Measuring & Using Patient Experiences: Surveying Adult and Child Patients
Measuring & using patient experience: surveying adults and children
What we will cover: About Picker Institute Europe Introduction Conducting and using surveys Measuring children’s experiences Using survey results for service improvement Conclusions
How it will work Each segment will be introduced with a brief presentation Then there will be a discussion We will try to make it as interactive as possible First of all I will introduce the Picker Institute Picker Institute Europe 4
An international charity dedicated to ensuring the highest quality health and social care for all Our work is underpinned by a commitment to the Picker Institute principles of person centred care. Our core aims are to: o Influence policy and practice so health and social care systems are always centred around people’s needs and preferences; o Inspire the delivery of the highest quality care, developing tools and services which enable all experiences to be better understood; and o Empower those working in health and social care to improve experiences by effectively measuring and acting upon people’s feedback. www.pickereurope.org
www.pickereurope.org
Picker Institute Europe Set up 15 years ago by Picker Institute Inc Employs some 60 staff across sites in Oxford and Hamburg Undertakes NHS staff survey (one of the biggest in the world) Undertakes patient surveys in a range of countries Applied research on person centred care, often in partnership with Oxford University Service improvement work including Always Events TM with IHI www.pickereurope.org 7
Why do surveys? Without measurement you cannot manage and evaluate performance and improvement Without measuring patient experience you cannot judge whether you are meeting customer needs – patient experience is core to quality Surveys are quantifiable and trends can be seen over time They are potentially representative It is also possible to judge in what ways they might not be representative They are a tool to get stakeholders on board and for accountability www.pickereurope.org 8
Our team Chris Graham, Director of Research and Policy Bridget Hopwood, Director of Health Experiences Myself – CEO of the Picker Group in Europe Hi, it is our first time in Dallas! www.pickereurope.org 9
ICEBREAKER www.pickereurope.org 10
Conducting and using patient experience surveys Chris Graham Director of Research & Policy @ChrisGrahamUK
Why survey patients? Strengths Weaknesses Can produce reliable, Care needed to ensure response generalizable estimates is representative Allow for robust comparisons Standardisation can limit ability to between wards/sites/institutions focus on specific local issues …and between different patient ‘One size fits all’ approach may groups miss issues important to minorities Can track trends over time Statistical results require some (limited) expertise to use Don’t tell individual stories Inclusive; wide opportunity to respond Cost effective, high volume data Picker Institute Europe 13
When you had important questions to ask a nurse, did you get answers that you could understand? Picker Institute Europe 14
Source: NHS England & Quality Health. 2014 National Cancer Patient Experience Survey National Report. https://www.quality- health.co.uk/resources/surveys/national-cancer-experience-survey/2014-national-cancer-patient-experience-survey/2014-national-cancer-patient-experience- 15 survey-national-reports (p52)
Surveys don't tell individual stories - but they do get representative feedback, including from people who wouldn't otherwise volunteer it Picker Institute Europe 7
What makes a good survey? Good surveys need to consider: Who we survey & how they are selected (sampling) How responses are sought (survey mode) What we ask (question design) These are interrelated, and decisions will be based on: Why we want feedback: what’s the purpose of the survey? Picker Institute Europe 17
Survey ‘modes’
Choosing the right survey mode Choice of mode will be influenced by: Budget Survey purpose How quickly the results are needed Audience There’s no one ‘best’ mode Results from different modes may not be comparable Picker Institute Europe 19
Mode effects – timing matters "Did you have confidence & trust in the nurses treating you?" Handout 75% 20% 6% Postal 58% 37% 6% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Yes, always Yes, sometimes No
NHS Inpatient Survey Patients receive questionnaires by post 2-6 months post discharge What are the advantages and disadvantages of this? Possible problems Strengths Memory? Allows time for reflection Practical problems – moving etc? Practical benefits – data availability ‘Landmark’/ ‘milestone’ view Delay in getting feedback to hospital Wide range; differential recall? Easily replicable & widely applicable Picker Institute Europe 22
Sampling www.pickereurope.org
What is sampling? Surveying entire populations is often impractical Sampling is an intuitive way to make estimates 24
Sampling A sample is drawn from a larger pool (or ‘frame’) of people If this is biased, then your results will be biased too – no matter how many people you get responses from Picker Institute Europe 25
Self-selecting samples Question: why do people respond to surveys? Interest in the subject Have a particular experience they want to share For money Sense of duty/social responsibility Feeling valued If the reasons are related to what you’re measuring, results are likely to be biased. Picker Institute Europe 26
Sampling: summary Start from an appropriate sample frame 1. Be wary of self-selection 2. Be mindful of how individuals are selected 3. Don’t get too hung up on the sample size – unless it’s 4. very small! Picker Institute Europe 27
Question design www.pickereurope.org
Survey design: Principles of good practice Keep questions simple and focussed Avoid jargon Do not use ‘double - barrelled’ questions Responses options should... Form balanced scales Be unambiguous and mutually exclusive Allow respondents to say if they don’t know Focus on recent experiences (within a year) Avoid complex layouts – eg matrices
Questionnaire length General assumption is that longer questionnaires discourage responses but evidence is patchy Salience may be more important. Underlying question is: What motivates an individual to respond to a survey? Routing can be a way of speeding up the questionnaire – but it might not help if the questionnaire still looks very long Picker Institute Europe 30
Summary – questionnaire design Questions should be simple, direct, and address a single concept Response options should be mutually exclusive and comprehensive Give people the opportunity to say ‘not applicable’ Avoid loaded or leading statements Test questions if you possibly can Limited use of routing can be helpful Be mindful of the possibility of contextual effects – eg question/response order Picker Institute Europe 31
Discussion Picker Institute Europe 32
Questions Where are surveys currently used within your organisation, if anywhere? Think about patient, carer, and staff feedback What is the aim of the surveys? How could this approach be improved to focus on the strengths of surveys? How are results used? Comparisons, trends, etc? Do these uses fit the methodology? Picker Institute Europe 33
Measuring children’s experiences of care Bridget Hopwood Director of Health Experiences Picker Institute Europe 34
Children should be seen and not heard? Few paediatric surveys exist parental surveys “typically used as proxies” Gathering national patient experience data from the children themselves not been a priority Distinct gap between what we know about adults’ experiences and that of children and young people’s own experiences Picker Institute Europe 35
Why ask the children? No decision about me, without me” [Harvey Picker] NHS Constitution – all patients (and families or carers where appropriate) have a right to be involved Society becoming more child-focused in general Evidence that it works….. “Children are more likely to be less stressed if their views are taken into account, and they are allowed to participate in their health care in accordance to their rights .” [ Tiina Pelander ; Children’s best and worst experiences during hospitalisation; 2010] Picker Institute Europe 36
Why ask the children? Because they want us to ….. “ At the end of the day, it’s my leg so I would rather be asked than my Mum or Dad… .” Unique perspective….. “Not much to do except “ ...this man had no legs eat and watch people die” and he was really old and he just left the door open and I had to see this man lying there with no legs ” Picker Institute Europe 37
Achieving Patient-Centred Healthcare: Indicators of Progress and Success CYP Patient experience
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