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Improving patients' experiences
 

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 Improving patients' experiences Presentation Transcript

    • Improving patients’ experiences
      An analysis of the evidence to inform future policy development
    • 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
      • Improved doctor-patient communication leads to greater compliance in taking medication and can enable greater self-management for people with long-term chronic conditions
      • Individuals’ anxiety and fear can delay healing
      Patient experience
      Clinical effectiveness
      Safety
      Slide 0
      2
    • “”

      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.
      Slide 0
      8
    • 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
      • in community services
      • in social care
      • in relation to services for specific clinical conditions
      Slide 0
      9
    • 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
    • Quantitative information collection methods
      • Self completion surveys (postal; touch screen kiosks; web based structured feedback e.g. NHS Choices and I Want Great Care)
      • Interviewer administered surveys (face to face; telephone; using electronic hand held portable devices (PDAs))
      • Routine administrative statistics
      12
    • 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
      • fine grained, clinical and service specific data
      • standard and local measures
      • comparison between own service and others
      • frequent, near real time data is essential
      Insight and motivation
      • Stories and personal accounts to motivate staff
      • Complaints
      • Face to face involvement with patients and families
    • 15
      Organisational
      Oversight, quality assurance, benchmarking, improvement priorities
      • Monthly feedback for managers
      • Boards review of patient experience, including complaints, at least quarterly
      • Fast, frequent access to results
      • Fine grained detail on departments and specialties
      • Near real time measures essential standard and local measures
       
      Insight, motivation and communication
      • Content of complaints and compliments
      • Patient stories, observers’ reports and face to face meetings with patients and staff
    • 16
      Regional
      • Performance assessment, standards monitoring, commissioning
      • Use locally collected data; avoid fresh data collection
      • 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
      • Standard measures of patient experience with demographics
      • Up-to-date, but not fast or often
      • 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
      • Registration
      • Visits & inspections
      • Reviews
      • GP patient survey
      • Nursing metrics
      • NICE quality standards
      • Indicators for Quality Improvement
      • Quality accounts
      • QOF
      • Energise for Excellence in Care
      • High Impact Areas
      • Supporting practices listening to patients
      • Staff experience and Boorman
      • Training and development
      • Patient and service user feedback
      • National surveys
      • User survey
      • Measurement (e.g. NASCIS)
      • Testing real-time feedback
      • Assessments of commissioning
      • Quality Information Strategy
      • Info on NHS Choices
      • Roles e.g. in LTCs
      • Personalisation inc
      • Implementation of Steele Review of Dentistry
      information for user
      • Developing quality improvement approach
      and user-led orgs
      • Workforce strategy &
      • Role of experience information in informing choices
      • Policy on surveys
      • Complaints
      • Skills for Care
      • Development of performance assessment
      • IpSOS MORI tracker survey
      • Bringing experience data together with HES data
      • Supporting local measurement and use for improvement
      • First set published in June
      • Improvement programmes on patient experience
      • Care planning and
      • Supporting use at all levels
      • Engagement and involvement
      information prescriptions
      • Service line management
      • Developing for LTCs
      • Realigning incentives
      • Vertical integration
      • CQUIN and incentives
      • Financial incentives
      • Commissioning pathways
      • Measures development
      • Use of experience information in commissioning
      Measurement and publication
      • Patient information
      Performance assessment
      • Quality Framework
      Improvement support
      • Commissioning packs for pathways
      • 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
    • 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