Rachel Reeves

Facilitated patient experience feedback can improve nursing care: a pilot study for a phase III cluster randomised controlled trial

BackgroundEngland’s extensive NHS patient survey programme has not fulfilled government promises of widespread improvements in patients’ experiences, and media reports of poor nursing care in NHS hospitals are increasingly common. Impediments to the surveys’ impact on the quality of nursing care may include: the fact that they are not ward-specific, so nurses claim “that doesn’t happen on my ward”; nurses’ scepticism about the relevance of patient feedback to their practice; and lack of prompt communication of results. The surveys’ impact could be increased by: conducting ward-specific surveys; returning results to ward staff more quickly; including patients’ written comments in reports; and offering nurses an opportunity to discuss the feedback. Very few randomised trials have been conducted to test the effectiveness of patient feedback on quality improvement and there have been few, if any, published trials of ward-specific patient surveys.MethodsOver two years, postal surveys of recent inpatients were conducted at four-monthly intervals in 18 wards in two NHS Trusts in England. Wards were randomly allocated to Basic Feedback (ward-specific printed patient survey results including patients’ written comments sent to nurses by letter); Feedback Plus (in addition to printed results, ward meetings to discuss results and plan improvements) or Control (no active feedback of survey results). Patient survey responses to questions about nursing care were used to compute wards’ average Nursing Care Scores at each interval. Nurses’ reactions to the patient feedback were recorded.ResultsConducting ward-level surveys and delivering ward-specific results was feasible. Ward meetings were effective for engaging nurses and challenging scepticism and patients’ written comments stimulated interest. 4,236 (47%) patients returned questionnaires. Nursing Care Scores improved more for Feedback Plus than Basic Feedback or Control (difference between Control and Feedback Plus = 8.28 ± 7.2 (p = 0.02)).ConclusionsThis study provides preliminary evidence that facilitated patient feedback can improve patients’ experiences such that a full trial is justified. These findings suggest that merely informing nurses of patient survey results in writing does not stimulate improvements, even if results are disaggregated by ward, but the addition of ward meetings had an important and significant impact.

Does hospital ownership affect patient experience? An investigation into public-private sector differences in England.

Using patient experience survey data, the paper investigates whether hospital ownership affects the level of quality reported by patients whose care is funded by the National Health Service in areas other than clinical quality. We estimate a switching regression model that accounts for (i) some observable characteristics of the patient and the hospital episode; (ii) selection into private hospitals; and (iii) unmeasured hospital characteristics captured by hospital fixed effects. We find that the experience reported by patients in public and private hospitals is different, i.e. most dimensions of quality are delivered differently by the two types of hospitals, with each sector offering greater quality in certain specialties or to certain groups of patients. However, the sum of all ownership effects is not statistically different from zero at sample means. In other words, hospital ownership in and of itself does not affect the level of quality of the average patients reported experience. Differences in mean reported quality levels between the private and public sectors are entirely attributable to patient characteristics, the selection of patients into public or private hospitals and unobserved characteristics specific to individual hospitals, rather than to hospital ownership.

Tied to the job: affective and relational components of nurse retention.

Objective To investigate whether affective and relational components of nurses’ experience of work have a significant impact on their intentions to leave either the job or the nursing profession in models that control forother factors (sociodemographic, work conditions, perceptions of quality of care) that are known to affect career decisions. Method An exploratory, cross-sectional postal survey of 2880 nurses in grades A-I in 20 National Health Service (NHS) Hospital Trusts, 11 in inner London and nine in outer London, was carried out between January and July 2002, looking at nurses’ intention to leave their current job or the nursing profession. The data were analysed using logistic regression with robust standard errors. Results In models that controlled for known sources of job dissatisfaction, relationships with supervisors and managers were found to have a significant effect on respondents’ career intentions. Feeling valued by the Trust and by society was very important. Nurses seemed to distinguish between local problems that are the responsibility of the Trust and those, such as levels of pay, that could only be solved at the national level. Conclusion Nurses’ career intentions are complex and multifactorial. Feelings of being valued and listened to play a role, as well as the individual and job-related characteristics. The study highlights the role of supervisors and managers in retaining staff and suggests that investment in robust systems of communication, conflict resolution and security could slow nurse turnover. The NHS as an employer may be most interested in the role of pay in nurse retention, and the general public in how societal attitudes and verbal abuse shape nurses’ career decisions.

