This case study was reported in Building Better Healthcare in January 2022.
The PEP Health and Royal Surrey Partnership
Over the last two years, Royal Surrey County Hospital NHS Foundation has been working with PEP Health to improve patient experience scores across the trust.
Using the PEP Health dashboard, Royal Surrey’s maternity department, which delivers 3,000 babies per year, was able to make impressive improvements to patient experience across the pregnancy journey. By analysing patient comments in real time they were able to:
- Increase awareness of antenatal classes during the pandemic
- Ensure continuity of care for mothers using the Home Birthing Service, which was suspended during the pandemic
- Improve communication on time-to-discharge through creation of a bedside folder
- Provide digestible feedback for staff, helping with motivation and morale
- Build up pandemic resistance to improve patient experience amid national decline
There is a continuing need to effectively document the views of women with recent experience of maternity care, as many services find themselves in the press due to litigation or poor CQC ratings. Collecting and analysing representative patient feedback is paramount to enable sustainable quality improvement. However, measuring patient feedback across the maternity pathway suffers from key challenges, such as:
- Low volumes of survey feedback at key stages of the journey (such as post-natal)
- Difficult and time consuming to manually conduct analysis of survey/text-based feedback
- A lack of representation of patient views due to low numbers of survey responses.
Royal Surrey also presented with these issues and had previously been reliant on the 2019 CQC Maternity Survey. However, with feedback from just 151 mothers, this survey yielded limited and unrepresentative comments. Additionally, the insights generated were not shared until almost 12 months later, further reducing their relevance.
The Ockenden Report, published in December 2020, laid out recommendations for how to improve maternity services. These included actively listening to patients and encouraging peer-to-peer support and review of care. The trust felt that their existing methods of collecting feedback were not fully representative and sought a more innovative solution to gain a full picture of patient experience, as recommended by the Ockenden Report.
The maternity team recognised the power of the patient voice as a vehicle for delivering high quality care and acknowledged that patients increasingly leave comments about their care online. As a result, the trust decided to team up with PEP Health to unlock the insight in the high volumes of online patient feedback they were receiving.
PEP Health provided Royal Surrey with a bespoke dashboard so they could easily see, in real time, the feedback they were getting from patients at an organisational, departmental, and individual level.
The dashboard offers a holistic view of millions of patient comments, across multiple platforms, such as social media and review sites. The data is gathered, scored from 1-5 and themed to eight internationally recognised quality domains, including Fast Access, Effective Treatment, Continuity of Care, Involvement in Decisions, Clear Information, Involvement of Families, Emotional Support, and Physical Needs.
Each comment is then analysed and categorised in real time, providing insights so that action can be taken before issues take hold and improvements can be made. The dashboard can help to predict CQC inspection ratings before they are given or automatically flag potential safety concerns, which has been especially helpful for Royal Surrey.
The technology also gives organisations the unique ability to benchmark patient experience performance between departments, peer providers, against other regions and against the national mean, which trusts have not been able to do before.
The realised impact
As a result of working with PEP Health, Royal Surrey has been able to increase their patient experience levels by 30% year-on-year, on average. This improvement was made during the pandemic, at a time when most other trusts across England struggled with declining performance.
In 2020, PEP Health analysed more than 800 comments from users of the maternity department. The insights generated were able to be used by the department in four important ways:
1. Improved visibility of available support services during the pandemic
PEP Health data revealed that mothers were unsure of what antenatal services were available to them, as in person classes and groups had been postponed due to the pandemic. The trust responded quickly, sharing information about online antenatal classes on social media.
2. Redistributing resource from the Home Birthing Service to in-patient
Using the PEP Health dashboard, the maternity team could see that patient experience declined at the beginning of the pandemic. This was because mothers who had opted to use the Home Birthing Service were now unable to do so due to infection control measures. To rectify this, the trust redistributed midwives from the Home Birthing Service to in-patient, assigning them to the same women they would have cared for during their home birth, ensuring greater continuity of care.
Elise Cordell, a mother who planned for a home birth but was reassigned to in-patient, said: “I went into hospital at the last minute and was met at the delivery suite door by a familiar face from the homebirth team. I felt so supported and looked after.”
3. Improved communication about the labour-to-discharge process
Analysing comments revealed that mothers were confused and often frustrated about the long wait between delivering their baby and being able to go home, despite being perfectly well. To improve communication and reduce anxieties, the trust matron created a bedside folder explaining the labour-to-discharge process. This folder was also shared with Maternity Voices Partnership, supporting the development of local maternity care in Surrey.
4. Boosting morale and motivating clinical teams
With more than 100 staff being able to access the PEP Health dashboard, Royal Surrey was able to quickly see that their services were being appreciated by patients during the pandemic. The positive comments helped to improve morale of teams potentially experiencing burnout.
5. Built up resistance to nationwide decline during the pandemic
During the pandemic many trusts suffered a major decline in patient experience in their maternity departments, which caused an inverse relationship to surface for the first time in three years. Royal Surrey were able to buck this trend and improve the quality of their services through the pandemic.
PEP Health and Royal Surrey plan to continue working together to track performance and identify areas for improvement, both in maternity and across the trust more widely, including:
- Improve patient safety through patient identified issues, such as medication errors
- Use the dashboard to track performance across departments, so teams can learn from one another
- Understand how the trust is performing against other trusts nationally, regionally, and within their ICS
- Address and reduce health inequalities
- Inform quality improvement strategies across the Trust with a diverse range of patient comments.
What staff said
Having real time feedback and insights has meant we have been able to consistently improve the services we deliver. The pandemic threw us a lot of curveballs but being able to see how patients were feeling all the time made it so much easier to deal with complications. The fact we actually improved our experience ratings during the pandemic has been amazing and has done wonders for staff morale during such a difficult time. Amy Stubbs Deputy Director of Midwifery and Head of Nursing, Women and Children, Royal Surrey County Hospital NHS Foundation Trust
We have been able to collect hundreds of comments, which would have been almost impossible to analyse manually. We have been able to access automated analysis and patient satisfaction scores to make sense of feedback, enabling us to iteratively improve the services we deliver at Royal Surrey. Clare Cardu Deputy Head of Midwifery and Transformation Lead Midwife for Women and Children, Royal Surrey NHS Foundation Trust
1 PEP Health - What patients think 2: Trends and variation in patient experience across hospital trusts in England 2020-21 (21 October 2021) - Keeping patients safe - Patient Safety Learning - the hub (pslhub.org) p.21