“” “ 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
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.
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
Experience forms part of many major initiatives Slide 0 6
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 q + ] _ s
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.
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.
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.
There are systematic differences in feedback from different groups.
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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:
in relation to services for specific clinical conditions
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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
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
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)
14 Team and individual Management, quality improvement and monitoring
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)
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
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
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
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 Slide 0 22 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
Uses of quantitative information Good for: Comparative assessments Measurement against numerical targets Benchmarking Slide 0 23
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
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