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QUALICOPC in the UK, the patient
perspective
Prof. Niro Siriwardena, Dr Coral Sirdifield, Ana Godoy Caballero
Introduction & Aims
• To discuss various approaches for defining and measuring patient satisfaction with primary care
• To present an approach for measuring satisfaction
• To show patients’ perspectives of primary care for:
o All patients participating in QUALICOPC UK
o Different population subgroups, such as age, health status and education
• To discuss how the levels of satisfaction that patients report could be improved
What is patient satisfaction?
• Satisfaction’ is defined in numerous ways in the literature
– Used interchangeably with ‘experience’ (Ahmed et al., 2014)
– Differentiated from ‘experience’ (Coulter et al., 2009)
– Viewed as “a multidimensional concept, based on a relationship between experiences and expectations” (Delnoij, 2009)
How is it measured? • Surveys
• Interviews
• Focus groups
• Patient forums
• Formal complaints
• Comments on websites
• Feedback in appraisals
• Compliments received by staff
Our approach
• We follow Delnoij’s definition “a multidimensional concept, based on a relationship between experiences and expectations”
• We defined ‘expectations’ as what a patient desires – ideal expectations
• We defined ‘experiences’ as what patients report occurred in the consultation (as opposed to their feelings about them)
Our approach
IMPORTANCE
PERFORMANCE
Low
Low
High
High
Concentrate here
Attributes that patients value very highly but that currently
receive a low (poor) experience rating after service users
see their GP. Providers should concentrate on these
attributes to optimise patients’ experience of primary care
services
Maintain performance
Attributes are highly valued by patients, and patients
report good experiences with regard to these attributes
after they have seen their GP, so the performance should
be kept as it is
Low priority
Attributes that are relatively unimportant to patients and
also receive low (poor) experience ratings. From a patient
perspective we should not concentrate on these attributes
Possible overkill
Attributes that are rated as relatively unimportant to patients but
nevertheless receive high (good) experience ratings. As these
attributes are not that important, efforts could be made to use these
“idle” resources in other aspects of the service
Our approach
• Where we obtained the data from
• QUALICOPC study
o 3 English regions
o It includes 4 types of questionnaires:
o Fieldworker
o GP
o Patient experience
o Patient values (expectations)
Attributes Used in the Analysis Attribute Theme
1. Doctor has the patient’s medical records at hand Informational continuity
2. Doctor is polite Communication
3. Doctor listens carefully to patients Communication
4. Doctor takes sufficient time/doesn’t make the patient feel under pressure Communication
5. Doctor involves patients in making treatment decisions Empowerment
6. Doctor asks patients about other possible problems besides the one s/he came for Comprehensiveness
7. Doctor knows important information about the patient’s background Informational continuity
8. Doctor knows about the patient’s living situation Continuity
9. After the visit the patient feels s/he can cope better with his/her health problem/illness Empowerment
10. Extensive opening hours Accessibility
11. Proximity of the practice to the patient’s house Accessibility
12. Short waiting time when contacting the practice Accessibility
13. The patient knows how to get evening, night and weekend services Accessibility
14. Reception staff are polite and helpful Communication
15. Ease of getting an appointment Accessibility
What we found
Most valued items Least valued items
Ease of getting an appointment Doctor knows about the patient’s living situation
Doctor knows important information about the patient’s background
Doctor asks patients about other possible problems besides the one s/he came for
Doctor has the patient’s medical records at hand Short waiting time when contacting the practice
Doctor listens carefully to patients Extensive opening hours
Doctor takes sufficient time/doesn’t make the patient feel under pressure
Proximity of the practice to the patient’s house
Doctor involves patients in making treatment decisions
Doctor is polite
After the visit the patient feels s/he can cope better with his/her health problem/illness
The patient knows how to get evening, night and weekend services
Reception staff are polite and helpful
What we found
Most positive experiences Least positive experiences
Doctor is polite Doctor knows about the patient’s living situation
Doctor listens carefully to patients Doctor asks patients about other possible problems besides the one s/he came for
Doctor has patients’ medical records at hand The patient knows how to get evening, night and weekend services
Proximity of practice to patient’s house After the visit the patient feels that s/he can cope better with his/her health problem/illness
Reception staff are polite and helpful Ease of getting an appointment
Doctor takes sufficient time/doesn’t make the patient feel under pressure
Doctor knows important information about the patient’s background
Short waiting time when contacting the practice
Doctor involves patients in making treatment decisions
Extensive opening hours
Questions
• How does this compare with experiences and
values in your settings?
