Stage 3: Working with patients and carers to improve quality and safety

Commissioners should work with service providers, potential suppliers, clinicians and frontline staff to improve services. It is important to plan new pathways with patients and retain this focus through to procurement and monitoring so that contracts and service-level agreements reflect what patients say they want.

If this stage is done well, there will be improvement in the following areas

• access to, and quality of, services
• patient experience
• patient outcomes
• integration of services
• co-ordination of care across health and social care
• the level of complaints and increased positive feedback will also improve staff morale.

Things to think about

Bring existing sources of data together

• Bring together existing patient experience data to help design services before embarking on new engagement work. The NHS should gather data in a wide range of ways, including using quantitative and qualitative data, ‘real-time’ feedback techniques, IT and social media, and bring it all together to impact on decision-making and ensuring change.
• Patients should be part of deciding what data to gather that is relevant, how it should be used and should have a partnership role in decisions about solutions and implementing change
• Align different initiatives (e.g. primary care redesign & client-specific pathway work). For example, working on ‘transitions’ between secondary and primary care will improve things for people of all ages and walks of life. It could also be a trigger for breaking down ‘silo’ working.

Go beyond traditional methods

• Use ‘co-production’ design principles. Engage patients and carers in identifying solutions – not just in terms of what’s going wrong or as subjects of research:
• Consider using a range of approaches – quantitative and qualitative (including stories, real time feedback, web 2.0, experience-based co-design).
• It’s not all about techniques that cost a lot of money. Think about how to capture and utilise the ‘1000s of everyday conversations’ between staff, patients and carers.
• Focus on understanding people’s experiences of services, not just views of the process (e.g. speed at which they travel through the system). Ensure attention is paid to the feelings a patient and carer experiences at crucial points in the care pathway.

Plan how the work will be sustained

• Engage patients in defining quality measures to be translated into contractual agreements and service standards:
• Ensure project initiation documents and business cases for improvement work include engagement and are resourced.
• Use one-off initiatives as a trigger for sustained engagement. Sustainability: Ensuring continuity in improvement The Sustainability Model is a diagnostic tool that will identify strengths and weaknesses in your implementation plan and predict the likelihood of sustainability for your improvement initiative.