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Case study 3: Embedding patient experience in organisational culture

Experience-based co-design is not just about making service improvements: it is about creating a cultural shift within organisations, helping staff reconnect with their values. Jo Bolger, Programme Manager, describes the impact of EBCD on Bolton NHS Foundation Trust.

When Jo Bolger led a small experience-based co-design project to improve the experience of hip and knee replacement patients, she never imagined that in time, the approach would become embedded across Bolton NHS Foundation Trust. Five years later hundreds of staff, from nurses to surgeons, have been through the approach, with EBCD used to improve services ranging from stroke care to accident and emergency (A&E) services.

The original project focused on patients undergoing hip and knee replacements. ‘We were aware that some patients, despite having a great clinical outcome, might not necessarily have had a very good experience,’ explains Jo. ‘Traditionally, we might have improved things based on what we thought people needed. We chose EBCD because we wanted to bring patients and staff together and use their experiences to improve processes, communication, attitude or even the environment. We liked the fact that it leads to action. As far as I’m concerned, collecting data is useless unless you’re going to do something with it.’

That first project produced many positive outcomes, including improved communication and interaction with patients, with staff offering more reassurance and support. The approach was supported at board level. The success spread, an teams from across the trust went on to carry out their own EBCD projects across the urgent care pathway, A&E, assessment areas and ward admission, with further projects including stroke and respiratory patients. These have resulted in a host of changes, from changing the layout of the waiting room in A&E to developing new patient information.

One of the latest projects, with the child and adolescent mental health service, has completely changed the way the service works with young people. ‘The team approach in CAMHS has really made a difference to children and their families,’ says Jo. The team found that patient experience is about more than just informing the design of the service: the young people, parents and carers also feel that they benefit from being involved, and have enjoyed getting involved in projects. In turn, this has helped to boost their confidence, which for young people using CAMHS is particularly beneficial.

Initially, the team did face challenges: ‘The first project was really quite resource intensive [it cost £20,000] because we were making it up as we went along,’ says Jo. ‘It would have been great to have The King’s Fund EBCD toolkit, because there are a lot more ideas out there now.’ However, with experience the process became easier. ‘After that initial one, we could understand what worked and what didn’t, and we developed guidance for staff. Now, the only cost is time.’

A key factor in the success has been the board’s commitment to the approach. After the hip fracture project, the board suggested that the team film one specialty a year, because they felt that the experience of each team was transferable across the whole trust. ‘Because it was seen as a priority at board level, it wasn’t just us setting up a small project that everyone would forget about: it became part of the way we do things within the organisation,’ says Jo. ‘We now have lots of different approaches, led by teams working alongside patients to improve experiences.’

Over the years, films have been watched at board level, at governors’ meetings, and there are currently plans to incorporate patient films into staff ‘customer service’ training. ‘It’s changed the whole system, both in the hospital and community services,’ says Jo. ‘We now have patients sitting on the divisional boards. “Patient driven” is our mantra: patients are the ones actually suggesting where we should go next with our services.”

Learning points

  • Plan your EBCD project so it’s not just a one-off activity but is aligned to wider organisational objectives, to ensure wider impact.
  • Positive feedback from patients can be just as valuable as negative feedback. When you receive complimentary feedback, ask yourself what is in place that makes that good experience, and how you can replicate it.
  • In the small groups, it can help to focus on points of the patient journey where the patient felt confused and think about what can be done to change that feeling.
  • Some feedback may alert you to wider work that needs to be carried out within the organisation.
  • The very act of watching the patient feedback can help staff reflect on how they communicate with patients. This in itself may produce positive change.