This is a question that colleagues and I from The King’s Fund and Picker Institute Europe have tried to answer, by examining trends in patient-reported experiences from the 2005–13 inpatient surveys for all acute trusts in England.
The vast quantity of data collected in the inpatient survey is potentially of use to multiple audiences – primarily trusts for monitoring and improving quality of care, but also regulators for quality assurance, commissioners for monitoring contracts, managers (locally and nationally) for performance assessments, the government and the public for accountability, and patients for informed choice.
While the data is ostensibly being used for all these purposes, how far are the survey results translating into improved services at a local level – and how much are they valued as a resource by trusts, clinicians and those directly responsible for ‘patient experience’?
The short answer is ‘not enough’ on both counts. Our research project – involving analysis of 28,000 data points (20 questions, at 9 annual points, for 156 trusts) – showed that patient-reported experience of inpatient care in acute trusts remains high and there have been some improvements over the 8-year period. But these improvements are comparatively modest and arguably driven by national initiatives and policies to tackle high-profile problems, such as health-care acquired infections. Given the financial challenges faced by the NHS and the wider system pressures in the health and care landscape – it is positive that patient-reported experience in acute trusts is not deteriorating (overall), and has even seen some improvement.
To investigate why this may be the case, we also ran a small qualitative study of patient experience leads at five trusts. Our conversations with them revealed various, inter-related challenges faced by trusts in using the inpatient survey data to improve services. Chief among these were resource and system pressures (including financial pressures); ‘blame cultures’ inhibiting staff from engaging with poor results; a lack of co-ordination across the trust; scepticism among clinicians about survey validity and relevance; and competing priorities within trusts.
The patient experience leads we spoke to highlighted the struggle to make patient experience everyone’s responsibility. Patient experience is typically seen as a ‘nursey’ thing. Unclear responsibility for the data was another major barrier. One interviewee said that as the data comes to the nursing team, the trust sees it as the responsibility of nurses alone.
Our conversations also offered some examples of how trusts are using the data effectively to improve quality. Interviewees described how one trust uses its own locally led surveys to track performance in worst-performing areas to drive more focused change. Another had identified that patients were dissatisfied about delayed discharges and noise at night. It developed specific policies to tackle these, including stopping internal transfers after 8pm to reduce disturbance. Another trust used the survey to discover that ‘information on discharge’ needed improvement. It developed a comprehensive discharge pack for patients, including danger signs to look out for and key contact numbers.
We wanted to know what enabled these trusts to take this data, understand it, work with it, and use it to improve patient experience overall. Three key themes came up time and again in our interviewees’ replies.
Organisational leadership and a patient-centred culture were critical. A champion with dedicated time, responsibility and interest in promoting the use of patient experience data was also seen as fundamental to effective use of the data. Staff engagement, training and support for improvement – not punishment for poor results – were considered key to enabling trusts to make the most use of survey data, and for encouraging all staff to engage in the concept of patient experience. Finally, trust-wide reporting and co-ordination of data were vital in drawing all this together, with the patient experience lead deployed to highlight issues and ensure they are tackled.
The NHS inpatient survey has been running for more than a decade now – and throughout this time it has been underutilised both locally and nationally. Our analysis – both of the survey and the discussions – offers new insights into this trove of data and into how it can be better used to improve patient experiences.