Neil Churchill Director of Patient Experience - (Domain 4 Lead)
Measuring, Understanding and Acting on Patient Experience Insight
Why is insight into patient
experience important?
“The data presented display that
patient experience is positively
associated with clinical effectiveness
and patient safety, and support the
case for the inclusion of patient
experience as one of the central
pillars of quality in healthcare”
A systematic review of
evidence on the links
between patient
experience and clinical
safety and effectiveness
British Medical Journal
What does a “very good” experience mean?
Q
Overall, how would you describe your experience of your GP surgery?
Very
good
31%
32%
39%
43%
49%
60%
Fairly
good
49%
66%
65%
29%
29%
49%
46%
44%
41%
33%
Neither
Poor
13%
12%
10%
9%
5%
5%
4%
3%
7%
2%
5%
4%
4%
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 to 84
85 +
All respondents who answered the question (948,758)
Source: GP Patient Survey 2012-2013
How do we take our love of doctors into account?
Q. “For each, would you tell me whether you generally trust them to tell the truth or
not?”
Doctors
Teachers
Professors
Judges
Scientists
Clergyman/Priests
The Police
Television News Readers
Social workers
The ordinary man/woman in
Civil Servants
Managers in the NHS
Pollsters
Trade Union officials
Local councillors
Business Leaders
Bankers
Managers in local
Journalists
Government Ministers
Politicians generally
% Not trust
% Trust
8
88
12
81
11110
74
17
72
17
71
20
68
27
63
26
62
25
60
25
55
34
47
45
40
37
39
46
34
57
31
55
29
62
29
57
26
70
19
74
17
80
14
Base: 1,026 United Kingdom adults aged 15+, 10-16 June 2011
Source: Ipsos MORI/BMA
To what extent do we need to tackle “gratitude bias”?
80%
Net satisfaction with the running of the NHS
60%
40%
20%
0%
1983 1984 1986 1987 1989 1990 1991 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
-20%
-40%
Pre War (born before 1945)
Generation X (born 1966-1979)
Baby Boomers (born 1945-1965)
Generation Y (born 1980 onwards)
Data: BSA 1983-2010. Each data point represents >100 respondents
So what impact will the changing demographic
have on satisfaction?
Proportion of UK population from each generational grouping
2010: All adults
aged over 66
100%
% sample universe from pre war generation
90%
80%
2010: All adults
aged between 45
and 65
70%
60%
1983: All adults
50%
% Baby boomers
2010: All adults
aged between 44
and 31
40%
1983: All adults
aged under 39
30%
20%
% Generation x
2010: All adults
aged under 31
10%
0%
83
84
85
86
87
89
90
Source: Eurostat
91
93
94
95
96
97
98
99
00
01
% Generation Y
02 03 04 05
06
07
08
09
10
How was your experience? (1)
Adult Inpatient Survey 2012
Overall…
30%
25%
20%
20%
18% rated their overall
experience lower than
7/10
15%
10%
5%
25%
24%
1%
1%
1%
2%
2%
0
1
2
3
4
12%
5%
6%
5
6
0%
I had a very poor experience
Base: 61399 (all respondents).
Fieldwork: Sept 2012 – Jan 2013
7
8
9
10
I had a very good experience
Source: CQC/Picker Institute
How was your experience? (2)
Adult Inpatient Survey 2012
BUT 62% reported at least one aspect of poor care
18%
Poor overall experience
62%
Experienced some form of
poor care
Overall experience measures good for tracking satisfaction
but not for rooting out problems?
Base: 61399 (all respondents).
Fieldwork: Sept 2012 – Jan 2013
Source: CQC/Picker Institute
Sometimes an overall measure can mask poor
experience
Paste cobrand logo
here
Female, white, 65+, in hospital for several months
Her report…
“… in [the hospital] they
treated me well”
“Oh yes I found it satisfactory”
© Ipsos MORI
Her experience…
• On third day she asked for a
bedpan
• Nurse told her it wasn’t worth
running back and forth, told her to
do it in the bed
• Nurse complained to her in the
morning that she was soaking wet
CASE STUDY
“I went to the dentist, reported to the receptionist and
the receptionist forgot about me. I’m not used to my
sight loss and lost my orientation and couldn't bring
myself to ask anyone for help and just felt too nervous
to shout out or anything. I ended up sitting there for
hours and it was an extremely frightening experience.”
