The National Quality Board returns with a focus on patient experience

The National Quality Board (NQB) was established in 2009. It has no statutory responsibility, and its impact is not always overt, but it is the only forum where all the national bodies with some responsibility for quality of care come together to provide strategic oversight and leadership on quality across the system.

Last week, the NQB published a new report, Improving experiences of care. This sets out why a good experience of care is important, commits in a very general sense that all the national bodies that make up the NQB will work using a shared definition, and includes case studies from providers and commissioners who are improving the patient experience.

Importantly, it also provides eight statements that form a jointly agreed definition of what a good experience of care should look like.

NQB screenshot.jpg

Screenshot of NQB report

Two of the eight things that users of health services should be able to say. See them all on page 11 of the NQB report.

In doing this it seeks to replace existing frameworks and definitions, including those from the Picker Institute, the Institute of Medicine and even the Department of Health’s own Patient Experience Framework.

Is this new definition any good?

Pedants and patient experience specialists like me might group and phrase some of the eight statements differently. They might also reasonably want to more fully understand the research and thinking behind how and why this definition varies from its predecessors.

Sceptics and cynics might question whether this new definition can unite national bodies, commissioners and providers, given that we already have CQC’s Key Lines of Enquiry, data from national surveys, the NICE quality standard, commitments in the NHS Constitution and other similar-but-different descriptions of good patient experience.

These (not unimportant) reservations aside, the NQB definition is a welcome and important attempt to create a single, clear understanding of that passive-sounding, vague, management-speak phrase ‘patient experience’.

Patient experience is difficult to summarise

NHS Medical Director Sir Bruce Keogh recently recounted his story of the development of the NHS triple definition of quality, and how someone going into hospital for surgery could sum it up in three questions:

  • Will it work?
  • Will it be safe?
  • What will it be like?

That third question tries to sum up patient experience from an acute care perspective but it doesn’t do justice to the breadth of issues that are involved.

Different people at different times and in different settings will have questions like:

  • Will I be treated like a person?
  • Will I keep my dignity and feel respected?
  • Will I be cared for with empathy and compassion?
  • Will my preferences be understood and met?
  • Will I be listened to?
  • Will I get the information I need?
  • Will I understand what is going on?
  • Will I feel fully involved in decisions about my care?
  • Will everything be well co-ordinated?
  • Will I be able to get help when I need it?
  • Will my environment be clean and comfortable?
  • Will I have enough to eat and drink?
  • Will I get the pain relief I need?
  • Will I die where I want to?

These questions and others like them form just part of a full understanding of patient experience, and yet to me each of them feels more meaningful, and more important, than that phrase ‘your experience of care’. The new NQB definition goes some way towards capturing this breadth of issues, but different services will need to use a different mix of questions to understand the experiences of their particular group of patients.

An essential component of quality care

It’s often said that in health care the little things are the big things; seemingly small acts of kindness or basic politeness can make a huge difference to how people feel.

And yet some of these things really aren’t little at all. There is strong evidence that experience of care is linked to outcomes and safety. In some settings, such as long-term conditions or end-of-life care, the distinction between clinical outcomes and patient experience outcomes is often blurred. And regardless of the relationships between experience and outcomes, caring for people well when they are vulnerable is an essential part of high-quality health care.

The NHS five year forward view recognises this and makes a clear and compelling case for improving how we involve and engage patients and communities in their health and care – something The King’s Fund wrote about last year.

I hope that people read and use the NQB definition. I hope that it can help to challenge colleagues who dismiss patient experience as the fluffy stuff, customer service or just the concern of nurses. I hope that it will encourage providers and commissioners to think about how they measure experience. And I hope, as the political pressure and media attention focuses on A&E and treatment waiting times, that it helps remind us how much these ‘small things’ matter.

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Comments

#535971 Alan Peterson

Yes that's right it will really helpful for the patients. It help also facilitate the patient in a good way with proper attention in national quality boards.
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#540801 Lamar

The National Voices Narrative on Integrated Care is best

#544928 Pearl Baker
Independent Mental Health Advocate and Advisor
Independent

As a Carer, and Independent Mental Health Advocate & Advisor for thirty years, including my position as the Carer Representative on the Mental Health National Service Framework I can report that it has got decidedly worse for Carers, and the severely Mentally Ill many left with no support from families or the state, this group (many) do end up on the streets, unable to complete endless forms to keep their Welfare Benefits, and to live.

I return to the list of questions> and answer accordingly.

No you will not 'be treated as a person' you are more likely than any other group to die young and live on the streets, or NEGLECT

No you will not keep your' dignity or respect' if you are forced to live on the streets.

No you will not be cared for with 'empathy or compassion' that is why there are so many mentally ill living on the streets.

What preferences! that you need a 'roof over your head and food' I think NOT.

Definitely NOT be 'listened to', or you would NOT be LIVING 'ROUGH'

No you will not 'get the information' you need, if you did you would not be on the streets, or living in 'squalor'.

I am afraid you will understand what is 'going on' nobody cares about you.

You will definitely NOT BE INVOLVED in 'decisions about my care' because that is why you are being IGNORED and TOTALLY NEGLECTED.

I am afraid 'co-ordination is a non starter, the co-ordinators have 'abandon' you.

Sorry but the co-ordinator abandon you, you 'will not get help when you need it'

Sorry but the environment be it the streets or in supported un-regulated accommodation will not be 'clean and comfortable'

Sorry you will get enough 'to eat and drink' if abandoned to the streets. DWP has made sure of that, you will be a 'beggar' with no money

No 'pain relief' when you need it.

No you will 'die' exactly where, you are on the streets.

My response to the question is true and accurate, based on my 'Community experience' as a Carer, and Advocate. I can save very few. It takes time, and that they don't have.

September 2015. My response to the 'Patient experience is difficult to summarise' IS NOT CORRECT, the above response is about the here and now 2015.

Insufficient money going into health and social care.

Insufficient staff to deliver 'integrated' co-ordinated health and social care.

Too many agency staff in LA to make a difference.

CQC have a new GP Inspection process. I am afraid not up to the 'job' based on their complete lack of understanding in how they could MAKE a DIFFERENCE if they would just listen to the EXPERTS BY EXPERIENCE.

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