DiscoveryInterviewSkillsBuilding

Interviewers Handout

Author: Jane Price, South East Wales Cardiac Network

Contributors: Ian Govier, CRT.

Attendants of the SkillsBuilding Days April & May 2007 from,

Black Country Cardiac Network, Pontypridd & Rhondda NHS Trust

&The Welsh Ambulance Service Trust.

Introduction by Jane Price

Feedback from South East Wales Cardiac Network in response to a recent questionnaire about prioritising work plans indicated that PPI is regarded as the lowest priority. It’s not surprising really as everyone struggles to meet targets & cope with the stresses & strains facing today’s NHS that many professionalsappear to still regard listening to patients as a “soft” subject & low on theirlong list of competing priorities.

But I would argue that it shouldn’t be.

Patients who are informed and involved, who know that they are being listened to and considered in the process of receiving healthcare are more willing to try, more communicative & more compliant. By discovering more about our patients we improve clinical outcomes for them & job satisfaction for ourselves.

National & Regional government expectations, the noticeably increasing trend that the public are taking a more active & vocal interest in their NHS & treatment & care mean it is becoming culturally unacceptable for patients to be regarded as passive & inanimate objects that lie back & gratefully accept what is done to them without discussion.

Believing that we know what patients think, feel, experience & need is not enough. We need to hear it from them, the only way to establish that we are getting it right is to listen to what they are saying, reflect & learn from it & make real positive adjustments to systems & practices based on their experiences.

Jane Price

Discovery Interview & Patient Public Involvement Lead.

South East Wales Cardiac Network.

Patient Public Involvement – Why does it matter?

Nationally

There are National & Regional expectations that patients & the public will be involved in the planning & service development that is undertaken in the NHS in future. Professor Sir Ian Kennedy, Chair of the Healthcare Commission stated in 2004

“Asking patients what they think about the care & treatment they have received is an important step towards improving care for patients in hospital and other health services”

In Wales two key documents are in print which, support this principle:

“We have made significant progress in recent years, but we all know that we need to do more. We all need to work better together and improve our services more quickly. This change process will need close engagement with patients, service users, staff and the wider general public to achieve the transformation that is required.”

Listening to Patients, Chapter 3 The Peoples NHS:Patient & Public Involvement.

“A common criticism of the NHS is that it sometimes fails to reflect or respond to the views and experience of patients and public when planning and delivering NHS services.

The importance of the patient’s voice is recognised as being centrally important in the drive for service improvement.”

Local PPI Activity – as reported by SkillsBuilding Day attendants in April/May 2007

Black Country Cardiac Network, Midlands, England

Discovery Interviews carried out in the Midlands in 2000.

PPI Lead person in each of the three of the Regions Networks.

Patient support group, mainstreamed with the PCT.

Information gathered from PPI activities is fed into the Regional Network through the local links.

Pontypridd & Rhondda NHS Trust

Patient Support Staff, assisting & signposting individual patients in the Trust.

Patient Stories collected through the RCN Clinical Leadership Programme.

Trust Patient Group, who are invited to attend regular meetings & participate in certain working groups within the Trust.

Welsh Ambulance Service Trust PPI Progress

In 2003 a questionnaire was sent out to Out Patient attendants who used WAST to get to clinic.

An identified person to lead on PPI

A PPI Policy/ 3-5 year plan

Inviting CHC representation on to some groups & boards.

Agreement & commitment from SE WAST to support selected professionals to participate in the SEWCN Discovery Interview project, in partnership with Network Member NHS Trusts.

Communication

The most important thing to remember is that we all spend a lot of time each day communicating! Obviously, there are many different types of communication and for the purposes of carrying out Discovery Interviews there are a number of different skills we need to use to get the best out of the session for the person who is telling their story.

Feeling confident in yourself to ask questions which will help the interview to flow.

Being able to listen, perhaps without interrupting when you may feel tempted to, so that the story teller can focus on what matters to them.

Giving the person confidence so that they feel able to trust the interviewer & disclose things they may not usually tell to a stranger.

Using listening & open questions to find out more about the person’s story.

Using positive body language which encourages the person being interviewed to feel relaxed & listened to.

Being aware of things that may affect the interview & responding to them appropriately.

Getting the Best from the Interview – The Aims

For the Interviewer

To establish good rapport quickly

To make a clear contract with the story teller, including consent & confidentiality.

Ask open questions

Use open, mirroring body language

Make the story teller feel comfortable & relaxed

Be respectful in the way you ask questions.

Say thanks at the end.

What you should get from the person telling the story – The Treasure

The hidden truth.

Remember that many patients will not disclose negative experiences to health professionals as they are afraid of the consequences it may have. Your primary aim must be to secure an honest account from the person you are interviewing…

Their Journey & Experiences

The subjectivity of Discovery Interviews enables the story teller to say how they felt about what happened to them.

If there is a particular thing that is important to them the interviewer needs to ensure there is adequate opportunity to talk about that. Remember: Quality is more important than quantity.

The Benefits for the Interviewer

On a personal level undertaking Discovery Interviews will help you to:

Gain a clearer understanding of how what Health Professionals actions impact on the people they are treating & caring for.

It is really important for NHS staff to acknowledge that there are good things happening so that they can maintain best practice, hearing the “bad” experiences should be seen positively as it provides opportunities to reflect on why these things may happen & discuss & development changes in practice to improve services in the future.

Put the patient back in the picture & enable the interviewer to focus on the quality of service which the NHS provides.

Remind interviewers why they joined the NHS in the first place.

Making a Real Difference.

The biggest challenge to any organisation undertaking a Discovery Interview project is ensuring that what is learnt from the process is disseminated, discussed and where indicated changed.

Arguably these hidden treasures should be shared across the whole of individual organisations so that all patients and staff can benefit from them. Realistically, this is probably more easily said than done!

What you as Discovery Interviewers can do though is:

Let colleagues know before the work begins that it is going to happen.

Tell them what it is about.

Be positive about the benefits of Discovery Interviews for colleagues as well as patients.

Share in general terms what you found out from the interviews you undertook yourself, good & not so good.

Remember that different people will see the same events in different ways & take account of that when reflecting on processes & practice.

Encourage front-line colleagues to read the report that result from the project.

Encourage front-line staff to come up with suggestions and make changes in their own area.

Ask the working group looking at the report what is happening as a result of it.

Remember:

Everyone coming together can achieve more! Team work produces better results, celebrate the good work that is happening & share the learning opportunities as well so that care delivery can get even better than it currently is. Setting out an efficient structure for learning from patient feedback will help enormously.