What should we do about patient experience in primary care?

I’ve never been a very good long-distance runner, but in finally seeing through our NIHR programme grant on patient experience I feel like I’ve crossed the line at an ultramarathon. In a good way, I hasten to add, with five years’ investigation into the impact and utility of measuring patient experience in primary care resulting, this week, in the publication of our rather doorstep-like report. Don’t panic, I’m not planning to drag you along the full course with me in this blog, but for those of you who don’t fancy ploughing through 452 pages, here are the headlines.

We conclude that there is currently a huge gap between the upstream measurement of patient experience, which is increasingly sophisticated and insightful, and the downstream actions being taken as a result. With little investment on quality improvement activities, the major question for the future is how we are going to take the wealth of data on patient experience and make experiences better, rather than simply better understood.

We also point out, in slightly more detail, where the current issues lie, as follows:

  1. Patient experience is important. Yes, that’s right – nothing we found would suggest that it isn’t just morally (in a publicly funded service) the right thing to do to try and improve patient experiences of care. How we do this is a rather larger question to answer, however.
  2. NHS staff are human too (in case you hadn’t noticed…). This means they often find it really difficult to make sense of and take action on all this patient feedback – usually in the form of numbers – that heads their way. Support, time, and resources are all essential if any quality improvement is going to happen as a result.
  3. Surveys of patient experience which suggest that minority ethnic groups (particularly South Asian communities) experience poorer quality of communication in primary care are pinpointing a real problem. Substantial gaps in the quality of care are not about variations in expectations or how questions are answered: they are about real and demonstrable differences which we need to be worried about.
  4. Surveys are incredibly useful in a number of ways, but we need to be careful how we interpret and use their findings. A number of our studies point to the fact that patients may be inhibited in criticising the quality of care in questionnaires, despite being unhappy about this care. We can’t assume ‘good’ means ‘good enough’, and survey results should be used to look at relative performance (in benchmarking and ranking), and not absolute performance.
  5. As such, whilst patient experience surveys are useful, they probably aren’t enough to capture the full range of patient experience. There are a range of innovative and exciting recent developments in evaluations of patient experience, from machine learning approaches to understanding large volumes of written feedback, to innovative smaller-scale video approaches to feeding back the patients’ view. We need to do a lot more to explore these, particularly to ensure that negative experiences of care are reported in full.
  6. Out-of-hours care is important too, and we have a really long way to go to work out how best to monitor and take action on patient experience in these sectors of care.

For our full report, see the NIHR Programme Grants Journal:

Burt J, Campbell J, Abel G, Aboulghate A, Ahmed F, Asprey A, et al. Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience. Programme Grants Appl Res 2017;5(9) dx.doi.org/10.3310/pgfar05090

Funding acknowledgement
This research was funded by the NIHR Programme Grants for Applied Research (RP-PG-0608-10050)

Department of Health disclaimer
The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

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