Four Steps: How to make it happen

In this section are practical suggestions in the four activity areas through which practices may deliver improvement:

• staff awareness
• information and communication
• physical environment
• using information to deliver a personalised experience.

1. Staff awareness

Patients with sight pick up information as soon as they walk into a practice by reading signs and name badges. They observe the behaviour and context of staff and other patients.

Practice staff may become accustomed to this situation being ‘normal’ and may benefit from sight loss awareness training. This will enable them to work out how their practice needs to operate, and what their own behaviours need to be, in order to improve the experience of patients with sight loss.

Receptionists, healthcare professionals and other staff should introduce themselves by name and the position they hold in the practice. They should also talk through the procedure that they are conducting or about to conduct, even if they are just looking for notes or telephoning through to a consulting room. A ‘commentary’ on what is happening really helps a patient with sight loss.

An added benefit of awareness training is the potential for practice staff to understand how simple changes to the operational environment and process may greatly improve the patient experience. For example, if a sight loss patient needs to fill out paperwork it is usual for reception staff to help them. They should be given privacy and not be asked to verbally provide personal or medically confidential information at the reception desk.

The reception staff might feel that the reception area is appropriate if they can see that it is separate from the waiting area and there are no more patients waiting. However, the sight loss patient may lack the comfort that this visual information provides. A move to a more private area tells the patient that the receptionist understands the patient’s needs and is acting accordingly.

Practice staff should be trained in sighted guide techniques, such as offering their arm to safely guide the patient to a seat or other destination. When guiding a patient to a waiting area, staff should never back a patient into a seat, but always guide them to it and describe it to them. This means telling them if it is a dining chair, low sofa or an office chair for example. Staff should understand how to seek verbal permission before touching a blind person, to avoid alarming them by touching them unexpectedly.

Awareness training is available from a number of national and local organisations. Several of the national organisations are listed at the end of this section. Practices should consider combining awareness training for patients with sight loss with that for hearing loss patients.

Many of the issues are similar, and combining the approaches offers improvement to an even wider patient group as well as making better use of staff training time.

2. Information and communication

For a sighted person, a general practice may appear to be overloaded with information: notices and posters, leaflets and booklets; sometimes even touch screens and video information screens in waiting areas. Very little of this material is of use to a patient with sight loss. Practices should consider conducting a simple audit of their material to see what they have available for patients with sight loss. Many of the organisations currently providing practices with information will have suitable formats for sight loss patients available. Practices need to take time to identify what is needed and request it.

A sight loss patient may have little access to information about a prescription they have received in a practice. When they take the prescription to a pharmacy, the standard patient information leaflet in the pack may be of little use. Practice staff should be aware that the Royal National Institute of Blind People (RNIB) operates a freephone Medicines Information Line. By calling the Medicines Information Line, the practice can request patient information leaflets in large/clear print, in Braille or on audio CD. Any member of the practice can make this call for the patient – the number is 0800 198 5000.

3. Physical environment

Patients with sight loss are continually faced with issues relating to access to the physical and social environment. Some practices are located in purpose-built buildings but many are located in older or converted buildings.

Such settings can be made more accessible by means of better lighting, appropriate signage, and the use of tactile and auditory cues, especially hazard markers and way-finding devices. Signage should be at eye level, well lit, in large font, and in contrasting colours.

The layout and contents of many busy practices often ‘evolve’ as time goes on. It may be worth looking at the physical environment of the practice again after awareness training. Look out for obstacles in the waiting room, such as children’s toy boxes, pamphlet stands or furniture. Practices might consider involving some of their own sight loss patients and patient organisations in this review exercise.

The NHS Institute of Innovation and Improvement has produced a simple process and set of resources to help this sort of review, called experience based design. This helps capture patients’ experiences of a service as the foundation for making improvements. The experience based design resources are available on the NHS Institute’s website; a link is provided at the end of this section.

4. Using information to deliver a personalised experience

In order to deliver a personalised experience for patients with sight loss, a patient’s written and electronic notes should clearly record their sight loss. The notes should also record any associated adjustments required and the patient’s preferred communication method.

For this information to be of value in improving the patient experience, it should be accessible in such a way that it does not have to be ‘re-discovered’ each time the patient interacts with the practice.

Key resources

Visual awareness training from Action for Blind People.

Visual awareness training from the RNIB.

Experience based design resources are available from the NHS Institute.

RNIB Web Access Centre.

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