 Good morning everyone. So Lisa and I are going to talk to you through this session. So Lisa will start by talking about a background to patient experiences work and introduce you to some of the work that has been done in the UK. And in the second part of this presentation, I will talk more specifically about our work in Kenya with regards to understanding the experiences of mothers of hospitalized sick newborns. So I hand over to Lisa. Thank you, Dorothy. Good morning, everybody. Dorothy, if you could click on to the next slide please. Great. Thank you. So the idea of this session is for Dorothy and I to give you an overview of some of the approaches to patient experiences research that we have done and that we're engaged with testing through a project called respect which Dorothy is going to give you a little bit more detail about a bit later on in the presentation. So we've just had a really interesting insight into one way of capturing patient experiences and thinking about the ways that they can feed into improving the quality of healthcare delivery and healthcare systems and I want to give you some insights into another approach. So patient experiences can reflect the range of introductions that patients have with the care system all the way along that their care pathway as we've just heard. And as sassy mentioned in her opening talk, they are now considered to be an integral component of healthcare quality. There are many different aspects of healthcare delivery that patients value highly when they seek care and when they receive care. And some obvious examples that I'm sure will all be familiar with just through our own lives are getting timely appointments, getting easy access to information about their health condition, their projected care pathway and their treatment plan. Perhaps most importantly in this list, good communication with healthcare providers. So that's a flavor of what's important about the patient experience. Next slide please Dorothy. And it's increasingly understood that a rich understanding of patient experiences is a key component of moving towards patient centered care which as you know is one of the things that we are particularly and increasingly focused on in high quality care. And there is a growing evidence base that suggests that patient centered organizations so organizations that have genuinely built their, their care provision on patient centered care and understanding the perspectives of patients can have multiple effects, including improving staff experience, staff morale and retention that I know is a real issue in in Kenya and it's it's also a very pressing issue here in in the UK as well. Patient centered organizations can also report shorter lengths of stay which obviously has all sorts of consequences for both the economics of the healthcare provider itself but also the experiences of patients and their families. So patient people's experiences can help us appreciate what's working well, what needs to change and how about how to go about making those improvements. In the book that that sassy mentioned in her first slide edited by Sue Zeveland and others. There are a range of different approaches to capturing patient experiences that are that are detailed. And, and some of them are focus groups, we've we've heard about the process mapping, and the approach that that Dorothy and I have been using is is doing in depth interviews with patients about their experiences of health and illness, or in in this case, interviewing mothers of with experiences of having preterm birth, and using patient experience data that is rigorously analyzed, you know, high quality data that's carefully collected and rigorously analyzed can help inform practice and health system change and improvement in loading the middle income countries. There has been a developing evidence base for these impacts in high income countries and Dorothy and I and others are very keen to develop the evidence base for demonstrating the impact that these can also be used in lower middle income countries. And one of the key things that we think is is important is this is that evidence generated to improve care can also be used in in other health care improvement settings so it's not just data that can be used to to improve care in in in one hospital in Nairobi but can actually be used to improve care at scale. So, Dorothy is going to talk more about the work that we have been doing in Kenya that builds on her doctoral research. But one study that I just wanted to mention before I hand back over to Dorothy is is work that's been done in high income countries to gain insights into the experiences of parents who have neonates admitted to the neonatal intensive care unit. And through a rich understanding of those parent experiences, those we've been able to develop a more personalized care for sick newborns that are that are genuinely meeting the needs of families. So this study mentioned here which is the Poppy study parents of premature babies in the UK. The results from this study that was led by Sophie Stanisłewska contributed to an understanding of parent needs and what they value which in particular was clear information, receiving emotional support and practical guidance and encouragement in caring for their baby. So I'm going to hand over now to Dorothy who's going to give you a bit more detail about the work that she and I have been undertaking in Kenya. Thank you. Right. So on this second part of the presentation, I will focus more on what's been happening in Kenya with regards to patient experiences. Our work primarily focuses on newborn care within hospitals in Kenya in the Kenyan setting. So the first set of qualitative work that we conducted and this was part of my DFL study was in looking at the experiences and perceptions of mothers with hospitalistic newborns across two hospitals in Kenya with a focus on one public hospital and a faith based hospital. Apart from that we also wanted to understand what roles do mothers play within the newborn unit. And