Trust develops a volunteering programme whereby volunteers are trained and offered placements, resulting in improved patient outcomes and threefold increase in volunteer retention

The High Impact Volunteering programme aimed to strengthen relationships between Kingston Hospital NHS Foundation Trust and the local communities by establishing a high impact volunteering model and thriving volunteer function. The Trust utilised core funds and an award from the Cabinet Office to establish a suite of over 10 roles acommodating more than 800 volunteers at its peak. The programme aligned with the Quality Strategy and Patient Experience Strategies to target its assets of people and time where the need was greatest and responsive to the Trust agenda.

The programme demonstrated three statistically significant patient improvements, including an 18% improvement in mood for patients with dementia and a 28% reduction in patient reported anxiety at discharge home. Improvements were also demonstrated linking volunteering to improvements in overall patient experience, accessing community and voluntary services and satisfaction with food and mealtimes amonst patients over 75.

Challenges

i) The existing approach to volunteering was not optimised through safe recruitment and thoughtful allocation of people, placements and services targeted.

ii) The absence of a clear infrastrucure led to poor volunteer retention, inconsistent volunteer experience, unstrategic deployment of volunteers and a sense of missed opportunity to maximise the appetite across our local communities to volunteer in a meaningful way.

iii) Frequently, the Trust faced challenges in time and resource to deliver meaningful and measurable improvements in for patient experience, highlighted by key strategic drivers in this area: Quality Improvement Priorities, Friends & Family Test and Patient Experience Improvement Plans. There was recognition at Board level that the local community was an untapped asset in hospital support systems to address systemic issues affecting mental health, patient experience and wellbeing post discharge, including: loneliness and social isolation, carers’ respite, demenita care, and nutrition in a frail elderly population.

iv) Kingston Hospital NHS Foundation Trust is situated within 5 miles of several major colleges and grammar schools. Many local students require structured work experience in preparation for careers in medicine, nursing and health care management. Given the risk of a hospital environment, a robust yet meaningful solution could be provided through a volunteering route, enriching both patient experience and future work-force planning.

v) Volunteering is hard to prioritise in budget setting and core funding. The Trust needed a credible evidence base for its qualitiative and quantitive impact and value for patients and productivity in order to justify its investment of core funds into a staffed volunteering function.

Actions

i) A comprehensive three year Volunteering Strategy and supporting Policy that was responsive to internal drivers such as the Quality Priorities, Dementia Strategy, Patient Experience feedback. This engaged and established buy-in at Board, CEO and Director level and leveraged engagement with key staff across the Trust.

ii) Listened carefully to the staff who would be directly supervising volunteers to define clear roles, boundaries and outcome measures that would add value to their services as well as enhance specific aspects of patient experience, e.g. support at mealtimes.

iii) Approved a detailed Volunteering Policy and implemented online data management systems to accomodate the management and placement of over 600 volunteers, and an additional 200 applications in progress.

iv) Created a streamlined yet robust ‘recruitment to placement’ volunteer pathway and acclaimed Volunteer Mandatory and Specialist Training Programme with strong appeal to local students, as well as adherence to the mandatory policies for safe and effective placements in a hospital environment.

v) Worked backwards, using a Theory of Change model to ascertain the impact results that the Trust wanted to achieve with its volunteer community for patient and Trust impact…..back to the activities (roles) we would develop and partnerships with services and clinicians in these areas. We then implemented an evaluation plan based on the key outcomes the programme aimed to achieve.

Results

i) Volunteering at KHFT increases overall patient satisfaction across Hospital services by 3.7% (FFT scores, control v. comparrison group)

ii) Dementia Therapeutic Volunteers increase patients’ mood and wellbeing by an average of 18% (baseline versus post-treatment score)

iii) Patient discharge support volunteers reduce patient anxiety about going home from hospital for patients aged 70+ by an average of 28% at the six week milestone.

iv) Dining Companions (mealtime volunteers) increase patients’ satisfaction with the help and support received at mealtimes by 4% (Points ii, iii and iv are statistically significant as reported by an independent evaluator)

v) Volunteer retention more than trippled from 20% in 2014 to a 77% retention rate in 2016.

