Improving patients' experience in real-time

When people are sick, they’re generally feeling at their most vulnerable. Hospitals are seen as large, busy and intimidating places by many patients, and despite our best efforts, institutionalisation happens. In the current climate clinical staff are under tremendous pressure to see and manage patients quickly and safely, but this may sometimes be at the cost of treating patients as individuals and recognising their lives outside of the hospital environment.

Working in acute medicine, I see this often. Patients are sometimes referred to as “bed five,” or “the man in the side room.” When the pressure of work is high, it’s easy to brush aside patients’ individual concerns which may seem ‘trivial’ or ‘irrelevant'. How many of us haven’t addressed the fact that someone is really worried their cat is locked out of their house when they find out they’re going to be in hospital for a few days? How many people have received a cup of tea with milk and no sugar (when they actually prefer it black and sugary) because they’re hard of hearing, or find verbal communication difficult and weren’t quick enough to respond? 

An intense curiosity about people’s lives was one of the reasons I went into medicine. In my role as chief registrar at Leeds Teaching Hospitals NHS Trust, I have been lucky to have had the time to speak to patients on the acute medical unit about their experiences and concerns. One elderly male patient was really worried about his cleaner turning up at his home and not being able to get in. He had her telephone number, but couldn’t walk to the ward telephone and didn’t want to bother the staff to take him there in a wheelchair. In a few minutes I was able to go and ring his cleaner for him. Not only did this allay his concern, it gave me a real sense of satisfaction and improved the rapport between us.

I recently heard someone say, “Patients expect competence. They expect to be treated in a clinically appropriate way. It’s the kindness and compassion we deliver that they really remember." From this, came my idea for a patient experience project. What if we give a card to each patient admitted to the ward, saying something like “what can we do to make your stay as good as it can be?” And what if we leave the card with the patient, for them or their relatives to write on and prop up on their table so that all staff passing by will be able to see it and think about whether they can help? 

Not all patients are as vocal as we think they might be. This card gives them the opportunity to highlight, in real time, something we could actually do to make things better for them, without feeling like they are ‘bothering’ already busy and overworked clinical staff. ‘Friends and Family’ questionnaires and compassion audits all have their place, but they can’t change anything for a specific patient during their specific hospital stay. 

The project is still very much in its infancy, but I am hoping that over time, the trust will see improvements in patient feedback, and perhaps even move towards an ‘outstanding’ rating in the ‘caring’ category of the CQC report. I have had a lot of support from the patient experience team at the trust, both in generating ideas and creating the cards themselves. A team I would never had known existed, had it not been for the chief registrar role. 

The difficulty with this project will be getting buy-in from clinical staff. It won’t necessarily result in clearly visible improvements early on, but I hope that it’ll eventually become a means of improving morale all-round. Just as happy staff means happy patients, happy patients means happy staff. 

Dr Katy Islip is chief registrar and acute medicine trainee at Leeds Teaching Hospitals NHS Trust