Understanding the patient experience Winter Research to meet the needs of your patients

Transcription

1 Understanding the patient experience Winter 2009 Research to meet the needs of your patients 1

2 Welcome Much has been said about the importance of patient experience. From its emphasis in World Class Commissioning to the rights and pledges set out in the NHS Constitution, the personalisation of services has been central to Government policy. With 2010 promising a general election and substantial financial challenges, the NHS will be looking at ways of increasing productivity and making efficiency savings. In this context, understanding, measuring and demonstrating improvements to the patient experience as well as patient reported outcomes will be central to retaining a focus on quality. This means providers and commissioners thinking about questions such as: Do you know what your patients and public really think about the health services you're providing? Are you doing everything you can to build on the messages coming through PPI and LINks? Do you know what the public see as the most important "problem" to fix? Do patients report that they feel better as a result of their treatment? Do patient outcomes match the patient experience? Do you know if you have the right data about local health services - and are you getting the most from it? Do you know who the "hardest to reach" sections of your community are - and do you know how to hear from them? Ipsos MORI can work with you to find the answers to these questions and this pack provides a brief introduction to the ways in which we are currently doing this. We provide social research solutions that are easily accessible and actionable and work with our clients to ensure services that are designed around the needs of your patients. Contents Welcome Pg 2 Patient Experience why it matters Pg 3 Using research Pg 4 Making sense of your data Pg 5 PROMs Pg 6 Designing effective research what to consider Pg 7 Designing effective research what to consider? Pg 8 Case studies Pg 8 Ipsos MORI key contacts Pg 9 We really hope you enjoy reading this booklet and that it gives you a taster of the different research we currently provide. If you would be interested in hearing more about the ways in which we may be able to work with you, please do get in touch. We look forward to working with you in the future. Anna Quigley Associate Director Health Team: Reputation and patient perceptions Anna.Quigley@ipsos.com Data protection: In order to carry out much of our research, clients entrust Ipsos MORI with personal data they control. Respondents also provide personal data, which can include sensitive information. As such, Ipsos MORI takes very seriously its legal, regulatory and industry code of practice obligations to ensure such data is processed in accordance with relevant legislation (including the Data Protection Act 1998), and with appropriate information security controls in place. 2

3 Patient experience - why it matters How research can help There are two ways in which Ipsos MORI can help you gain insight and feedback to help improve services: Attitudes of individual patients: understanding the views of patients about the quality of care that they receive. We can translate this into recommended actions for service improvement; Understanding your wider public: building the intelligence you need on what matters to local populations how satisfied are they with local services? At Ipsos MORI we can help you to understand existing metrics, from both local and national surveys and ad hoc research. By mapping what you know ; we can also work out where there are gaps; and how to plug those gaps by designing effective research. Meeting the needs of patients - improving service delivery In the current drive for quality improvements, collecting and using patient feedback is more important than ever. The various dimensions of a patient s experience span physical and emotional aspects access and waiting times, being treated with respect, feeling involved in their care and being treated in clean surroundings. Understanding which research methods to use quantitative and qualitative will ensure that your patient experience data can sit at the forefront of your quality reform process. Meeting the needs of commissioners - performance management There are increasing demands on providers for patient experience data whether as indicators to form part of CQUIN payments or to feed into your organisation s Quality Accounts. Understanding which metrics to use from the mix of national, comparable measures and local tailored solutions will ensure that your patient experience data is a robust addition to your quality reporting. We can also help you track performance over time and benchmark it with other NHS organisations. Measuring the patient experience National policy and delivery drivers continue to emphasise the importance of patient experience in driving and measuring quality improvements. We can help you develop research that asks patients about what matters most to them about their health service. This will ensure your organisation is informed about what makes a good patient experience, and where improvements can achieve this for all patients. 3

