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IMPROVING PATIENT EXPERIENCE ACROSS A RENAL SERVICE USING A QI COLLABORATIVE APPROACH

SYoussouf, K Pennington, V Poynton, J Hegarty

on behalf of the Patient Experience Collaborative QI Teams

Introduction

The NHS outcomes frameworks for 2014-2015 include patient-reported outcomes, experience, and enhancing quality of life in long-term conditions as key performance measures [1]. Patient-centred care requires a holistic approach that encompasses psychosocial as well as physical care needs. In 2010 our network embarked on an ambitious quality improvement (QI) programme to improve quality of care in ourpopulation. During the first two phases we worked on attainment of clinical standards in dialysis.For phase 3 stakeholder input highlighted the imperative to work on improving the experience of our patients.

Methods

In 2013 we performed a survey of dialysis patients across our network using a modified version of the BRS patient survey performed across the UK in 2006. Patients identified communication, information and support, transport and waiting times as areas for improvement. We held a stakeholder day with patients and carers, clinical staff, experts in dialysis care, patient experience and quality improvement, to discuss the survey and identify areas for improvement. An expert faculty set an aim of >90% of patients reporting a positive experience of care and designed the framework for improvement. The project is led by 3 co-directors consisting of a patient, senior clinician, and senior manager with a QI facilitator responsible for day-to-day management. Teams of frontline staff and patients/families from across our kidney network attended the first learning session in November 2013. They have co-produced improvements in patient experience in the subsequent year.

Results

Changes have included:

  • Improving communication and medication safety through the use of “teachback”, ‘ask me 3’ and shared decision making in outpatient settings
  • Self-care and peer support- identifying and training peer supporters
  • Designing patient-led and multi-media education tools including videos and blogs.
  • “Themed months” focusing on an aspect of kidney care in a dialysis unit each month.
  • Information – newsletters and ‘wishwalls’ within dialysis units
  • Social support - facebook groups, organising trips, entertainment/events, and community days for dialysis patients to improve psychosocial wellbeing.
  • Volunteer services- developing a network of skilled volunteers, including complementary therapists, event planners and fundraisers.
  • Redesigning dialysis shift patterns and transport to reduce waiting times.
  • Partnership with GMKIN, an online kidney patient network, a source of information and support for renal patients across the north west

Conclusion

“Dialyse to live, don’t live to dialyse”. After 2 years of QI which concentrated on clinical outcomes, we were challenged by our patients to think beyond the clinical indicators of the quality of our service. We hope that we have begun a journey to put patients’ and families’ experience of kidney disease and the services that support them centre-stage in what we do.

1.NHS Outcomes Framework for 2014/2015. Department of Health, 2013.