Karen Ives-Smith, Advanced Nurse Practitioner at the Royal Derby Hospital, tells us about her experience as Pledge Lead for the Service Pledge at her hospital.

Wednesday 8 June 2016      Policy and Campaigns blog
Karen Ives-Smith and her team

Karen Ives-Smith and her team

Breast Cancer Now’s Service Pledge programme has been running since 2003, and helps breast cancer services across the country involve patients and staff in reviewing services and implementing patient-centred improvements. We work with dedicated and passionate NHS staff to deliver this programme, and in this blog Karen tells us about her experience as Pledge Lead in 2015.


Becoming a Service Pledge Lead

I’ve been in nursing for over 23 years and still love caring for people when they need it. I’ve always worked in surgery but for the last 15 years I’ve specialised in breast care. I currently work as an advanced nurse practitioner in the Breast Unit at the Royal Derby Hospital.

The Surgical Lead first sent me some information about the Service Pledge for Breast Cancer in January 2015 and asked if I might be interested in leading the programme at our hospital.

I remember reading about ideas for service improvements coming directly from breast cancer patients, and this was the reason why I wanted to get involved – to take ideas from our past patients in order to make the experience better for our patients in the future.

How it works in practice

In April 2015, the Surgical Lead and I attended Breast Cancer Now’s training day, to find out more about the steps required to make the Service Pledge a reality, hear how the programme has helped to improve services and introduce changes in other hospitals, and to get an idea of timelines.

By the end of April, I had contacted our data team to collate a list of patients and staff who we could send surveys to, obtained costing for printing the surveys locally and set a target date of 5 May to send them out – which we achieved!

Dates and venues were then agreed for the patient workshop in September and the improvement goal meeting in October.

The response rate from patients was overwhelming, with 185 out of 247 completing the patient experience survey. The staff survey response rate was 52% (37 out of 71). It was very useful to get both patient and staff feedback not only on how the service runs but also suggestions for improvements.

The improvement goal meeting was well attended by relevant staff who could help to implement some of the changes identified by our patients, and also by two Patient Advocates, trained Breast Cancer Now volunteers with direct personal experience of breast cancer, who contributed to the discussions.

What did the surveys identify, and how are we improving our service?

Results from both the patient and staff surveys were overall very positive, which was great. However, here are some recommendations which we’re now addressing:

  • Patients said they didn’t always feel informed about how their breast surgery would affect their appearance or what postoperative complications might be – we plan to routinely offer patients the opportunity to look at a selection of postoperative photographs.
  • Patients stated that they were not kept informed about waiting times in clinical areas – we have introduced a white board to display information about waiting times in the treatment waiting area and plan to audit its effectiveness. We plan to introduce something similar in our reception area.
  • Staff stated that the ‘symptomatic’ waiting area, where patients sit in gowns, is often used as a thoroughfare – we have now put up signs to ask staff not to walk through that area when there is a clinic in progress.
  • Patients didn’t know who was who in clinic – as a Trust, we have signed up to the ‘hello, my name is….’ campaign and we have now updated our staff photo board, displaying all the staff within the Breast Unit.
  • Patients suggested a ‘buddy’ service for fellow patients diagnosed and treated for breast cancer – the local breast cancer support group have agreed to provide information to patients about their own treatment journeys, and also their contact details if patients wish to contact them directly. This will be supported by the breast care nurse specialist team.

The Service Pledge team has really enjoyed working with Karen and it’s fantastic to see the outcomes of her and her team’s hard work. If you’re interested in getting involved with the Service Pledge and helping us deliver significant changes and improve services for patients across the UK, you can find out more here.