4 Using research Ipsos MORI can help you understand the perceptions of your patients and the wider public through a variety of research techniques. Traditional research techniques Postal and self completion Cost-effective for larger surveys and questionnaire materials can be tailored with visual stimuli. Telephone Ideal for reaching a representative population, this is a fast approach that can provide real-time updates and results. A telephone survey allows more flexible questionnaire content. Online A wide range of quantitative and qualitative solutions available, all of which are fast, flexible and cost-effective. Omnibus studies Nationally representative in-home interviewing which captures quantitative data on a weekly basis. Set-up costs are shared, saving money for individual clients. Ethnography Filmed extended interviews revealing what people do, not just what they say they do. Revealing patient experience as it is lived. New innovations Real-time patient feedback Provides continuous feedback from patients that can be reported quickly and directly to the staff caring for them this approach uses touch button handsets that allow patients to immediately review their care. Unlike other products, Ipsos MORI use a solution that allows more in-depth questioning of patients to provide a fuller understanding of the patient and their experiences. Question content is flexible and can be presented in a variety of ways. Results can be benchmarked nationally to contextualise the data. Focus groups and workshops Ideal for thematic discussions to provide insight and understanding about the drivers of opinion and perception. Depth interviewing One-to-one interviewing which explores individuals opinions through a detailed thematic discussion. Particularly useful for seldom heard audiences. 4

5 Making sense of your data Dashboards Dashboards offer a way of bringing together all of your existing data and turn it into knowledge. By turning raw numbers into maps, charts and graphs, dashboards offer a simple way to monitor relevant and timely information. This can then be easily used to inform decision making and drive quality. We recently developed a dashboard for NHS South East Coast to help show their Key Performance Indicators and World Class Commissioning results in clear and succinct way. Subsequently we have produced tailored versions for the eight PCTs in the region. Understanding the patient journey We know that understanding patient experience is not about a single point in time. The patient pathway has many touchpoints and it is important to understand how these interlink and contribute to the patient experience. Some of the things that are important to know and understand include: What are the key touchpoints along the patient journey? What is the patient experience at each of these touchpoints? Is the process working? What happens when things go wrong or right? What is the impact on the person? What is their emotional response? How do touchpoints differ: frequency, intensity, audience? We recently worked with West Midlands SHA on the Darzi pathways untangling the key parts of the patient journey to understand where things go right or wrong. We would be happy to talk you through more of this type of work if this is an area you are interested in. 5

6 Getting more from your patient experience data Working the data you have Knowing what you know and what you don t Map and gap Key Driver Analysis of Recommending Hospital There is so much data already collected both locally and nationally that a key first stage for all NHS organisations is about understanding what you know and what you don t. We can work with you to Map and Gap your current data and understand where you may need to commission research to fill in the gaps. Crucially, we can also help you to make best use of the data you already have. Using your existing data: Further analysis The number of possible patient experience matrices can seem daunting where do you prioritise when making service improvements? What matters most if you get it wrong and which areas concern patients less? This is more important than ever if you are to target resources effectively. Key Driver Analysis is one tool that will allow you to look at all the different measures of patient experience to understand which matter most in driving patient satisfaction.. How likely are you to recommend your local hospital to a friend or relative? R 2 =0.3 3 Base: 5,616 adults in East of England, Aug-Sep % 14% 13% 9% 8% 8% 8% 7% 7% Cleanliness of hospitals Keeping infections like MRSA under control Being treated with dignity and respect Waiting time for hospital cons ultants Information about services Waiting lists Quality of care by GP pr actice s Mater nity/midwifer y ser vices Time spent waiting in A&E S A T I S F A C T I O N W I T H Knowing the things that make a big difference if you get them right will help you to focus resources and plan strategically. It also allows you to brief staff on where they can have the most impact on improving patient experiences. The importance of place Our work on Frontiers of Performance in the NHS gets behind the standard rankings of PCTs and places patient perception in the context of local communities and challenges. Through looking at a combination of patient surveys and geodemographic factors that are associated with patient ratings, we identified that the nature of local communities has a huge impact on satisfaction. By knowing the characteristics of the local population served by the PCT, we have identified those Trusts which perform best and worst taking into account these local conditions. We can also predict patient ratings with some accuracy, simply by knowing the local population profile. To download Frontiers, visit: Translating the results into service improvement Reporting and organisational development Having data on patient experience is only part of what is required to deliver service improvement. At Ipsos MORI we can work with you to ensure that you have the ability to make use of your data in an effective and efficient way. We can develop with you a range of options for reporting your data to your organisation, your key stakeholders and the public. Our approach at Ipsos MORI is not only to deliver data, but to work further with you in identifying the next steps you need to put in place to secure service improvement. We can provide you with intelligent analysis that helps you to effectively address the key drivers of patient experience and to help you to develop solutions to drive improvements. 6

