaire to gather information from as many people as possible in a consistent way, however, surveys predominantly measure satisfaction rather than gaining a depth of insight into experiences of care.  This guide outlines how the Care Experience Improvement Model approach to discovery conversations can be used to systematically gather experience feedback. It does this in a way that more effectively enables teams to make improvements that are meaningful for people who use their services and that make a positive difference for the team.

Experience of care and satisfaction data

Experience data is an affective measure based on emotion. To gather this involves an in-depth exploration of how a person's behaviours, attitudes, and emotions are impacted by a range of interactions, processes, or environments within a health or social care system.

Experience of care is often used as a diagnostic method to help provide an in-depth understanding of the issues and context and can assist in identifying solutions.

Satisfaction data is a cognitive measure that often involves rating how positive someone feels about an encounter.

Satisfaction can be more suited to measuring the impact of changes and tracking how positively an interaction or intervention is being experienced over time.

Experience Discovery Conversations

The Experience Discovery Conversation is a key concept in the CEIM Experience Improvement Model.

A person’s experience starts from their very first contact with the health or social care system through to their last. Therefore it is important to gather feedback in order to truly understand what shapes their experiences right across their journey of care or support.

A care experience discovery conversation is a qualitative inquiry method that is structured to help a person giving feedback to focus on and talk about their specific care or support journey (or pathway), and helps them to offer insights into how they experienced key moments in that journey.

The discovery conversation approach shifts the focus of inquiry from asking a range of close-ended satisfaction questions, based on service-led topics or priorities, to one where the person is asked a small number of broad open-ended questions relating to the person’s experiences across a defined care or support journey. Using this approach generates a natural discussion that can trigger significant memories, emotions or thoughts.

Capturing the detail of these conversations provides depth and context into how a care journey is being experienced and this can be used to identify improvement opportunities. Using this qualitative method gives a unique understanding that would be difficult to gain from a closed-ended question survey.

Although this conversation method has the ultimate goal of identifying opportunities for future improvement, it avoids focusing on asking people to look forward to an imagined improved future that they have yet to experience. It concentrates instead on what has actually been experienced during the care or support journey and in describing the emotions at key points in that journey.

Being ethical and legal

Before planning to use this approach, you should always check and address your organisation’s information governance requirements, which may include the completion of a data protection impact assessment (DPIA).

Good practice would also call for an information leaflet to be prepared for the people you hold a conversation with. This should support the General Data Protection Regulations (GDPR) by outlining what the project is about, how you will use the information you collect, your data protection approach, the person’s privacy rights and who to contact if the person changes their mind about how they want you to use their insights. 

Identifying people to be involved

The Care experience Improvement Model (CEIM) recommends holding care experience discovery conversations at, or close to, the point of care or support. This means that the people invited to feedback may still be receiving some level of care or support from the team, or have recently received care or support services.

The discovery conversation approach is based upon routine qualitative inquiry over time with a relevant subgroup of people who have experience of a particular care journey, support service or pathway. This means that a small number of typical, rather than an exact representative sample, of people will be involved. This requires a convenience sampling method, which simply means inviting people to participate who are easily accessible to you. Selection using this method requires attention to being as unbiased and inclusive as possible and to actively seek to include as many people across a wide a range of characteristics and diversity.

When convenience sampling there is no inclusion criteria, anyone should be able to participate who has the capacity to do so.

How many conversations are needed?

The goal of a discovery conversation is to hear and record detailed experiences. As even one person’s story can provide many ideas for improvement or highlight where a team or individual is providing care or support that has been valued. 

Studies have shown that around 5-6 conversations routinely undertaken each month may be sufficient over time to provide a good picture of the quality of experience of care (Etchells E, 2017).  So, when thinking about the number of conversations needed for improvement purposes we do not need to be constrained by sampling to provide a representative picture of all the users of a service, we simply need to gather feedback consistently over time. 

In the Care Experience Improvement Model approach, a minimum of 6 conversations are undertaken each month.

Assessing capacity to participate or give consent

Involvement using this approach may not be suitable for people who cannot give their permission or consent to participate. For example, if they are too unwell or if they have a cognitive impairment that limits their ability to share their experiences in this way.  When identifying people to be involved in giving feedback it is important to assess their capacity to participate in a care experience discovery conversation in advance.

The Scottish Government’s Adults with incapacity (Scotland) Act 2000: guide to assessing capacity, describes capacity to consent as ‘the ability to understand information relevant to a decision or action and to appreciate the reasonably foreseeable consequences of taking or not taking that action or decision’. Therefore, a person who lacks capacity will not be able to make an informed decision about whether to give feedback or may be unable to engage fully with the method of enquiry being used.

It is important not to assume lack of capacity.  However, where there is no possibility of the person being able to participate, you should then consider how you might gather insights from family members or carers (paid or unpaid), as they may be able and willing to share their experiences of the care or support journey alongside the person.

Supporting people with communication needs

The Care Experience Improvement Model (CEIM) is centred around good communication and using this approach with people who have communication difficulties can sometimes be challenging. People who have Speech, Language and Communication Needs (SLCN) may have difficulties across one or many aspects of communication, such as:

• understanding language (what people say)
• using language (to express their needs, thoughts and wishes), or
• interacting with others (understanding non-verbal rules of communication or using language in different ways to  question, clarify or describe) 

If a person’s communication needs are not understood and addressed, this can lead to less meaningful engagement that is likely to have a significant impact on the use of a discovery conversation approach to understand experiences. This does not however mean that a discovery conversation approach cannot be used with people who have communication needs. Thinking about how we communicate or use language in advance could support the person to engage meaningfully in the conversation.

There are many ways that can effectively support communication to gather and understand experience.  Often a good starting point is finding out if the person has any existing communication strategies or tools they use. For example they may use an AAC device (augmentative or alternative communication); visual communication approaches such as boardmaker, photosymbols or talking mats ™; or a signing system such as Makaton or Signalong.  Carers and relatives may also  be able to help identify communication strategies or supports that will allow you to hear experiences from someone who has speech, language and communication needs.

Planning discovery conversations

Planning how you will approach a care experience discovery conversation is important. Creating a conversation framework (or plan) helps you and the person you will have a conversation with to be clear about the focus of the discussion and its purpose.  It also helps to guide the conversation so it stays on track as much as possible.

It is important to remember that any conversation framework will be unique to the person who created it. In addition, where a single conversation framework is used by multiple people to initiate conversations, the delivery of these are likely to be different because of many factors that include the person’s conversation style, their confidence, their curiosity, or their previous experience in having this type of conversation. As long as the conversation follows the agreed care or support journey pathway and uses a discovery approach, the core data will be consistent but the variation in conversation style may provide an even broader range of insights for the care team.

It is vital that a conversation plan isn’t used as an interview script or a checklist. Its purpose is simply to provide question prompts that help guide the conversation along the care or support journey being explored.

There are four key steps in planning a care experience discovery conversation

Step 1  define a care/support journey to explore with feedback

Step 2  create a discovery conversation framework

Step 3  ‘dig deeper’ into experiences to generate more insight and context

Step 4  record feedback in the words of the person