One ward designed an initiative for patients and visitors to provide feedback on care, which allowed staff to address key issues in the Francis report
An initiative was developed to address local issues and key lessons in the Francis report by listening to patients. Targeting the views of all parties can help teams provide responsive high-quality care that reflects on, and learns from, people using and delivering the service. This article details how it can be implemented in a range of settings and adapted to target the views of staff, patients and specific Coperational issues.
Citation: Bowles L (2016) Cocktail Conversations: listening to patients. Nursing Times; 112: online issue 2, 7-8.
Author: Lindsay Bowles is ward sister, St Luke’s Hospital, Market Harborough.
- This article has been double-blind peer reviewed
- Scroll down to read the article or download a print-friendly PDF here
Changing the culture and direction of an organisation as large as the NHS is complex but necessary. Learning from patients and staff experience is recognised as being a powerful change agent. It can improve services, reduce incidence of poor care and lead to a culture of openness, greater clin- ical engagement and professional empowerment (NHS Confederation, 2010). This article shares a simple process that can be used to ensure patients’ voices are heard and at the heart of our care.
In 2012 a ward at St Luke’s Hospital in Market Harborough received a high number of complaints, staff were struggling and morale was low. The trust enrolled the ward on the In Your Shoes initiative. This was inspired by the NHS Institute for Innovation and Improvement’s Patient Feedback Challenge, which provides a range of tools and ideas to involve staff at all improve care need not be levels in generating and responding to patient feedback.
Staff interviewed recent and current patients and carers, and completed graffiti boards to reflect thoughts on the ward. They then considered the themes and responded with statements and action plans. This was an invaluable but lengthy and costly process due to transport costs, facilitators, backfilling of staff etc, which may have been prohibitive to run long term. Also, because our team was evolving, when information was collated it was already out of date.
The Francis reports (Francis, 2010 and 2013) highlighted that no one listened to the concerns of patients, staff or families and, as a consequence, no one addressed them effectively or took ownership of them. The themes were similar to those we had addressed through the In Your Shoes project. We felt that patients should have more involvement in improving care.
To solve this we developed Cocktail Conversations, an adaptable initiative that is fun and inexpensive to run, which generates valuable feedback on our service. The aim is to be as transparent and responsive as possible, and to ensure that initiatives to improve patient care are in step with their priorities.
On the day of the event, we take over the day room for an hour and provide a range of hospital-themed fruit cocktails – such as Doc on the Rocks, Patients’ Punch and a Ward 1 Wallbanger – from our Cocktail Conversation menu. While patients and visitors enjoy snacks and drinks, we ask:
- What we do well;
- What we could improve;
- What they’d like to see us provide;
- How they would rate us on the 6Cs;
- What event/person they will remember from their stay – these need not be positive but, so far, have been.
They can add further comments or raise other points if they wish.
All the information is collated and displayed on bright cocktail-themed posters on the ward. PowerPoint slides are printed, laminated and displayed on the ward to show planned improvements. Any suggestions that fall outside of our remit are forwarded to the relevant parties.
Staff review the displays to see what works and what doesn’t. Key issues are followed up at ward meetings so staff can solve them together. We have improved the ward by acquiring plugs for the sinks, garden furniture, new visitors’ chairs, a TV guide and Wi-Fi. The latter allowed a dying patient to say goodbye to her son in Canada and an ardent football fan to share his team’s progress. Patients and visitors asking for specific things helps us gain support from senior management when resources are outside our control.
One family said they felt Cocktail Conversations was “a very good idea… to help improve systems and situations to assist patients and families”. We may not always get things right, but through the initiative we can show that we listened and tried to improve things.
Feedback has also resulted in our “meet and greet” initiative, which is led by our healthcare assistants and ensures patients are signposted to key information and have a named person to speak to. This has increased job satisfaction for HCAs and gives them protected time to get to know their patients, which, in turn, improves patient care, relationships and outcomes.
