What happens at the end of a hospital stay?  Are patients forgotten the moment they leave the ward?  Sadly, it is often a case that once patients are out of sight they are also out of mind.

We do things differently at Spiral Health.  At our Bispham rehabilitation unit we’ve been introducing a pioneering approach to patient care.  Our patient-centred journey begins before a patient even arrives in our unit and it doesn’t end until the patient is fully settled at home.  Having invested so much effort in getting to know our patients as real people with unique needs, how could we turn our backs on them the moment they leave our unit?

We have one dedicated nurse in charge of pre-arrival assessments and post-departure follow up. When patients are discharged, Zandra puts their name and phone number into a diary. Seven to ten days later she calls them at home to ask how they are doing.  This is Zandra’s chance to give advice and pick up on problems and she doesn’t miss a trick.

Recently, Daisy stayed with us to recover after a series of falls. Her main carer was her son, Richard, but he was also unwell.  After Daisy was discharged, Zandra phoned her at home and Richard answered. “I’m worried,” he said. “Mum’s confidence has gone, she’s having problems with her mobility and she’s not eating. And I’ve got to go into hospital next week myself, so I don’t know how we are going to cope.”

Zandra suggested that Richard contact Daisy’s GP to see if she could be re-admitted to Bispham for more physiotherapy – and to see if this could coincide with the time he was in hospital. Zandra also spoke to Richard at length about claiming his carer’s allowance: he’d had no idea he was entitled to it. 

The plan worked like a dream. Daisy came back to us and we gave her lots of care and attention and fed her up – and Richard went into hospital as scheduled.

Calling patients at home is also a good way to check that they are receiving continuity of care.  We’ve recently discovered that a few of our patients are missing their first few days of physiotherapy once they return home, because they are waiting for the community physiotherapist to visit them.  A gap in care could mean that they sit, immobile for several days and this will undermine their long-term progress.  To stop this happening, we’re trying to instigate a new procedure whereby one of our own physiotherapists makes home visits, when needed.

With follow-up calls, sometimes it is just a case of giving advice on the phone. Perhaps a patient has been struggling to use certain equipment or is wondering if they can contact their GP about a certain issue. Zandra has a calm way about her and even if the patients just want a chat, she’ll make sure she has the time to listen. She’ll pick up the phone and tell them, “I’m the little one with glasses; you met me before you were transferred to Bispham.” They’ll say, “Oh I remember you,” and then they’ll talk. 

At Bispham every aspect of our work is dedicated to the moment when a patient returns home healthy and happy.  Zandra’s role is to provide what some may call customer service, but what we like to think of as a human touch.

“It’s satisfying,” said Zandra. “I feel as if I make a real difference.  It’s nice to know that our patient-centred journey begins and ends with me.”

“Imagine a workplace where people are energised and motivated by being in control of the work they do. Imagine they are trusted and given freedom, within clear guidelines, to decide how to achieve their results. Wouldn’t you want to work there?”

I love this quote from ‘The Happy Manifesto’ by Henry Stewart and, yes, I’d love to work in an organisation like that. I believe these are principles all managers should aspire to. But, more than this, I believe that only a happy, motivated team can provide a superior level of customer service.  What it boils down to at Spiral Health is that we can’t be truly patient-centred unless we are person-centred with our staff.

When it comes to being person-centred with staff, the buck stops with the senior management team – me included.  Our philosophy is to be visible and approachable. We regularly walk the wards, talking to patients and visitors and we are extremely open and accessible to staff.  As an aside, Happy Manifesto rule 4 is to be open and transparent – I hope our staff would say that we do this well.

That’s not enough, though. Staff need a voice. They need to feel that their views are listened to and valued. Unusually for a healthcare setting, two staff members sit on the board of Spiral Health as non-executive directors.  Normally, non-executive directors would be chosen from outside an organisation, but because we are mutually owned, we felt it was imperative for our staff to have this board-level representation.

We also have three very active working groups – an operations group, a business development group and a workforce group.  Each group is facilitated by a staff member and attended by a complete mix of staff, representing all aspects of our operation, from nurses to administrators.  Our working groups inform all our important decisions and although group membership is voluntary, the majority of staff do attend and engage with the process positively.

