NHS Trusts in the UK are encouraged to involve patients in all aspects of their work, but ensuring patient partnership initiatives work well is challenging. This article by Neil Cowan, Director of Operations for Surgery at Bournemouth and Christchurch Hospital NHS Foundation Trust and Rachel Jury, lead patient partner who set up the Rocking2stomas blog, describes how they overcome the challenges of joint working, and the positive impact of their partnerships on the trust’s work.
Neil’s perspective
Towards the end of 2017, while I was a participant on the NHS Leadership Academy’s Nye Bevan programme for aspiring directors, I decided that my leadership would be strengthened if I had a deeper understanding of the perspective of patients. This view was backed by Penny Lock, my learning set adviser, who was also Programme Director of the Aspiring Chief Executive programme. It was suggested I consider the brief on patient partnering used there. (Lock P, 2018) This brief asks leaders to form a relationship with a patient, meet with them throughout their time on the programme, and co-create experiences that will enable the leader to experience healthcare through the patient’s eyes. The ultimate aim is to reinforce service to patients as the purpose of NHS leadership.
Initially, I had a lot of reservations about developing a close working relationship with a patient. The role I hold as Director of Operations for Surgery means I am directly accountable for quality, performance and finance in the Surgical Care Group, employing over 1,000 staff who operate on 80-120 patients each day. This requires an never-ending balancing act. I was concerned that building a relationship with a single patient partner would conflict with my obligation to consider the Trust patient population as a whole and I was also concerned about finding time to do it.
If I’m honest, I was also uncertain about what difference it would make to my leadership, but, thanks to my set adviser, Penny Lock, I launched in with a clear intent that Rachel and I would be equal partners in the transformation of care and that we would work out together what that would mean.
Our partnering relationship has developed to the extent where I now consider Rachel to be a senior member of the team. Rachel has shown me how to use social media (having 3,000 twitter followers herself, @rocking2stomas showed me how it was done), and I have become Rachel’s coach and mentor, helping Rachel gain even more confidence in presenting and attaining further reach for her important messages, particularly increasing understanding about urostomies.
We recently presented at Bournemouth University, and in planning Rachel noted that not once in our many meetings had I ever cancelled her. There had been times when this would have been the easier option, given all my other pressures. But as they say, you find time for what you hold important.
Rachel’s perspective
I have been a patient at Royal Bournemouth and Christchurch Hospitals for five years and have had multiple surgeries which have resulted in having two stomas—an ileostomy (for faeces) and a urostomy (for urine) due to a rare disease under the umbrella of autonomic neuropathy. This has involved many hospital admissions over the years and with that an insight into how the wards work from a patient perspective. I also founded the blog Rocking2Stomas which helps support people and in particular raises awareness for urostomies which can sometimes be the forgotten stoma. Urology is my particular interest due to the multiple interventions I have had. I also saw a need for more patient participation in this area.
After all my years as an inpatient I only really got involved more in the hospital when I had to file a complaint about some questionable care that I witnessed. From that, I was asked to speak to the staff and my name became known. When Neil asked the patient engagement team about identifying a potential partner they put my name forward as they felt I would challenge Neil.
If I am honest when I was asked to be Neil’s patient partner I was unsure what to expect and initially I felt a little intimidated by the job title. However, I was also excited to get the opportunity to share my experience and observations.
Our partnership began and we met almost weekly for at least an hour, always over coffee in an open forum.
These early meetings which we both approached openly to understand each other’s experiences and perspectives were vital in building trust, which in turn, is key if the relationship is to make any wider difference. We both agreed a clear purpose to improve engagement and Neil also helped my own impact in the advocacy work I engage in.
I felt right from the start I could talk openly about my care sharing the positives and negatives to help give Neil a perspective from somebody who is regularly admitted on the surgical wards.
Personal impact
Neil’s view: Meeting with Rachel allowed me to gain more insight into what patients go through when they are admitted to hospital wards and made me reflect harder on what leadership in the health service is actually for. I now think about the patient journey first, and this has recently led us to include several patients in the re-design of a truly seven day consultant led Urology service.
Rachel’s view: Through Neil’s coaching and mentoring advice my impact as a patient advocate has improved and my approach to presentations to hospital staff. I think I underestimated how much I would learn from this partnership. I had naively thought it would be Neil learning from me. But seeing things from the management side has been an invaluable and given me a different perspective.
Impact on the trust
Joint working has resulted in the following changes:
- Senior Leadership Team support, including presentation by Rachel to the Trust board on patient engagement, leading a patient session at a joint trust Digital Transformation Summit and presenting on improving patient engagement to senior surgical nurses
- Mobilising the trusts patient engagement strategy, by taking concrete actions to increase engagement. This prior to the training of two dozen staff by point of care to become patient engagement champions, highlighted as good practice by the Regulator
- Increased awareness of patient partnership and the results is can deliver. This including the appointment of additional patient partners for senior manager in the trust
- Supporting future care models, with new patients coming forward to support the implementation of the new seven day Consultant Led Urology service at the trust. Clear voice from patients to reduce the amount of hospital appointments and provide more virtual services.
- Patients as part of the decision making process on interview carousels to appoint new senior roles, and an expansion of this plan through 2019 to include Consultants and other senior roles
- Supporting attendance for Rachel to the National patient leadership summit
Challenges
Time: It would be easy for a senior leader to feel too busy to do this. All NHS staff are facing unprecedented levels of demands on their time to deliver in times of ever-increasing demand, therefore time spent solely with a patient is not seen as a priority for many. However, solutions lie in that partnership and therefore raising the profile of the patient partner initiative is one way to allow others to see the tangible benefits of such partnerships and the potential for true co-production.
Of course service commitments impact on our ability to get together at times. Both Rachel and Neil prioritised continually in their meetings, helped by Rachel’s willingness to be flexible, even when this has at times involved out of hours phone calls to ensure the relationship was maintained
Concern for impact on care: Despite significant reassurances, Rachel was slightly worried that her care would be impacted in taking this role. However a recent admission has proved that this had no impact whatsoever on the care delivered.
Staff reactions: A small minority of staff had reservations about the patient partner initiative and its justification. These concerns were tackled by constant and clear communication about the intent. For example Rachel noted that some senior staff were not visible on some wards as others (given that many knew her name from repeat admissions but many also did not). This exposed a vital gap that needed to be rectified but it was not an easy message to deliver.
Care ethics: Rachel was recently an inpatient, and Neil had to carefully consider if it was right to visit her on the ward. This was approached by gaining consent first and waiting until Rachel was recovered enough to accept visitors.
This partnership initiative has shown that both partners gain from working collaboratively. You can’t predict exactly what benefits will emerge but you can be sure that this simple, different connection between patient and senior manager will act as a catalyst for change if both partners take it seriously.
Rachel Jury is a patient and a patient advocate.
Neil Cowan is director of Operations for Surgery, Royal Bournemouth and Christchurch Hospitals.
Competing interests: None declared
References:
Lock, P. 2017. Personal communication on the development of the patient partner brief on the NHS Leadership Academy’s Aspiring Chief Executive Programme
Seale, B.2016 ‘Patients as Partners: Building Collaborative Relationships Among Professionals. Patients, Carers and Communities’, https://www.kingsfund.org.uk/publications/patients-partners [Accessed 20/11/18]
NHS England 2018. ‘What matters to you?’.https://www.england.nhs.uk/what-matters-to-you/