1. Improving patients’ experiences An analysis of the evidence to inform future policy development

3. Improved doctor-patient communication leads to greater compliance in taking medication and can enable greater self-management for people with long-term chronic conditions

4. Individuals’ anxiety and fear can delay healingPatient experience Clinical effectiveness Safety Slide 0 2

5. “” “ Terminology is important The term ‘patient’ is not appropriate for many care settings. Language and policy messages must engage and motivate frontline staff. ‘Patient-centred’ is multi-dimensional: it covers both the what and the how. 3

6. Experience, satisfaction, and reported and defined outcomes, are all different concepts Patients’ reports of their experience of care come in a number of forms. 4 810 While terms such as ‘experience’ and ‘satisfaction’ are sometimes used interchangeably, with satisfaction often used colloquially, this can be confusing.

7. Experience, satisfaction, and reported and defined outcomes, are all different concepts Patient experience = direct experience of specific aspects of treatment or care 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 Patient-reported outcome = patient’s perspective on whether a procedure improved quality of life Patient-defined outcome = patients are involved in the definition and design of measures of the outcome of particular procedures or services. 5

8. Experience forms part of many major initiatives Slide 0 6

9. Internationally recognised definition of patient centred care 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) 7 q + ] _ s

11. However, at a more detailed level, significant improvements can be seen in access, trust and confidence in health professionals remains high and most patients report being treated with dignity and respect.

12. There seems to be need for significant progress to improve issues such as the provision of information, noise in hospitals, and the engagement of patients in decisions about their care.

13. There are systematic differences in feedback from different groups.Slide 0 8

15. in community services

16. in social care

17. in relation to services for specific clinical conditionsSlide 0 9

18. Systematic difference in feedback from different groups 10 Age: Older patients generally more positive than younger patients Ethnicity: Variations between black and minority ethnic (BME) groups and their white British counterparts. Where differences do exist, most are negative Health status and disability: Patients with poor health status, poor mental health and disabilities significantly more likely to respond negatively Gender: Differences exist but effects were not consistent across surveys

19. Qualitative information collection methods Semi-structured and in-depth face to face interviews Discovery interviews Web based free text comment (e.g. Patient Opinion) Focus groups Complaints, letters and cards Patient diaries Observation 11

21. Interviewer administered surveys (face to face; telephone; using electronic hand held portable devices (PDAs))

22. Routine administrative statistics12

23. 13 Conceptual model of a multi-tier healthcare system showing generic functions at each level National Policy formulation and infrastructure Regional Performance monitoring and macro-management Organisational Operations management Team and individualClinical service provision and individual accountability Adapted from Leatherman and Sutherland (2003)

25. standard and local measures

26. comparison between own service and others

28. Complaints

30. Boards review of patient experience, including complaints, at least quarterly

31. Fast, frequent access to results

32. Fine grained detail on departments and specialties

35. Use locally collected data; avoid fresh data collection

37. Standard measures of patient experience with demographics

38. Up-to-date, but not fast or often

40. Happy staff = happy patients Staff who are satisfied and engaged with their work are more likely to communicate well with patients, to therapeutic benefit Stress and burn out affect recently-qualified nurses’ capability to provide high quality care Improved team working is good for the mental health of both staff and patients Hospitals with high levels of staff satisfaction score well on patient perceptions of experience 19

41. Uses of qualitative information Answers to questions: What happens? How? Does it matter? Why? Relationship between contexts, events and behaviours Rich, detailed, descriptions of contexts and practices Slide 0 20 Good for: Not good for: Making generalisations Answers to questions: How many? How often? How typical? Or How different? Comparisons of quality between services and organisations

42. Uses of qualitative information Good for: Not good for: Insights into the meanings for patients and families Insight difficult to measure but important aspects of experience Motivating audiences Reminding case-hardened staff of the human dimension Slide 0 21

43. Uses of quantitative information Answering questions: How many? How often? How typical? How different? Monitoring changes over time Showing how patients rank events and experiences Measuring differences within and between patient populations Slide 0 22 Good for: Not good for: Insight into the nature and meaning of experiences Explanations of rankings Bringing to light serious deficiencies Explaining why or how a mechanism or incentive works Explaining why a change occurs

44. Uses of quantitative information Good for: Comparative assessments Measurement against numerical targets Benchmarking Slide 0 23

46. Visits & inspections

47. Reviews

48. GP patient survey

49. Nursing metrics

50. NICE quality standards

51. Indicators for Quality Improvement

52. Quality accounts

53. QOF

54. Energise for Excellence in Care

55. High Impact Areas

56. Supporting practices listening to patients

57. Staff experience and Boorman

58. Training and development

59. Patient and service user feedback

60. National surveys

61. User survey

62. Measurement (e.g. NASCIS)

63. Testing real-time feedback

64. Assessments of commissioning

65. Quality Information Strategy

66. Info on NHS Choices

67. Roles e.g. in LTCs

68. Personalisation inc

70. Role of experience information in informing choices

71. Policy on surveys

72. Complaints

73. Skills for Care

74. Development of performance assessment

75. IpSOS MORI tracker survey

76. Bringing experience data together with HES data

77. Supporting local measurement and use for improvement

78. First set published in June

79. Improvement programmes on patient experience

80. Care planning and

81. Supporting use at all levels

83. Developing for LTCs

84. Realigning incentives

85. Vertical integration

86. CQUIN and incentives

87. Financial incentives

88. Commissioning pathways

89. Measures development

92. Priority recommendations Co-ordinate and align DH programmes to agree common approaches to language, measurement, analysis and joint business planning. Patient experience should continue to be a priority for providers and commissioners. Improving patient experience is a slow and complex process. Organisations can implement quick wins, but focus needs to remain for the long haul. Ultimately patient experience agenda needs to be owned and led by frontline staff and patients working together. Fill information gaps in experiences of care pathways, community services, specific clinical services and social care. Develop capability for near real-time measurement. Co-ordinate work on improving staff experience and patient experience. 25