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The role of boards in shaping patient experience

Jocelyn Cornwell 03 December 2015

In this blog, chief executive Jocelyn Cornwell describes the different ways in which boards tackle the issue of patient experience in the NHS.

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Sometimes it seems that every report on every NHS issue of any significance ends with recommendations/exhortations to ‘senior leaders’ to engage with the issue and lead the changes in person.   It’s not always clear who commentators mean by ‘senior leaders’ but generally, it seems to be the executive and non-executive directors of boards.

Boards interpret their roles differently, depending on the view they take of their ultimate goals at a given time. Different models rightly come to the fore at different times: in times of crisis, a board may be more likely to adopt an ‘agency’ approach, taking executive action, with low tolerance of risk, and a high desire for control. At other times, the same board may see its role more as ‘stewardship’, representing all the various stakeholders, prioritising transformation and cultural change, and engaging with staff and patients to improve the quality of services, rather than prioritising minimisation of risk (Chambers 2013).

In our work, we see how boards differ in they way they engage with, listen to and learn from patients and carers. Without over-simplifying, we could say they opt for one of two main models.

The customer always knows best

Model A is a customer service-type model. Here the organisation expects the patient experience manager to investigate complaints, manage PALS and volunteers, and support the patients whom the board invites to its meetings.  The manager will also provide reports to the board/board committee on what patients say about their experience via the national patient surveys and the Family and Friends Test.

In this model, the board sees its role primarily as one of assuring the quality of patients’ experience of care using its powers to set standards and monitor performance.  Sometimes, the board will do ‘deep dives’ into particularly troubling complaints or services with poor patient feedback, so that its members can really understand the causes of the problems and assure themselves they are making the right decisions to prevent a recurrence.

Bringing patient experience data to life

Model B is less common, but it does exist in a few trusts.  In this model, the board sees its role more in terms of driving quality improvement and devising the mid to long-term strategy for learning from patients and carers. Here, the patient experience manager’s role is to collect, analyse and disseminate timely, accurate andactionable data on patients’ experiences direct to the line managers and clinicians providing the service.

The patient experience manager also produces comparative reports for the board on patient experience, but the board sees its role less in terms of making key decisions and more in terms of challenging and holding service line managers to account for improvements.  Typically, organisations that have adopted model B began the journey from quality assurance to quality improvement by first developing the data collection, analysis and reporting system in a small number of services, before gradually extending the approach out across the whole organisation.

How do you measure culture?

The journey from one model to another is not a direct one from A to B. It is necessarily influenced by external factors that are outside the board’s control and it takes years. Patient experience teams need time to develop the internal data-handling and reporting capability they require, and boards need time to learn that front line teams will reliably take action in response to patients’ feedback (good and bad) and will make the improvements required. Boards necessarily adopt different styles and behaviours at different times for all kinds of reasons, depending on the context in which they find themselves and their immediate priorities.

The other thing they need to do is to learn as they go by monitoring the progress the organisation is making in changing the internal culture to one that empowers front line staff to lead change.  As they do so, the challenge is to be able to spread new ways of working across the organisation, which means building the data and other support that front line staff need if they are to take ownership of their own improvement.