Making patient experience surveys useful: Improving care by asking about what went wrong, as well as what went right

How can we make patient experience surveys more useful for improving care? Should we ask about what went wrong (as well as what went right), in order to learn where improvements are most needed?

Driving improvements in care: Making patient surveys useful

Patient surveys are an important part of the quest to measure, manage, and improve quality in health care. In many patient surveys, more than 90% of respondents report a positive experience of care. Yet the very high levels of positive patient experience reported in such surveys sits uncomfortably at odds with the examples of poor patient experience that are frequently encountered when you ask the same patients about their experience of care using qualitative interviews. Ceiling effects in patient surveys can make it difficult to identify poor experiences of care, and mean that survey results are often less helpful than they could be as drivers of improvements in care. It’s not that patient surveys are not useful for improving care. But I think we could make them more useful. One way to do this might be to ask about what went wrong (as well as what went right) in order to learn where improvements are most needed. Does this sound too radical?

Should we ask about what went wrong as well as what went right?

If you want to know where improvements in care are needed, it might help to ask patients where the problems are (seems obvious really). For instance, if you want to know about poor doctor communication or problems with co-ordination of care you could ask about how often or to what extent patients experience such problems. I’m sure you will be able to think of some better examples, but here are a few for starters. Poor communication: My doctor is too busy to listen properly to what I have say; My doctor uses too many long medical words that I don’t understand when explaining what is wrong with me. Poor co-ordination of care: communication gaps between the different doctors involved in my care means my care is not properly co-ordinated; important information about my health and care is not shared between my doctors at the hospital and doctors in the community. Ok, you get the idea…

How you go about collecting and interpreting data on patient experience is important. Asking about the patients’ experience, particularly the experience of any problems in care, needs to be done in a way that doesn’t engender a defensive responsive from doctors/nurses, health care managers, and their professional bodies. If people feel they are being criticised, they might be less likely to engage with the survey results, and less motivated to make changes to improve care. It’s also important that patient surveys are not used in a way that demoralises staff.

Asking patients about problems in their experience of care: ‘off limits’?

At present, I can think of very few patient surveys that ask directly about the experience of problems in care. Is this because asking patients about problems in their care is somehow ‘off limits’? Should it be? Most importantly, if we subscribe to such an approach does this constitute a missed opportunity for using patient experience to improve the quality of care? I’m really interested to learn what others think.


Want to learn more?
Using and understanding patient experiences: Improving patient care (2013) (Editors: Sue Ziebland; Angela Coulter; Joseph Calabrese; Louise Locock)
Collecting data on patient experience is not enough: they must be used to improve care (2014). Coulter, A., Locock, L., Ziebland, S., Calabrese, J. BMJ 2014;348:g2225

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