7 PROMs Patient Reported Outcome Measures Assessment of the impact on treatment and services Patient Reported Outcome Measures (PROMs) measure quality from the patient perspective. PROMs can be incorporated into patient surveys, or conducted as a survey in its own right, to assess the impact of care, treatment and services on health outcomes. Pre and Post surveys can be undertaken to measure patients experience and clinical status (in the Pre study), and experience and outcome (in the Post study). Thus, the effectiveness of clinical intervention from the patient s own perspective can be assessed - i.e. Do patients report that they are feeling better? Do patients report that they re feeling better as a result? Ipsos MORI, in collaboration with academic partners, can produce information on the patterns of care and outcomes experienced by patients with particular conditions. So at PCT level, this gives valuable insight into how well your services are working for patients. PROMs information can be used in a number of ways by the NHS particularly at PCT level: To evaluate the relative clinical quality of Providers of elective procedures. PROMs data can be used by clinicians, managers, regulators and PCT Commissioners to benchmark Providers' performance. It can be used for clinical audit and it can be used by patients and GPs exercising choice; To research what works. Efficacy and costeffectiveness of different technical approaches to care can be evaluated using PROMs in association with other measures; To assess the appropriateness of referrals to secondary care. PROMs data can be used to establish whether referrals for elective procedures are appropriate by examining variation in baseline PROMs scores across the country; To support the reduction of inequalities; To empower commissioners. PCT Commissioners can use the data to establish the quality of services that they are contracting with Providers. Ipsos MORI can help you link the PROMs data to other patient experience data you may have, bringing together information from disparate sources, analysing it and providing a multi-layered view of services. This can enhance the use of PROMs information as listed above. We are already working with professional body and academic partners to take forward one of the first two PROMs programmes to be conducted on a national basis when it goes into the field next year. Reporting We can report in a variety of ways, bringing in other patient experience data as described to give a bigger, more rounded picture. Ipsos MORI has access to a specially tailored online tool which gives clients access to regularly updated real time information on PROMs. The online tool allows data to be cut and analysed in a variety of ways including by area or PCT. 7

8 Discussion groups? Ethnography? Surveys? Online? Designing effective research - How we can help? What is the research question? What do you ultimately want to find by conducting research? Ipsos MORI can help analyse the core requirements of your brief and offer suggestions on how the main research question can be answered. We can also help you construct and tailor questions so they are suitable for a wide range of audiences. An iterative approach is employed to shape a research project, consulting you, and your organisation, at all key stages. How will the research be used? What is it that you, and your organisation, want to achieve with research? Is it to provide a robust base of evidence to inform decision making, or perhaps take a baseline measurement of service satisfaction to identify where improvements are needed. We can help tailor your research around your objectives to ensure you gain the most out of your project. Deliberative events? Who is the ultimate audience for your outputs? Knowing who will view the findings is important when considering how they should be reported and presented. Is a comprehensive written report required to inform a strategy document, or perhaps a concise and visual PowerPoint report to present to a communications team? Ipsos MORI can discuss a range of reporting and delivery options to meet your specific needs. Who is the audience to be researched? Identifying which audience you intend to research is a core part of defining your overall research objectives. For instance, do you want to research opinion among a representative sample of the general public, or perhaps a more targeted range of key opinion-leading stakeholders? We have high levels of expertise in reaching numerous target audiences, and can offer insight on what you can typically expect when considering who to research. Methodology? There are many ways to conduct research among target audiences. However, it is crucial that the correct approach is chosen and implemented if your objectives are to be achieved. Dependent on your requirements, we can advise on whether to choose a qualitative or quantitative methodology, or even a dual approach. There are also many different techniques to each of these approaches, from deliberative events to in-depth interviewing (qualitative), and large scale telephone surveys to online pop-up surveys (quantitative). We will clearly outline the benefits of each to help inform your decision making. For specific information on designing a research brief and what to consider, please feel free to get in contact with a member of the Health team (see back cover). 8

