Inpatient survey triggers the development of culture and diversity services at specialist trust

Birmingham Women’s and Children’s NHS Foundation Trust reviews staff training to support diverse patient experiences.

Summary

The first of its kind in the UK, the Birmingham Women’s and Children’s NHS Foundation Trust (BWCT) has close to 650,000 patient visits each year and is committed to providing the highest quality care and treatment for women, children, and families. The trust unites two historic hospitals deeply rooted in the community it serves – the Birmingham Children’s Hospital (BCH) and the Birmingham Women’s Hospital (BWH) – and operates a range of services for women, children, and young people in Birmingham. The NHS Adult Inpatient Survey, run by Picker on behalf of BWCT, is designed to capture the experiences of adults that have been an inpatient at an NHS hospital.

As a specialist hospital, participating in national surveys is crucial to understanding how we can ensure our high standards in patient care are maintained.

Mark Hillier, Senior Patient Experience Manager at BWCT

Challenges

As part of the Picker survey methodology, results of the IP are split by ethnicity, religion, and mobility. In its 2020 IP results, BWCT saw scores were slightly higher for White British women across many questions compared to the other categories, particularly on needs being met. A large enough difference was seen for patients who identify as Asian, Muslim, and those with mobility issues that it triggered independent research into the patient experience. This resulted in several initiatives being created to improve communication, services, and understanding for patients from minority groups.

Actions

In response to Picker’s report on the IP, the Patient Experience Team at BWCT arranged a focus group to understand the experiences of women who had identified as coming from an Asian or Asian British background in greater detail. The focus group was held in person and concentrated on key areas that were identified in the Picker report; communication, wayfinding, food, and Covid policies. The session proved important in identifying changes to services and staff training, including a revision of signage and bolstering interpretation methods.

To gain further insight into the experience of non-English speaking patients, BWCT plans to hold further focus groups with women from Arabic, Urdu/Punjabi, Somali, Bengali, and Romanian speaking backgrounds to build on the initial session, undertaking comprehensive preparation beforehand to encourage attendance.

Covid drives major communication changes

The results of the 2020 IP were captured during a time in which the pandemic created or exacerbated communication issues between non-English speaking patients and the staff. Normally where relatives and friends of patients would communicate on their behalf, they could now no longer accompany or visit due to social distancing rules. Furthermore, face masks inhibited speech, body language, and lip reading. Despite the hospital boasting a team of in-house interpreters, findings from both the survey and focus group showed this wasn’t adequate support due to patients only being able to communicate whilst interpreters were present.

BWCT immediately began reinforcing their approach to communication and access to BWH by:

• Opening an Interpreting Services Office in its main reception area
• Increasing the number of Dora Electronic Interpreting Devices
• Introducing 4G on some devices to improve reception in Wi-Fi blackspots.
• Offering direct instruction about the use of in-house, agency,
• and electronic interpreting
• Improving marketing with bright and clear posters
• Giving small business cards listing Interpreting Services contacts were
• given to patients
• Updating signage with some community languages and picture symbols
• to aid key navigation in the hospitals

In addition to the many changes to interpreter methods and communications, BWH increased its Friends and Family Test (FFT) local survey feedback with non-English speaking families by asking interpreters to always seek feedback at the end of a session. Furthermore, the trust has introduced a specific Inclusion and Diversity Survey – offered as an extra survey to all respondents to FFT – which currently has almost 200 responses just two months after launch.

Impact

At the request of the Inclusion and Diversity Committee at BWC, the PET developed a proposal for a Patient and Families Ambassador for Inclusion and Diversity (PFAID) to match the existing Staff and Inclusion Ambassadors in the Trust. The plan also included an educational awareness package to improve training for staff, delivered with Experts by Experience designed to:

• Improve care delivery by enabling clinical teams to better understand cultural concepts of care and tailor provisions to meet those individual needs
• Improve the care experience for patients from diverse or disadvantaged groups by making services more accessible to them

This led to the creation of the Cultural Competency project, a series of cultural awareness workshops designed to help staff discuss and overcome cultural barriers with patients. A particular success has been the spotlight on patient
experiences, where representatives from various minority communities have shared their unique experiences, allowing staff to gain a deeper level of empathy, and understanding in their approach to care. Representatives have included those from the deaf, transgender, autistic, and from the Gypsy, Roma, and traveller communities. The workshops have been a huge success and we now have over 650 trained staff across the Trust attending the webinars and receiving positive feedback.

I can honestly say the workshop I attended was brilliant. I have worked with autistic children for a while, and I still learned a lot. It was incredible.

Member of nursing staff

The PFAID established a Cultural Advisors Group to help BWCT learn from its Experts by Experience who will produce a full 2023 programme of cultural awareness sessions, offer resource packs, and provide further input for improvement. To continue to keep ahead of the curve, BWCT has established communication with Healthwatch Birmingham on reports from ethnic communities about health care access.

What’s next?

The IP was the catalyst that triggered the review of services and staff training within the BWCT. It is designed to engage trusts to understand at a granular level, what they are getting right, what needs improvement, and what might need urgent attention. To maintain a culture that welcomes, supports, and celebrates inclusivity and the diversity of staff and patients, BWCT has continued its examination of staff awareness and training beyond the initial challenges. A staff survey regarding the Cultural Competency project has uncovered a desire to improve the understanding, processes, and practices for several groups going into 2023 including mental health, learning disabilities, refugee/asylum seekers, and LGBTQ groups.