When it comes to patients’ experience of care, some things matter more than others, says Neil Churchill
In one sense, everything matters in your experience of care. If you could not find a parking space, got lost in the hospital and were not expected when you arrived at the department, you may not be in the best frame of mind to get the most out of your appointment.
That is why the Beryl Institute argues that patient experience is the total sum of all of your interactions with healthcare.
Yet looking at it another way, some things do matter more than others.
The car park can be an annoyance you soon put behind you. Being told bad news in an inappropriate way, however, without having family or friends there for support, can be unforgettable.
On the whole, it’s the quality of human interactions which matters most and compassion is the quality patients value most.
‘It’s the quality of human interactions that matters most, and compassion is the quality patients value most’
That’s why Improving Experiences of Care: Our Shared Understanding and Ambition, from the National Quality Board, focuses strongly on the human dimension of care.
Based on the Warwick framework – the independent, evidence based approach that underpins the National Institute for Health and Care Excellence quality standard – the document sets out eight dimensions of experience that matter most to patients and their families.
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Dimensions of experience
- I am an active partner in my care.
- I am treated as an individual, my needs, values and preferences respected.
- I am able to access services when I need them and my care is coordinated.
- The people providing my care recognise that I am the expert on me.
- Communication is tailored to me and delivered with care and compassion.
- I have access to the information I need.
- I have access to the support I need, including emotional support.
- The environment in which I receive care is clean, comfortable and dignified.
These “I statements” contain elements of care that are demonstrably transformative. Active involvement and effective communication have been shown to be directly related not only to standards of safety but also to self-reported health outcomes.
One challenge for us now is to make sure that, amid all of the things we measure about experiences of care, we retain clear sight of those which make the most difference, both in the immediate sense to patients, but also to allowing more empowerment of patients, something which lies at the heart of the NHS Five Year Forward View.
‘Active involvement is directly related to safety standards and self-reported health outcomes’
At a strategic level, it was important that the national organisations involved in health and care agreed a common approach to care experience. Confusing signals would inevitably have followed had each organisation adopted its own definition and framework.
There are health systems elsewhere in the world without a single, common framework, which I have been told hinder mutual understanding and collaboration.
The National Quality Board, and especially its lay members, have played a vital part in insisting on effective alignment in the relatively new quality area of patient experience and I was delighted that it has been re-energised following the forward view.
Practice, rather than theory
More significant, however, is the fact that the board has chosen to publish a “narrative” rather than a “framework”.
This means that the focus is much more on practice than theory: case studies, testimony and useful resources that people can use and add to.
The evidence is there to support the “I statements” if you want to pursue it.
But the bulk of the publication consists of practical examples from across the NHS where staff have worked with patients to improve experiences of care. I believe this is very much in keeping with HSJ’s campaign to promote change from the bottom up and not the top down.
There are, of course, things national organisations need to help achieve and the new document sets out their respective contributions. Payments need to reflect what patients think about quality, for example, and the silos which undermine experience need to be designed out by the new models of care.
‘Great patient experience cannot be delivered at the expense of staff experience’
Yet it reflects the fact that the human dimension of care is just that – the human connection between staff and patient, brilliantly captured by Kate Granger’s Hello My Name Is campaign. National organisations need to help set the right climate for the right patient cultures to thrive.
The evidence suggests the NHS is making steady, and I would argue encouraging, progress.
In the recent NHS Staff Survey, 50 per cent said that patient feedback was used in their service or department to make improvements.
Is that enough? Of course not. But I’m in the glass half full camp. The service has come a long way from the executive team reviewing a patient survey once a year.
What’s also needed, of course, is as strong a focus on staff experience, something we did not include in the National Quality Board exercise. Great patient experience cannot be delivered at the expense of staff experience. In fact, as the Point of Care Foundation pointed out, good staff experience generates good patient experience.
Perhaps the board could consider how national organisations need to work together to create a climate that engages and supports staff in trying to do the right thing for patients and carers.
Neil Churchill is NHS England director for patient experience