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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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  • 1. Improving patients’ experiences
    An analysis of the evidence to inform future policy development
  • 2. Patient experience is closely related to and influences clinical effectiveness and safety
    For example, research evidence tells us that:
    • Organisations that are more patient-centred have better clinical outcomes
    • 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. Individuals’ anxiety and fear can delay healing
    Patient experience
    Clinical effectiveness
    Safety
    Slide 0
    2
  • 5. “”

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

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