Are patient experience surveys for quality assurance or quality improvement?

Patient experience surveys are a central feature of primary care evaluation. For years we have had the national GP Patient Survey; we also recently had the Patient Participation DES, part of which required practices to conduct a local patient survey; and there is the requirement for every GP to have patient feedback as part of the revalidation process. Our five year National Institute for Health Research (NIHR) programme grant is looking into many aspects of the utility and impact of such surveys. As part of this work, we conducted a full patient survey – at individual practitioner level – at 25 GP practices. At 14 of these practices, we also conducted focus groups with the practice staff, to ask them to reflect on their attitudes towards and engagement with patient experience surveys. Our findings will hardly be surprising for all those who work in primary care, and they focus predominantly on the implementation gap – very little often changes as a result of all these surveys. Whilst practice staff do engage with surveys, and we did identify possible areas where improvements may be made, these are few and far between.

Our paper outlines some possible reasons why this is the case: there are concerns around the reliability and validity of surveys, their cost and feasibility, their potential for educational impact in their current formulation, and their acceptability to patients and staff. Whilst attitudes to receiving feedback from patients are broadly positive, practices are usually left to their own devices to interpret and plan changes as a result of feedback, with little or no resources to do so. In short, surveys are currently functioning for practices as quality assurance, but not quality improvement, mechanisms.We argue that the notion that survey feedback alone can stimulate major changes in care is an unrealistic expectation.  In our resource limited environment, any commitment to developing patient experience surveys as a quality improvement mechanism will inevitably have to displace other competing priorities, and policy-makers and practitioners must be realistic about what can be achieved.

For full details, read the Open Access paper:

Boiko O, Campbell J, Elmore N, Davey A, Roland M, Burt J. The role of patient experience surveys in quality assurance and improvement: a focus group study in English general practice. Health Expectations 2014 doi: 10.1111/hex.12298

This work was funded by the National Institute for Health Research Programme Grants for Applied Research (NIHR PGfAR) Programme (RP-PG-0608-10050). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

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  • The Cambridge Centre for Health Services Research (CCHSR) is a thriving collaboration between the University of Cambridge and RAND Europe. We aim to inform health policy and practice by conducting research and evaluation studies of organisation and delivery of healthcare, including safety, effectiveness, efficiency and patient experience.