Measuring what matters: how patient experience drives person centred care
The purpose of measuring patient experience is to understand and improve person centred care. High quality patient experience measures are essential for this, but it is important to remember their purpose and measure what matters, argues Chris Graham.
Today, healthcare systems and providers around the world make extensive use of patient experience measures. It wasn’t always so: the focus on patient experience remains comparatively new and reflects rapid evolution over a comparatively short period of time.
The mainstreaming of “patient experience” over the last 20 years is fundamentally a good thing – at the very least, it requires providers to solicit and value people’s feedback about the services that they use. But this is only part of the purpose of patient experience – and unless we remember other elements, there is a danger of taking a box-ticking approach to patient experience that may fail to drive person centred care.
In this and a subsequent blog, we argue first that organisations should reflect on why patient experience matters – and, second, that there should be a much greater focus on using feedback for improvement.
Why measure patient experience?
The measurement of patient experience grew out of earlier attempts to measure and use patient satisfaction, which had begun to attract interest in the 1980s. Williams (1994, p. 510) argued that interest in patient satisfaction measures grew from a desire to promote compliance (e.g. attending appointments and taking medication as directed) and reflected a rise in consumerism wherein the consumer becomes “the central figure of accountability in all public services”.
In this context, the patient is a customer – their satisfaction and patronage matters as it does for any business, but they remain the subject of care. The role of the patient has progressed from being “done to” to being “done for”, but their treatment is still defined by a kind of benign paternalism.
Through the 1990s, this paternalism came to be increasingly out of step with modern thinking. By this time, the Picker Institute in the USA had articulated a vision of patient centred care based on the principle that patients should be active participants in, rather than the passive recipients of, care: that they should be “done with”, not “for” or “to”. By the turn of the century, policy makers in the UK had firmly embraced the language of “partnership” (e.g. Coulter, 1999).
Understanding people’s experiences as partners in their care requires more nuance than patient satisfaction measures can offer, because satisfaction is superficial and fails to reflect the complex set of beliefs that people bring to their care. Patient experience measures were designed to address this by asking people to report what did or did not happen during their care; by exploring the presence or absence of the things that matter to most people, they offer insight into whether care is person centred.
Addressing the wrong priorities?
Patient experience surveys can be incredibly informative – at their best, they provide rich, reliable, and comparable data about the experiences of people from different groups, and their results represent the observable outcomes of person centredness. But they do not always capture or lead to the prioritisation of the right things.
Similarly, not all aspects of patient experience are equally important – and those that are, are often the hardest to measure and to change. The easiest things to measure and improve are often transactional (like scheduling appointments, or managing waiting times) – but the things that matter most to patients are often relational (like the quality of communication from clinicians).
The best feedback programmes use qualitative research and insights from patients and service users to define their content and measure what matters to them – which includes subjective elements of their experience. However, the apparent objectivity of more transactional questions can prompt disproportionate use of these: a reliance on what was done, rather than how it felt.
The same pattern can affect improvement work. Staff are often more comfortable addressing transactional elements of care not only because there is more data on these issues but also because they are more amenable to simple changes (e.g. NIHR Dissemination Centre, 2019). Changing the deeper issues that affect care quality is much harder and takes both time, support, and insight – all of which may be incompatible with a ‘box-ticking’ approach to patient experience.
Conclusions
Person centred care is an approach to health services that goes beyond treating and curing illness: it is about recognising patients as individuals with their own needs and preferences, and welcoming and facilitating their involvement as active participants in their own care.
High quality patient experience measures provide important insight into the quality of person centred care. To understand and improve person centredness, it is important that our measures reflect the things that matter most to patients: including vital but difficult to measure concepts like communication; involvement; and empathy. If we can do this consistently, patient experience measures can help drive a culture shift towards person centred care.
Further reading
The Picker Principles of Person Centred Care (Picker Institute Europe, n.d.) provide a framework for understanding what matters most to most people: these should be used in the design and delivery of health services and patient experience measures alike.
References
Coulter, A. (1999). Paternalism or partnership?: Patients have grown up—And there’s no going back. BMJ : British Medical Journal, 319 (7212), 719.
NIHR Dissemination Centre. (2019). Improving Care by Using Patient Feedback. NIHR Dissemination Centre.
Picker Institute Europe. (n.d.). Principles of Person Centred Care. Picker. Retrieved 22 October 2024.
Williams, B. (1994). Patient satisfaction: A valid concept? Social Science & Medicine, 38 (4), 509–516.
