Improving patients’ experiences<br />An analysis of the evidence to inform future policy development<br />
Patient experience is closely related to and influences clinical effectiveness and safety  <br />For example, research evi...
Improved doctor-patient communication leads to greater compliance in taking medication and can enable greater self-managem...
Individuals’ anxiety and fear can delay healing</li></ul>Patient experience<br />Clinical effectiveness<br />Safety<br />S...
“”<br />“<br />Terminology is important<br />The term ‘patient’ is not appropriate for many care settings. <br />Language ...
Experience, satisfaction, and reported and defined outcomes, are all different concepts<br />Patients’ reports of their ex...
Experience, satisfaction, and reported and defined outcomes, are all different concepts<br />Patient experience = direct e...
Experience forms part of many major initiatives<br />Slide 0 <br />6<br />
Internationally recognised  definition of patient centred care  <br />Compassion, empathy and responsiveness to needs, val...
There is some evidence of improvement, but many areas of patient experience still need further progress<br /><ul><li>Littl...
However, at a more detailed level, significant improvements can be seen in access, trust and confidence in health professi...
There seems to be need for significant progress to improve issues such as the provision of information, noise in hospitals...
There are systematic differences in feedback from different groups.</li></ul>Slide 0 <br />8<br />
We have the largest patient survey programme in the world, but significant information gaps need to be addressed.  <br />W...
in community services
in social care
in relation to services for specific clinical conditions</li></ul>Slide 0 <br />9<br />
Systematic difference in feedback from different groups <br />10<br />Age: Older patients generally more positive than you...
Qualitative information collection methods<br />Semi-structured and in-depth face to face interviews <br />Discovery inter...
Quantitative information collection methods<br /><ul><li>Self completion surveys (postal; touch screen kiosks; web based s...
Interviewer administered surveys (face to face; telephone; using electronic hand held portable devices (PDAs))
Routine administrative statistics</li></ul>12<br />
13<br />Conceptual model of a multi-tier healthcare system showing generic functions at each level<br />National  Policy f...
14<br />Team and individual<br />Management, quality improvement and monitoring<br /><ul><li>fine grained, clinical and se...
standard and local measures
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Improving patients' experiences

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  • Interesting slide deck, with a number of strong points (as ever from the Kings Fund).

    The one comment I would make is that the definition of Patient experience as the 'direct experience of specific aspects of treatment or care' is a little old fashioned and dare I say a bit introspective.
    From my own work with people living with chronic health conditions, they describe patient experience much more holistically. For instance, dealing with the practicalities of getting to (often multiple) hospital sites is an important factor in access to care. Is this part of an NHS care plan? Or learning how to communicate their health condition to friends and work colleagues - this directly impacts their quality of life, but is rarely something that the NHS sees as part of a multidisciplinary care plan.
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Improving patients' experiences

  1. 1. Improving patients’ experiences<br />An analysis of the evidence to inform future policy development<br />
  2. 2. Patient experience is closely related to and influences clinical effectiveness and safety <br />For example, research evidence tells us that:<br /><ul><li>Organisations that are more patient-centred have better clinical outcomes
  3. 3. Improved doctor-patient communication leads to greater compliance in taking medication and can enable greater self-management for people with long-term chronic conditions
  4. 4. Individuals’ anxiety and fear can delay healing</li></ul>Patient experience<br />Clinical effectiveness<br />Safety<br />Slide 0 <br />2<br />
  5. 5. “”<br />“<br />Terminology is important<br />The term ‘patient’ is not appropriate for many care settings. <br />Language and policy messages must engage and motivate frontline staff.<br />‘Patient-centred’ is multi-dimensional: it covers both the what and the how.<br />3<br />
  6. 6. Experience, satisfaction, and reported and defined outcomes, are all different concepts<br />Patients’ reports of their experience of care come in a number of forms. <br />4<br />810<br />While terms such as ‘experience’ and ‘satisfaction’ are sometimes used interchangeably, with satisfaction often used colloquially, this can be confusing.<br />
  7. 7. Experience, satisfaction, and reported and defined outcomes, are all different concepts<br />Patient experience = direct experience of specific aspects of treatment or care<br />Patient satisfaction = an evaluation of what happened, reporting the patient’s feelings about the experience of care, usually requiring patients to give an overall rating based on their whole service experience<br />Patient-reported outcome = patient’s perspective on whether a procedure improved quality of life<br />Patient-defined outcome = patients are involved in the definition and design of measures of the outcome of particular procedures or services.<br />5<br />
  8. 8. Experience forms part of many major initiatives<br />Slide 0 <br />6<br />
  9. 9. Internationally recognised definition of patient centred care <br />Compassion, empathy and responsiveness to needs, values and expressed preferences<br />Coordination and integration<br />Information, communication and education<br />Physical comfort <br />Emotional support, relieving fear and anxiety<br />Involvement of family and friends<br />(Institute of Medicine 2001)<br />7<br />q<br />+<br />]<br />_<br />s<br />
  10. 10. There is some evidence of improvement, but many areas of patient experience still need further progress<br /><ul><li>Little improvement in experience using the overall composite measures in 10 years.
