It’s official. The NHS has discovered “the patient experience” and it has moved from a position of inconsequential “soft data”, usually relegated to the “touchy-feely” domain, to being a hard reality at executive and policy levels.
This is welcome, if slightly bemusing to nurses who have been researching the patient’s lived experience and urging that we attend to patient narratives/stories since at least the early 1980s.
If I were sceptical, I might think that this particular Road to Damascus had a speed bump in the shape of Darzi’s next stage review and its three “non-negotiable parameters” - safety, effectiveness and patient experience - and the promise of funding that these will attract.
To date, however, the focus on patient experience has been almost exclusively on how to measure it, unfortunately, before we have truly understood and appreciated it.
In the same way, “the patient journey” was shrunken down to a question about speed of throughput rather than concern for what actually happened to you as a human being moving through not only the hospital or health system but through other more deeply personal and existential experiences.
There is now a veritable cottage industry of health professionals, and companies frantically trying to devise “the scale” or “the gizmo” that will ultimately measure patient experience and provide the desperately needed magic numbers.
A senior colleague recently told me that the patient experience could be measured using only four questions. Four questions to open up the worlds of the human experience of illness and hospitalisation. Quite a feat.
The other emerging imperative is the desire to measure “real time” patient experience. The dream here is that patients tell us about their experiences in real time, usually by completing a survey on some kind of PDA or bedside computer terminal.
With almost palpable excitement, proponents tell us that this instant feedback will allow us to adjust the patient’s care and thus respond in an equally real time. Perhaps future enhancements to these systems will encompass “real time patient empowerment” upgrades that allow them to vote a particular nurse or doctor off the ward.
That such a system of real time assessment of patient experience is seriously proposed as a service improvement, while the considerably more “real” patients’ experiences depicted in the Patients Association’s Patients Not Numbers, People Not Statistics report are still seared into our consciousness, gives an idea of the magnitude of just what we may have lost in nursing and healthcare.
Nurses and health staff of a particular vintage may remember the powerful and widely respected “biopsychosocial real time patient experience monitoring system” that was once a lynchpin of services.
Once or twice a day this highly responsive system would monitor and assess all of the patients (not only a self-selecting sample), using a sophisticated, cross-platform, interactive human to human interface to ask the kinds of questions that we are now reinventing: about how the patients were feeling, how their treatment and care was being carried out, how things were going back home, did they understand what was said during the doctors’ round, how the family were managing, was someone looking after the dog and more.
So personalised, responsive and nuanced was this real time system that instant adjustments to care could be made and subsequently evaluated in a future round, thus establishing the kind of quality feedback loop that would cause full circuit meltdown in today’s alleged patient experience monitoring gadgets.
The system was called an experienced ward sister or charge nurse and “real time patient experience monitoring and assessment” was as much a part of their core business as breathing.
The patient experience agenda is throwing up some fascinating questions. What are the important aspects of people’s experiences of health, illness and hospitalisation that cannot be measured and how then should we meaningfully account for them? Should we be trying to devise a uniform national system for assessing and describing patient experience or should healthcare providers and practitioners be encouraged to develop their own approaches? How do we hardwire the need to understand patients’ and clients’ experiences into our staff and systems?
Do I propose an end to all measurement? Of course not, but it is surely damaging and impoverishing to a genuinely humane understanding of the patient experience - to reduce all thinking, decision making and practice to only aspects that can be counted and measured. As damaging as it would be to imagine that nothing at all in nursing and health care can be counted and measured.
Philip Darbyshire is director of Philip Darbyshire Consulting and adjunct professor at the School of Nursing and Midwifery, University of Western Sydney. www.philipdarbyshire.com.au