Value

Assessing the cost/benefit of a volunteerning programme conflicts with the core principles that Volunteering cannot replace staff or service needs. Given this challenge, added value is quantified through a robust evaluation of impact and outcomes on patients’ qualitative experiences of care, enriching the local community and the Trust’s reputation across the NHS for its innovative approach and scalable model of impact volunteeirng for quality improvement.

i) We have seen an increase of 7% (from 20% in 2014 to 27% in 2015) of volunteering time targeted towards our most elderly and frail patients, as measured through the FFT.

ii) Patient experience of support at mealtimes (4% improved score), mood and anxiety in dementia patients (18% improved score) and anxiety about going home from hospital in an elderly and isolated population (28% improved score after 6 weeks) actively demonstrates the added value. NHS England recognises the links between objective care outcomes and the subjective experience of receiving care in their FFT strategy and communications.

iii) The Care Quality Commission (CQC) inspected Kingston Hospital in January 2016. The Inspection Team’s report in July 2016 described the Volunteering Programme as an area of Outstanding practice and referred to ‘the volunteers’ invaluable contribution.’ The Trust is cited by the Cabinet Office, Nesta, Centre for Social Action and The Soil Association for its approaches and invitations to scale the model across other sites.

In detail

Kingston Hospital NHS Foundation Trust has become a sector leader for high impact volunteering in hospitals. Supported by The Centre for Social Action ‘Helping in Hospitals’ grant 2014-15, the Trust has more than doubled the number of volunteers to over 650 and tripled volunteer retention. High Impact Volunteering is aligned with the Trust’s agenda for Quality Improvement and Patient Experience Improvement including Dementia Care, Food & Nutrition, Patient Experience and Hospital Discharge. Volunteers are motivated by making a difference and over 95% are proud to be a Kingston Hospital Volunteer. Staff are invested in supporting volunteers as a precious ‘and time-rich resource which enhances the quality of their services and the exceptional care that the Trust aspires to in its corporate vision. Volunteering is an investment by the Trust in its local community.

With three large universities on the doorstep and an affluent retirement aged community, volunteering offers opportunities with wide appeal. The Trust offers competitive intensive roles for local students with ambitions in medicine and health care. As well as utilising the maturity and talents of an older community over longer periods of time with a strong sense of citizenship and often, direct experience of their local hospital. The Trust has built a thriving volunteering function to recruit, manage and support volunteers at this scale.

Spread:

We have succeeded in developing a high impact volunteer programme that continues to grow, with rewards for the patient, volunteer and communities we serve. In 2014, we were one of only ten hospitals across the UK to receive a grant from the ‘Helping in Hospitals’ Programme - an initiative run by the Cabinet Office and the innovation charity Nesta, to grow existing volunteer schemes that work on improving overall patient experience and outcomes. This grant enabled us to nearly triple the number of volunteers we work with, from 300 to 650 volunteers, in under two years. Our programme has since been described as sector leading and was highlighted in a case study “Setting up an Impact Volunteering Programme” in a report commissioned by the Cabinet Office Centre for Social Action (2016).

Value:

In a difficult financial climate for the NHS, our volunteer programme has enabled us to turn the time and commitment of our local population, into tangible improvements to services and patient experience. Where the Kings Fund (2014) estimates a cost improvement ratio of £11.01 to every £1 invested, the impact of our volunteer programme is particularly evident amongst our elderly patients. As such, we increased volunteers’ time directed towards elderly care by nearly 10% from 20% to 27% between 2015 and 2016. Support and care from our volunteers has reduced their risk of prolonged hospital stays and emergency re-admissions – two factors than can affect hospitals financially.

Involvement:

For the future we aim to build on this achievement, buy directing support to carers of elderly patients. The National Carers’ Strategy updated in July 2015 stated that up to 30% of hospital admissions for people aged over 75 years can be attributed to the deterioration in the health of a carer, who themselves are often elderly. We already have in place a Carers Support Programme, delivered in the hospital by the Kingston Carers Network. They support over 200 carers’ ensuring they have established support plans before their loved one is discharged. For the future we are aiming to direct our volunteers to also support this programme, enabling further benefit for our patients and their carers. Our volunteer programme has also enabled a novel way to tackle future workforce planning.

For example, our partnership with Kingston College’s Access to Midwifery course has supported their students to achieve a minimum of 60 hours supervised work experience within our maternity unit. This valuable experience helps them to meet entry criteria for further studies in Midwifery or midwifery support worker roles. There are number of reasons why other demographic groups volunteer including adults exploring career changes and active citizens who are loyal and protective towards local public services. Once recruited, we provide our volunteers with a rigorous training programme, tailored to the roles they are interested in.

