Putting patients at the heart of care

What we mean by patient experience

If we want to achieve truly person-centred care in the NHS we need to look at all the elements of care a person experiences: from the clinical care received to how a person is greeted by a cleaner or receptionist, or how easy it is to find their way round a hospital or health centre. Often it’s the little things that make a big difference to how people feel about the way their care needs are met. 

Ultimately, it’s how the many different members of staff and multiple services interact with people that will create their impression of the NHS, and helps to determine how far they feel confident and in control of their care.

A hot topic

Using ‘patient experience’ as a driver for improvement is not a new idea. It was a key part of Lord Darzi’s work on quality in the NHS Next Stage Review in 2008, and was emphasised in the NHS Constitution. The NHS Confederation published a report about it in November 2011 and The King’s Fund has been running an annual patient experience conference for five years.

But patient experience is a particularly hot topic at the moment. The Secretary of State for Health, Jeremy Hunt, made it clear when he launched the new NHS Mandate in November 2012 that good patient experience is a priority for government. He said: ‘When we place ourselves in the hands of others, we should be confident that we will be treated well, our dignity respected and that that will be the case regardless of our age or mental state, or whether we are in a hospital, a care home or our own home.’

High profile failings in care, such as those at Mid Staffordshire NHS Trust and Winterbourne View Care Home, have highlighted just how bad patient care can be and show what happens when patient experience is not treated as a priority. With the Francis report into Mid Staffordshire due to be published early next year, all healthcare organisations are conscious they need to be listening to patients more, measuring patient experience and finding ways to improve it.

But do we know what good patient experience is?

The newly developed NICE Quality standard for patient experience, issued in February 2012, provides guidance on the components of good patient experience. Its 14 statements include topics such as dignity and kindness, the right to ask for a second opinion, care coordination and knowing who to contact about ongoing health needs. This provides a basis for understanding what good patient experience looks like.

Talking at the King’s Fund annual conference on patient experience this year, Richard Gleave, Director of Patient Experience at the NHS Commissioning Board, pointed out that ‘the national survey shows only 13% of inpatients report being asked for their views’. This suggests that even if we think we know what good healthcare looks like to a patient, the health service isn’t currently asking enough people, and therefore can’t really know whether it is providing quality care in the eyes of those it serves.

The government’s plan to introduce a ‘friends and family test’ next year aims to make sure all NHS organisations maintain an ongoing focus on improving patient experience. The test will involve asking patients a simple question about their care: ‘How likely would you be to recommend our ward or department to friends and family if they need similar care?’

Writing in the Guardian, Dr Neil Bacon (founder of iWantGreatCare) explains how it’s hoped the link between transparent user feedback and improved service quality will help to solve the quality challenge in the NHS – just as displaying restaurant rating assessments to diners in New York has helped to improve food hygiene.

In his opinion, this tool will become ‘one of the most effective improvement tools the NHS has ever seen... which highlights excellence while shining the light of transparency onto sub-standard performance’. However, an HSJ article explores the views of those who are not so sure.

Putting patients at the heart of improvement

As well as measuring patient experience, we need to develop practical ways to improve it. This also means working closely with patients to work out what could be done better and how.

This month we look at some specific ways the Health Foundation is working with organisations to try and improve patient experience. We speak to Dr Joanne Watson about the Patient and Family-centred Care programme, which follows patients through a particular area of care and draws on this learning to improve patient and staff experience. We also look at one of our Shared Purpose projects, where a team from Birmingham are working with patients to develop a new approach to scheduling inpatient care.