In the first of our series of case studies from the Give More Get More programme, we explore how King's College Hospital is prototyping intensive volunteering placements for people approaching or in retirement, in hospital A&E departments.
About the A&E volunteers at King's College Hospital NHS Foundation Trust:
King’s College Hospital is one of London's largest and busiest teaching hospitals, providing care for patients across multiple sites, serving some of the most deprived communities in South East London. Their innovation is set in the A&E departments at King’s Denmark Hill and Princess Royal University Hospital (PRUH), which treat over 200,000 patients a year and serve as major trauma and hyperacute stroke centres.
What is King’s doing and what are the goals?
King's are recruiting 100 volunteers to support patients during their journey through A&E, from their first contact to discharge and, where appropriate, when they return home. By doing this, they aim to improve patient experience and quality of care and, for patients who receive follow-up support, to prevent, reduce or delay readmission.
What is the time commitment for volunteers?
Fifteen hours of support a week for six months, which can be given at any time during the week, over the weekend or a mix of both, with the aim of having more volunteers on shifts during peak periods in A&E.
What will volunteers be doing?
Support in A&E could include providing patients with company and reassurance, keeping them informed about waiting times, contacting family and friends, accompanying them for X-rays and other tests, helping patients fill out forms, assisting at mealtimes, offering drinks and snacks and supporting paediatric play specialists to entertain children.
Some patients, who are vulnerable, isolated, frail and anxious to return home, will also be supported with follow-up phone calls or visits in the home for up to four weeks after they are discharged. Volunteers will be able to help by making follow-up appointments with their GP or other health professionals and connecting them with other support in the community.
Where did the idea come from?
King’s wanted to improve patients’ experience in A&E. The idea was informed by insight from King’s A&E staff and senior managers, patient experience survey data, qualitative patient feedback and the current volunteering programme (King’s has 700 volunteers, aged 16-87, working across its hospitals.
A&E departments are pressurised environments for staff and can be daunting places for vulnerable, seriously unwell patients. Although King’s has a number of volunteers in the department, they felt that an intensive volunteering role could make a significant difference by providing patients with continuity of support during their journey through the system.
The initiative also responds to external recommendations on improving patient experience and the potential for volunteering in A&E. Attendance at A&Es nationally continues to rise and a recent House of Commons Health Committee report has urged A&E departments to focus on managing the patient journey and implementing measures to improve the quality of care through the whole patient journey.
How did King’s develop the idea?
King’s joined the Give More Get More programme in March 2017. As part of the programme, they spent eight weeks developing their idea, testing their assumptions, gathering further insights, engaging with key stakeholders and refining the volunteer role.
1. Talked to the patients and volunteers
King’s based their plans on a wealth of data and, through the prototyping phase, talked to as many people as possible to help test their assumptions before they began recruiting volunteers. Interviews with patients helped explore the assumption that patients would accept support from a volunteer and find it helpful.
King’s talked to existing volunteers about their motivations for volunteering in an NHS and A&E setting, which were often linked to giving something back after they or a family member had been treated. These conversations also highlighted the need to take the volunteers’ own health and mobility into account. For example, ensuring that volunteers are not required to stand for long periods if they are not able to, or placed in the paediatrics department if bending down to a child’s level is an issue.
Gathering these insights helped King’s understand which patients are more likely to value and accept help from a volunteer, while also gaining a greater understanding of the needs and motivations of their volunteers
2. Created a prototype
King’s made a physical model of the A&E department, this helped them to bring the idea to life. It helped staff think through where volunteers could be placed, identifying which parts of the department would benefit most from volunteers and what potential support they could provide in each area.
3. Engaged with colleagues
Talking to colleagues early on in the development of the idea provided important information. Insights from the Head of Nursing, with responsibility for A&E, the Director of Nursing for the Trust, and the Senior A&E Management Teams at both sites identified key opportunities for volunteers to take on tasks that would give staff more time to focus on clinical care. For example, sitting with patients who may be at a risk of wandering due to dementia and helping patients with the administration of lost property.
As a result, King’s has developed one volunteer role with the flexibility to rotate around five areas of A&E according to need: reception, minor injuries, major injuries, the Clinical Decision Unit (an observation ward) and paediatrics.
4. Engaged with partners
King’s also worked closely with partners in the local health system and designed training to equip volunteers with the skills they need to support patients in A&E. This includes communicating with and supporting the frail and elderly, recognising and supporting patients with mental health problems and dealing with loss and bereavement. The need for this training was informed by first-hand experience and data about increases in the number of elderly patients and patients with mental health needs coming through A&E.
5. Built the right team
As major trauma and stroke centres, King’s A&Es are used to running at full capacity and staff are often stretched. The team running this initiative have a strong focus on staff engagement, which they know will be key to successfully integrating the A&E volunteers into the A&E staff teams to help maximise their impact.
King’s have completed the prototyping stage and finalised the volunteer role. They have recruited around a quarter of their hundred volunteers, predominantly from community networks and word of mouth. More than half of all enquiries have come from individuals who aren’t currently involved in King’s existing volunteering programme. The first phase of new intensive volunteers has been trained and will start in early July.
How to get involved:
If you are interested in getting involved in volunteering in A&E at King’s Denmark Hill or PRUH sites, you can contact [email protected]
Tools used to help develop the idea:
These are some of the useful tools King's used to help prototype the idea:
· Model making
More useful prototyping resources can be found in the DIY Toolkit.
Photo Credit: Kings College Hospital NHS Foundation Trust