Cocktail Conversations began in July 2013 and a session was held every month. We found there was insufficient time to progress the necessary actions between meetings so they are now held every two months. To date there have been 17 events with 100 patients attending and 225 visitors contributing. We send copies of the PowerPoint presentation displayed on the ward to our patient experience team and our management team to keep them informed of patients’ concerns.
It is important for us to remember to ask what is pertinent for us at ward level and change the questions when needed. We can assess many aspects of care, such as changes in visiting times or how people feel about communication initiatives, and respond to the information directly.
We displayed the initiative to the trust’s annual general meeting in September 2014 and asked attendees – anyone from union members, student nurses and board members to ex-patients – to make a cocktail containing:
- A body – the essence of things they liked about the trust;
- Additional trimmings – laminated paper lemons, cherries and parasols on which they wrote suggested improvements.
Attendees named their cocktails, then we photographed all 26 and sent them to the trust board. This was our opportunity to disseminate the concept to colleagues outside of our unit.
The concept can be adapted for other services – for example, staff in children’s services could make caterpillars composed of things users like, with their wish list being butterfly wings or leaves. Services preferring an informal but less creative approach could simply have tea and cakes, accompanied with a discussion on the quality of care or specific issues. Issues to consider when planning an event are outlined in Box 1.
Every year since the project began we have won Celebrating Excellence Awards for innovative ideas and providing quality care through effective team working. Complaints have also dropped, incidents have been reduced, and patient and staff satisfaction has improved. The success of this initiative and the ideas generated has primarily been down to three factors:
- Commitment and hard work of the team;
- Local leadership driving it forward, empowering staff to lead their own ideas to improve care, and ensuring regular feedback is disseminated at board level;
- Support from trust management – giving the team the freedom and support to develop and adapt its ideas, encouraging dissemination to other parts of the division, giving the board event feedback, helping to facilitate funding/infrastructure changes when required.
Box 1. Planning Cocktail Conversations
- Allow enough time to prepare for and hold the event, and act on the issues raised;
- Ensure staff or volunteers are available to offer drinks and support patients. They must not “lead” patients’ answers but need the necessary skills to help those who may struggle to voice their opinions;
- Limit the aspects of care discussed.
Patients and relatives may not wish to commit to a long process and if there are specific issues to explore, it may be more productive to hold several smaller sessions that each focus on one issue. If general feedback is wanted then alternating post-its with formal cards will help to keep interest, cover more topics and ensure each voice is heard.
The Cocktail Conversations initiative could be further enhanced by:
- Increasing staff involvement – staff currently have a supportive role (event preparation, supporting patients) but the initiative is led by the ward man- ager. Greater involvement of the whole team, particularly staff nurses who oversee the majority of clinical care, could be beneficial.
- Greater patient and relative involvement – the event primarily focuses on raising the issues and, although it allows for suggestions, problem solving tends to be designated to specific meetings targeting the bigger or more complex issues.
Cocktail Conversations is adaptable, has given staff and service users a voice, and increased staff ownership of ward developments. Its strength is in providing ongoing, practical feedback, that enhances staff engagement and ensures we keep in step with patients. Issues can be identified and acted on quickly, with changes monitored and evaluated.
It should be seen as a supplement, not a substitute, to existing feedback methods. Health professionals must take a broad approach to gathering and responding to feedback to ensure we have as full a picture of the patient experience as possible. Any area that stops listening and responding to concerns is likely to have problems – and if listening is part of the answer, this tool can be an invaluable part of the solution.
- Listening to patients is vital if services are to be improved
- Initiatives to improve care need not be complicated or expensive
- Staff feel empowered when they can put forward ideas and bring them to fruition
- An informal set-up can help patients open up about their experience
- Communication is important to disseminate information and gain the necessary support and resources
Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry.
Francis R (2010) The Mid Staffordshire NHS Foundation Trust Inquiry.
NHS Confederation (2010) Feeling Better? Improving Patient Experience in Hospital.