It takes patience and persistence to get negative feedback about patients’ experiences: a secondary analysis of national inpatient survey data

BackgroundPatient experience surveys are increasingly used to gain information about the quality of healthcare. This paper investigates whether patients who respond before and after reminders to a large national survey of inpatient experience differ in systematic ways in how they evaluate the care they received.MethodsThe English national inpatient survey of 2009 obtained data from just under 70,000 patients. We used ordinal logistic regression to analyse their evaluations of the quality of their care in relation to whether or not they had received a reminder before they responded.Results33% of patients responded after the first questionnaire, a further 9% after the first reminder, and a further 10% after the second reminder. Evaluations were less positive among people who responded only after a reminder and lower still among those who needed a second reminder.ConclusionsQuality improvement efforts depend on having accurate data and negative evaluations of care received in healthcare settings are particularly valuable. This study shows that there is a relationship between the time taken to respond and patients’ evaluations of the care they received, with early responders being more likely to give positive evaluations. This suggests that bias towards positive evaluations could be introduced if the time allowed for patients to respond is truncated or if reminders are omitted.

An evaluation of peer-led self-management training for people with severe psychiatric diagnoses

Purpose – The purpose of this paper is to establish the effectiveness of self-management training as an intervention for people using secondary mental health services. Design/methodology/approach – A self-management and peer support intervention was developed and delivered by secondary mental health service users to 262 people with psychiatric diagnoses living in the community. Data on wellbeing and health-promoting behaviour were collected at three time points (baseline, six, and 12 months). Findings – Participants reported significant improvements in wellbeing and health-promoting lifestyle six and 12 months after self-management training. Peer-led self-management shows potential to improve long-term health outcomes for people with psychiatric diagnoses. Research limitations/implications – Due to the lack of a control group, the positive changes cannot definitively be attributed to the intervention. Other limitations were reliance on self-report measures, and the varying numbers of completers at three time points. These issues will be addressed in future studies. Practical implications – The evaluation demonstrated the effectiveness of self-management training for people with psychiatric diagnoses, suggesting self-management training may bring significant wellbeing gains for this group. Social implications – This study represents a first step in the implementation of self-management approaches into mental health services. It demonstrates the feasibility of people with psychiatric diagnoses developing and delivering an effective intervention that complements existing services. Originality/value – This is the first study to investigate the effectiveness of a self-management training programme developed and delivered by mental health service users in the UK.

Changes in inpatients’ experiences of hospital care in England over a 12-year period: a secondary analysis of national survey data

Objectives Adult inpatient surveys generate approximately 70,000 responses per year about patients’ experiences of National Health Service hospital care in England. We examine historical data to assess change between 2002 and 2013 and consider the factors that may have stimulated any change. Methods Archived national data from National Health Service Inpatient Surveys between 2002 and 2013 (comprising 840,077 patient responders) were obtained. Questions were selected for inter-year analysis if they had been replicated for at least seven years. The percentage of responses in the most positive category was compared for each question’s earliest and most recent year. The statistical significance of differences was tested using chi-square. Also, since such large sample sizes mean that even 1% differences are statistically significant, effect sizes were used to assess the practical significance of those differences. Results There were statistically significant (p < .001) increases in positive responses to 35 questions, a significant deterioration for 8 questions and no change for 7 questions. There was one ‘moderate’ improvement (ϕ = 0.3), six ‘small’ improvements (ϕ > 0.1) and one ‘small’ decline, but differences were not meaningful for 42 questions. The greatest improvements were for patients receiving copies of doctors’ letters; single sex ward areas; clinicians’ hand washing; ward cleanliness and planned admission waiting times. The greatest decline was that fewer responders said their call bells were usually answered within 2 min. Conclusions More aspects of care have improved than have deteriorated. This study highlights the need for a consistent repeated survey programme to detect changes over the long term, since year-to-year changes tend to be small. The greatest improvements are in areas that can be influenced by organisation-wide interventions and many are associated with top–down government policies, targets or media campaigns. Patients’ evaluations of many aspects of their interactions with clinicians are unchanged or have declined. Further research could test whether ward-specific facilitated communication of survey results to clinicians could drive improvements in clinician–patient interactions.

Patient feedback as a way to improve quality of care.

We agree with Coulter and colleagues that patient experience data should be used more effectively, but introducing another NHS data collating/analysing body could be counterproductive if the implicit assumption is that all data are (more or less) equally valid.1 Poorly collected data detract from scientifically valid data. The recent proliferation of “rapid” patient feedback focuses attention on quick fixes at the expense of tackling …