Ten tips for measuring patient and carer experience

Patients and their carers are our best witnesses of healthcare. Being centre of the healthcare process, unlike most staff, they observe almost the whole process of care, meaning that they can provide invaluable insights into the quality and delivery of care provision.

Although some patients may not understand (or wish to understand!) all the technical and clinical issues, they do observe inconsistencies in care and can identify quality issues that may otherwise go undetected by staff. Patients and families can play a critical role in drawing attention to poor quality and even major tragedies, such as events in Mid Staffordshire, which regulators and monitoring systems have failed to detect.

Despite a wealth of initiatives – such as the national patient survey programme, NHS Patient Experience Framework, a NICE quality standard for patient experience in adult NHS services and the collection of patient-reported experience measures (PREMs) and patient-reported outcomes (PROMs) – there are stil gaps in understanding at a local and national level about how healthcare is really experienced.

I suspect that many parts of the health service continue to simply pay lip service to eliciting views and acting on patient experiences. Many services do routinely ask people for feedback about the care that they have received, however a recent report from the Ombudsman goes so far as to say there is often a culture of defensiveness in hospitals, with staff being reluctant to hear and address concerns.

So questions remain about the best ways to assess and, more importantly, act on patient feedback, especially as patients move between different parts of the health service. The understanding of patient experience is so often side-lined as too subjective and divorced from the ‘real’ clinical work of measuring effectiveness and safety. I believe we still have a long way to go to make this central and critically important to the way we redesign and deliver healthcare services.

There are an overwhelming number of approaches to measuring patient and carer experiences which need to be considered and used wisely. We recently published an evidence scan to provide a succinct overview of the range of methods that have been used. We hope it will help practitioners, managers, commissioners and researchers to consider the most suitable ways to measure patient experience in their own local initiatives and services.

The scan outlines 10 simple things that need to be considered when planning how to measure changes in patient and carer experience over time:

• Consider how patient experience is being defined to inform exactly what needs to be measured.
• Think about why patient experience is being measured and how the information will be used.
• Assess whether it would be useful to combine approaches so that both qualitative and more quantitative material is collected.
• Consider whether to ask everyone using the services or only a sample to provide feedback.
• Think about whether the best time to collect feedback is immediately after using the services, when experiences are fresh in people’s minds.
• Allocate enough time at the outset to plan and test measurement methods, particularly if these will be used for many years to monitor change over time.
• Think about how the end-result needs to be presented for various audiences as this may shape how data are collected. Potential outputs include statistical averages, in-depth quotes or graphs.
• Make sure that there is appropriate infrastructure at an organisational level to analyse and use patient experience information.
• Make sure that patients, carers, managers and health professionals are all comfortable with why feedback is being collected and how it will be used. Staff need to be on board as well as patients.
• Ensure that patient experience measures are seen as one component of a broader framework of measurement and that all of the approaches work well together, without excessive burden for either staff or patients.

We hope this will be of use to anyone considering how best to assess patient experience. It’s an essential indicator of quality that needs to be built into all aspects of service design and delivery.

Jane is an Assistant Director at the Health Foundation.