It’s fair to say that when we first set up the working groups, some staff felt the meetings were negative and those who were less confident in a group setting often felt unable to contribute.  We invested in specialised training (we learned how to run Positive and Productive Meetings) and now the meetings buzz with energy and even the quieter staff are very vocal.

Our business development group works hard on our strategic vision at Spiral Health. It considers how we should grow as a social enterprise.  For example, it considers whether we should tender for London-based projects or stay local.

Our operations group is very focussed on our Bispham unit. This group considers big issues, such as our Care Quality Commission reports, but also handles the smaller things that are key to making our unit thrive. Thanks to this group we have Easter eggs at Easter, celebrations at Christmas and – following a brainwave from one group member – special non-slip slippers available for patients to buy.

The workforce group focuses on the nitty-gritty of our operations.  It is in these group meetings that we use ‘The Happy Manifesto’ as a source of ideas and inspiration.  Henry Stewart’s management philosophy has influenced everything from our corporate vision and core values to our recruitment processes and performance reviews.

Another important way we are person-centred with staff is by involving them in our continuous change process, Working Together for Change.  During this process patient feedback is scrutinised by a team of stakeholders representing the entire organisation – and the action points agreed truly reflect all viewpoints.

Our working group structure isn’t perfect yet. As with every aspect of our patient-centred work, this is a moving feast.  One thing I can report, though, is that running an organisation that is actively person-centred with its staff makes me…. happy.

Tracey Bush

As we are a rehabilitation unit, many of our patients come here for physiotherapy. They may be recovering from a hip or knee replacement or have reduced mobility because they’ve been unwell and are weak. Getting them up on their feet and moving steadily and with confidence is a top priority.

Recently, we asked patients what was working and not working in our hospital unit. The research was part of a business change process we are going through called Working Together for Change.  Our patients gave us some feedback on the exercise regime we have in place here.  “I need more demonstrations about my exercises,” said one patient. Another commented that there weren’t enough discussions about how to use equipment.  A younger patient added that he did not want to have to sit in a circle doing exercises.  He said, “I looked around and everyone was older than me.”

I scheduled a meeting with our therapy team (this includes three physiotherapists and three occupational therapists), and we sat back and thought hard about these comments.  I was proud of the way we already personalised our exercise regimes but clearly we need to do more in order to be truly patient-centred in our approach.

When it comes to demonstrating exercises, we use a computer programme to top up personal instruction.  The programme shows pictures of people carrying out the exercises and it also contains links to video clips.  When patients leave us, we can email them information about how to progress with their exercise plans.  We felt there were a couple of ways we could improve upon this approach. Clearly, we need to work harder to explain exercises during the one-to-one sessions with patients – and this is now happening.  We are also looking at ways to make our computer programme easier to use for technophobes. This is a serious issue because many of our patients are elderly and unused to the sort of technology we take for granted.

There’s something brand new in the pipeline, too. We are looking at producing a series of our own generic physiotherapy videos, as many of our patients have similar exercise regimes.  No, this isn’t just a repeat of our existing computer programme – it is far more exciting. The idea is that our own therapy team would appear in these videos, explaining the exercises and demonstrating them themselves or with patients.  Our physiotherapist, Claire, explained the thinking behind this. She said, “At the moment, when patients leave us and return home, the community team follows up with them.  That change in personnel can set patients back. Having the familiar face of someone they’ve got to know and trust on a video will be a comfort to them and help them progress that little bit more.”

As I said above, one of our patients had commented that he felt far too young to be sat around doing exercises in a group with much older people.  From his point of view, this can’t have been good for morale.  We do offer a group exercise every day, which is run by our healthcare assistants. Although we like patients to attend, we are now working harder to tell patients who are perhaps younger and fitter that it is optional. Claire said, “If you are recovering from, say, cardiac surgery and were previously fit and well, doing simple leg exercises in a group may not be the best option for you.  Instead, we’d rather work with you on a one-to-one basis in the gym to develop an exercise regime that takes your fitness up to the next level.”

Claire stresses, though, that for many people inventive group exercise regimes can be tremendously beneficial both for morale and fitness.  Some of our patients enjoy Crown Green bowling, so one of Claire’s classes uses this as a theme for balance exercises.  In another session, Claire will put down mats with bumpy surfaces and get patients to walk over it. This can be daunting for those who are unsteady on their feet, but when patients do this as a group, they encourage each other and suddenly a task that seemed difficult becomes fun.

