East Cheshire Hospice takes a ‘deep dive’ into their service user experience

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East Cheshire Hospice recently commissioned service marketing academics at the University of Liverpool Management School to carry out some in-depth research with patients and families to find out what they could do better.

How often are we told that we have transformed the experiences of those we look after at the most critical time in their lives? That our services are needed and appreciated by our many service users? And how often do we then fall short of anything but anecdotal evidence to back this feedback up? Or experience a sense of frustration or anxiety that excellence might actually lead to complacency?

The team at East Cheshire Hospice have tackled this head on, commissioning service marketing academics within the University of Liverpool Management School to undertake a ‘deep-dive’ of the impact of hospice care upon the different inpatient and outpatient service users.

Keen to give a voice to all service users, including patients, families, carers, friends and bereaved families, the study methodology was intentionally designed:

  • to allow participants to share their own stories on areas that mattered to them, and not be led by the researcher
  • to address all parts of the service experience, pre-, during and post use
  • to challenge excellence by encouraging participants to identify areas for improvement, particularly in terms of “…and what one thing would you change/improve?”

The team gathered data from 38 respondents, including day patients, outpatients, inpatients, discharged outpatients, carers, family and friends and bereaved families, on each stage of their service experience.

Adapting the fundamentals of a service blueprinting technique (a powerful technique that can be used to depict a service at multiple levels of analysis, as a single step or part of a networked system) seven distinct touchpoints within the hospice journey were identified:

  • pre-arrival information
  • arrival and admissions process
  • facilities
  • clinical and support
  • rooms and shared spaces
  • the little extras
  • discharge and aftercare support.

"You are excellent"

The ‘deep-dive’ approach unearthed multiple instances of excellence embedded throughout the services the hospice offered.

The welcome which all staff – paid and voluntary – extended to all service users was frequently described as “lovely”, “friendly” and “helpful” – “they always come and help you if they see you struggling”. This welcome makes people feel safe and have trust in the hospice. Staff were appreciated, respected and frequently acknowledged as going above and beyond what people expect – “everyone who works there has their heart in it”.

The hospice’s responsiveness was frequently applauded. This included preparing individual meals for patients struggling to eat, involving patients in decisions about their treatments, offering support and accommodation to family and friends, offering counselling and other treatments to those in need and providing a support network for carers. Such responsiveness makes a difference to the lives of not only patients, but families and carers too.

In an environment where the senses are on full alert, the management of hygiene and cleanliness was a common reference point, an intrinsic fear factor for some, with attention to detail demonstrated by the hospice appreciated by many.

So too “the little details” were also noted: fresh flowers appreciated for making the hospice more “home-like”, the tearoom a safe space allowing inpatients to socialise and reduce feelings of isolation without the fear of having to leave the premises, the courtyard a window on nature, the chapel a “quiet” and “peaceful” place, the chaplain relaxed and “did not push themselves on you” and the lounge somewhere where the grandchildren could play whilst visiting.

"But if you could change one thing ... ?"

But the point of the study was not to simply celebrate success, it was to be brave and continuously question “ok yes, but if you could change one thing, how might you improve the service?” Persistent questioning here helped to identify a number of areas which warrant further reflection.

In pre-arrival discussions, hearing about the hospice was, at times, found to be serendipitous. The website, whilst useful, was not accessible to all.

Arrival and admissions prompted discussions linked to signposting concerns and making sense of who is who upon arrival.

Facilities, clinical and support service discussions prompted conversations linked to depression and a desperate need for counselling. Respondents also expressed the need for greater clarity of communication to the relatives of the dying.

Rooms and shared spaces divided respondents in relation to single rooms versus shared wards. Some preferred one over the other. Mobile phone signals were hit and miss with some rooms failing to have a landline.

The little extras highlighted a lack of clarity about the services offered and when they were available.

Discharge and aftercare unearthed a fear in some respondents about what support they would have next. For some bereaved relatives, returning to the hospice to collect death certificates was a problem.

East Cheshire Hospice is taking these findings on board in their strategic planning. But what can the hospice community more generally learn from the study?

Two powerful messages emerge. First, knowing that their friends and relatives were being similarly cared for brought a peace of mind to patients that is frequently overlooked in existing research.

The message: look after the needs of family and friends and we automatically enhance the wellbeing of the patients we care for.

Second, there is a communications barrier in place when it comes to hospice care. From the generic questions of what does a hospice do? how can my relative be admitted? and what support services are there for carers, family and friends? through to the specific questions linked to location, a ‘who’s who’ of staff, and the services provided, all study participants voiced some issue which falls under this heading.

The message: investment in internal and external communication strategies will have the greatest reach and be the single most effective use of finite resources.  

Interested in the study? We welcome all feedback or interest in this study. Do make contact with the team via Pippa Hunter-Jones at phj@liverpool.ac.uk

Pippa Hunter-Jones is reader in marketing, University of Liverpool Management School; Lynn Sudbury-Riley is senior lecturer in marketing, University of Liverpool Management School; Laura Menzies is lecturer in operations management, University of Liverpool Management School. Mike Pyrah is hospice director, East Cheshire Hospice; Helen Knight is clinical and operations director, East Cheshire Hospice.

This article was originally published by Hospice UK on the UK edition of ehospice.