The Patient’s Perspective

1. The Patient’s Perspective Angela Coulter Picker Institute Europe www.pickereurope.org

2. Three Perspectives on Quality • Professional: technical competence, clinical outcomes • Management: cost-effectiveness, risk management, service development • Patient: access, responsiveness, communication, symptom relief, quality-of-life

3. Patient-Centred Care • Prompt access • Respect for patients’ preferences • Co-ordinated care • Information and education • Physical comfort • Emotional support • Involvement of family and friends • Continuity and transition

4. Methods for Seeking Patients’ Views • Observations • Interviews • Diaries • Focus groups • Surveys • Meetings

5. Uses of Patient Surveys • Identify priorities for quality improvement • Reduce complaints • Promote patient safety • Monitor health system performance

6. Overall, how would you rate the care you received?

7. Reporting Questions • A&E care disorganised 38% • Reason for delay not explained 6% • Staff gave conflicting information 23% • Doctors talked as if I wasn’t there 30% • Had to wait too long for pain medicine 9% • Risks and benefits not discussed 24% • Not told when to resume activities 60%

8. Problems With Rating (Satisfaction) Questions • Yield positive results, which do not reflect reported experience • Do not discriminate well between countries, hospitals, units • Do not help to identify causes of dissatisfaction or priorities for quality improvement

9. Measure Patients’ Experience, NOT Patient Satisfaction Reporting NOT Rating.

10. Didn’t have enough say about treatment (Picker Inpatient Surveys)

11. Test results not clearly explained(Picker Inpatient Surveys)

12. Not told about side-effects (Picker Inpatient Surveys)

13. Not told about danger signals to watch for (Picker Inpatient Surveys)

14. Most Common Problems • Not enough involvement in decisions • No one to talk to about anxieties and concerns • Tests/treatments not clearly explained • Insufficient information for family/friends • Insufficient information about recovery

15. Patient Feedback Should Be Used to Stimulate Change

16. Using Patient Surveys to Improve Quality in a Swedish Hospital (1) • Observation of admission routine and patient pathways • Changed procedure • Waiting reduced

17. Using Patient Surveys to Improve Quality in a Swedish Hospital (2) • Reorganised into smaller groups • Staff training in communication • Nurses involved when doctors talked to patients

18. Using Patient Surveys to Improve Quality in a Swedish Hospital (3) • Action plan • Specialist nurse • Staff training • Self-medication • Regular surveys of pain control

19. Summary • Measure experience, not satisfaction • Survey results should be published and used • Patient feedback should drive quality improvements

20. Patient-centred care and quality improvement Patients’ participation in treatment decisions Eliciting users’ views of health services Public perceptions of health services Citizen involvement in health care policy making Citizen involvement in priority-setting Methods for monitoring and evaluating participation Empowerment and consumerism Health ExpectationsAn international Journal of Public Participation in Health Care and Health Policy Editor: Angela Coulter Deputy Editor: Vikki Entwistle Published Quarterly, Paper 1369-6513, Online 1369-7625 Papers are invited for publication – for more information and Guidelines for Authors visit www.BlackwellPublishing.com/Journals/HEX