Coulter

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Measuring Patients’ Experience of Measuring Patients’ Experience of Hospital CareHospital Care

Angela CoulterAngela Coulter

Picker Institute EuropePicker Institute Europe

[email protected]@pickereurope.ac.uk

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Three Perspectives on QualityThree Perspectives on Quality

Professional: technical competence, Professional: technical competence, clinical outcomesclinical outcomes

Management: cost-effectiveness, risk Management: cost-effectiveness, risk management, service developmentmanagement, service development

Patient: access, responsiveness, Patient: access, responsiveness, communication, symptom relief, health communication, symptom relief, health status, quality-of-lifestatus, quality-of-life

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Why measure patients’ experience of Why measure patients’ experience of health care?health care?

To assist local quality improvementTo assist local quality improvement For national performance assessmentFor national performance assessment For strategic policy-makingFor strategic policy-making To build public confidenceTo build public confidence To inform purchasersTo inform purchasers To inform patients To inform patients To compare health systemsTo compare health systems

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Measuring patients’ experienceMeasuring patients’ experience

Focus on recent personal experience Focus on recent personal experience Ask patients about what is important to Ask patients about what is important to

them (focus groups and interviews)them (focus groups and interviews) Ask patients to report on what happened, Ask patients to report on what happened,

NOT how satisfied they were (surveys)NOT how satisfied they were (surveys) Feed back actionable resultsFeed back actionable results

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Overall, how would you rate the Overall, how would you rate the care you received?care you received?

05

10152025303540

exce

llent

very

goo

d

good fair

poor

UKUSA

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Reporting QuestionsReporting Questions

A&E care disorganisedA&E care disorganised 38%38% Reason for delay not explainedReason for delay not explained 6%6% Staff gave conflicting informationStaff gave conflicting information 23%23% Doctors talked as if I wasn’t thereDoctors talked as if I wasn’t there 30%30% Had to wait too long for pain medicineHad to wait too long for pain medicine 9%9% Risks and benefits not discussed Risks and benefits not discussed 24%24% Not told when to resume activitiesNot told when to resume activities 60%60%

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Picker Surveys of Patients’ Picker Surveys of Patients’ ExperienceExperience

Access to careAccess to care Respect for patients’ preferencesRespect for patients’ preferences Co-ordination of careCo-ordination of care Information and educationInformation and education Physical comfortPhysical comfort Emotional supportEmotional support Involvement of family and friendsInvolvement of family and friends Continuity and transitionContinuity and transition

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Questionnaire DevelopmentQuestionnaire Development

Define scope of surveyDefine scope of survey Review literatureReview literature Focus groups – professionals and patientsFocus groups – professionals and patients Cognitive interviews with patientsCognitive interviews with patients Two stage pilot testingTwo stage pilot testing Validation tests and scale developmentValidation tests and scale development

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ImplementationImplementation

Random samples of patientsRandom samples of patients Detailed self completion questionnairesDetailed self completion questionnaires Mailed 2 – 4 weeks after dischargeMailed 2 – 4 weeks after discharge Two reminders to non-respondersTwo reminders to non-responders Response rates of 60 - 70%Response rates of 60 - 70% Problem scores and dimensions Problem scores and dimensions

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Patient Safety: AHRQ GuidelinesPatient Safety: AHRQ Guidelines

Active participation of patientsActive participation of patients Information sharingInformation sharing Allergies and adverse reactions to drugsAllergies and adverse reactions to drugs Understanding instructionsUnderstanding instructions CleanlinessCleanliness Discharge information and treatment planDischarge information and treatment plan

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05

1015202530354045

Test results notclearly explained

12


0102030405060

Not told aboutmedication sideeffects

13


0102030405060

Not told aboutdanger signals towatch for at home

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NHS Survey of Patients with Coronary NHS Survey of Patients with Coronary Heart DiseaseHeart Disease

Sampled patients with diagnosis of CHD from Sampled patients with diagnosis of CHD from hospital recordshospital records

Names, addresses from 194 NHS Trusts in EnglandNames, addresses from 194 NHS Trusts in England Sample size 112,000Sample size 112,000 Postal questionnairePostal questionnaire 84,300 completed questionnaires84,300 completed questionnaires Response rate 74%Response rate 74%

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NHS Patients Survey (CHD):NHS Patients Survey (CHD):Information and CommunicationInformation and Communication

0 20 40 60 80

Didn't understand doctors

Staff talked in front of me

Didn't know could see records

Didn't have confidence in allnurses

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NHS Patients Survey (CHD):NHS Patients Survey (CHD):Coordination and ContinuityCoordination and Continuity

0 5 10 15 20 25 30 35

No doctor incharge

Staff gaveconflicting info

No warning oftests

Tests not doneon time

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NHS Patients Survey (CHD): NHS Patients Survey (CHD): Hospital EnvironmentHospital Environment

35% on mixed sex ward 35% on mixed sex ward (5-76%)(5-76%)

38% bothered by noise 38% bothered by noise (26-54%)(26-54%)

35% said toilets/bathrooms not clean 35% said toilets/bathrooms not clean (16-(16-69%)69%)

36% said not enough nurses on duty 36% said not enough nurses on duty (23-(23-54%)54%)

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Did not feel sufficiently involved in Did not feel sufficiently involved in decisions about caredecisions about care

0

5

10

15

20

25

30

16-54 55-64 65-74 75+

menwomen%

National Surveys of NHS Patients. Coronary Heart Disease 1999 (n=84,500)

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NHS Patients Survey (CHD): NHS Patients Survey (CHD): Discharge and TransitionDischarge and Transition

34% no written information about recovery 34% no written information about recovery (5-53%)(5-53%)

39% no advice on prevention 39% no advice on prevention (10-55%)(10-55%)

32% no advice on resuming normal 32% no advice on resuming normal activities activities (10-53%)(10-53%)

31% said home circumstances not taken 31% said home circumstances not taken into account into account (18-45%)(18-45%)

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Patient Surveys Should Be:Patient Surveys Should Be:

Relevant to patients’ concernsRelevant to patients’ concerns Relevant to policy goalsRelevant to policy goals ActionableActionable TimelyTimely ComparableComparable Methodologically soundMethodologically sound AccessibleAccessible

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National vs. Local SurveysNational vs. Local Surveys

Local surveysLocal surveys Locally ‘owned’Locally ‘owned’ Locally relevantLocally relevant Shorter time-scaleShorter time-scale

National surveysNational surveys Consistent Consistent

methodologymethodology Cost-effectiveCost-effective Independent of Independent of

hospitalhospital

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A Third Way: Locally-organised A Third Way: Locally-organised Surveys with National StandardsSurveys with National Standards

Core set of validated questionsCore set of validated questions Implementation standards and manualImplementation standards and manual Data analysis tool kitData analysis tool kit National benchmarksNational benchmarks Flexibility to add local questionsFlexibility to add local questions

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ConclusionsConclusions

Patient feedback is a key element of Patient feedback is a key element of quality improvementquality improvement

Surveys of patient experience are more Surveys of patient experience are more useful than patient satisfactionuseful than patient satisfaction

Patient surveys can help to improve safety Patient surveys can help to improve safety standardsstandards

National benchmarks can stimulate National benchmarks can stimulate improvementsimprovements

Documents

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