Measuring quality of health care in the NHS: Giving a voice to the patients

The high profile role that the NHS played in Brexit and recent general election campaigns demonstrates that the health care system remains foremost in the minds of all political parties when considering how to present their policies | The Health Foundation

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These campaigns put a spotlight on the sustainability of the health care system, but may have also fuelled a fear over deteriorating health system performance. In 2017, the NHS was recently ranked by the Commonwealth Fund as the best performing health care system out of 11 countries, including Germany, Australia and the United States. However, 82% of the general public expressed concerns about the future of the NHS in a survey following the 2017 General Election, with quality of care identified as one reason for dissatisfaction previously. Arguably, this disparity may be the result of intense media coverage of the human and financial pressures on the NHS, which could have shaped public perception to some extent. However, it might also point to a deeper disparity: a disconnect between the general assessment of measurable health system performance versus the quality of care perceived by patients when accessing the NHS.

One reason for this relates to the difficulty in measuring quality of health care at the system level. Quality in the context of health care is a multi-dimensional framework that captures six domains:

  • Effectiveness
  • Efficiency
  • Equity
  • Safety
  • Timeliness
  • Patient-centeredness.

Read the full blog post by Rocco Friebel here

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A Multifaceted Intervention to Improve Outcomes in Intensive Care

This study examines the effectiveness of a patient-centered care and engagement program in the medical ICU | Critical Care Medicine

Interventions: Structured patient-centered care and engagement training program and web-based technology including ICU safety checklist, tools to develop shared care plan, and messaging platform. Patient and care partner access to online portal to view health information, participate in the care plan, and communicate with providers.

Measurements and Main Results: Primary outcome was aggregate adverse event rate. Secondary outcomes included patient and care partner satisfaction, care plan concordance, and resource utilization. We included 2,105 patient admissions, (1,030 baseline and 1,075 during intervention periods). The aggregate rate of adverse events fell 29%, from 59.0 per 1,000 patient days (95% CI, 51.8-67.2) to 41.9 per 1,000 patient days (95% CI, 36.3-48.3; p < 0.001), during the intervention period. Satisfaction improved markedly from an overall hospital rating of 71.8 (95% CI, 61.1-82.6) to 93.3 (95% CI, 88.2-98.4; p < 0.001) for patients and from 84.3 (95% CI, 81.3-87.3) to 90.0 (95% CI, 88.1-91.9; p < 0.001) for care partners. No change in care plan concordance or resource utilization.

Conclusions: Implementation of a structured team communication and patient engagement program in the ICU was associated with a reduction in adverse events and improved patient and care partner satisfaction.

Full reference: Dykes, P. et al. (2017) Prospective Evaluation of a Multifaceted Intervention to Improve Outcomes in Intensive Care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study. Critical Care Medicine. Published online: 3rd May 2017

Why UK hospital staff find it difficult to make improvements based on patient feedback

Patients are increasingly being asked for feedback about their healthcare experiences. However, healthcare staff often find it difficult to act on this feedback in order to make improvements to services | Social Science and Medicine

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This paper draws upon notions of legitimacy and readiness to develop a conceptual framework (Patient Feedback Response Framework – PFRF) which outlines why staff may find it problematic to respond to patient feedback.

A large qualitative study was conducted with 17 ward based teams between 2013 and 2014, across three hospital Trusts in the North of England. This was a process evaluation of a wider study where ward staff were encouraged to make action plans based on patient feedback.

Through the development of the PFRF, we found that making changes based on patient feedback is a complex multi-tiered process and not something that ward staff can simply ‘do’.

  • First, staff must exhibit normative legitimacy – the belief that listening to patients is a worthwhile exercise.
  • Second, structural legitimacy has to be in place – ward teams need adequate autonomy, ownership and resource to enact change. Some ward teams are able to make improvements within their immediate control and environment.
  • Third, for those staff who require interdepartmental co-operation or high level assistance to achieve change, organisational readiness must exist at the level of the hospital otherwise improvement will rarely be enacted.

Case studies drawn from our empirical data demonstrate the above. It is only when appropriate levels of individual and organisational capacity to change exist, that patient feedback is likely to be acted upon to improve services.

Full reference: Sheard, L. et al. (2017) The Patient Feedback Response Framework – understanding why UK hospital staff find it difficult to make improvements based on patient feedback: A qualitative study. Social Science & Medicine. 178. pp. 19-27.

 

Exploring the perspectives of patients with dementia about the hospital environment

Hung, L. et al. International Journal of Older People Nursing. Published online: 18 April 2017

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Background: Recognising demographic changes and importance of the environment in influencing the care experience of patients with dementia, there is a need for developing the knowledge base to improve hospital environments. Involving patients in the development of the hospital environment can be a way to create more responsive services. To date, few studies have involved the direct voice of patients with dementia about their experiences of the hospital environment.

Conclusions: Patient participants persuasively articulated the supportive and unsupportive elements in the environment that affected their well-being and care experiences. They provided useful insights and pointed out practical solutions for improvement. Action research offers patients not only opportunities to voice their opinion, but also possibilities to contribute to hospital service development.

Read the full article here

Implementing a people powered approach to health

This report gathers a wide range of insights taken from three community sites on how to implement a people powered approach to health and wellbeing.

These three main insights were found to be the most important to making a difference on the ground:

  • Helping people help themselves
  • Creating opportunities for people to help one another
  • Creating value between the professional and social spheres – helping health and care

Mobilising Communities was a short, experimental programme aimed at exploring the practical applications of the idea of ‘social movements’ in health in three communities in England.

The objective of the programme was to work with three sites to explore the opportunities to support effective ways of combining people power and community resources, together with publicly funded services, for better health outcomes across local communities.

The report goes into detail on how each of the three insights above can be developed to support a social movement in health for people and communities.

Download the full report: Mobilising Communities: Insights on Community Action for Health and Wellbeing 

Choosing Wisely: improving conversations between patients and their doctors and nurses

Across the UK, there is a growing culture of overuse of medical intervention, with variation in the use of certain treatments across the country | Choosing Wisely UK

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For example, the prescribing of antibiotics can vary by as much as two and a half times between one part of the country and another.

Common examples of overused medicines are antibiotics for common colds or other non-bacterial infections or prescriptions given for mild depression when alternative options such as exercise could be explored first.

View the full overview and resources here

 

Patient reported outcome of adult perioperative anaesthesia

Walker, E.M.K. et al. (2016) British Journal of Anaesthesia. 117(6) pp. 758-766.

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Background. Understanding the patient perspective on healthcare is central to the evaluation of quality. This study measured selected patient-reported outcomes after anaesthesia in order to identify targets for research and quality improvement.

Conclusions. Anxiety and discomfort after surgery are common; despite this, satisfaction with anaesthesia care in the UK is high. The inconsistent relationship between patient-reported outcome, patient experience and patient satisfaction supports using all three of these domains to provide a comprehensive assessment of the quality of anaesthesia care.

Read the full abstract here