We need a better model for patient experience measures in the NHS

NHS organisations usually have something like a Quality Assurance Committee which is responsible for gathering and analysing information on service quality. They do this primarily by gathering a range of data, most of which they are required to use and has been created at a national level.

However, we don’t usually consider why these measures exist in the first place – and whether they are fit for purpose. 

Lets take a step back…..

The NHS is a national service which is managed through the Government’s delivery arm – NHS England.

Many of the experience measures that local NHS organisations are required to use such as National Surveys, CQC, Friends and Family Test (I talked about these in an earlier blog here) are there primarily to give assurance to central government that organisations are delivering services that are of a good standard – they allow the government to compare one NHS trust against another.

They therefore tend to:

• be broad brush – focussing on organisations or services rather than on specific interactions at in specific sites – eg wards.
• place an emphasis on reaching a sample of patients which is usually at an organisation not a service level.
• not distinguish between the views of patients and those of carers
• be insufficiently targeted so miss out on Carers and people who struggle to have their voices heard such as those on locked wards or with a profound disability
• not be in real time
• provide limited opportunities for qualitative feedback
• offer few opportunities for coproduction and relational dialogue

Nonetheless because their utilisation is performance managed by Government local NHS organisations devote a significant amount of intellectual and organisational energy to establish and maintain systems that analyse them.

I think this means that less attention is paid to questioning whether this information is useful for service improvement and what would work better.

A better way?

Local Health and Care Systems need systems that respond more sensitively to particular services and relationships and empower frontline workers to take action to improve.

Patient experience measures need to reflect the circumstances that people find themselves in and the relationship they have with health services, for example experience measures will vary according to whether:

• its a short term relationship – going in for a fairly straightforward and one off surgical intervention
• the depth of relationship – a relative caring for someone with Alzheimers
• its a long term relationship – someone with a long term condition such as an ongoing mental health problem or someone with a learning disability
• someone is a frequent User – someone with type 1 diabetes or kidney disease

There are other considerations too – at a local level NHS and Care organisations need experience measures that:

• provide a framework that helps frontline staff feel empowered to have a dialogue with people who use their services
• helps front line staff feel that issues that are raised with them can help them make the case for improvement.
• builds a shared agenda between staff and patients

We need a much greater emphasis on measures that empower front line services to improve. There are examples – I do think that Care Opinion provides a useful model – it is:

• Real time
• service focussed – providing a platform for front line staff and managers to engage
• patient focussed – allowing the public to tell their story in a wholistic way
• takes dialogue out of committees and to the front line
• provides a strategic model that allows organisations to keep tabs on quality as a whole and at the same time reflects the different relationships and concerns of different services

What do you think?

This blog is based on a talk a gave to a Care Opinion away day earlier this year