Ramsay Health Care Client Story

Achieving outstanding PROMs response rates: A success story from North Downs Hospital

Achieving outstanding PROMs response rates: A success story from North Downs Hospital

Ensuring every patient’s journey is enriched with PROMs.

Based in the beautiful south of the United Kingdom, North Downs Hospital is one of Surrey’s leading private hospitals with a reputation for delivering high quality healthcare treatments. A part of Ramsay Health Care UK, it is one of 36 private facilities offering a range of treatments from hip replacements and knee replacement surgery to cosmetic surgery.

baseline response rates
response rate (Hip & Knee PROMs)

Stephanie Vaughan, POA Senior Staff Nurse and Catherine Hart, POA Administrator, have spearheaded the Patient Reporting Outcome Measures (PROMs) programme at North Downs Hospital together for the past couple of years. In that short amount of time, they’ve achieved a remarkable 95% baseline response rate and 85% response rate for completed PROMs in the Hip and Knee programme.

In this article, we delve into their strategies, insights and practices to understand what factors have helped to drive this outstanding success.

A commitment to 100% inclusion

At the core of North Downs Hospital’s achievement lies the commitment of their nursing team to ensure every patient’s journey is enriched by PROMs. Stephanie and Catherine both work in specific pre-assessment roles – alongside one other colleague – and they all share a conviction that PROMs must start at that pre-assessment stage. But that’s obviously easier said than done. To achieve that 100% catchment of patients takes tenacity and persistence – two characteristics that Catherine and Stephanie have in infinite supply.

For the North Downs Hospital team, it all comes down to having PROMs champions – people who are proudly responsible for the collection of PROMs responses and who have the time and consistency to ensure the process is replicable and constantly adhered to.

“We basically don’t let them leave pre-assessment until they’ve done it. We don’t let them go away and do it at home. You don’t trust that they’ll do that, so we like to make sure it is done in pre-assessment.” Catherine Hart

Design safety nets

Even with the right people in place, things don’t always go according to plan. But Catherine and Stephanie are committed to 100% inclusion. The team go as far as having backups should their core data capture mechanisms, in this case tablets, not work. The team keeps paper-based questionnaires handy so that even a technology malfunction can’t be a reason to miss a patient. If a patient does need to use a paper form, the responses are then transcribed into the digital tool later and the form is securely shredded to ensure data privacy.

On rare occasions, patients may not have their own email address:

“There were two instances where they didn’t have an email. So we ask for a family member’s email address and we take it and then we’ll input it into the patient management system from there.” Stephanie Vaughan

Working within hip and knee replacements, many of the patients are elderly and so sometimes struggle with the use of a tablet or reading questions. Again though, Stephanie and Catherine work through these eventualities and ensure there’s a way of capturing them in the programme:

“If someone elderly does get a bit flustered or confused at first, we show them how to click one or two of the answers and then click next. They can then do the rest of it themselves.” Stephanie Vaughan

“Sometimes people are like, oh, I forgot my glasses, I can’t read the question. So we read it out to them.” Catherine Hart

By creating backstops and demonstrating commitment to dealing with every eventuality, Stephanie and Catherine can remain focused on 100% completions, without making allowances for anyone slipping through the net.

Explain what’s in it for the patient

Tenacity and planning only gets you so far. To ensure they’re able to achieve the 100% baseline that they’ve set themselves, Catherine and Stephanie know they need their patients to understand why spending their time reporting their outcomes delivers value to them. Patients are informed that completing the questionnaire serves as a tool to assess their progress and the success of their joint replacements. This communication bridges any potential hesitations, resulting in widespread acceptance and participation.

“There’s never refusal. When you explain what it is and the benefit of it… patients don’t say, no I’m not signing anything and I’m not doing it. They do it quite happily and fill out the questionnaire no problem.” Catherine Hart

Communication is key for engagement

By ensuring feedback is accessible for North Downs Hospital, PROMs serves as much more than just data points. They use the collected responses as a tool to assess the necessity for surgeries and measure the quality and improvement of patient outcomes. By analysing trends, they can identify which surgeries are necessary and successful, thereby optimising patient care.

However, such analysis is only possible if patients continue to engage with the programme post-surgery. And to drive that, early communication and setting clear expectations is the key:

“We say to them, this is basically to see how you are now. And then in six months to a year’s time you will get another one emailed to you with the exact same questions. And I will then tell them, it is compared to see what the improvement is and how successful that joint replacement is.” Stephanie Vaughan

Keep it brief

Even for patients who understand how engaging in the PROMs programme will benefit them, it’s vital to ensure the process takes up as little time as possible. This is for two reasons. Firstly, it encourages the patient to stay engaged. But just as importantly, it ensures that when the department is busy and the team are running around trying to stay on top, they still have time to focus on the PROMs participation.

“It probably takes less than five minutes to explain the whole thing and log them on obviously. And then you put it in front of them. 10 minutes max.” Stephanie Vaughan

On the rare occasion when time does become a challenge, they still ensure nobody slips through the net:

“When there was another patient waiting, I put them out in the waiting area and gave them the tablet and explained what they needed to do and then they just give the tablet back to the receptionist. So basically even if I’m under pressure – they still have to do it.” Stephanie Vaughan


North Downs Hospital’s success leaves us with some valuable takeaways. To maximise the response rates in their PROMs programme and deliver value to their clinical teams and patients, they’ve made some key strategic decisions.

The journey of North Downs Hospital exemplifies how dedication, strategic integration, effective communication, and a commitment to patient-centred care can drive exceptional response rates in PROMs. Their story serves as an inspiring example for healthcare providers seeking to enhance patient experiences, optimise outcomes and continuously improve their services through the power of patient reported data.

Key strategic decisions

  • Maintaining razor-sharp focus on one department.
  • Refusing to compromise on 100% participation.
  • Building a dedicated team responsible for ensuring the collection of responses.
  • Integrating PROMs into pre-assessment.
  • Communicating the benefits of participation to patients.
  • Allocating sufficient time.

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