Measuring patient views of health care quality

Margaret Goose is a Governor of the Health Foundation and a lay trustee of the Royal College of Physicians.

As a lay member of the National Quality Board she advises ministers and the Department of Health, and has been awarded an OBE for services to healthcare. We spoke to her about the value and challenges of including patient views in the measurement of healthcare quality.

Why is it so important that we include patient views in the measurement of quality?

Patients and staff emphasise different issues. The patient is trying to improve their health in the context of their life, whereas specialist staff tend to concentrate on the presenting problem in their specialist area. The Mid Staffordshire Inquiry shows how quality of care can slip if feedback from patients and carers is ignored; reliable quality of care needs rigorous measurement. Patient experience is now accepted as the third arm of quality; Quality Standards were published by NICE in 2011 and the fourth domain of the NHS Outcomes Framework is ‘Ensuring that people have a positive experience of care’.

What are the benefits of considering patient views?

If staff can engage patients and help them feel involved, patients are more likely to hear the advice they are given, and to act on it, so treatment is more effective. For example, if a patient who has had a stroke enjoys playing bowls, if a practitioner tailors their rehabilitation treatment to the functions they need to resume that activity, the patient is more likely to do the exercises and staff will feel they have done a good job.

Tell us more about how patient views on safety and quality tend to differ from staff views?

I remember a local survey of outpatients some years ago that asked which elements of the department were most important to them. The order of importance for patients was the reverse of what it was for staff. For patients, the priorities were good communication, shorter waiting times and being treated as individuals. For staff, professional standards were paramount; the patients took that as given. Both groups want the same high quality of care – safe, effective and reliable – but patients want it tailored to their personal needs.

How do we go about measuring patient and family views?

Different methods of measurement are appropriate at different levels. At hospital level there is an annual national patient survey that covers involvement in decision-making, communication with staff, and whether staff attitudes are kind and helpful. There are also websites like ‘Patient Opinion’ where people can post their views on their local hospital.

Ministers have asked for a ‘friends and family’ test to be introduced, asking whether people would recommend a hospital to their family and friends.

At individual patient level, there are commercial and other tools available, based on questionnaires, as well as interviews and real-time feedback. The Society of Cardiothoracic Surgeons is designing a tool to gather patient feedback, to be published at individual consultant level. If someone needs a heart operation, they will be able to look at the practitioner’s professional competence as well as the views of previous patients. The new medical revalidation process means doctors will be formally reassessed by the General Medical Council every five years; this will involve feedback from patients.

The Health Foundation are doing a lot to try and make sure patient views of quality are used as a measure when assessing the success of improvement projects. The Co-creating Health programme, for example, aimed to demonstrate that increased self management by patients with long-term conditions, when appropriately supported, leads to better health outcomes. To evaluate the success of the programme they used a mixture of measures, including surveys of patients. They were able to compare feedback from patients who took part in the programme with feedback and outcomes from patients in the same pathway of care who didn’t participate.

What are the challenges in measuring and using these views?

Each patient is an individual, but studies have shown which issues are consistently important. Measurement and benchmarking tools are being developed, but to achieve change of practice, a change of culture is usually needed to make sure that patient views of quality are incorporated into assessment of quality as standard.

It is often patient stories which make the difference. Some boards begin each meeting with a patient story, which can really help to ensure that senior management listen and act on feedback from patients and use it to prioritise areas for improvement work.

The NHS Institute has brought together the research evidence and examples of good practice in a programme of work called Transforming the Patient Experience, which aims to support organisations to improve how they measure patient views of quality.