Gathering experiences of the patient journey in Highland from referral to treatment using patient diaries
Gaye Jaffrey
Clinical Governance Facilitator
Project summary
Patients at Raigmore Hospital completed diaries to record their experiences on the journey from GP referral to treatment. Patient diaries are a resource-intensive method but they yielded rich data on the quality of contacts between patients and staff and where this could be improved.
Project Dates
Start Date:1/11/2008
End Date:1/7/2010
Location of project
Highland,
Sector
Acute care, Primary care,
Target groups
All groups,
Methods
Patient Diaries, Written Information
Aims and objectives
The project focussed on the 18 Week Referral to Treatment Target (18wRTT) and the patient journey from GP referral (to a consultant-led service) to treatment (or the decision that no treatment is required). We wanted to gather information on patients’ contacts and experiences across their journey from referral to treatment, with the aim of supporting ongoing improvements in the quality of care. Patient diaries were used to record the waiting time between referral and treatment, along with more detail about patients’ experience of care and contact with services.
What we did
Patients were invited to tell us about their journey from consultant referral to treatment in a structured way using a patient diary. They were recruited by sending an invitation to participate with their appointment letter. The approach, format and content of the diary were discussed with NHS Highland’s 18wRTT Patient Reference Group.
Patients were invited to complete a diary providing information about the time taken between key milestones on their journey from referral to treatment. They were also asked to tell us about their own experiences, and their views on how the service could be improved. This approach allowed for both immediate documentation of thoughts and facts, and a reflective response. In the first phase of the project, patients being offered appointments at Raigmore and Belford Hospitals were invited to take part. Those that agreed were sent a diary to complete and return to us once their episode of care had finished. The project was extended in March 2010 to recruit patients from GP practices across Highland at the time of their referral to consultant-led services.
Patients were invited to complete a diary providing information about the time taken between key milestones on their journey from referral to treatment. They were also asked to tell us about their own experiences, and their views on how the service could be improved. This approach allowed for both immediate documentation of thoughts and facts, and a reflective response. In the first phase of the project, patients being offered appointments at Raigmore and Belford Hospitals were invited to take part. Those that agreed were sent a diary to complete and return to us once their episode of care had finished. The project was extended in March 2010 to recruit patients from GP practices across Highland at the time of their referral to consultant-led services.
Impact
Based on the feedback the group gave us, we improved the design of the project to make it more patient friendly.
The completed diaries indicated that the majority of patients were being treated (or told that no treatment was required) within the 18 week target. However there was significant variation in the waiting time from referral to consultant appointment, and from referral to treatment. Patients have shared both concerns and positive comments about their experience of the service. We are working with service managers to learn from patients’ experiences and the information provided is being actively used to support ongoing quality improvement. One example is the development of a flyer to go out with outpatient appointments, explaining the procedure fro pre-operative assessment.
Patient feedback from this project has also been included as part of LEAN improvement work – “Voice of the Customer”.
The completed diaries indicated that the majority of patients were being treated (or told that no treatment was required) within the 18 week target. However there was significant variation in the waiting time from referral to consultant appointment, and from referral to treatment. Patients have shared both concerns and positive comments about their experience of the service. We are working with service managers to learn from patients’ experiences and the information provided is being actively used to support ongoing quality improvement. One example is the development of a flyer to go out with outpatient appointments, explaining the procedure fro pre-operative assessment.
Patient feedback from this project has also been included as part of LEAN improvement work – “Voice of the Customer”.
Evaluation
The patient diary project gathered good quality information to support service improvement and to provide feedback to staff. The diary format enabled patients to record both immediate reactions and more reflective comments, and worked for both shorter and longer periods of care.
“Only the patient experiences the whole process. Most staff often see just one part of a patient’s journey. To get an overall view from referral to treatment, it made sense to ask patients.” (18 Week RTT Programme Manager)
This was a relatively resource-intensive method, and although the completion rate for patients who had consented to record their experiences was good, it was difficult to recruit patients to participate. It was especially difficult to recruit patients from the GP surgeries, and diaries have only been completed by patients attending Raigmore Hospital. The results are therefore not representative of the Board as a whole. The format of the diary may not be accessible for all patient groups.
If we were to repeat this approach, we would adapt the methodology to increase participation and representation across the Board. For example, we would consider facilitation across a number of sites and/or a face-to-face approach when inviting patients (if resources are available). We would also explore the possibility of offering a choice of formats (electronic version/ audio recording and so on).
We did not ask for specific feedback from patients about what they thought of the process of filling in the diary, as we wanted to keep it as simple as possible. Perhaps next time we would include a short evaluation section in the diary itself for a sample of patients. However, many diarists provided us with rich data about their journey from referral to treatment, relating to a number of contacts. This could indicate that the diary format was acceptable to patients.
“Only the patient experiences the whole process. Most staff often see just one part of a patient’s journey. To get an overall view from referral to treatment, it made sense to ask patients.” (18 Week RTT Programme Manager)
This was a relatively resource-intensive method, and although the completion rate for patients who had consented to record their experiences was good, it was difficult to recruit patients to participate. It was especially difficult to recruit patients from the GP surgeries, and diaries have only been completed by patients attending Raigmore Hospital. The results are therefore not representative of the Board as a whole. The format of the diary may not be accessible for all patient groups.
If we were to repeat this approach, we would adapt the methodology to increase participation and representation across the Board. For example, we would consider facilitation across a number of sites and/or a face-to-face approach when inviting patients (if resources are available). We would also explore the possibility of offering a choice of formats (electronic version/ audio recording and so on).
We did not ask for specific feedback from patients about what they thought of the process of filling in the diary, as we wanted to keep it as simple as possible. Perhaps next time we would include a short evaluation section in the diary itself for a sample of patients. However, many diarists provided us with rich data about their journey from referral to treatment, relating to a number of contacts. This could indicate that the diary format was acceptable to patients.
Additional Project Documents