Involvement

Seeking the views of children and young people is of fundamental importance because it is a basic human right enshrined in the United Nations Convention on the Rights of the Child (United Nations 1989). Article 12 sets out the right of all children and young people to be able to express an opinion and to have that opinion taken into account in any matter that affects them. The convention encourages adults to listen to the opinions of children and involve them in decision making, recognising that the level of a child’s participation in decisions must be appropriate to the child’s level of maturity.

This is supported in Wales through the introduction of the Rights of Children and Young Persons (Wales) Measure (Welsh Government 2011), which places a duty on Welsh ministers to consider children’s rights. This ministerial responsibility encourages the development of a mainstream children’s rights culture within the work of the Welsh Government and, ultimately, in wider Welsh society.

In recent years, there has been a significant commitment across health, social care, education and the voluntary sector to involve young people more actively in having a voice and a choice in matters that affect them. As a result, a range of resources has been developed that enables or supports the participation of children and young people in line with the Children and Young People’s National Participation Standards for Wales.

These standards have been established to help improve the process for children and young people to be involved in participation and decision making. Children and young people need to be offered various methods to participate that are appropriate to their age.

The NHS Institute for Innovation and Improvement (2013) has developed a proactive approach to seeking the views of children and young people about inpatient services and this article explores how this approach has been implemented in practice.

The 15 Steps Challenge

A mother of a child in hospital commented to healthcare staff on the importance of first impressions, as service users quickly know whether they have confidence and trust in the care service they are using. Her comment, ‘I can tell what kind of care my daughter is going to get within 15 steps of walking on to a ward’, inspired the creation of the 15 Steps Challenge (NHS Institute for Innovation and Improvement 2013).

The NHS Institute for Innovation and Improvement developed the 15 Steps Challenge, one of a suite of toolkits (Box 1), in partnership with service users, healthcare staff and board members to redesign and drive quality improvements as part of the Productive Care workstream for NHS England. This was part of the Quality, Innovation, Productivity and Prevention (QIPP) national workstream (NHS Institute for Innovation and Improvement 2013) which aimed to ensure that patients are cared for in the most productive environment, for example a ward, theatre or their own home. The NHS Institute for Innovation and Improvement closed on March 31 2013 and has been replaced by NHS Improving Quality.

The 15 Steps Challenge implemented at Aneurin Bevan University Health Board includes varying degrees of participation for children, young people and their families and, although the idea for the challenge was initiated by an adult, the tool was developed in partnership with young people. The 15 Steps Challenge helps healthcare professionals, service users and others to work together to identify improvements that will enhance the patient experience. The challenge involves a ward ‘walk-around’, seeing the ward through the eyes of a child or young person and parent/carer.

The 15 Steps Challenge toolkit consists of a poster, observation guide and feedback sheet that helps facilitate a service evaluation, clearly documenting all the items that children and families say matter to them during admission. Following an explanation of the process by the 15 Steps Challenge co-ordinator, the team is asked to consider what good quality care looks, sounds and feels like from a child’s and a family’s perspective using the observation guide and feedback sheet.

The guide and sheet concentrate on the four key themes that families have identified as important:

Following the ward walk-around, the co-ordinator feeds back findings to the clinical area, focusing on good practice and areas for improvement. This process is then repeated on a regular basis, with the frequency largely depending on the outcome of the walkaround. The aim is to ensure that improvements are sustained and that there is progression.

Implementation

Recognising the potential value of the 15 Steps Challenge toolkit for children and young people’s inpatient services, senior nursing staff adapted and piloted the toolkit within the Aneurin Bevan University Health Board.

One of the five children’s areas was chosen for the pilot as it was the largest ward and provided care for children up to 18 years. Acknowledging that the average length of stay as an inpatient on the children’s unit is generally one day, the team were unsure whether there would be a suitable patient available and prepared to participate in the walk-around. To address this, a young person was invited from a local youth forum. There is no specific health forum within the area so a request was made to the generalist youth forum for someone with no previous experience of hospitalisation to participate in the walkabout.

Feedback from all members of the challenge team was positive as they felt really involved and empowered by the process and welcomed the equal partnership that existed between team members. The ward staff felt it was beneficial to receive direct feedback as this helped them focus on the areas for improvement that really matter and make a difference to service users.

What was learned

During the ward walkaround, the 15 Steps Challenge team highlighted areas of good practice and areas that need improvement. These included:

The 15 Steps Challenge co-ordinator fed back to the nursing team in a staff meeting and was received positively. Suggestions were made about how to address the ideas for improvement and how a 15 Steps noticeboard could be used to feed back to families.

Conclusion

As health professionals, nurses are in a prime position to support the engagement of children and families to influence service developments. This takes time but can be rewarding as it ensures their views about ways to improve and transform healthcare services are heard. Staff need to be innovative in their approach to meeting the needs and abilities of service users – one size does not fit all.

Involving service users is beneficial to them and to professionals. Children and families learn new skills and feel empowered, and as professionals nurses receive the assurance that services are being developed to meet the needs of families. Staff liked the 15 Steps Challenge approach as it helped capture the service improvements made and it is hoped it can be adopted in other inpatient areas.