Claire and the rest of our therapy team are essential to our patient-centred journey. They spend plenty of one-to-one time with patients, getting to know their backgrounds and their interests – and can pass back information to nursing colleagues.  Claire says she particularly enjoys the banter she has with patients.  She said, “They don’t call me ‘nurse’, they call me by my name and that’s important.”

Last month we celebrated Dignity Action Day at Bispham hospital. The action day had been arranged by the National Dignity Council as a day on which patients and those receiving care would be treated as individuals and given choice, control and purpose.

Our passion here is that every single patient should be treated as a real person, not just a patient with a condition – and so we were pretty sure we could make Dignity Day rock.

One of the longer term objectives in the patient-centred journey we are developing is that every single day we’ll ask every patient two very specific questions.  In the morning a nurse or healthcare assistant will ask, “What would it take to make this a good day for you?”  That same evening, a night nurse or assistant will ask, “Has this been a good day for you?”  We’re not quite ready to incorporate those daily questions into our routine yet, but we were ready to give the system a trial run – and so we chose Dignity Action Day to be the pilot day.

So, first thing in the morning our healthcare assistants visited all our 40 patients and asked them the question. They wrote the answers down on coloured card, depending upon which ward the particular patient was in, and the cards were posted at our nurses’ station.  We weren’t sure what to expect but our patients humbled us with the nature of their requests.  They reminded us that the simplest things – even a gentle touch or a kind word – can make the world of difference to someone who is unwell and in unfamiliar surroundings.

Here’s what they asked for:

“A friendly smile”

“Company”

“Two more cushions, please”

“Fruit for breakfast”

“A hair wash”

“Card games to play”

“A bacon butty”

Then we asked our patient Elizabeth what she wanted. Her answer, so sweetly and innocently delivered, with just the faintest glimmer of amusement in her eyes, was that she’d like to meet Gary Barlow, please.  Our heathcare assistants took up the challenge with gusto. They followed Gary on Twitter and sent him several messages. But to no avail. Gary was not to be found. In the end, they printed out a large picture of him, which we posted above Elizabeth’s bed.

Pop stars aside, our healthcare assistants managed to fulfil all our patients’ requests on that day.  The atmosphere on the wards was terrific amongst patients and staff.  As a team, we learned that the simplest thing can transform someone’s day and we felt a unity of purpose that was heart-warming.  It reminded us why we are implementing our patient-centred journey and encouraged us to stick with it until we are one hundred per cent there.

And if anyone out there knows Gary, please tell him our patients would like him to visit.  If he can sing to us, that would be a bonus.  Perhaps ‘Back for good’, or, my personal favourite, ‘Relight my fire’?  He can contact me any time via Twitter on @spiralhealth.

Tracey Bush

By Zandra French, nursing sister and assessor

The patient-centred journey at Bispham hospital starts with me.  I’m the very first person a new patient sees; in fact, I meet patients before they even arrive at our unit. Most of our patients come from Victoria Hospital in Blackpool.  We’re a nurse-led rehabilitation unit and patients come here because they need physiotherapy, occupational therapy or to build up strength after major surgery.

In the past, whenever a new assessment was required to see if a patient was suitable for us, one staff member would have go up to the Victoria. It meant the staff left behind really felt the pressure.  Last year we piloted a new approach. I was to be the one designated person who would visit the Victoria to do all the assessing.

Last October I was a finalist in the employee of the year category of the Social Enterprise Awards, in recognition of the work I’ve done in this new role.  The experience has spurred me on and I’m now focussing on finding out more about patients and their families so that we can build a picture of the real person who’ll be visiting our unit. I ask a patient what is important to them and what support they feel they will need during their stay. The answers to these questions will later be collated into a special one-page patient-centred profile, which staff at the unit complete for every patient.  This drive to really understand what matters to a patient is at the very heart of our patient-centred approach.

When I do an assessment I sit down at the bedside of the patient. Very early on I make it clear that we are a short-stay unit. Elderly people are frightened if they think they’re going to a long-stay establishment. You can almost sense the breath of relief when they realise this is just a stepping stone to home and not a nursing home.  I always talk to them about a tentative discharge date (although I make it clear we’d never send them home if they weren’t ready) and this is tremendously reassuring.

