Along with hundreds of other people my wife had a new outpatients appointment in October. “Big deal” I hear you say “so did my husband” but unfortunately my wife has severe long-term health problems and for us this was a challenge we were not particularly looking forward to. As she is housebound, confined to an electric wheelchair, intolerant of any noise and unable to stand for more than 30 seconds even a simple appointment is an expedition of Herculean proportions.
However rather surprisingly and to our great pleasure the whole visit to DGRI was a fairly simple and stress free experience. I had arranged for a quiet room in the department for my wife to wait for her appointment and we asked the departments she was visiting if they could phone when they were ready so we didn’t have to wait around in noisy waiting rooms. All the staff we came into contact with were as helpful as they could be and did everything they could to make the experience as easy as possible for my wife. Although it may at times only have been little things or minor changes to normal practice they made my wife feel more comfortable so to her they mattered and were appreciated. I’ll put my hands up here and admit that the fact I work in DGRI helped as I had the knowledge of the building and the services my wife would need to access. However you do wonder how many other patients have a less than pleasant experience when visiting the hospital simply because people were unaware of their needs or the challenges they faced getting to hospital in the first place. So how do we measure the quality of the services we deliver to our patients?
At the end of 2004 the NHS Dumfries and Galloway decided in their wisdom that I was the ideal candidate to be sent on a 3 year BSC Adult Nursing secondment at what was then Bell College. At the time I was working in IT as an Information Officer producing exciting reports on bed occupancy, waiting times and other information requests. So I headed off to college for 3 years of hard work, extensive study, long holidays and copious drinking and quickly realised that for much of the last 5 years I had been producing work that whilst accurate was actually fairly one-dimensional in the great scheme of things (and fairly useless a lot of the time). Numbers matter but they don’t tell the full story; for example in my previous job I had been asked to provide information on a ward’s workload as the ward involved claimed their workload had massively increased. The data did not show a change in admissions, discharges and length of stay for patients in that ward over a 2 year period so on paper the workload had not increased. However due to a change in the patients admitted to the ward the amount of time required to deal with each patient had increased thereby increasing the workload considerably. I learnt how hard work a shift on this ward was as a student and since then have been very aware of the one dimensional nature of data and how it only tells part of the story.
Whilst I found nursing very stimulating and enjoyable in a challenging way a change in supplier of hospital soap led to my hands starting to bleed and crack hideously. For some reason there was a feeling that my ability to bleed spontaneously was not really necessary for a career in nursing, in fact it was positively discouraged and so this led to another change in career and I washed up in Cancer Services doing cancer audit work, ie back to the data I’d hoped I’d escaped 5 years earlier. It quickly came apparent I was back to where I started, “counting procedures” rather than the measuring the “quality of the procedure”. It was also clear that the clinical standards we were being measured against were “voluntary” so there was no sanction for not collecting the data and no requirement to publish it openly so patients and other health professionals could review it. Then in 2012 everything changed with the introduction of the Quality Performance Indicator for Cancer.
“Better Cancer Care, An Action Plan” published by the Scottish Government in 2008 detailed the new strategy for measuring cancer quality across all of Scotland’s Health Boards Specifically the government committed to the following
“By 2010, all of Scotland’s tumour-specific networks will take part in national audit that will enable an ongoing programme of improvements to clinical practice, based on national indicators which allow benchmarking against other countries’ approaches”
As is often the case it was actually 2012 by the time we started collecting data using the new national audit framework. The significant difference between the QPI’s and the old clinical standards is that the collection and publication of data is mandatory and all the data collected will be available on the internet for all to view. In addition they have been developed by clinical, managerial and support staff working on a daily basis with and supporting cancer patients to ensure they are relevant to the clinical teams delivering care. However it was noted at a high level that in many cases we were still collecting data to ensure protocols had been followed rather than looking at the individual. Therefore the “Cancer Patient Experience Quality Performance Indicators” were born (to download any of the cancer QPI’s please click here)
Initially 3 Patient Experience QPI’s have been developed each dealing with a different area of the patient journey
QPI 1 Communication – Patients should experience excellent communication from healthcare professionals throughout their cancer care.
QPI 2 Information Provision – Patients should experience excellent information provision from healthcare professionals throughout their cancer care.
QPI 3 Shared Decision Making – Patients are empowered by healthcare professionals to share decisions about their care and treatment
Ok it won’t change the world but at least now the patient is at the centre of our audit work and we will have to ask them what they think of our service and we will have to share the results, warts and all, with all who want them. We are also still collecting an awful lot of data on procedures to ensure that clinically our patients receive the correct diagnostic tests and the appropriate treatments. So going forward in cancer we will be looking at the “whole picture” rather than just the medical side of the patient’s journey which will hopefully lead to improvements in the whole patient experience.
So for those who have managed to stay awake till this point we are back to where we started, how exactly do we measure the quality of a hospital appointment? I hope that the work that has been accomplished in cancer will eventually feed into other services with the same proviso that data collection and open reporting are mandatory. I also hope it actually makes a difference in the long term and we do see actual improvements in patient care and this does not just become a “tick-box” exercise. Whilst gathering data on the patient experience is very time consuming and surprisingly challenging it matters. Everyone reading this will at some point, either personally or through family members and friends, be affected by cancer. By concentrating on the individual and the quality of care they receive it is hoped that the QPI programme will mean that everyone will get not only the highest standards of medical care but also feel a welcome participant throughout their illness rather than a number.
Martin Keith is a Cancer Improvement Officer at NHS Dumfries and galloway