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Patient Experience Network Conference – 19 January 2011 Joan Saddler National Director of Patient and Public Affairs, Department of Health What do we mean by Patient Experience? 1. Patient experience = direct experience of specific aspects of treatment or care 2. Patient satisfaction = an evaluation of what happened, reporting the patient’s feelings about the experience of care, usually requiring patients to give an overall rating based on their whole service experience 3. Patient-reported outcome = patient’s perspective on whether a procedure improved quality of life 4. Patient-defined outcome = patients are involved in the definition and design of measures of the outcome of particular procedures or services Factors contributing to patient-centred care at organisational level: 1. Leadership at Chief Executive and Board level 2. Strategic vision 3. Involvement of patients and families 4. Supportive work environment for staff 5. Systematic measurement and feedback 6. Quality of the built environment 7. Supportive technology (Source: Shaller 2007) Providing a good patient experience involves providing patient-centred care A multitude of frameworks list ‘key domains of patient experience’ e.g. Institute of Medicine: Compassion, empathy and responsiveness to needs, values and expressed preferences Coordination and integration Information, communication and education Physical comfort Emotional support, relieving fear and anxiety Involvement of family and friends (Institute of Medicine 2001) Patient experience is also related to productivity and efficiency Whilst not all improvement in patient experience saves money, evidence shows a link: • poor patient experience can be costly • poor doctor-patient communication and poor performance on patient surveys associated with higher litigation costs (US) • evidence of an association with excellent patient experience and market performance and financial health of providers (US) Patient experience is closely related to and influences clinical effectiveness and safety For example, research evidence tells us that: • Organisations that are more patient-centred have better clinical outcomes • Improved doctor-patient communication leads to greater compliance in taking medication and can enable greater self-management for people with long-term conditions • Individuals’ anxiety and fear can delay healing Patient experience Clinical effectiveness Safety Feedback can be captured in a variety of ways, at different times, for different purposes • • • Key is getting the right balance - national, regional, local activity Appropriately informing different decisions Postal Capturing views at the right point in the patient journey Regulation Contract Management Service improvement Pay and incentives Patient stories Public meetings Qualitative Quantitative surveys Telephone Face-to-face surveys surveys Hand-held On-line technology surveys Comment Complaints cards On-line Compliments communities Citizens juries Feedback websites PALs feedback Service improvement Commissioning Kiosks Focus Mystery shoppers groups Local Involvement Networks (LINks) Healthwatch Walking the floor Bedside terminals Local Accountability Performance Benchmarking New service development For illustrative purposes only Improving patient experience is a long haul, not a quick fix As much about cultural change as is it is about availability of data: “Sustaining more substantial change is likely to require organisational strategies, engaged leadership, cultural change, regular measurement and performance feedback, and experience of interpreting and using survey data.” “Small measurable improvements in patient experience may be achieved over short projects.” Davies et al 2008 England has some of the most comprehensive patient survey programmes in the world – but further refinement and development is needed We have extensive data on patient experience through: • national patient survey programme • GP Patient survey Year Survey 2007/08 Users of maternity services Adult inpatients PCT residents registered with GP Users of community mental health services (CPA) A&E/Emergency services Personal Social Services Survey of Adults Receiving Community Equipment & Minor Adaptations GP Patient Survey Adult inpatients Ambulance (category C) Mental health inpatients Personal Social Services: Home Care Users Aged 65 or over, England GP Patient Survey Outpatient services GP Patient Survey (now running as a quarterly survey) Information on patient experience is much more limited in other areas The main gaps are: • along whole pathways of care • in community services & social care • in services for specific clinical conditions 2008/09 2009/10 Learning from others: Patient Experience Online Network Vision • To share ideas and practice to drive improvement in patient experience. • To continually develop a network which connects and supports its members to exchange experience and knowledge Membership • 300+ patient experience professionals across NHS, UK and abroad. Content • Policy and context • Tools and approaches • Connecting patient experience networks and professionals • 30+ case studies from across