  11. 11. However, at a more detailed level, significant improvements can be seen in access, trust and confidence in health professionals remains high and most patients report being treated with dignity and respect.
  12. 12. There seems to be need for significant progress to improve issues such as the provision of information, noise in hospitals, and the engagement of patients in decisions about their care.
  13. 13. There are systematic differences in feedback from different groups.</li></ul>Slide 0 <br />8<br />
  14. 14. We have the largest patient survey programme in the world, but significant information gaps need to be addressed. <br />We have extensive data on patient experience through the national patient survey programme, particularly covering hospitals and GP services.<br />However, information on patient experience is much more limited in other areas.<br />The main gaps are: <br /><ul><li>along whole pathways of care
  15. 15. in community services
  16. 16. in social care
  17. 17. in relation to services for specific clinical conditions</li></ul>Slide 0 <br />9<br />
  18. 18. Systematic difference in feedback from different groups <br />10<br />Age: Older patients generally more positive than younger patients <br />Ethnicity: Variations between black and minority ethnic (BME) groups and their white British counterparts. Where differences do exist, most are negative<br />Health status and disability: Patients with poor health status, poor mental health and disabilities significantly more likely to respond negatively<br />Gender: Differences exist but effects were not consistent across surveys <br /> <br />
  19. 19. Qualitative information collection methods<br />Semi-structured and in-depth face to face interviews <br />Discovery interviews<br />Web based free text comment (e.g. Patient Opinion) <br />Focus groups <br />Complaints, letters and cards <br />Patient diaries <br />Observation<br />11<br />
  20. 20. Quantitative information collection methods<br /><ul><li>Self completion surveys (postal; touch screen kiosks; web based structured feedback e.g. NHS Choices and I Want Great Care)
  21. 21. Interviewer administered surveys (face to face; telephone; using electronic hand held portable devices (PDAs))
  22. 22. Routine administrative statistics</li></ul>12<br />
  23. 23. 13<br />Conceptual model of a multi-tier healthcare system showing generic functions at each level<br />National Policy formulation and infrastructure<br />Regional Performance monitoring and macro-management<br />Organisational Operations management<br />Team and individualClinical service provision and individual accountability<br />Adapted from Leatherman and Sutherland (2003)<br />
  24. 24. 14<br />Team and individual<br />Management, quality improvement and monitoring<br /><ul><li>fine grained, clinical and service specific data
  25. 25. standard and local measures
  26. 26. comparison between own service and others
  27. 27. frequent, near real time data is essential</li></ul>Insight and motivation<br /><ul><li>Stories and personal accounts to motivate staff
  28. 28. Complaints
  29. 29. Face to face involvement with patients and families </li></li></ul><li>15<br />Organisational <br />Oversight, quality assurance, benchmarking, improvement priorities <br /><ul><li>Monthly feedback for managers
  30. 30. Boards review of patient experience, including complaints, at least quarterly
  31. 31. Fast, frequent access to results
  32. 32. Fine grained detail on departments and specialties
  33. 33. Near real time measures essential standard and local measures</li></ul> <br />Insight, motivation and communication<br /><ul><li>Content of complaints and compliments
  34. 34. Patient stories, observers’ reports and face to face meetings with patients and staff </li></li></ul><li>16<br />Regional <br /><ul><li>Performance assessment, standards monitoring, commissioning
  35. 35. Use locally collected data; avoid fresh data collection
  36. 36. Develop the tools to map patient journeys and collect data along pathways</li></li></ul><li>17<br />National <br />Comparative performance assessment, performance against targets, trends, develop new surveys and tools to fill information gaps, R&D into core domains<br /><ul><li>High quality quantitative data
  37. 37. Standard measures of patient experience with demographics
  38. 38. Up-to-date, but not fast or often
  39. 39. Qualitative information to generate new insights, support policy making; understand the barriers and enablers to implementation</li></li></ul><li>Improving patient experience is a long haul, not a quick fix<br />“Small measurable improvements in patient experience may be achieved over short projects.”<br />18<br />“Sustaining more substantial change is likely to require <br />organizational strategies, engaged leadership, cultural change, regular measurement and performance feedback, and experience of interpreting and using survey data.” <br />(Davies et al 2008)<br />
  40. 40. Happy staff = happy patients<br />Staff who are satisfied and engaged with their work are more likely to communicate well with patients, to therapeutic benefit<br />Stress and burn out affect recently-qualified nurses’ capability to provide high quality care<br />Improved team working is good for the mental health of both staff and patients<br />Hospitals with high levels of staff satisfaction score well on patient perceptions of experience <br />19<br />
