Scottish Inpatient Patient Experience Survey 2014 Volume 1: National Results

4. Results - Hospital and Ward Environment

Summary

• Results for the hospital and ward environment show several improvements in experiences since the previous survey. Eighty-eight per cent of patients rated the hospital and ward environment 'overall' as good or excellent, a rise of 8 percentage points since 2012 (Chart 3).
• As in previous surveys, patients views about the hospital and ward environment were mixed. Patients tended to be most positive about cleanliness and the visiting hours, however they were markedly less positive about food and drinks, noise at night, and knowing which nurse was in charge of the ward.

Chart 3 Overall rating of the hospital ward and environment (%)

The hospital and ward environment

4.1. Patients were asked how much they agreed or disagreed with eight statements about the hospital and ward environment covering: cleanliness; noise at night; catering and drinks; receiving assistance; impact of other patients and visitors; and overall rating of the hospital and ward environment.

4.2. In addition they were asked to indicate the extent to which they were content with the visiting hours, ability to spend time with others and the availability of hand gels.

4.3. In general, responses were mixed (Table 2). Patients were most positive about the following statements:

• the main ward or room I stayed in was clean (95% answered positively),
• hand-wash gels were available for patients and visitors to use (95% answered positively,
• I was happy with the visiting hours (95% answered positively)

4.4. However, patients were markedly less positive on other aspects:

• I knew which nurse was in charge of the ward (42% answered positively)
• I was bothered by noise at night from other patients (54% positive) and staff (69% positive)
• I was happy with the food / meals I received (85% answered positively)

4.5. Compared to the previous survey, patients were considerably more positive about their overall rating of the hospital and ward environment: 88 per cent of patients rated the hospital and ward environment as good or excellent, an increase of 8 percentage points. (Table 2). This improvement was seen across nine of the 15 NHS Boards and in some Boards the rises were considerable.

4.6. There were slight improvements in patients' ratings of cleanliness (ward/room and bathroom/toilets) which showed an increase of 2 percentage points from the 2012 survey, which had itself shown modest improvements from the 2011 survey.

4.7. Similarly patients were slightly more positive than in 2012 about receiving assistance within a reasonable time and the impact of other patients or visitors with an increase of 2 percentage points each (Table 2).

Table 2 Summary of the results to questions about the hospital and ward environment (%)

	Negative	Neither positive nor negative	Positive	Change in Positive Per Cent from 2012
The main ward or room I stayed in was clean.	2	3	95	+ 2
The bathrooms and toilets were clean.	5	5	91	+ 2
I was bothered by noise at night from other patients.	29	17	54	n/a1
I was bothered by noise at night from hospital staff.	16	14	69	n/a1
I was happy with the food/meals I received.	20	12	68	n/a1
I was happy with the drinks I received.	7	9	84	n/a1
When I called I received assistance within a reasonable time.	6	6	88	+ 2
There were times when I felt bothered or threatened by other patients or visitors.	9	6	84	+ 2
Did you know which nurse was in charge of the ward?	33	25	42	n/a1
Were hand-wash gels available for patients and visitors to use?	1	4	95	n/a2
During your stay, were you happy with the visiting hours?	5	0	95	n/a2
Did you feel you were able to spend enough time with the people that matter to you (e.g. family and friends)?	4	15	81	n/a2
Overall, how would you rate the hospital and ward environment?	2	10	88	+ 8

Notes:

1. Comparison is not available for this question as changes were made to the 2012 question.

2. New question added to the 2014 survey.

Food and drink

4.8. Food and drink play an important part in a patient's recovery and consequently they are subject to national standards for food, fluid and nutritional care in hospitals^[5]. NHS Boards' performance in the provision of food, fluid and nutritional care are assessed based on these standards.

4.9. The survey asked people about the food and drink they had received while in hospital. Food, similar to noise, is an area where a substantial percentage of patients reported a negative experience (20 per cent were not happy with the food they had received). However patients were more positive about the drinks they had received, with only seven per cent reporting a negative experience (Table 2).

4.10. There was considerable variation between NHS Boards in the responses to the question 'I was happy with the food/meals I received'. Responses ranged from 53 to 89 per cent.

Noise

4.11. Noise at night can be disruptive for patients, affecting their sleep and potentially their recovery. This might explain in part why noise at night is an area which patients feel strongly about: 29 per cent felt they were bothered at night by other patients during their hospital stay, while fewer patients reported being bothered at night by hospital staff (16 per cent).

4.12. There was considerable variation between NHS Boards in the responses to the question 'I was not bothered by noise at night from other patients'. Positive responses ranged from 47 to 85 per cent. In comparison, there was less variation between NHS Boards in relation to noise at night from staff with results ranging from 61 to 87 per cent.

Knowing who was in charge of the ward

4.13. One of the aims of the Leading Better Care programme^[6] was to redefine the role of Senior Charge Nurses. This included making sure that the Senior Charge Nurse is visible and accessible to patients. To reflect this aspiration, a question around knowing who is in charge of the ward has featured previously in our surveys, albeit with slightly different wording. Of those that responded to the 2014 survey:

• 42 per cent of patients indicated that they knew who was in charge of the ward all or most of the time
• 25 per cent indicated that they knew who was in charge of the ward some of the time
• 11 per cent indicated that they did not know who was in charge of the ward but they would have liked to know
• 23 per cent indicated that they knew who was in charge of the ward, but it didn't bother them

4.14. These results show that patients still find it difficult to identify who was in charge of the ward; over one third of patients indicated that they didn't know which nurse was in charge of the ward. It is worth noting however, that of these patients who did not know, over two-thirds (68%) were not bothered by this.

Single rooms

4.15. Patients were asked if they had a single room at any time during their most recent stay in hospital. One third (33%) of respondents indicated that they had a single room and two thirds (67%) didn't.

4.16. Most patients (81%) were happy about whatever room(s) they had occupied, irrespective of whether they had had a single room or not (Table 3). However, additional analysis has shown that those in a single room were more likely to be happy with their room. Ninety per cent of people in a single room responded positively about the room they were in whereas only three quarters (76%) of those patients who did not have a single room were happy about it.

Table 3 Single rooms (%)

Per cent	I was happy	I would have preferred another room	Total
I had a single room	30	3	33
I did not have a single room	51	16	67
Total	81	19	100

Single room and noise by patients and staff

4.17. As might be expected, those who had been in a single room were less likely to have been bothered by noise at night by patients than those that did not have a single room (25% vs. 32%). However, there was little difference when it came to being bothered by noise from staff (17% vs. 16%) (Chart 4).

Chart 4 Being bothered at night by patients or staff by whether patient had single room or not (%)

Moving wards

4.18. Moving wards can be disruptive to patients and in cases where patients are moved from a specialist ward to a ward treating different conditions known as 'boarding', it can result in longer hospital stays^[7]. It can also increase in the risk of infections spreading. Effective management of patient flows through hospital is a key priority for NHS Boards to minimise the need for moves.

4.19. We asked patients to indicate whether they moved wards during their stay and if so the time of day. Over a third (36%) of survey respondents had moved ward at least once during their hospital stay.

4.20. Of the ward moves that took place, the largest proportion (54%) occurred during the day. However, a significant proportion (14%) moved during the middle of the night (i.e. after 10 pm) (Table 4).

Table 4 Moving wards

Time	%
Morning/afternoon	54
Evening (6pm to 10pm)	29
Middle of the night (10pm onwards)	14

4.21. Patients that had moved ward were also asked whether the ward moves were well-managed. Of those that had moved wards, 71 per cent felt that their moves had been managed well (Chart 5).

Chart 5 Were your ward moves managed well?