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

Abstract

Background Although NHS organisations have access to a wealth of patient experience data in various formats (e.g. surveys, complaints and compliments, patient stories and online feedback), not enough attention has been paid to understanding how patient experience data translate into improvements in the quality of care. Objectives The main aim was to explore and enhance the organisational strategies and practices through which patient experience data are collected, interpreted and translated into quality improvements in acute NHS hospital trusts in England. The secondary aim was to understand and optimise the involvement and responsibilities of nurses in senior managerial and front-line roles with respect to such data. Design The study comprised two phases. Phase 1 consisted of an actor–network theory-informed ethnographic study of the ‘journeys’ of patient experience data in five acute NHS hospital trusts, particularly in cancer and dementia services. Phase 2 comprised a series of Joint Interpretive Forums (one cross-site and one at each trust) bringing together different stakeholders (e.g. members of staff, national policy-makers, patient/carer representatives) to distil generalisable principles to optimise the use of patient experience data. Setting Five purposively sampled acute NHS hospital trusts in England. Results The analysis points to five key themes: (1) each type of data takes multiple forms and can generate improvements in care at different stages in its complex ‘journey’ through an organisation; (2) where patient experience data participate in interactions (with human and/or non-human actors) characterised by the qualities of autonomy (to act/trigger action), authority (to ensure that action is seen as legitimate) and contextualisation (to act meaningfully in a given situation), quality improvements can take place in response to the data; (3) nurses largely have ultimate responsibility for the way in which data are collected, interpreted and used to improve care, but other professionals also have important roles that could be explored further; (4) formalised quality improvement can confer authority to patient experience data work, but the data also lead to action for improvement in ways that are not formally identified as quality improvement; (5) sense-making exercises with study participants can support organisational learning. Limitations Patient experience data practices at trusts performing ‘worse than others’ on the Care Quality Commission scores were not examined. Although attention was paid to the views of patients and carers, the study focused largely on organisational processes and practices. Finally, the processes and practices around other types of data were not examined, such as patient safety and clinical outcomes data, or how these interact with patient experience data. Conclusions NHS organisations may find it useful to identify the local roles and processes that bring about autonomy, authority and contextualisation in patient experience data work. The composition and expertise of patient experience teams could better complement the largely invisible nursing work that currently accounts for a large part of the translation of data into care improvements. Future work To date, future work has not been planned. Study registration NIHR 188882. Funding The National Institute for Health Research Health Services and Delivery Research programme.

What does the patient have to say? Valuing the patient experience to improve the patient journey

“…Some authors have emphasised that understanding the patient experience represents an opportunity to design healthcare service delivery [ 5 , 6 ]. However, healthcare professionals need to understand whether and how patient experience data can inform the design of service delivery from a patient-centred perspective more pertinently than other indicators [ 7 – 10 ].…”

Understanding how front-line staff use patient experience data for service improvement: an exploratory case study evaluation

“…At the request of the Health Services and Delivery Research (HSDR) board, we collaborated with researchers from King's College London who were conducting a separate NIHR-funded study (reference 14/156/08) that was to include a national patient experience leads survey. 71 These researchers also reviewed the draft questionnaire. A few further adaptations were made to ensure that the researchers gathered the information they needed.…”

Whose data is it anyway? Patient experience and service improvement

“…1(p.9) Whilst Locock et al acknowledge the challenge of finding 'ways to encourage staff empathy and creativity as a route to patient experience without reverting to assumptions that staff know best', 1(p.5) the importance of granting ownership, autonomy and resources to frontline staff for quality improvement is a consistent message from other empirical studies. 2,4,10 Structures and systems for patient experience data collection and use should therefore be aligned with formal quality improvement, whilst also recognizing the equal value of the everyday, informal nature of much quality improvement work on wards, 10 particularly in relation to patient experience. 2 Health care organizations need to understand and make sense of the different combinations of ways in which they currently ask for feedback and what they do with that feedback.…”

“…acknowledge the challenge of finding ‘ways to encourage staff empathy and creativity as a route to patient experience without reverting to assumptions that staff know best’, 1 (p.5) the importance of granting ownership, autonomy and resources to frontline staff for quality improvement is a consistent message from other empirical studies. 2 , 4 , 10 …”

“…Structures and systems for patient experience data collection and use should therefore be aligned with formal quality improvement, whilst also recognizing the equal value of the everyday, informal nature of much quality improvement work on wards, 10 particularly in relation to patient experience. 2 Health care organizations need to understand and make sense of the different combinations of ways in which they currently ask for feedback and what they do with that feedback.…”