  41. 41. Uses of qualitative information<br />Answers to questions: What happens? How? Does it matter? Why?<br />Relationship between contexts, events and behaviours<br />Rich, detailed, descriptions of contexts and practices<br />Slide 0 <br />20<br />Good for: <br />Not good for: <br />Making generalisations<br />Answers to questions: How many? How often? How typical? Or How different?<br />Comparisons of quality between services and organisations<br />
  42. 42. Uses of qualitative information<br />Good for: <br />Not good for: <br />Insights into the meanings for patients and families<br />Insight difficult to measure but important aspects of experience<br />Motivating audiences <br />Reminding case-hardened staff of the human dimension <br />Slide 0 <br />21<br />
  43. 43. Uses of quantitative information<br />Answering questions: How many? How often? How typical? How different?<br />Monitoring changes over time<br />Showing how patients rank events and experiences<br />Measuring differences within and between patient populations<br />Slide 0 <br />22<br />Good for: <br />Not good for: <br />Insight into the nature and meaning of experiences<br />Explanations of rankings<br />Bringing to light serious deficiencies <br />Explaining why or how a mechanism or incentive works <br />Explaining why a change occurs<br />
  44. 44. Uses of quantitative information<br />Good for: <br />Comparative assessments <br />Measurement against numerical targets <br />Benchmarking <br />Slide 0 <br />23<br />
  45. 45. <ul><li> Registration
  46. 46. Visits & inspections
  47. 47. Reviews
  48. 48. GP patient survey
  49. 49. Nursing metrics
  50. 50. NICE quality standards
  51. 51. Indicators for Quality Improvement
  52. 52. Quality accounts
  53. 53. QOF
  54. 54. Energise for Excellence in Care
  55. 55. High Impact Areas
  56. 56. Supporting practices listening to patients
  57. 57. Staff experience and Boorman
  58. 58. Training and development
  59. 59. Patient and service user feedback
  60. 60. National surveys
  61. 61. User survey
  62. 62. Measurement (e.g. NASCIS)
  63. 63. Testing real-time feedback
  64. 64. Assessments of commissioning
  65. 65. Quality Information Strategy
  66. 66. Info on NHS Choices
  67. 67. Roles e.g. in LTCs
  68. 68. Personalisation inc
  69. 69. Implementation of Steele Review of Dentistry</li></ul>information for user<br /><ul><li>Developing quality improvement approach</li></ul>and user-led orgs<br /><ul><li> Workforce strategy &
  70. 70. Role of experience information in informing choices
  71. 71. Policy on surveys
  72. 72. Complaints
  73. 73. Skills for Care
  74. 74. Development of performance assessment
  75. 75. IpSOS MORI tracker survey
  76. 76. Bringing experience data together with HES data
  77. 77. Supporting local measurement and use for improvement
  78. 78. First set published in June
  79. 79. Improvement programmes on patient experience
  80. 80. Care planning and
  81. 81. Supporting use at all levels
  82. 82. Engagement and involvement</li></ul>information prescriptions<br /><ul><li> Service line management
  83. 83. Developing for LTCs
  84. 84. Realigning incentives
  85. 85. Vertical integration
  86. 86. CQUIN and incentives
  87. 87. Financial incentives
  88. 88. Commissioning pathways
  89. 89. Measures development
  90. 90. Use of experience information in commissioning</li></ul>Measurement and publication<br /><ul><li> Patient information</li></ul>Performance assessment<br /><ul><li> Quality Framework</li></ul>Improvement support<br /><ul><li> Commissioning packs for pathways
  91. 91. How people want to access info/services</li></ul>Policy development<br /><ul><li> Innovation pilots</li></ul>Patient/user info<br />Major work on patient experience at DH, Care Quality Commission and Monitor<br />Based primarily on phone conversations with a range of DH officials and CQC and Monitor staff<br />Quality Framework<br />Includes:<br />CQC<br />Primary Care<br />Includes:<br />Nursing <br />Includes:<br />Perm Sec<br />NHS Chief Executive<br />Social Care, Local Govt & Care Partnerships<br />Includes:<br />Workforce<br />Includes:<br />Choice<br />PPE<br />Includes:<br />Long-term Conditions<br />Includes:<br />Monitor<br /><ul><li>Research into main factors in patient satisfaction</li></ul>PROMs<br />Policy and Strategy<br />Includes:<br />Transforming Community Services<br />Includes:<br />Urgent and emergency care<br />Includes:<br />Commissioning and contracts<br />Includes:<br />CMO<br />Key(not mutually exclusive)<br />Research and Development<br />Includes:<br /><ul><li> Funding relevant research programmes</li></ul>Channel strategy<br />38<br />
  92. 92. Priority recommendations<br />Co-ordinate and align DH programmes to agree common approaches to language, measurement, analysis and joint business planning.<br />Patient experience should continue to be a priority for providers and commissioners. Improving patient experience is a slow and complex process. Organisations can implement quick wins, but focus needs to remain for the long haul. Ultimately patient experience agenda needs to be owned and led by frontline staff and patients working together. <br />Fill information gaps in experiences of care pathways, community services, specific clinical services and social care.<br />Develop capability for near real-time measurement.<br />Co-ordinate work on improving staff experience and patient experience.<br />25<br />

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