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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
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
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
NCGC current work programme

  Clinical                  Primary               International
 Guidelines                 research                  work




                Quality                Evidence
              Improvement              updates




                            NCGC
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
NCGC international involvement
• Oman Evidence translation and
  Utilisation Programme
• Collaboration with the Belgium Health
  Care Knowledge Centre
• International model of support




                 NCGC
NCGC website: www.ncgc.ac.uk
NICE website: www.nice.org.uk

                         NCGC
Thank you for listening!

         Thank you to the GDG

For more information please contact me:
                Liz Avital
      Liz.Avital@rcplondon.ac.uk




                 NCGC

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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
  • 22. NCGC website: www.ncgc.ac.uk NICE website: www.nice.org.uk 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

  1. The NCGC is a governance collaboration, funded by NICE and hosted by the RCP
  2. (excluding adult mental health services)
  3. Health professionals from wide range; GP, older age health, allied health, academic Number of patients is specific to this guideline – normally have 2
  4. 3 areas of qualitative data; cancer, CVD and diabetes
  5. Developed from recommendations
  6. 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.