Together we can make a difference

One of the fundamentals of quality improvement methods used in industry is for companies to view their service or product through the eyes of their customers. It was with this in mind that I recently decided to explore how to do this with a group of practices and their Patient Participation Groups (PPGs) from my CCG area.

A number of important themes emerged, both about how patients can contribute to improving their practice and about some of the barriers to this happening well. The themes were:

  • how we can work with patients to help us to identify things that need improving,
  • how patients can help to create a positive culture for quality improvement,
  • how patients can help us generate ideas for trying out new approaches.

Involving patients in uncovering problem areas

Feedback from our patients about what hasn’t worked well for them can help us to redesign our systems and processes. However both giving and receiving feedback can be fraught with difficulties. Patients often feel they need courage to criticise, as they are concerned it might jeopardise their care in the future. Also, if we usually get things right, and they like us, they can be very forgiving of our inefficiencies and unresponsive systems. When they do give feedback it is often to our reception staff, who can feel very vulnerable. As a result the patients are often met with a leaflet on how to use the formal complaints process, when this isn’t what they wanted to do at all.

Winston Churchill once said, “Courage is what it takes to stand up and speak. It is also what it takes to sit down and listen”.  Real listening is allowing yourself to be changed. Patients who are brave enough to tell us their stories when things didn’t go well can provide us with gems of information that we may not get from any surveys or friends and family tests. We need to be genuinely curious about exactly what they experienced – it may uncover a flaw that we never realised existed.

One of the QI methods we have described in a previous edition of Clinical News is process mapping. This involves creating a visual display of all the stages of a practice process, for example the repeat prescribing system or the managing of investigations and results. The map helps practices to identify wasted steps and problem areas to maximise efficiency, saving time and money. It encourages ‘system thinking’. Giving patients easy and rewarding opportunities to share their experience is valuable to the practice. At our recent session with patients and practice teams we ‘process-mapped’ the repeat prescribing system; we couldn’t have done it as efficiently without the input of the patients and what went on ‘behind the scenes’ was a huge revelation to them. It’s a great exercise for PPGs and is likely to lead to some real changes to current processes.

Patients can help to create a practice culture that promotes quality improvement

Your practice culture (i.e. your values, how you communicate, how you feel about your work, whether you are functioning as a team etc) is of vital importance in determining whether your quality improvement efforts will be successful.  The more positive view the practice team has of the practice and the future, the more likely you are to be successful. The Greek writer and philosopher Nikos Kazantzakis (1883-1957) said, “In order to succeed we must first believe that we can”. In this way the lovely things patients say about us can really boost our QI efforts. In our session the patient group recognised how positive feedback on NHS Choices and Friends and Family can make practices feel their efforts are worthwhile and means that future improvement work can have more impact.

Patients help us to ‘think outside the box’

The QI resource page on the RCGP website describes how we can use the Model for Improvement as a tool to improve our practices. It describes the ‘3 questions and a wheel’:

  1. What are we trying to accomplish?
  2. How will we know if there has been an improvement?
  3. What changes can we make to drive an improvement?

The final question generates ideas that you can then test out using PDSA (Plan-Do-Study-Act) cycles. Patients have a valuable role to play in coming up with ideas for testing. In our joint session, the patients and practice staff worked together to generate ideas for reducing the number of patients who failed to show up for their appointments. The idea that works is not always the one you expect and patients help us to really ‘think outside the box’.

PPGs are developing their role over the whole country, and some CCGs are developing support structures for PPGs. There are so many patients interested in making a positive contribution to the NHS – lets ‘let them in’ and allow them to make a real difference.


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