NHS with links to others • Materials from National Patient Experience Learning Programme http://www.institute.nhs.uk/share_and_network/pen/welcome.html Outcomes Framework (domain 4 - ensuring people have a positive experience of care ) Overarching Indicator Improvement Areas Outcome Indicator Supporting Quality Standards Frames NHS Commissioning Board’s broader responsibilities SofS holds NHS Commissioning Board to account for progress Support commissioning of high quality service e.g. acute care - A&E, in-patient, out-patient e.g. mental health services - community mental health, in-patient e.g. Composite Patient Experience Indicator e.g. Maternity services Outcome Indicator e.g. children and young people - e.g. Children with disabilities e.g. end of life care Outcome Indicator A suite of quality standards relating to the patient experience Consultation feedback – some headline comments and views Local measurement and ownership is key A balance is required – local and national activity Must avoid domain 4 becoming a ‘research’ and ‘tick-box’ industry Staff will need support to assist them in their work to improve patient experience Is different to other more clinically-orientated indicators - success on one may not always mean success in the others Focus on general public, not just recent service users Need to make sure vulnerable patients and those who are excluded, hard to reach or seldom heard are fully included The approach adopted needs to be evidence based, well designed, be simple and easy for the NHS to implement and people to take part in. Framework for 2011-12 4 Ensuring that people have a positive experience of care Overarching indicators 4a Patient experience of primary care 4b Patient experience of hospital care Indicator to be developed Available Improvement areas Improving people’s experience of outpatient care Indicator to be developed 4.1 Patient experience of outpatient services Improving hospitals’ responsiveness to personal needs 4.2 Responsiveness to in-patients’ personal needs Available Improving people’s experience of accident and emergency services 4.3 Patient experience of A&E services Indicator to be developed Improving access to primary care services 4.4 Access to i GP services and ii dental services Indicator to be developed Improving women and their families’ experience of maternity services 4.5 Women’s experience of maternity services Indicator to be developed Improving the experience of care for people at the end of their lives Survey to be developed 4.6 Survey of bereaved carers Improving experience of healthcare for people with mental illness 4.7 Patient experience of community mental health services Indicator to be developed Improving children’s experience of healthcare 4.8 An indicator needs developing Survey to be developed The role of NICE Quality Standards? • A bridge between outcomes and the structures and processes of care needed to deliver those outcomes • NHS Commissioning Board will be able to commission Quality Standards from NICE – used to help commissioners achieve better outcomes for patients • Will also be used to inform the development of payment mechanisms and incentive schemes • Quality Standards are not targets / mandatory or subject to regulation NICE quality standards Guidance and related products Research and audit evidence A quality standard is a set of specific, concise statements and associated measures that: • act as markers of high-quality, cost-effective patient care across a pathway or clinical area; • are derived from the best available evidence; and • are produced collaboratively with the NHS and social care, along with their partners and service users Real-time Patient Feedback - Primary Care • The Best Practice Guide to using Real-time Patient Feedback is an appendix to and sits alongside Improving access, responding to Patients: A ‘how-to’ guide for GP Practices. • Using case studies, the Best Practice Guide demonstrates the positive impact on practices’ performance and patient engagement. It provides practical advice and a step-by-step guide for GP practices interested in carrying out real-time patient feedback. It summarises the approaches taken by pilot practices, providing: • • • • Examples of issues they tackled Learning from experience Improvements achieved Available at http://www.practicemanagement.org.uk/realtimepatient-feedback Other approaches in primary care NHS Leicester City Improvements to services for adults with diabetes •Engaging patients & public to review diabetes pathway •Procurement of new community diabetes service better suited to patients' needs •Cost savings £100,000+ per year. NHS North Lincolnshire Patient Stories - Making A Difference Care pathways, service specifications & new services commissioned as a result of patient stories. NHS Bradford and Airedale Building Engagement & Experience into Contracts Addressing patient experience at local level. Contract monitoring - providers receive qualitative feedback. Provider reports back on issues including: • Approaches to engagement undertaken • Patient-identified issues • Actions taken by the trust. • How action has improved patient experience • Evidence of feedback to patients