Person-centred care means talking to patients to understand their needs, sharing information with them and involving them in decisions that affect the care they receive. It is a cornerstone of delivering high quality healthcare and doctors and other practitioners are encouraged to do this in every interaction with every patient. However, healthcare policy and practice needs to be based on evidence.
Researchers can use different types of data of patient experience to inform policy and practice, for example national surveys of recently discharged patients can give the bigger picture view of what patients think about aspects of their care.
This data is then fed back to individual NHS boards to inform the quality improvement plans that they draw up. However, this approach has some limitations. The data is based on what those who have designed the survey have decided is important to ask about (although sometimes the questions are based on focus groups). There is also little opportunity for patients to explain why they have given a particular score or what they think might improve the situation.
This is where qualitative or mixed methods studies are useful, as individuals or small groups of patients are asked what is important to them. Survey questions can be then be designed based on this bottom-up approach of what matters to patients.
We successfully used this approach to find evidence about how patient experience related to very different aspects of care, for example in relation to screening for the superbug MRSA and the impact of reducing avoidable night time noise.
In this second example, NHS Scotland’s surveys of patient experience showed that night time noise was consistently highlighted as a problem by patients. However we didn’t know what caused the noise, how often this happened or how disruptive the noise was. So although we knew night time noise was a problem, we didn’t have enough detail to begin to improve this situation for patients.
Working in collaboration with a large NHS board – NHS Greater Glasgow & Clyde – we conducted a research project that involved interviewing patients to obtain much more detail about what actually disturbed their sleep. This showed that patients were disturbed by noise from staff, by talking or walking past with noisy shoes for example, or from trolleys being wheeled, telephones ringing, other patients snoring, being confused, emergency admissions, and the environment, lights being switched on.
We then worked with patient involvement groups and ward staff to develop solutions to these problems. A follow-up evaluation showed improvement in those causes of noise where ward staff had most influence, such as staff talking, delays in answering call buzzers. The project illustrated how different kinds of patient experience data can be used to create solutions to a common problem.
Infection rates in hospitals are also often used as an indicator of the quality of patient care, and avoiding spread of infection between patients is important. Screening for common infections, such as MRSA is common policy. However, a study we conducted of the patient experience of MRSA screening showed that patients were not always given information about why they were being screened, were rarely given the result of the screening test, and did not have good information about how the infection would be managed if they were found to have MRSA present.
Patient experience data from that study was used to develop an education tool for NHS staff to improve communication around MRSA screening. Changes in policy guidance emphasised the importance of effective information for patients to improve the quality of care.
These two examples of the use of research data to provide evidence on the patient experience of care demonstrate the importance of finding out what matters to patients in very different contexts. In the same way that individual clinicians must listen to individual patients to provide excellent care at that one-to-one level, healthcare policy must be based on robust evidence of the patient experience of different aspects of care if we aspire to provide a service that is truly centred around patients.