Evidence is clear that if you listen to patients and improve their experiences you will achieve better clinical outcomes and safer care..
But in spite of this evidence, actively measuring patient experiences is sometimes still thought of as an optional extra, involving grumbles about car parking, hospital food and delayed appointments. Clinical effectiveness, patient safety and dealing with formal complaints are being seen as higher priorities, carrying higher risk.
Forward-looking healthcare providers understand that times are changing. Better experiences lead to fewer readmissions, better adherence to medication regimes and better health outcomes so with an ageing population, and growing numbers of people living with long term conditions, actively tracking patient experiences can help efficiently manage this increasing demand for care.
This is not just a matter of compassion, fundamental as that might be. It is also a matter of good leadership and a rigorous management approach to ensure money is not wasted and resources are focused on things that make a real difference to people receiving care.
To keep this topic top of mind for our health community, we have conducted a review of recent literature on patient experience, and drew out these top 5 trends:
1. Real-time feedback is overtaking surveys.
Conventional approaches to patient feedback involve laborious surveys, whose results take too long to get back to staff. A typical comment from a recent reporti is that survey feedback “is painfully slow, which makes it irrelevant”.
Leading providers recognise that in the rapidly emerging world of digital health, patient feedback systems need to keep up. Electronic PREMs (Patient Reported Experience Measures) enable much quicker feedback from patients, which in turn enables much greater responsiveness from providers. Newly published researchii states that “The area of online patient feedback (and its use for improvement) is undoubtedly an emerging field for policy-makers and practitioners seeking to deliver patient-centred health services that make best use of technology”. Some providers may want to hang on to traditional methods of engagement with patients. But, say the authors of this study, online patient feedback “can provide a valuable and timely adjunct to existing sources”.
2. Evidence-based practice means more than just medicine.
Medicine prides itself on being evidence-based. But today’s high-performing healthcare systems rely on more than just medical knowledge. Patient experience and patient safety sit alongside clinical effectiveness as the three pillars of high quality healthcare. And all three require a rigorous, evidence-based approach.
So collecting patient feedback via compliments can be good for staff morale – but thank you cards may not actually tell you very much. Likewise, it has been observed that complaints processes can focus on “the timeliness of response to complaints and trying to reduce the volume of them”iii, as opposed to actually learning from them.
Patient feedback needs to be gathered and analysed systematically, to provide actionable insight into variation and performance. Otherwise, as one commentator has noted, “If your clinical work is evidence-based, but your patient engagement work is not, your whole provision and perspective are out of balance”iv.
3. Pilots don’t fly.
It has been common, in traditional quality improvement work, to run one-off pilot projects in the hope of seeing what works. But researchv shows that quality improvement depends on ongoing organisational commitment as opposed to small-scale or time-limited projects.
Fidelity to the chosen quality improvement method matters, as does devolution of decision-making responsibilities to frontline staff. And rigorous evaluation and sharing of learning across the organisation is crucial. The lesson is clear: how you design and implement your programmes is as important as the metrics you use. Real time patient-reported outcomes need to be built in, not bolted on.
4. Patients are becoming more assertive.
In conventional patient experience work, patients have waited quietly and politely until they are invited to give their feedback via occasional surveys. But increasingly these days, they are not prepared to wait.
Commentators have notedvi the emergence of a new phenomenon in healthcare: self-organising, online communities operating via a variety of niche digital platforms. This ecology is largely evolving outside the world of traditional health policy or formal healthcare organisations. Elsewhere, patients bypass traditional feedback mechanisms to share ideas and concerns via social media platforms such as Twitter.
The trend shows an appetite for real-time conversations about healthcare, and switched-on providers are working hard to improve responsiveness. But open dialogue and learning doesn’t have to be purely reactive. Some patients may see electronic PROMs reporting (Patient Reported Outcome Measures) as a way to deepen the dialogue, and for providers that can mean shifting communication and learning from reactive to proactive. Assertive patients need to be drawn in, not shut out.
5. Patient experience is moving beyond customer experience.
Patients are of course consumers of healthcare services. It has been statedvii that although “healthcare is not the hospitality business or primarily a retail environment, those leading healthcare would be naive to think they are not being compared to those other experiences people are having”.
Having said that, the study found that for most people, “patient experience” matters more than “consumer experience”. The top three priorities all touched on physical needs and how patient experience contributes to healing and health outcomes. By contrast, the bottom three priorities were about customer-focused items such as time and money. It turns out that “experience is not about just [customer] satisfaction, but the real outcomes people hope for in their healthcare encounters”. So patient experience is “not just an idea at the softer edges of healthcare, but rather it sits at its heart and has significant impact and serious implications for how healthcare is led into the future”.
Cemplicity keeps abreast of trends like these because our job is to re-imagine how patient reporting should work. We see patient reported outcomes as an essential component of evidence-based practice. And it’s important that we ourselves practise what we preach – so our own service development is based on the kinds of research and evidence outlined above.
A systematic and active approach to improving patient experience is a must-have in the quality toolkit for all public and private healthcare providers. Let us show you how to transform the capturing of patient feedback, how to understand both the stories and numbers and how to act at the right time and place to bring about improvement.
i Health Foundation, 2019. Briefing: The measurement maze.
ii Powell et al, 2019. Using online patient feedback to improve NHS services: the INQUIRE multimethod study. NIHR Health Services and Delivery Research Volume 7, Issue 38.
iii Gillespie and Reader, 2018. Patient-Centered Insights: Using Health Care Complaints to Reveal Hot Spots and Blind Spots in Quality and Safety. The Milbank Quarterly, Vol. 96, No. 3, 2018 (pp. 530-567)
v Dixon-Woods and Martin, 2016. Does quality improvement improve quality? Future Hospital Journal 2016 Vol 3, No 3: 191–4
viiWolf, J. 2018. Consumer Perspectives on Patient Experience. Beryl Institute