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Measuring Patients’ Experience of Hospital Care

Measuring Patients’ Experience of Hospital Care. Angela Coulter Picker Institute Europe angela.coulter@pickereurope.ac.uk. Three Perspectives on Quality. Professional: technical competence, clinical outcomes Management: cost-effectiveness, risk management, service development

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Measuring Patients’ Experience of Hospital Care

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  1. Measuring Patients’ Experience of Hospital Care Angela Coulter Picker Institute Europe angela.coulter@pickereurope.ac.uk

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

  3. Why measure patients’ experience of health care? • To assist local quality improvement • For national performance assessment • For strategic policy-making • To build public confidence • To inform purchasers • To inform patients • To compare health systems

  4. Measuring patients’ experience • Focus on recent personal experience • Ask patients about what is important to them (focus groups and interviews) • Ask patients to report on what happened, NOT how satisfied they were (surveys) • Feed back actionable results

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

  6. 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%

  7. Picker Surveys of Patients’ Experience • Access to care • Respect for patients’ preferences • Co-ordination of care • Information and education • Physical comfort • Emotional support • Involvement of family and friends • Continuity and transition

  8. Questionnaire Development • Define scope of survey • Review literature • Focus groups – professionals and patients • Cognitive interviews with patients • Two stage pilot testing • Validation tests and scale development

  9. Implementation • Random samples of patients • Detailed self completion questionnaires • Mailed 2 – 4 weeks after discharge • Two reminders to non-responders • Response rates of 60 - 70% • Problem scores and dimensions

  10. Patient Safety: AHRQ Guidelines • Active participation of patients • Information sharing • Allergies and adverse reactions to drugs • Understanding instructions • Cleanliness • Discharge information and treatment plan

  11. Picker Surveys of Patients’ Experience

  12. Picker Surveys of Patients’ Experience

  13. Picker Surveys of Patients’ Experience

  14. NHS Survey of Patients with Coronary Heart Disease • Sampled patients with diagnosis of CHD from hospital records • Names, addresses from 194 NHS Trusts in England • Sample size 112,000 • Postal questionnaire • 84,300 completed questionnaires • Response rate 74%

  15. NHS Patients Survey (CHD):Information and Communication

  16. NHS Patients Survey (CHD):Coordination and Continuity

  17. NHS Patients Survey (CHD): Hospital Environment • 35% on mixed sex ward (5-76%) • 38% bothered by noise (26-54%) • 35% said toilets/bathrooms not clean (16-69%) • 36% said not enough nurses on duty (23-54%)

  18. Did not feel sufficiently involved in decisions about care % National Surveys of NHS Patients. Coronary Heart Disease 1999 (n=84,500)

  19. NHS Patients Survey (CHD): Discharge and Transition • 34% no written information about recovery (5-53%) • 39% no advice on prevention (10-55%) • 32% no advice on resuming normal activities (10-53%) • 31% said home circumstances not taken into account (18-45%)

  20. Patient Surveys Should Be: • Relevant to patients’ concerns • Relevant to policy goals • Actionable • Timely • Comparable • Methodologically sound • Accessible

  21. Local surveys Locally ‘owned’ Locally relevant Shorter time-scale National surveys Consistent methodology Cost-effective Independent of hospital National vs. Local Surveys

  22. A Third Way: Locally-organised Surveys with National Standards • Core set of validated questions • Implementation standards and manual • Data analysis tool kit • National benchmarks • Flexibility to add local questions

  23. Conclusions • Patient feedback is a key element of quality improvement • Surveys of patient experience are more useful than patient satisfaction • Patient surveys can help to improve safety standards • National benchmarks can stimulate improvements

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