9 Case studies 1. Guy s and St Thomas Ipsos MORI has undertaken twelve waves of a telephone survey for Guy s and St Thomas (2006-present day) with no less than 4,000 patients interviewed per annum. The survey covers all aspects of Patient Satisfaction and the Patient Experience. Not only does this monitor performance in relation to key metrics for CQuin and Quality Accounts, it tracks change and identifies areas of improvement for the Trust. In 2008, qualitative work was undertaken to unpick findings from key areas dignity & respect and cleanliness so we could offer actionable findings to allow the Trust to make a difference to its patients. Ipsos MORI worked closely with the team at Guy s and St Thomas to develop the sample profile and in the setting of quotas. We were able to provide a useful breakdown of the results across different specialties. This allowed the Trust to monitor performance more closely and provide information on areas for improvement specific to those services. Results were presented in a variety of formats to ensure they were appropriate for different audiences, and so the findings can be widely distributed among stakeholders, staff and patients. 2. West Midlands In 2008 NHS West Midlands brought in Ipsos MORI as their social research partner to help ensure that patients and the public have a say in their health services. The programme has largely focused on priority areas from the SHA s strategic framework for 2007 to 2012, Investing for Health, while also exploring other key policy areas such as High Quality Care for All. The research has included an annual telephone survey of adult residents, which is representative of the West Midlands region and provides results at PCT-level. The telephone survey fulfilled requirements under Vital Signs, the Department of Health s Operating Framework, to measure the reputation of the local NHS, particularly public satisfaction and confidence. It also provides evidence for world-class commissioning capabilities. We also conducted follow-up qualitative research around some of the issues that arose in the survey, such as perceptions of access to NHS dentistry and how residents want to receive information about dentistry; what information might help residents choose their GP; and perceptions of hospital cleanliness. Most recently, we have worked together on a study that explored patient, public and staff definitions and perceptions of quality in the secondary sector, specifically focusing on what would reassure them that quality is a top priority for the NHS. 3. City & Hackney tpct As part of its wish to improve Public and Patient Involvement in the provision of Community Health Services, City and Hackney Teaching PCT commissioned Ipsos MORI to undertake patient experience tracking surveys in 2008 and The survey covered 20 individual service areas within Community Health Services and covered both patient and carer satisfaction and experience. The survey was conducted by telephone, interviewing over 1,000 service users, including those where English is not a first language. The results of the survey were used to track areas of good performance in the Trust s Community Health Services and to directly identify areas where services could be improved. Findings were used by both senior and service level management to understand both the strategic issues the PCT needs to address and where small changes in an individual service area can bring about improvements in service. 4. PROMS The Royal College of Obstetricians and Gynaecologists has recently been awarded a national PROMS audit among women with HMB (heavy menstrual bleeding), jointly with Ipsos MORI and LSHTM (The London School of Hygiene and Tropical Medicine), on behalf of HQIP. The aim of the audit is to record, measure and analyse patient outcomes for women with heavy menstrual bleeding. Ipsos MORI are managing the fieldwork & administration; our partners Royal College of Obstetricians & Gynaecologists and London School of Hygiene and Tropical Medicine will lead on the analysis. Pre- and post- intervention self completion questionnaires will be used. The pre-intervention questionnaire will be administered in the healthcare setting, when the patient attends for an appointment. The follow-up questionnaire will be posted to the patient's home 12 months later to track how symptoms have improved or not since intervention. The findings will be used to measure outcomes for women receiving treatment for heavy menstrual bleeding. 5. Quality accounts This research is designed and prioritised around the patient experience. The Ipsos MORI health team have been commissioned by the Department earlier this year to engage NHS stakeholders in defining the scope and format of Quality Accounts ( Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH_102807). Once finalised, we will work with health authorities to develop quality accounts tailored to the health needs and priorities of NHS users. More on our work We work with a huge number of health clients both on ad hoc projects and in longer term research partnerships. If you would like to talk through some of the work we do and ways in which we could work with you in the future, please do give us a call. 9

10 Further information For further on reputation and patient perceptions please contact: Jonathan Nicholls Research Director Head of Health and NHS Dan Wellings Research Director Head of Public Health Malcolm Dickson Associate Director Evaluation and consultations Michele Corrado Research Director PROMs Anna Quigley Associate Director Reputation and patient perceptions Sara Butler Research Director Public engagement Alternatively you can call us on +44(0) Or visit our website at About Ipsos MORI: Ipsos MORI s Social Research Institute works closely with national government, local public services and the not-for profit sector. Its 200 research staff focus on public service and policy issues. Each has expertise in a particular part of the public sector, ensuring we have a detailed understanding of specific sectors and policy challenges. This, combined with our methodological and communications expertise, ensures that our research makes a difference for decision makers and communities. 10