I am always calm and patient.  Through experience you know how to talk to a certain type of person. You can be down to earth and jolly with one and with another you’d say ‘hello Mrs Brown’ and it would be Mrs Brown throughout the whole conversation. People find it easy to talk to me and quite often they’ll open up to me. Recently, I assessed an elderly gentleman who’d had mental health issues, alongside his physical condition. I told him that if you have your leg in plaster, people can understand that – but it’s not so easy getting people to understand a mental issue. He said this was the first time he’d heard anyone acknowledge that. The gentleman told me his whole story and now I’m very clear about how we can help him feel safe at Bispham.

When I asked another patient what was important to her, she mentioned ready meals. It may seem like a small thing, but she’d been anxious about going home after her rehabilitation. Her local shop only stocked two or three choices of meal and she couldn’t cook for herself. I told her about Wiltshire Farm Foods and other companies that deliver pre-cooked meals.

When I’ve spoken to the patient, I phone their family or friends from the ward. I tell them the patient is being moved and give details of visiting hours but I also make a point of asking about the patient as a person. What are they like? What is important to them? Often they’ll say, “Mum says she can do this and that but actually she’s really struggling.” That’s good to know because sometimes a patient isn’t being realistic about what they can do.

The notes I write travel with the patient to the unit – but I ring ahead so that our receptionist is expecting them and there’s a bed booked. Every patient who arrives at Bispham is greeted by name. This is an important part of our patient care. It makes you feel you are not a number and that you are very welcome here.

We’ve come a long way in our approach to assessment, but it still feels like we’ve only just started. We are always looking at ways to improve our patient-centred approach and I feel as if I’m learning all the time.

Spiral Health began as a social enterprise on 1 April 2012. Prior to this, ward meetings were held on a monthly basis but there had been something of a lack of focus around meetings, and unclear objectives – when it came to meetings, people hadn’t always felt able to contribute and there had been some conflict, with only sporadic attendance.

Meeting agendas lacked real focus and were really more about giving information than engaging people in decision-making and discussion. Meetings were often very one-sided and when disagreement occurred it had the potential to result in a ‘free-for-all’. It wasn’t unknown for people to get quite emotional and leave feeling upset.

But when the structure of the organisation changed, so did some of the personnel, and there was a real desire to do things differently.

Spiral Health Managing Director Tracey Bush and Clinical Lead Cheryl Swan began considering what the best possible experience for staff and patients would be, and how meetings could contribute to this.

Spiral were boosted by the previous experience that Tracey had of positive and productive meetings in other roles. She was using this in the meetings that she already chaired, such as workforce development, but she was keen to introduce it across all meetings in the organisation.

Training was organised for all staff – regardless of job title or role, and it was seen as important that everyone learned and contributed to the development of positive and productive meetings together. On day one of the training, the group came together to decide what the purpose of the ward meeting was – the group used a technique used in positive and productive meetings called ‘thinking rounds’ to ensure that all views were considered, but it was difficult for the group to agree and it became clear that the purpose of the meeting was no longer understood.

It emerged that although meetings were much better than in the past, it was still felt that they were covering too much information, some of which didn’t relate to the work taking place on the ward – and this was causing frustration. The group spent some time exploring what they wanted to achieve in the meeting, and used this discussion to clarify the purpose.

Once this had been clarified and recorded, it then became easy to figure out who should be attending, which items would need to be on the agenda and more importantly, which didn’t. Jan Moutrey, the Nurse Lead, then took responsibility for taking the process forward and introducing it into the newly-named ‘clinical meetings’.

Following this, things have gone from strength to strength. People now share roles and responsibilities within the meeting, contribute to the agenda and are using thinking rounds to actively take part in meeting discussions. There’s a much more collaborative atmosphere and people are feeling positive and motivated when leaving the meeting.

The staff coming together to contribute to the agenda has made a huge difference to overall understanding of the meeting’s purpose, and the meetings have become more positive and productive as a result.

By Michelle Livesley and Cheryl Swan

You can watch Cheryl’s YouTube video on the introduction of positive and productive MDT meetings here