For example, volunteers keen to deliver care for patients with dementia receive training that is accredited by the Alzheimer’s Society Dementia Friends Scheme (we were the second NHS Trust to be awarded this accreditation) along with specialist clinical input. For some of our roles, we are able to ‘cohort’ recruit and train with between 8 and 30 volunteers per group – this encourages peer support and enables time and financial efficiencies. Our volunteers support the Trust’s services including maternity, accident and emergency (A&E), dementia care, chaplaincy, hospital to home, dining companionship and paediatric play.

Some of our volunteers are at the front-line of care, supporting families of patients at end of life, or meeting the needs of anxious patients in A&E. Other volunteers prefer to help behind the scenes providing administrative support. The success of the programme as a support service rests on its network across all services hosting volunteers to ensure that roles continually add value to staff and patients in these areas. All roles are defined through a Service Level Agreement, which is a collaborative way between a support service and the clinical front-line teamsn to define the volunteering role, placement, training and supervision of volunteers in-situ that will deliver on its impact outcomes for them and their patients.

It is therefore a ‘living’ agreement to ensure our volunteering programmes are responsive to the needs of the service, as well as emergent themes for patient experience. There is a wealth of evidence on the importance of thanking volunteers and how it affects their experience, satisfaction and retention to organisations. We thank our volunteers through regular events including awards ceremonies and comprehensive induction and training processes that are delivered with participation from our Executive Team and clinical specialists. We also seek feedback from our volunteers via their supervisors - informally and through more formal listening events; and encourage them to be drivers for improvement.

Outcome:

•We have proactively mobilised our volunteers to address the issue of poor nutrition amongst patients in hospitals, because this can impair their rate of recovery. Thirty percent of our inpatients over the age of 75 are malnourished at the point of admission. Through our volunteer-led Dining Companions scheme,165 volunteers support elderly patients during mealtimes, helping them to eat and drink well to support their recovery. Their support releases nursing time to patient care and reduces the risk of prolonged hospital stay. This scheme has led to increased patient satisfaction at mealtimes by an average of 4% for each visit and has received support from BAPEN (British Association for Parenteral and Enteral Nutrition) and The Soil Association.

•Volunteers are equipped to help patients at the point of discharge which reduces some of the key risk factors for emergency re-admission including social isolation and poor self-care. Our volunteers deliver a Hospital to Home Service which supports patients over the age of 70 returning home alone. Through coaching and support planning, volunteers make referrals to community and voluntary organisations to ensure that patients are supported outside of statutory or private health care. Their support has reduced patients’ anxiety between day of discharge and 6 weeks from point of discharge by 28%.

•Our programme is aligned with the Trust’s strategy and outcomes, delivering impact and improving patient experience, where it is needed most. Forty-eight percent of our patients over 75 years have dementia (double the national average) and our Dementia Strategy aims to deliver excellent care them and their carers. An independent evaluation of our Dementia Volunteers’ therapeutic activities service in March 2016 concluded that in one year and amongst a sample size of almost 1,000 patients, there was an average 18% improvement in the mood and wellbeing scores of patients affected by dementia, following their participation in therapeutic activities.

•The value of social action and community cohesion that our volunteer programme brings is reflected in a recent (2015/16) volunteer satisfaction survey. Eighty percent of our volunteers reported that volunteering is a good way for Kingston Hospital to give something back to the local community, 84% of respondents felt that they make a positive difference to patient experience and 95% described feeling proud to volunteer at Kingston Hospital.

•Following a Care Quality Commission (CQC) inspection at Kingston Hospital in January 2016, the Inspection Team’s report described our volunteer programme as an area of outstanding practice and referred to “the volunteers’ invaluable contribution”.

From the Chairman to the domestic staff who greet and sign-in volunteers in their clinical area placements, volunteers are quintessential to the Trust’s definition of ‘excellent’ care. The volunteering programme has instigated a complete transformation in the mobilisation of the time, talent and appetite to give back to public services in the community. We believe the strength of this entry is the innovation that has utilised strategy, robust operations and extensive networking between a support services and front-line clinical and other support teams to deliver service enhancements and patient experience improvements in areas of high need across the Hospital.

The external recognition that the last three years’ work to establish, test and optimise Impact Volunteering has come from the Centre for Social Innovation, NHS England Active & Supportive Communities, Nesta, BAPEN and others. This collaboration at a national level is a testimony to what can be achieved and its scalability across the NHS and indeed other public services.