Measuring the patient’s experience – some thoughts

Measurement of the patient’s experience of the care received is essential for the delivery of high quality care throughout the patient’s journey from diagnosis.

In October 2011 the NHS National Quality Board (NQB) agreed on a working definition of patient experience to guide the measurement of patient experience across the NHS. This framework outlines those elements which are critical to the patients’ experience of NHS Services. Published in 2012 the 7-key elements of  the  framework  are:

  • Respect for patient-centred values
  • Coordination and integration of care across the health and social care system
  • Information, communication, and education 
  • Physical comfort 
  • Emotional support and alleviation of fear and anxiety
  • Transition and continuity
  • Access to care 

Currently there is  no single bespoke measure of patient experience of integration in or across the NHS services and the NHS Future Forum report on Integration recommended that new patient experience measures should be developed to evaluate patients’ experiences across whole journeys of care. This I believe to be unfeasible as such a broad  approach  would impact on the depth and validity of the data collected. Rather I would recommend that a core set of questions be developed – perhaps based on the 7 general questions mentioned in the report – with a series of plug-in modules specific to the different elements for assessment.

Service can be evaluated using both qualitative and quantitative methods. These include: depth and discovery interviews, focus groups, semi-structured interviews, Self-completion/interviewer administered/telephone surveys and patient reported outcome (PRO) measures as well as more technically advanced procedure such as web-based and real-time patient feedback. Other approaches include observational techniques such as diaries, mystery shopping, non-participant and participant observation.

Although in-depth and  focus groups tend to be the traditional approach to gaining qualitative patient feedback this will not always be appropriate and The choice of method must be based on a sound rationale and  fit the purpose for the type of information gathered and how it will be used.

Questionnaires are also commonly used to collect quantitative feedback from patients, however, there are many pitfalls in the design and use of questionnairesthat can result in the collection of unreliable and invalid data. Questionnaires may also be inappropriate for certain populations.

It is therefore, essential that in designing a patient experience survey questionnaire:

  • the objective of the survey are made clear.
  • questions need to be specific and unbiased
  • questions need to be clear
  • questions need be relevant

These are just some of the key point for questionnaire design For more tips on questionnaire design click here.

Availability of web-based survey technology such as ‘Survey Monkey’ provides easy access to the development and implementation of questionnaires in a range of settings and therefore, has the potential of increasing the number of unsound surveys being conducted in an organisation when the questionnaire design has been left to someone inexperienced.

In addition to the method of collecting information is the issue of ensuring representative of the feedback received when comparing between sites, hospitals, wards etc. or bench-marking, monitoring trends and submitting quality accounts. Sampling is less of an issue when undertaking qualitative research but, it is important that the information collected is representative of the particular patient population under study and the sample is of sufficient size to make sure a comprehensive range of views is collected.

Ethical issues are of paramount importance when obtaining patient feed whether this be through qualitative or quantitative methodologies, service evaluation, development or audit. Therefore, prior to any form of patient contact, guidance must be sought to show whether ethical clearance must first be obtained.Failure to get ethical clearance will result in the finding not being available for use.

There are standard codes of practice for patient recruitment including identifying and contacting patients, gaining consent, maintaining confidentiality, undertaking the research and data storage.

Do you have experience in designing or using patient experience questionnaires?

What kind of issues/problems have you experienced? I would like to know

Some relevant links:

Patient experience in adult NHS services

Published statistics about the experiences of NHS patients



Categories: Patient reported experience, Questionnaire design

Tags: , , ,

1 reply

  1. Intresting piece on Patient Experience. From my own experiences working in the NHS, especially when I was an On Call Director, I found that the things that really matter are often small and easy to do. Things like letting patients and relatives know what is going to happen, about delays and reasons. Really basic communication. The level of care is not somthing most would question.

    Sometimes when you are dealing with the workload that people in the NHS have it is easy to forget that what you know inside out and take for granted is completely new to patients and relatives.

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