Improving the experience of care for people using adult health services: Developing the NICE Guidance and Quality Standard.
1. Improving the experience of care for
people using adult health services:
Developing the NICE Guidance and
Quality Standard.
Liz Avital
Associate Director NCGC
NCGC National Clinical Guideline Centre
2. Overview
• Background of the National Clinical
Guideline Centre (NCGC)
• How the Patient experience in adult
NHS services (CG138) guidance was
developed.
• Main themes and examples of
recommendations and quality
statements
NCGC
3. National Clinical Guideline Centre
(NCGC)
• Formed in April 2009 - merger of 4 national
collaborating centres; Royal Colleges of Physicians,
Nursing, General Practitioners and Surgeons
• NCGC develops clinical guidelines on behalf of the
National Institute for Health and Clinical
Excellence (NICE)
• One of the largest centres in the world developing
clinical and cost effective evidence focused on
improving patient experience and outcomes
NCGC
4. NCGC current work programme
Clinical Primary International
Guidelines research work
Quality Evidence
Improvement updates
NCGC
5. Patient Experience guidance and
quality standard
• Commissioned by NICE in 2010 to develop
guidance, recommendations and quality
standards outlining a level of service that
people using adult national health services
should expect to receive.
• Guidance for all staff (including non-clinical
staff) involved in providing health services,
as all interactions can have a profound
effect on patient experience of care
NCGC
6. What are NICE guidance and
quality standards
• Guidance underpin recommendations for the
care of individuals within the NHS (usually
population/setting specific).
• Guidance and quality standards outline a level
of service that people using adult NHS services
should expect to receive
• Has an important role in influencing provision
of high quality, effective relevant care
• By design they address variations in practice,
optimising care delivery and experience
NCGC
7. Collaborative development of
Guidance and Quality Standard
• Underpinned by an agreed scope
• Driven by a multidisciplinary guideline
development group (GDG);
– 10 health professionals
– 6 patient representatives
• Supported by a technical team
• Consultation with and incorporation of
feedback from stakeholders
NCGC
8. Technical Team
Is comprised of: Their function:
GDG Chair Undertook evidence
Information Scientist reviews / synthesis
Research Fellow Presented the
Health Economist evidence to the GDG
Project Manager Wrote the final
Guideline Lead document.
NCGC
9. Role of the GDG
• Attended 7 all day development meetings
• Contributed constructively, acknowledging the
equal standing of each group member.
• Helped technical team refine and develop review
questions
• Considered and debated evidence.
• Developed recommendations based on the
evidence and GDG consensus
• Helped write the guideline
• Debated and prioritised areas for quality standards
NCGC
10. Guidance Development - Sources
of evidence
• Review of existing patient experience frameworks
• Patient Experience Scoping Study – focused thematic
qualitative overview, identifying key themes
• Review of NHS Survey Results
• Review of existing NICE guidelines extracting
recommendations related to patient experience
• Selected systematic literature reviews for specific
interventions (eg. Decision Aids)
NCGC
11. GDG evidence interpretation
A powerful combination of :
• Patients (40% of the group)
• Clinicians
• General Practitioner
• Specialist Nurses
• Allied Health Professionals
• Public Health Specialists
• Academic researchers
• Technical team members
Rapid synthesis of multiple
sources distilling into evidence
and consensus shaped
recommendations.
These inform the development
of indicators for measuring
what ‘quality looks like’.
NCGC
12. Identified themes
The following key themes were identified
which underpinned 67 recommendations;
1.Knowing the patient as an individual
2.Essential requirements of care
3.Tailoring healthcare services for each
patient
4.Continuity of care and relationships
5.Enabling patients to actively
participate in their care.
NCGC
13. 1. Knowing the patient as an
individual
• Patients appreciate being recognised and
treated as individuals by health care
providers. It is an essential component of
the patient experience.
• Recommendation:
Develop an understanding of the patient as
an individual, including how the condition
affects the person, and how the person’s
circumstances and experiences affect their
condition and treatment.
NCGC
14. 2. Essential requirements of care
• Recognition of all aspects of patient needs: respect,
patient concern, nutrition, pain management, personal
needs, patient independence , consent and capacity
• Recommendation:
All staff involved in providing NHS services should;
• treat patients with respect, kindness, dignity,
compassion, understanding, courtesy and honesty
• Respect the patient’s right to confidentiality
• Not discuss the patient in their presence without
involving them in the discussion
NCGC
15. 3. Tailoring health care services for
each patient
• The importance of:
– an individualised approach to services taking into account
patients views and preferences
– involving family members and carers
– Acknowledging the place for feedback and complaints
• For example:
Adopt an individualised approach to healthcare services that is
tailored to the patient's needs and circumstances, taking into
account their ability to access services, personal preferences and
coexisting conditions. Review the patient’s needs and
circumstances regularly.
NCGC
16. 4. Continuity of care and
relationships
• Highlighting the need for appropriate
communication enabling continuity of care between
service providers. Ensuring continuity of care
appreciating the impact this has on the patient.
• Recommendation:
Assess each patient’s requirement for continuity of
care and how that requirement will be met. This may
involve the patient seeing the same healthcare
professional throughout a single episode of care, or
ensuring continuity within a healthcare team.
NCGC
17. 5. Enabling patients to actively
participate in their care
• The understanding that patients need and appreciate clear
and accurate communication, information, the opportunity
for shared decision making.
• The necessity for evidence based patient education
programmes
• For example:
All staff involved in providing NHS services should have
demonstrated competency in relevant communication skills.
When discussing decisions about investigations and
treatment, do so in a style and manner that enables the
patient to express their personal needs and preferences.
NCGC
18. Quality standard
What is a quality standard?
A quality standard defines best practice
through 14 specific, concise quality
statements, plus measures to provide the
public, health and social care
professionals, commissioners and service
providers with definitions of high-quality
care
NCGC
19. Examples of quality statements
• Patients are treated with dignity, kindness,
compassion, courtesy, respect,
understanding and honesty
• Patients are made aware that they have the
right to choose, accept or decline treatment
and these decisions are respected and
supported.
• Patients have their physical and
psychological needs regularly assessed and
addressed, including nutrition, hydration,
pain relief, personal hygiene and anxiety.
NCGC
20. To conclude:
• Guidance and quality standard are the evidence
and expert consensus base to create sustainable
change.
• Produce care that is effective, acceptable and
appropriate for patients.
• The generic nature of this guidance makes it
internationally transferable and applicable to
other healthcare environments.
NCGC
21. NCGC international involvement
• Oman Evidence translation and
Utilisation Programme
• Collaboration with the Belgium Health
Care Knowledge Centre
• International model of support
NCGC
23. Thank you for listening!
Thank you to the GDG
For more information please contact me:
Liz Avital
Liz.Avital@rcplondon.ac.uk
NCGC
Notes de l'éditeur
The NCGC is a governance collaboration, funded by NICE and hosted by the RCP
(excluding adult mental health services)
Health professionals from wide range; GP, older age health, allied health, academic Number of patients is specific to this guideline – normally have 2
3 areas of qualitative data; cancer, CVD and diabetes
Developed from recommendations
This guidance provides the evidence and expert consensus base to create sustainable change. in changing health care professionals’ behaviours and directing commissioning to meet this challenge, resulting in the cultural shift required to produce care that is effective, acceptable and appropriate for patients.