What do doctors think of patient experience surveys?

Patient surveys have become increasingly important in recent years, in part due to policy initiatives that emphasise the utility of patient feedback for quality improvement. In England, patient experience is measured by surveys including the General Practice Patient Survey (GPPS) in primary care and the Inpatient Survey in secondary care. At the individual doctor level, the General Medical Council (GMC) recently introduced a revalidation programme requiring doctors to collect patient feedback as supporting information in a five-yearly quality assurance procedure through which doctors ‘revalidate’, i.e. retain their licence to practise. Surveys commonly measure key aspects of patient experience, including access, continuity and communication. If appropriately validated and administered, they capture an important dimension of healthcare quality.

As yet, few researchers have focused upon doctors’ engagements with surveys administered at the individual doctor level, or upon how doctors working in different care settings engage with such surveys. In order to deepen our understanding of how doctors relate to patient experience surveys, we interviewed 21 GPs and 20 consultants working in outpatient clinics at a large regional hospital. Doctors from both groups had recently received patient feedback on their care, emulating the individual-level surveys that are now required for revalidation.

As our paper in Health Expectations explains, we found that doctors displayed contradictory views regarding the plausibility of patient surveys, leading to complex and, on balance, negative engagements with patient feedback. We outlined two main identified dimensions of these views. The first relates to doctors’ views of patients’ motivations and competence as survey responders. While doctors endorsed patients’ motivations for participating in surveys and their competence to provide relevant feedback, these notions were outweighed by doctors’ emphasis upon what they saw as patients’ questionable motivations (e.g. propensity to axe-grinding) and lack of competence. With regard to the latter, doctors mentioned a number of factors, including: positive bias (patients giving doctors unrealistically good feedback); failure to understand survey questionnaires; inconsistency (e.g. different patients giving different ratings for similar experiences); and inability to evaluate clinical aspects of care. Consequently, doctors appear to view patients in a contradictory fashion – that is, as being simultaneously competent and incompetent at evaluating doctors and as being both accurate reporters of experience and inevitably biased commentators.

The second aspect of our findings relates to doctors’ views of surveys from a quality improvement perspective. Doctors emphasised the potential utility of patient feedback for quality improvement in three main areas: providing reminders of core proficiencies (e.g. communication skills); reinforcing known problems and providing evidence to support change; and contributing unexpected (but useful) ideas for care improvement. However, doctors’ positive views were outweighed by more negative views, highlighting a range of problematic areas including: concerns about survey properties (e.g. validity and reliability); difficulties surrounding interpretation of survey data, especially non-benchmarked data; worries that surveys do not account for different care contexts; anxiety arising from negative feedback; and concerns that surveys might raise patient expectations to unrealistic levels.

Over all, we found that doctors’ engagements with patient experience surveys were highly contested, problematic and inconsistent, with the majority of doctors we interviewed appearing to consider more than one interpretation of patient experience surveys as plausible at the same time. Nevertheless, doctors did not see all interpretations as equally plausible. Rather, they tended to settle on negative views of patients (considered as survey respondents) and of patient experience surveys, thus undermining the potential for reflective change and quality improvement in response to patient feedback. Thus, while policy developments over the past decade have increasingly emphasised the importance of patient experience surveys for quality improvement, our findings suggest that this agenda faces significant challenges in terms of doctors’ inconsistent and highly critical engagements with patient feedback. In response, our paper highlights the need for constructive dialogue on the part of policymakers, managers and clinicians in order to engage with doctors’ concerns about the plausibility of patient experience surveys.

Farrington, C., Burt, J., Boiko, O., Campbell, J. & Roland, M. Doctors’ engagements with patient experience surveys in primary and secondary care: a qualitative study. Health Expect. n/a-n/a (2016). doi:10.1111/hex.12465

This entry was posted in Blog and tagged , , . Group: . Bookmark the permalink. Both comments and trackbacks are currently closed.
  • 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.