Monday 20 July 2009

Analysis of - “Understanding what matters” (Department of Health)

iWantGreatCare’s ‘Analysis Of...’ series (1) - 'From Ward to Board'

This is the first post in the ‘Analysis Of...’ series; stuctured commentary on salient publications, conferences and newspaper articles related to patient experience monitoring, analysis and improvement. There will be an ever increasing volume of discussion across many channels in the patient experience space and this series will carefully select out the most relevant, most controversial or the most authoritative and look at them in more detail. The structure for ‘taking a closer look’, and one that will become familiar to readers is Cut it, Dissect it, Digest it, Rate it.

First in the series is a publication from the Department of Health titled Understanding what matters: A guide to using patient feedback to transform services (May 2009). This is a good publication with which to kick off this series since it is recent and topical. It also presents a well written, comprehensive guide to the labyrinth that patient experience can be to some. The publication title is somewhat long winded and for brevity will be referred to as ‘the guide’ from now on...

CUT IT? (i.e. does it ‘cut it’?)– Yes it does. This is a timely piece. The interest in, and activity around, patient experience is rising and many are jumping on this wagon with no clinical background or understanding. The risk of such opportunism is that valid patient experience measurement is not acheived, and the importance and power of unlocking the voice of patients is not given the priority it deserves. There is no time to be wasted with “making it up as you go along” or deploying non-specialised providers for what is a highly specialised area. The impending pressure on budgets, and consequent cuts in services, could have a profound effect on patient experience, and rigorous baseline measurements must be put in place with out delay.

The guide is a comprehensive account, touching on all the main themes in patient experience: capture, analysis, feedback and action. Only one problem with guides – they are like torches in a drawer on a dark night: someone needs to switch them on.

DISSECT IT – The guide notes that patient experience is still very hospital focussed and needs to be widened across PCTs, including community care. Although hospitals may be doing some patient satisfaction surveying and complaints handling, only a few are doing adequate patient experience ‘tracking’. The granularity of the data being collected is at best limited to ward or department level, reducing the ability to use the information to deliver the behaviour and culture changes necessary for sustained improvements. Moreover, patients and carers should be offered simpler means of rating the services they use; tracking experience on hand held pads is far from adequate to collect the detail and quantities of data required. The evidence base suggests that patient perception is mostly influenced by the individual clinician or carer and thus assessing experience at this level is key. Implementing such systems requires clinical engagement as a core component for the success of patient experience performance management programmes.
Case examples throughout the guide provide illustrative detail and meaning and are recommended.

DIGEST IT – The guide touches on the essential principles of patient experience but since it is a guide and not a ‘how to manual’ it does not go into detail. The first issue is the benefits to be gained from excellent monitoring of patient experience. Board directors need to fully understand these principles: business cases and investment papers need to demonstrate the full value justification over time; a business case for patient experience which simply puts forward a ‘plug and play’ type technology acquisition will not work.
Another area not covered in the guide is the importance of local media engagement as part of any patient experience programme. This has to be done to promote and celebrate success within local communities. Brand building for the local NHS can be powerfully worked out of good media engagement.

The guide also warns readers to be conscious of the need to get ethical approval for conducting patient experience research. The ethical issues and consideration of patients is paramount and should always be considered carefully. However, there are effective ways to do this whilst still maintaining momentum and the speed required to deliver rapid benefits in patient experience programmes. iWantGreatCare is particularly interested in research to fully understand the links between patient experience and safety, and patient experience and clinical outcomes. The skill will be to combine this academic base whilst rapidly addressing the new wave of consumer-driven healthcare; doing this now, both for and WITH patients and carers.

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