PLACE (Patient Lead Assessment of the Care Environment) are a self-assessment of non-clinical services which contribute to good quality patient care.
The assessment process encourages the involvement of patients, patient representatives and staff providing an opportunity to measure current performance whilst also identifying areas for improvement/development. The audit team comprised of a 50/50 ratio Patient Representatives/Trust Staff including external verifiers from across the region.
Queen Elizabeth Hospital
At national level average site PLACE scores have slightly improved since 2017 for all domains. The largest increases were seen for Dementia (+2.2%) and Disability (+1.6%) These increases may reflect increased investment in and understanding of these newer PLACE domains. ( Dementia was introduced in 2015 and Disability in 2016)
Overall, this years results was again above the national average with the highest national average domain score for Cleanliness at 98.5%
Please see Appendix A for local level comparison in site scores
During the process a number of general themes for improvement were considered.
Areas the assessments were focused on included:
Emergency departments/minor injuries unit;
External areas; Car Parks, Entrances, Grounds and Gardens
Internal areas; Public circulation areas, refreshment areas, public toilets
Food – including the availability of food and drink
Assessment of these areas included the following domains;
Food and Hydration
Privacy, Dignity and Wellbeing (how the environment supports the delivery of care with regards to the patient’s privacy dignity and wellbeing)
Condition, Appearance and Maintenance of healthcare premises
Dementia (whether the premises are equipped to meet the needs of people with dementia against a specified range of criteria)
Disability (the extent to which premises are able to meet the needs of people with disability against a specified range of criteria)
On completion patient representatives are required to complete their own review of the assessment process.
ASSESSMENT PROCESS/ PLACE DOMAINS
The assessment of Cleanliness covers all items commonly found in the healthcare Premises, including patient equipment; baths, toilets and showers, furniture, floors and other fixtures and fittings.
The assessment of Food and Hydration includes a range of organisational questions relating to the catering service, for example, the choice of food, 24-hour availability, meal times and access to menus. An assessment of food services at ward level and the taste and temperature of food are also completed.
The assessment of Privacy, Dignity and Wellbeing includes infrastructural/ organisational aspects such as provision of outdoor/ recreation areas, changing and waiting facilities, access to television, radio, computers and telephones. It also includes the practicality of male and female services such as sleeping and bathroom/ toilet facilities, bedside curtains sufficient in size to create a private space around beds and ensuring patients are appropriately dressed to protect their dignity.
The assessment of Condition, Appearance and Maintenance includes various aspects of the general environment including décor, the condition of fixtures and fittings, tidiness, signage, lighting (including access to natural light), linen, access to car parking, waste management, and the external appearance of buildings and maintenance of grounds.
The Dementia assessment focusses on flooring, decor and signage, but also includes such things as availability of handrails and appropriate seating and, to a lesser extent, food. The items included in the assessment do not constitute the full range of issues requiring assessment which, in total, are too numerous to include in these assessments. However they do include a number of key issues, and organisations are encouraged to undertake more comprehensive assessments using one of the recognised environmental assessment tools available.
The Disability assessment focusses on issues of access including wheelchair, mobility (e.g. handrails), signage and provision of such things as visual/ audible appointment alert systems, hearing loops, and aspects relating to food and food service. It shares many facets with the dementia assessment, and with very few exceptions draws on existing aspects of the assessment rather than introducing new additional questions. This ‘double’ counting allows better use of data and avoids imposing additional burdens on data providers. The items included in the assessment do not constitute the full range of issues, rather focussing on a limited range with strong buildings/environment related aspects.
The aim of PLACE assessment is to provide a snapshot of how an organisation is performing against the range of non-clinical activities highlighted which impact on the patient experience of care. PLACE aims to promote the principles established by the NHS Constitution that focus on areas that matter to patients, families and carers:
Putting patients first;
Active feedback from the public. patients and staff;
Adhering to basics of quality care;
Ensuring services are provided in a clean and safe environment that is fit for purpose.
The inspection process was completed over 2 days in May 2018; audits were completed at agreed dates and times enabling assessment throughout the working day.
The decisions on where to visit were agreed with the patient representatives, consideration was given to the areas assessed in previous years, to ensure over time all areas of the Trust are included in annual audit. The Trust is required to include all units/sites with 10 in-patient beds or more. Assessment to included 10 In-Patient Wards (or 25% whichever is the greater) and a similar number of Out Patient Facilities all covering a range of specialties and buildings of different age and conditions. The Team are also required to sample and complete food assessments which were completed at the lunch and evening meal service at the QE and lunch at the ICAR Unit.
Appendix A. - Our scores achieved, this also includes national/regional, comparison scores. It can be seen that the Trust’s overall score in all categories achieved higher than the national average score.
Appendix B comparison site scores 2017 / 2018 for QE and ICAR
Appendix C demonstrates year on year progress in the 6 measured domains, QE and ICAR
PLACE assessment and scoring will be used by a range of public bodies such as the Care Quality Commissions Intelligent Monitoring (IM) process, the Department of Health and NHS England. The data being used to support ongoing quality programs encompassing nutrition, compassion and privacy and dignity.
In overview it was considered by all involved that the assessments went very well. Constructive comments were received from the patient representatives who commented on the value of the weekly PLACE audits which they feel very strongly supports the annual process and sustained improvements.