How can we improve customer care in the NHS? It is obviously important to seek the views of users of the service, its staff and the general public.
The patient survey as currently used by the Healthcare Commission would seem to be a reasonable starting point. Given that my hospital featured in the bottom 10, it would perhaps be unwise to be unduly defensive. Nevertheless, there are some points that have to be made. I should emphasise that only a fool would deny that the NHS needs to up its game in respect of consumer care.
In trying to improve the patient experience, one of the key drivers has to be the ability to motivate staff. When they recognise the validity of the points made, motivation becomes easy. The patient survey devised by the Picker Institute for the Healthcare Commission is designed to be developmental. It picks out many aspects of care that are important to patients (and to staff, of course) and then allows each trust to see where they stand and where they need to improve.
There are, however, a number of problems with the way the current survey is used.
First, an “English only” postal survey carried out months in arrears and based on recollections is always likely to be problematic, particularly when a high proportion of the target population has a poor command of English and low educational attainment. One organisation with decades’ experience of gauging public opinion suggests that London and trusts serving younger, more ethnically fractionalised populations face particular challenges when it comes to patient surveys. The reason for this is not yet fully understood.
Second, when results are presented as comparative data there is a problem. The current patient survey divides hospitals into the lowest and highest-scoring 20 per cent and the middle-scoring 60 per cent. Other surveys have been presented as interquartile ranges. No matter how such results are presented, statistically there will always be a bottom-performing percentage. This inevitably leads to the NHS as a whole being portrayed as failing large numbers of patients when it may be doing no such thing.
Third, the make-up of those responding means interpretation needs to be done carefully. As an example, around 25 per cent of our survey respondents said they waited more than four hours to be admitted from accident and emergency, whereas we know the overall figure to be around 2 per cent. This respondent population is thus very different from the general population of patients we admit and is therefore not representative.
Ironically, when we have been inspected (often at short notice) by the Healthcare Commission in response to previous patient survey results, the commission has tended to support our view rather than the patient survey. Indeed, they have found evidence of “best practice” in some areas.
HSJ’s report on the survey results quotes Healthcare Commission chief executive Anna Walker saying the lowest-performing trusts should look to the best for ideas.
In the absence of any useable qualitative information from the patient survey, it seems that hospitals such as ours should move to an ethnically homogeneous area, close the A&E department, stop dealing with the generality of medicine and surgery and opt instead for a well-defined range of life-saving treatments for dramatic diseases. That should work.
We need a tool that provides rapid, simple feedback from patients to staff in order to improve their performance. The current method is not helpful to those of us who wish to improve the patient experience.