What the patient experiences is a central pillar of healthcare quality – but much needs to be done to bring it to the forefront of the agenda, writes Helen Mooney
There is strong evidence that good patient experience is associated with clinical effectiveness and patient safety. Patient experience is one of the central pillars of quality in the NHS alongside safety and effectiveness.
Defining patient safety
The US based Beryl Institute defines patient experience as “the sum of all interactions, shaped by an organisation’s culture, that influences patient perceptions across the continuum of care.”
And yet many of those directly involved in trying to advance measuring and improving patient experience do not believe it has achieved the prominence it deserves.
New kid on the block
As Neil Churchill, director of patient experience at NHS England, notes: “Patient experience is still the new kid on the block. We have had quite some investment in clinical effectiveness and patient safety but patient experience has not had that.”
The NHS, it seems, has yet to put the patient experience into patient safety.
The link between patient safety and experience
In 2013, the British Medical Journal published a systematic review of 55 studies and concluded the data presented display that: “Patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare”.
This is more than just a feeling – there is now both global and UK research to back the assertion.
A joint inpatient survey by The King’s Fund and Picker Institute Europe published last December concluded that much more needed to be done on this front.
A move towards a patient experience model will require an enormous culture change
The study Patients’ Experience of Using Hospital Services: an analysis of trends in inpatient surveys in NHS acute trusts in England, 2005–2013 found that over the past nine years trusts have seen only a modest improvement in quality of care as judged by patients.
Ten things leaders can do to improve patient experience
1. Drive the patient experience agenda and offer strong direction and leadership.
2. Ensure that leadership is visible and accessible.
3. Ensure staff are empowered to make changes to improve a patient’s experience.
4. Model good management from the top. Embody behaviour that reflects the patient experience vision and values: kind, compassionate, caring, empathic, respectful, informative, efficient and professional.
5. Enable patients to tell their story of care.
6. Set up work processes that allow time and space to achieve the improvement objectives.
7. Ensure that feedback from patients is turned into action plans that are carried out.
8. Enable staff to gather feedback from patients and make improvements.
9. Set up processes so that staff have a means of capturing feedback in real time.
10. Include real time data as part of organisational patient experience data.
This was the first longitudinal study of patient experience by trust and it found that while overall there had been small improvements in patient experience reported between 2005 and 2013, the results showed a tendency towards inertia or regression to the average.
Mr Churchill says: “Patient experience starts with human factors as patients and carers see them and links back to clinical care and how services are provided.
“The NHS has got a very solidly entrenched medical model in terms of who makes decisions and on what basis so a move towards a patient experience model will require an enormous culture change.”
It is not just the UK that has identified culture change as critical.
The Beryl Institute’s 2015 global research report State of Patient Experience attempted to benchmark patient experience excellence in healthcare organisations across the world.
The largest study of its kind, the researchers interviewed over 1,500 respondents from 21 countries to create a detailed picture of challenges and opportunities in addressing the patient experience across all healthcare settings from GPs to hospitals to long term care.
It highlighted “purposeful leadership and a strong culture” as “critical” to achieving great patient experience and encouragingly it found that staff development and culture change efforts are top areas of investment with an increasing focus on patient and family engagement.
The study found that while patient experience remains a top priority and that structures for addressing patient experience are widely present, organisational definition still lags behind. That can be hard to provide organisational focus.
Soft and fluffy
Jason Wolf, president of the Beryl Institute, says that although healthcare organisations are often very good at forming committees and structures to address patient experience, on average less than 50 per cent of those organisations have a definition of patient experience.
“And although more and more places have committed to having leadership on patient experience (42 per cent in 2015), only 33 per cent of those leading this commit 100 per cent of their time to it,” he explains.
Strong patient experience leadership means ensuring that roles are not diluted
Mr Wolf questions how, if the majority of organisations do not have a dedicated patient experience leader, they can claim that patient experience is the most important issue for their organisation?
“Many organisations have the chief nurse, for example, as the patient experience lead. That’s like having the chief financial officer running housekeeping. Yet all organisations have a dedicated HR or finance function.
“Strong patient experience leadership means ensuring that roles are not diluted. Moving an organisation to a state of strong and sustained patient experience performance may well be one of the greatest culture change efforts a healthcare organisation can and should take on,” he says.
Ruth Evans, founder of the UK-based Patient Experience, agrees. Getting patient experience right is crucial and makes a big impact on “hard metrics like finance and mortality”.
She says: “The eternal challenge is that we are often preaching to the converted, although events such as the Patient Safety Congress where patient experience is now being discussed.”
“The (government’s) family and friends test is a bit like Marmite, some people love it and some people hate it,” she says. “But one thing is sure, it has transformed metrics at board level in terms of patient experience because now boards have to talk about it.”
Some of the best examples of patient experience do not need large sums of money to get them started. Rather, they start with boards and leadership.
Ultimately she would like to see all NHS organisations with a board director responsible for patient experience.
Christine Morgan, a patient member on the People and Communities Board for the Five Year Forward View and co-production group member of the Coalition for Collaborative Care, says it is still an uphill struggle to “break in” at board level.
“Patient experience is still seen as the soft and fluffy stuff but it is a patient safety issue if patient experience is not taken seriously,” she says.
Ms Morgan would like to see all boards recruiting not just people with the right skills to put patient safety at the heart of the board agenda but also those with the experience of being a patient.
While the new emphasis on incorporating patient experience into the fabric of the healthcare organisations is to be welcomed, the consensus is that the NHS has much more to do before it can truly be said that the experience of those it serves is at the forefront of the agenda.
Supplement: Patient safety back to the drawing board
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Let patient experience take centre stage