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10,000 Voices: improving patient experience in Northern Ireland

Christine Armstrong and Oriel Brown The 10,000 voices initiative in Northern Ireland and Public Health Agency 08 May 2015


In Northern Ireland, the Public Health Agency and the Health and Social Care Board have jointly commissioned and funded the 10,000 Voices Initiative. This exciting project is being run with the six health and social care trusts in the country and provides a mechanism for patients not only to share their experience of the health service but to affect and influence the way services are commissioned and delivered. 10,000 Voices is providing innovative ways of capturing and responding to patient expereince information, using qualitative and quantitative approaches to “see the person behind the data.”

10,000 Voices is a metaphor for collecting patient experiences on a large scale and has provided a unique and innovative opportunity to raise the profile of patient experience in NI. The initiative enables and supports ‘real time change’ and provides assurance to members of the public that their voice is being heard by those who commission and deliver health and social care services.

Narrative methodology

One of the unique features of 10,000 Voices is that it uses a narrative methodology, in which patients describe their experience by telling their story.  These ‘stories’ are reviewed by senior staff in the PHA and trusts weekly and shared with front line staff.  This ensures that action can be taken immediately if required and planned improvements are led by multidisciplinary teams who deliver the services. The use of patient stories has been widely tested, both nationally and internationally, and has been shown to be useful as a key indicator of quality. Evidence from 1000 Lives campaign in Wales has demonstrated that when stories are subjectively told from the point of view of the patient or service user, attention focuses on the individual and not on the organisation/condition.

Bringing patients and staff together

The principles of Experience Based Co-Design have been adatpted to provide the framework for implemeting change through the 10,000 Voices initiative. Key to this has been the facilitation of a number of workshops across trusts at which patients and staff from all disciplines have worked collectively to anaylse and interpret the information and to higlight areas for improvement. This approach has empowered staff to own and drive local action plans for quality improvement. Through the information we have received we have been able to make a number of improvements to improve patient experience, for example providing better information for patients on how emergency departments work, provision of food and fluids in ED on 24/7 basis, review of cleaning regimes, review of how babies and children are cared for in ED.

As part of the initiative, facilitators were appointed in each trust and are supported by a regional facilitator. 10,000 Voices focuses on specific areas of practice, for example ‘unscheduled care’, ‘care at home’, ‘nursing and midwifery care’, To further build on the partnership approach we have recently commenced a staff experience survey.  It is proposed in future to gather both patient and staff experiences simultaneously.

This initiative has helped to raise the profile of patient experience in Northern Ireland, and  provides a rich source of information which has been used to influence practice and has been widely cited as good practice in inquiries and reviews.

The technology

10,000 Voices uses SenseMaker, which is a narrative-based research technology that enables the capture and analysis of a large quantity of stories in order to understand complex change.  Over 6,500 patients, carers and their families have taken the time to share their experience – this ranges from a few sentences to several pages.  This proprietary software had been used in a number of previous patient experience improvement projects in Northern Ireland with good results.

Improving and influencing service delivery

We believe the work of 10,000 Voices  is making a real difference for patients in Northern Ireland  and ensures that those who commission and deliver services gain an overview of the experiences that patients have. The commitment to 10,000 Voices demonstrates that it is more than a collection of patient stories it is about:
• Listening to patients
• Learning from patients
• Improving the quality of services for patients by involving patients and
• Influencing how services are shaped in the future.

Have you had experience using patient stories to help deliver service improvement? Tell us about your initiatives and your thoughts about 10,000 Voices – we’d love to hear from you!