An evaluation of a near real-time survey for improving patients’ experiences of the relational aspects of care: a mixed-methods evaluation

Abstract

Background The Francis Report (of 2013) provided many recommendations to improve compassionate care in NHS organisations, including more widespread use of real-time feedback (RTF) to collect patient experience data. This research directly addressed these recommendations and aimed to provide an evidence-based toolkit to support NHS quality improvements. Objectives To develop and validate a survey of compassionate care for use in near real time on elderly care wards and accident and emergency (A&E) departments. This research also evaluated the effectiveness of the RTF approach for improving relational aspects of care and provides suggestions for how the approach can be used by other hospitals to strengthen compassionate care. Design The research utilised a mixed-methods design, using quantitative, qualitative and participatory research approaches to collect patients’ experiences of relational care and the views of NHS staff in an effort to evaluate the processes and impacts of near real-time feedback (NRTF) data collection. Data sources included a NRTF patient experience survey, weekly volunteer diaries, staff interviews and surveys, workshops and meetings with case study sites. Setting The research was carried out across six case study sites across England, in wards that predominantly serve elderly patients and in A&E departments. Participants The 3928 participants in the patient experience survey were inpatients on elderly care wards, or persons who had sought medical care in A&E. Frontline staff, service leads, senior management and volunteers also took part in surveys (n = 274) and interviews (n = 82) designed to understand the staff perspectives and opinions of collecting patient experience data. Interventions A patient experience survey was implemented using a tablet computer-based methodology, facilitated by trained volunteers. Responses were used alongside feedback from staff to evaluate the use of a NRTF approach as a method for improving patient experiences of relational aspects of care. Main outcome measures The patient experience survey measured relational aspects of care. Another outcome measure was improvements to care as planned, implemented and reported by staff. Results A small but statistically significant improvement (p = 0.044) in relational aspects of care over the course of the study was noted overall. Staff implemented a variety of improvements to enhance communication with patients. Limitations Maintaining volunteer and staff engagement throughout the study was difficult. Few surveys were completed per ward or department each week. This made examining trends in patient experiences over time challenging. Conclusions Near real-time feedback offers an effective approach for monitoring and improving relational aspects of care. Future work Staff frequently expressed a view that volunteers’ interactions with patients while administering the survey were themselves beneficial to patients. Future research should examine the impact of volunteer interactions with patients on their experiences of relational aspects of care. Study registration The project is registered on the Clinical Research Network portfolio under the primary trial identification number 18449. Funding The National Institute for Health Research Health Services and Delivery Research programme.

Organisational strategies and practices to improve care using patient experience data in acute NHS hospital trusts: an ethnographic study

“…Related studies simultaneously commissioned by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HSDR) programme are conducting scoping or systematic reviews to examine what methods are potentially available to elicit patient experience data in the UK, 15 to find out what is known regarding online feedback from patients, 16 and to identify, describe and classify approaches to collecting and using patient experience data to improve inpatient mental health services in England. 17 However, to help contextualise the policy and practice implications arising from our study findings (see Conclusions and implications for policy, practice and research), and with regard to situating our study of the relationship between patient experience data and QI in relation to the contemporary literature, we highlight below three particular recent contributions: a viewpoint piece by Flott et al, 18 a 5-year programme of research by Burt et al 19 and an empirical study by Graham et al 20 Each of these acknowledges that patient surveys, in multiple forms, continue to dominate the patient experience data landscape. We also discuss the different perspectives found in the work, for example of Ziewitz 21 and Pflueger, 22 to provide a fuller picture of the scholarly work relevant to the analysis of the impact of patient experience data.…”

“…Following on from Burt et al's 19 research programme (which also included an exploratory trial of real-time feedback in a primary care setting), Graham et al 20 conducted a study to develop and validate a survey of compassionate care for use in near real-time on elderly-care wards and accident and emergency (A&E) departments, as well as evaluating the effectiveness of the real-time feedback approach to improving relational aspects of care. 20 The study found a small but statistically significant improvement in relational aspects of care and that staff implemented a variety of improvements to enhance communication with patients. The authors made a series of recommendations for future research (summarised in Box 2) that relate not only to several of the other studies cited in this section but also to the findings and some of the implications of our own study detailed in Chapter 9.…”

Using patient-reported measures to drive change in healthcare: the experience of the digital, continuous and systematic PREMs observatory in Italy

“…Recently, some healthcare organizations have introduced web-based PREMs including real-time feedback systems [32][33][34], to give a quick response to patients' issues and to foster the culture of patient-driven quality improvement [31,33]. Currently, this methodology has been mainly used to capture patients' on-site feedback, and rarely to collect post-treatment or post-episode feedback in a regular and continuous manner [23,[32][33][34]. At present, patients can also voluntarily give feedback on their experiences using social networks [35], and on institutional websites, if any (i.e.…”

The Relational Aspects of Care Questionnaire: item reduction and scoring using inpatient and accident and emergency data in England

“…There is currently no electronic instrument with which to measure staff’s interactions with older people or those attending A&E services with regard to relational care. With these considerations in mind, University of Oxford (Oxford, UK) and Picker Institute Europe (Oxford, UK) developed an instrument, the Relational Aspects of Care Questionnaire (RAC-Q), 17 for use within this context.…”

“…A detailed account of the instrument’s development is outlined elsewhere. 17 During testing, the questionnaire was administered via a tablet computer, ensuring its suitability for use in the inpatient context. The process resulted in 20 confirmed items which were regarded as relevant and acceptable when measuring staff’s interactions with regard to delivering relational care.…”