Patients’ perceptions about the treatment they receive is becoming increasingly important. Steve Tolan, a CSP professional adviser, discusses the key issues.
The NHS Constitution for England is currently being redrafted and the new version will include a greater emphasis on the importance of patient experience.
The Department of Health has already reaffirmed its commitment to improving patient experience by publishing the Patient Experience Framework.
But why is patient experience so important, wherever you practice, and what can we learn from listening to what patients think of us and our services?
Patient Experience Framework
The Department’s framework for England contains elements that are critical to patients’ NHS experiences:
respect for patient-centred values, preferences and expressed needs
- co-ordination and integration of care
- information, communication and education
- physical comfort
- emotional support
- welcoming the involvement of family and friends
- transition and continuity of information
- access to care
While the importance of patient experience in the NHS has become increasingly enshrined in policy in all four UK countries, it is more than a tick box exercise.
Rather, it offers opportunities to move past a biomedical model and should be considered the ‘other side of the coin’ to patient outcomes.
Increasing value is placed on a patient’s perception of his or her own outcome and experience (rather than the clinician’s perception of ‘recovery’). Patients’ responses can help us in attempts to try and quantify the true value of healthcare.
Patient views can be very powerful in the healthcare market.
There are also plans for patient experience to become linked with tariffs, service evaluations and developments at all levels of healthcare.
The patient voice is already swaying commissioners, health boards, politicians and GPs towards and away from services.
Clearly, there is a need to consider patient experience in the NHS from a policy perspective.
But physios in both the NHS and private sector have recognised the need for patient engagement, in a bid to improve their services, for some time.
In a presentation at October’s Physiotherapy UK 2012 conference, Dr Lisa Roberts of the University of Southampton outlined some points from a soon-to-be-published paper on service delivery and patient satisfaction. She highlighted the value of patient feedback in delivering services and bringing about change.
Dr Roberts used patient experience information to evaluate a service and bring about change within a musculoskeletal physiotherapy team.
Some of the benefits that sprang from listening to the patients’ experiences included changing administration and clinical pathways to make the patient journey easier.
These led to fewer wasted appointments, improved record keeping standards and enhanced the quality of information being offered to patients. The new systems also reduced patient waiting times significantly.
Indivdual responsibility for all
Dr Roberts also discussed the difference between a ‘system approach’ and an individualised one.
As physios we all want the patient to feel emotionally and physically supported, and satisfied with how they accessed the service.
So, if we’re individually committed to this aim, why doesn’t it always occur?
The greatest challenge can be the cultural change but this could also lead to the biggest success.
Could a positive patient journey increase compliance and cut the number of wasted appointments?
To use an analogy, how keen might we be to return to a hotel where we felt we had received poor service, even though we eventually had a good night’s sleep?
These positive experiences are built on an organisation’s culture in which everyone takes individual responsibility.
We can, of course, learn lessons from business where customer satisfaction is a highly-valued commodity, but we should also consider patient experience as a commonsense approach to the challenges of providing health services.
While physios often discuss ‘yellow flag issues’, how often do we consider the likely risk of a patient’s experience with us as being a yellow flag contributing factor?
This may be where patient experience complements patient outcome.
Likewise, our understanding of the issues from a service perspective might help us to use patient experience or patient outcome to evaluate services from the perspective of those whom we serve.
The CSP has backed the use of patient reported outcome measures (PROMs) for some time. Services should also include objective measurement through patient reported experience measures (PREMs).
These may take the form of local organisation questionnaires or validated tools.
The CSP recommends using the Consultation and Relational Empathy (CARE) measure (Mercer SW et al.
‘Relevance and practical use of the Consultation and Relational Empathy (CARE) Measure in general practice’. Family Practice 2005; 22(3):328-34).
This validated tool can be useful to provide insight into a service or individual clinician and could be applied with ‘bolt on’ service specific questions if required.
The value of PROMs and PREMs is expanding.
The roles that these tools need to fulfil are expanding from the individual patient and clinician need to national data collection and evaluation.
As physiotherapists providing a modern, productive and effective service it is important to understand the power of these tools and the likelihood that at some point we will be patients ourselves.
Irrespective of the sector, specialty or region in which we work (including non-clinical, health-related roles) the patient voice can provide a true reflection of our individual performance and our service effectiveness.
Patient experience really does matter.
Dr Roberts’ paper on service delivery will appear in a future issue of Manual Therapy. fl
To contact the author, email: EQ-5D-5L@csp.org.uk
How to use this article for your CPD
- The CSP’s quality assurance standards were published with Frontline (24 October 2102).
- They set an expectation for members to collect, record and use patient feedback to inform their practice.
- This activity is designed to help you think critically about whether you meet this expectation in your day-to-day practice.
- Visit: www.csp.org.uk/publications/quality-assurance-standards-audit-tool and download the audit tool for Section 8 - Physiotherapeutic treatment and clinical management: Quality Assurance audit tool.
- Select some patient notes and use the audit tool to evaluate how closely they match Section 8’s expectations.
- Once you have completed the audit, celebrate the fact that some items appear in the ‘yes’ column.
- Then look at the items ticked ‘no’ or ‘not applicable’.
- Think back to your interaction with this client – what will you do differently to meet the expectations of section 8?
- What are the implications for your future practice?
- Note down your responses and store them with your audit in your portfolio.
- Look at some examples of how stories of patient and service user experiences can change practice.
- Digital stories from patients, carers, practitioners and managers about practice and service delivery. Visit:www.patientvoices.org.uk
- Video, audio and text-based accounts of people’s experiences of more than 60 health-related conditions and illnesses. Visit:www.healthtalkonline.org
- Opportunities to learn about learning and development practice from a student perspective. Visit:www.studentstories.co.uk
Student voice: what does this mean in practice?
- Carol Robinson from the University of Brighton gives an the introductory talk at a research conference in February. Visit: www.youtube.com/watch?v=CVa2f6hK1Cw
- To download the Patient Experience Framework, visit: www.dh.gov.uk/health/2012/02/patient-experience-framework
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