Our research showed that many senior leaders and others charged with improving quality in the NHS either do not know, or do not believe, that there is an evidence base on patient experience. They are not confident about measuring patient experience themselves, and do not necessarily understand that there are real and important conceptual differences between different types of measure (measures of satisfaction, experience, patient reported outcomes (PROMS), and patient defined outcomes). Regrettably, it is questions such as these, that are essentially technical (What indicators should we use? How many data points is sufficient? Which method should we use to collect the data?), which tend to dominate the approach in NHS organisations towards improving patients’ experiences.
We have found that NHS organisations collect feedback from patients without first asking the fundamental question, 'What problem are we trying to solve?' and 'When we have the data, what will we do with it?' We found very few NHS organisations with an overall strategy for improving patient experience, a defined budget, personnel with relevant expertise to collect data, analyse and present it, and an education and training plan with a budget for improving patient experience.
In this respect, patient experience differs from other dimensions of quality (clinical quality and patient safety) where the debate is rightly less about measures and measurement, and more about what needs to be done to respond to the evidence and what works in terms of change management.
A national definition of patient experience is a welcome step in the right direction. Hopefully it will help stop people re-inventing the wheel, and provide a common base for the way government and national bodies (such as NICE and the Care Quality Commission) develop guidance and hold NHS bodies to account.
However, still more could be done at national level to direct local organisations to focus more effectively on what they can do to improve patients' experience of care. There are some resources available, including the NHS Institute's Transforming Patient Experience: essential guide, and we would like to see a national resource with a helpline, along the lines perhaps of the Health Quality Improvement Partnership for national clinical audit, dedicated to answering the technical questions that trusts need answering about indicators, measures and measurement.
Drawing on our recent research, on the evidence on what works in health care improvement, and on our own work with NHS trusts, we recommend that any set of national measures of patient experience should be designed to serve the three purposes of the Outcomes Framework: accountability (reporting upwards), transparency (reporting out to patients and the public, which means reporting measures people understand) and improvement. The key to making improvements in service quality though, is to win over clinical staff, especially doctors, and encourage clinical leadership on patient experience. We believe that measures of patient experience must be aligned with clinical level data on process and outcomes; must be rigorously based on evidence (a no brainer), must be simple and must be embedded in the new quality standards from NICE.
Find out more about our work on patient experience