in doing this we were able to apply three main approaches, the first one being non-participant observation. We were able to conduct over 600 hours of observations within the newborn unit and discovered both day and night shifts and weekdays and also weekend shifts. And this approach is very useful in terms of enabling us to get a detailed understanding of the context within which case provided across the two sectors. These two sectors have got different funding approaches, different structures, different staffing and different processes. We were also able to observe the roles that the mothers play within the newborn unit in terms of understanding what do they actually do, at what point do they actually take on the roles such as feeding, bathing the babies and also understand how are they actually prepared to take on these roles. Of importance was also in that to be able to understand the interactions, not just amongst the mothers but also between the mothers and the staff across the two hospital settings. The second approach that we used was in the interviews at the point of discharge. We were able to interview a total of 14 mothers across the two hospitals, that is 20 in each hospital. And this was important in terms of enabling us to follow up on issues that we were observing within the newborn unit during the non-participant observation phase. And by interviewing the mothers, they were able to talk about what roles they played and the perceptions about their involvement in care and some of the fears and concerns that they had while inside the newborn unit. The last method that we used was the storytelling or narrative intervening, where we were able to visit a subset of mothers two to three weeks post discharge in their homes. And what we saw was in terms of methodological approaches, in terms of the value that having storytelling exercises with the mothers in an environment where they're more relaxed post discharge outside the hospital setting played. In terms of their ability to openly talk about not just the positives but also the negatives in terms of how they were treated within the hospital setting. So this is a lesson that we continue to carry forward as we continue engaging with patient experiences, research. A key output of the qualitative work was us piloting the video recording of narrative interviews with mothers, which is an approach that Lisa and colleagues at the health experiences research group at Oxford have used over the years. But this is something that we wanted to test whether it could be acceptable, and would be something that would work within our Kenyan setting. So we're able to interview a couple of mothers and produce a pilot trigger film here in Kenya, and it's accessible on this link. So the current work which is building on from the initial qualitative work, and my different work is what we call the respect study. And what we want to do is collect additional narrative interviews with mothers or preterm babies and explore how we can actually use these experiences to improve care. So we are aiming to, we've been interviewing mothers across public hospitals and also some who have recruited through support groups within Nairobi. Basically to identify what are their needs and how can mothers be supported within newborn units. And one of the key issues that is emerging from the narrative interviews that we've conducted so far is the need for adequate and timely information for the mothers. So how are we going to incorporate mothers voices or the experiences of the mothers into quality improvement strategies. What we propose to do in the respect study is adopt the experience based code design approach, where we will incorporate the narratives of the mothers into quality improvement strategies. And experience based code design is an approach that enables staff and patients to code design basically come together work together in a participatory manner to come up with interventions that can improve care quality. So the first step is setting up the study which involves a lot of engagement with the hospitals, and the mothers and the staff engaging with the staff. And it's powerful that we are working closely with colleagues. One of one chassis were working with the nurses and also able to learn about the nurses experiences, what listen I am focusing on is on the patient experiences so talking to mothers and video recording their narratives. And then having a series of code design workshops where we'll bring together mothers and nurses in different workshop settings. Where we'll be able to share some of the key touch points emerging from the narrative interviews that we've been conducting face one of the respect study and produce short video clips which will share with the with the mothers and the nurses to get their feedback about the key emerging things or key emerging issues of interest that we are identifying from the stories of the mothers. And from that together design audio visual training materials and also information and education materials that can support mothers who have sick newborns or premature babies within our hospital settings in Nairobi. The next step would be to be able to test some of the audio visual training materials and the information support materials that will be code designed by the mothers and the nurses into two hospitals in Nairobi. And then we'll be able to also evaluate that using both qualitative and quantitative approaches. Before the rollout of or the testing of the material that we have developed, we are going to be able to have a baseline data collection or where we interviewed the mother's administer questionnaires to the nursing staff and then go in and implement a pilot, the intervention that will be code designed by the mothers and the nurses. And after that have a final phase where we do a post implementation assessment of the intervention that will be developed. So that is a plan that we hope to undertake with experience code design sometime in the early the first quarter of 2022. Thank you.