Discovery Interviews learning from patients and carers

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Discovery Interviews - learning from patients
and carers
Insert name of presenter
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Session objectives

• Background to the work
• Underlying principles
• Overview of methodology
• Implementation considerations

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Progress across Modernisation Agency

• Coronary Heart Disease Collaborative (now Heart
  Improvement Programme)
• Whole health community approach
• Non English speaking pilot
• Critical Care Collaborative
• Retention and Recruitment programme
• Action on ENT and Orthopaedics
• Booking programme - ABC
• Ideal Design of Emergency Admissions

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Who are the experts? Where is the expertise?
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The Model for Providing Care
Functional Health Status
Access System
Assess
Diagnose
Treat
Satisfaction Against Need
Clinical Outcomes
Follow-up
Patient with need
Total Costs
(Nelson G., Batalden P. et al, 1996)
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• Many of the most important issues for service
  users are the kind of things not always seen as
  priorities by managers and staff

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Aim of the Discovery Interview

• To identify realistic and manageable
• ways for clinical teams to learn directly
• from their patients and carers about
• their needs so that they
• can be met better.

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The essence of the process

• The Discovery Interview process is used by
  practice teams to improve the way they meet the
  needs of their patients and carers
• through listening to their stories about the
  impact of their illness or condition on their
  everyday lives, and linking what they learn with
  their own professional knowledge and experience .

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Discovery Interviews are

• Semi-structured interviews of patients and their
  carers
• Based on key stages of the patients/carers
  journey through their illness
• A framework or spine is used by the interviewer

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CHD Discovery Interview Spine

• Thinking something was wrong
• Seeing someone in the NHS
• Having tests to find out what was wrong
• Being told what was wrong
• Receiving treatment
• Getting better
• Living with your condition
• Being followed up

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Discovery Interviews

• Triggers memories not constrained by thinking in
  the box of their care experience
• Do not ask them to make value judgements about
  the services they have received

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A patients story
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Hearing the patients story
As you listen to this story how does it make you
feel? What are the key points that strike
you?
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Sharing stories with teams

• Experience suggests that a creative approach
  helps
• patient and carer transcripts read by a peer at
  group meetings appeared more acceptable
• excerpts of transcripts recorded on audio tape
  and video played back to groups sent a powerful
  message reproduced by someone other than the
  patient or carer
• carers and patients telling the story of their
  experience to groups of health care workers
• reading stories at the end of ward reports helped
  access a broad variety of staff and mix of
  grades.

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The Nolan Framework
What are we trying to accomplish?
How will we know that a change is improvement?
ACT
PLAN
What changes can we make that will result in
improvement?
STUDY
DO
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Possible responses to hearing a story

• A change that is so small and obvious that it can
  be immediately implemented.
• A change that requires more attention by the team
  providing care, and for which using the Nolan
  framework as a guide will enhance the chances of
  learning and success.
• A question that requires more investigation
  before any change is made.

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A small change

• The bench story..

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A change that required more attention

• The diet story..

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A question that requires more investigation

• The information story.

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Patients and carers needs

• Ability to recognise symptoms
• Receive appropriate information - timing,
  delivery, quality, consistency
• Involvement in the care process and decision
  making, including carers
• Financial burdens
• Treated with courtesy and kindness
• High levels of anxiety - need for psychological
  support
• Impact on peoples lives - patients and carers

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Implemented changes from patients and carers
stories

• Carers support group established.
• Patient booking into one stop follow-up clinic.
• Cardiac Rehab Nurse contacts patients four days
  after discharge someone to talk to.
• Drop-in Clinic.
• Cardiac Navigator role.
• Development of buddy/befriending service

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(No Transcript)
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You may need support with

• Ethical approval
• Training for staff
• Resource packs
• Information for patients carers
• Peer review groups
• Sharing the learning nationally