• How does this compare with policies in your
countries?
The IPA 1. Doctor has the patient’s medical records at hand 2. Doctor is polite 3. Doctor listens carefully to patients 4. Doctor takes sufficient time/doesn’t make the patient feel under pressure 5. Doctor involves patients in making treatment decisions 6. Doctor asks patients about other possible problems besides the one s/he came for 7. Doctor knows important information about the patient’s background 8. Doctor knows about the patient’s living situation 9. After the visit the patient feels s/he can cope better with his/her health problem/illness 10. Extensive opening hours 11. Proximity of the practice to the patient’s house 12. Short waiting time when contacting the practice 13. The patient knows how to get evening, night and weekend services 14. Reception staff are polite and helpful 15. Ease of getting an appointment
Possible Overkill Quadrant
o Extensive opening hours
o Proximity of the practice to
the patient’s house
o Short waiting time when
contacting the practice
Maintain Performance Quadrant
o Doctor has patient’s medical
records at hand
o Doctor listens carefully to
patients
o Doctor is polite
o Reception staff are polite and
helpful
Concentrate Here Quadrant o The patient knows how to get evening,
night and weekend services
o Ease of getting an appointment
o After the visit the patient feels that s/he
can cope better with his/her health
problem/illness
o Doctor involves patients in making
decisions about treatment
o Doctor know important information
about the patient’s background
o Doctor asks patients about other
possible problems besides the one s/he
came for
o Doctor takes sufficient time/doesn’t
make the patient feel under pressure
ANALYSES BY PATIENT
CHARACTERISTICS
BY AGE
Patients aged < 65
Patients aged ≥ 65
BY HEALTH STATUS
Good health
Poor health
What do the patients expect?
Patients < 65/Good health Patients ≥ 65/Poor health
Most valued
?
Most valued
?
Least valued
?
Least valued
?
What experiences do patients report?
Patients < 65/Good health Patients ≥ 65/Poor health
Best experience
?
Best experience
?
Worst experience
? Worst experience
?
What do the patients expect?
Patients < 65 Patients ≥ 65
Most valued Ease of getting an appointment
Most valued
Ease of getting an appointment
Doctor knows important information about the patient’s background
Least valued Doctor knows about the patient’s living situation
Least valued
Doctor knows about the patient’s living situation
What experiences do patients report?
Patients < 65 Patients ≥ 65
Best experience Doctor is polite Doctor listens carefully to patients
Best experience
Staff at the reception are polite and helpful
Worst experience Doctor know about the patient’s living situation
Worst experience
Doctor know about the patient’s living situation
Summary of changes
Attribute Age < 65 Age ≥ 65
Doctor has the patient’s medical records at hand Concentrate here Maintain performance
Doctor listens carefully to patients Concentrate here Maintain performance
Extensive opening hours Possible overkill Low priority
What do the patients expect?
Good health Poor health
Most valued Doctor listens carefully to patients Ease of getting an appointment
Most valued
Ease of getting an appointment
Doctor knows important information about the patient’s background
Least valued Doctor know about the patient’s living situation
Least valued
Doctor know about the patient’s living situation
What experiences do patients report?
Good health Poor health
Best experience Doctor is polite
Best experience
Doctor is polite
Doctor has patient’s medical records at hand
Staff at the reception are polite and helpful
Worst experience Doctor know about the patient’s living situation
Worst experience
Doctor know about the patient’s living situation
Summary of changes
Attribute Good health Poor health
Doctor has patient’s medical records at hand Concentrate here Maintain performance
Doctor listens carefully to patients Concentrate here Maintain performance
Extensive opening hours Possible overkill Low priority
Proximity of practice Possible overkill Maintain performance
How satisfaction could be improved
• In all analyses focusing on these three aspects of accessibility and empowerment is likely to improve patient satisfaction:
o The patient knows how to get evening, night and weekend services
o Ease of getting an appointment
o After the visit the patient feels that s/he can cope better with his/her health problem/illness
o Item 5 (doctor involves patients in making treatment decisions) also needs improvement for those age ≥ 65
Implications for practice
• Measuring satisfaction as patients’ subjective perceptions of the quality of aspects of care often results in high reported satisfaction levels
• This makes it difficult for practices to decide where they should focus their improvement efforts
• Instead we could use patient questionnaires with questions on both ideal expectations and experiences
• This would make it easier to identify areas for improvement for the whole practice population and for patients with particular characteristics
Thank you for listening!
Find out more about our research at:
www.CaHRU.org.uk
