Patients and clinicians driving service change in partnership: understanding the big picture

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Lynne Quinney, a member of the Patient and Carer Network (PCN) and part of the Future Hospital development site team at Mid Yorkshire Hospital NHS Trust, discusses how and why lay members, patient representatives and healthcare professionals must work together for a successful service.

What patients experience in their interactions with hospital and health professionals is at the heart of the Future Hospital Programme (FHP). The FHP places strong emphasis on the real and meaningful involvement of patients in designing and influencing the provision of a high quality service. As a Patient and Carer Network (PCN) member, I am playing a part in achieving these aims.

The power of patient involvement

Since July 2015 I have been linked to Mid Yorkshire Hospital NHS Trust, one of the Future Hospital development sites, and to their local patient representative. Together we form part of the team intent on improving acute elderly care in the trust. Making changes in the way services are delivered is challenging and exciting and if ever there was an incentive to do this, it’s the changing demographics and clinical advances that enable us to live longer with not one but many medical conditions. As someone in late middle age with a frail elderly mother, I have some personal experience of what this means.

Being lay members of a team comprising clinicians and managers who work in a large and complex organisation, and who are subject to the accompanying constraints, can be challenging. However, it is potentially powerful, significant and rewarding.

The big picture

My professional background developing leadership and teams in the NHS has given me some understanding of the ‘big picture’ driving service change; perhaps helping me to adapt quickly to being part of the team. Working together with a local colleague, experienced as a volunteer at the hospital and with a purely patient focus, provides what I think is a committed and well balanced lay viewpoint.

Does what we say in the monthly team meetings we attend get noticed and acted on, even when it’s uncomfortable?

Lynne Quinney

The way we are treated as patient representatives should be a gauge as to how patients experience the service. Patients are quick to identify when their involvement is motivated by a need to ‘tick the box’ and this often leads to disillusionment and disengagement. Are we, as lay members of the team, inside or outside the place where decisions are made? Does what we say in the monthly team meetings we attend get noticed and acted on, even when it’s uncomfortable? Certainly our first meetings were characterised by some cynicism from the local patient representative that, for example, the goal of early discharge of appropriate patients was driven by financial pressures. Seeing that attention was being paid to joining up services for this age group through close working with GPs, community staff and social workers, and voluntary bodies like Age UK, allayed such concerns.

A shared enterprise

Since our regrettable late entry to the team (the service changes were already designed) I believe we are now active and significant players. Our concerns are addressed and acted upon and it feels like a genuinely shared enterprise. One tangible example of this is our considerable involvement in the production and design of patient information where our comments and feedback led to the final product. The local lay representative has recently visited patients who are being cared for by the Rapid Emergency Assessment and Communication Team (REACT) and there are plans for greater involvement, along with other local volunteers, in administering the patient experience questionnaire. It is a considerable advantage that, being in the age group at which the service is aimed, she is able to use shared experiences and an empathetic manner to listen actively to responses and seek amplification as appropriate.

Current patient involvement owes much to strong clinical leadership and attention to staff engagement. The literature on patient experience stresses the importance of culture; authentic engagement will only happen where there is congruence between what is said, particularly by those in leadership roles, and what actually happens. My experience to date demonstrates that what matters to patients matters to the REACT team.