Patient experience is closely linked to patient involvement and engagement
Being involved is part of
having a good experience
Experience
Individual
Involvement
Involving patients is one means
to understanding and improving
experiences
Individual
and
collective
Means nothing if nothing is done
UNCLASSIFIED
http://www.kingsfund.org.uk
/projects/ebcd/experiencebased-co-design-description
www.institute.nhs.uk/theguide
The priorities for patients with breast
and lung cancer were different
Lung cancer
Breast cancer
Communication of diagnosis
Functioning of day surgery unit
Information about treatment
Appointments system and conduct
of OP clinics
Continuity and coordination of care
Communication
Information about symptoms
Everyone Counts: Planning for Patients
2014/15 to 2018/19
– Plans are expected to demonstrate measurable improvement in patient
experience as well as continued investment in generating feedback;
• enhance feedback and insight from vulnerable patient groups;
• measure and improve the experience of carers;
• easier access to proven techniques and support for their
implementation;
• strengthen forms of staff engagement which can support
improvements in patient experience through better staff experience;
• learn from complaints and improve the experience of making a
complaint.
Putting Patients First: NHS England
business plan 2014/2015
• NHS England’s Commitments to Carers published April 2014
• Introduction of Staff FFT April 2014 and support to engage staff on patient
experience;
• All NHS services provide real-time feedback through FFT by March 2015;
• Insight strategy 2014;
• Plans for ‘Always Events’ and a system-wide approach to improving patient
experience by Sept 2014;
• Patient Rights programme November 2014 and strategy to embed NHS
Constitution;
• Patient Centred Outcome Measures (PCOMs) by March 2015;
• Accessible Information Standard and extension of PLACE to cover disability issues
by March 2015;
• Strategy for nutrition and hydration by March 2015
• Support for patient leaders.
Friends and Family Test Overview
Simple test based on Net Promoter Score methodology
‘How likely are you to recommend our <ward / A&E department>
to friends and family if they needed similar care or treatment?’
1
2
3
4
5
6
Extremely Likely
Likely
Neither Likely nor Unlikely
Unlikely
Extremely Unlikely
Don’t know
Friend and Family Test - outcomes
Environmental issues
• Soft closing bins have been purchased for
inpatient areas as a response to patients feeding
back that noisy bins kept them awake at night
• Comments regarding disturbed nights led to
Introducing the ‘Quiet Protocol’ to help patients
sleep well at night
Mid Staffs NHS
Foundation Trust
Sandwell and West
Birmingham
Hospitals NHS Trust
Friend and Family Test - outcomes
Medication issues
• After negative feedback, the Trust has introduced
medication cards for patients who are off the
ward during drug rounds to alert them that their
medication is waiting to be dispensed
• "Was in pain on previous admission, felt ignored
by staff" – comment led to self-medication
programme - patients manage their own analgesic
medication when they are in pain
The Royal
Wolverhampton
NHS Trust
The Royal
Wolverhampton
NHS Trust
Nutrition and Hydration
3 million people in the UK are malnourished or
at risk of...
Of those:
• A third are over the age of 65 - more than 1
million older people are malnourished
• 93% are in the community, 5% in care
homes, 2% in hospital
• Public Sector expenditure is estimated to be
billions of pounds a year.
• NICE identifies better nutritional care as the
sixth largest potential source of cost savings
to the NHS
Nutrition and Hydration
Building on
success and
promoting
what works
Improving
understanding of
malnutrition and
dehydration
Making every
contact with
patients and
carers count
23
Involving all
staff and
building
collaboration
between teams
Embedding
responsivene
ss to patient
voices
Strengthening
commissioning
Building on Compassion in Practice to
connect values with behaviours and make
nutritional care an agenda that resonates
within and beyond nursing
‘If you’d asked me the most
important quality of a
doctor, I would have said
competence. When I
became a patient I soon
realised how important
compassionate attributes
in the people looking after
me were’
Kate Granger
17 April 2013
Derbyshire Healthcare NHS Foundation Trust
Opening Ceremony
@GrangerKate
Ensuring we listen and act on feedback from
vulnerable patients
Accessible Information Standard
• There is a formal process to develop an Information Standard.
• We are asking people for their views to inform the details of the
standard, which we will start to write in spring 2014.
• There will be a formal consultation on the draft standard in summer
2014.
• We are expecting to have a final version of the standard approved in
autumn 2014 – organisations will then have up to 12 months to comply.
PLACE assessments
Point of Care 2014
Staff Satisfaction = Improved Patient
Satisfaction and Care