Experiencing patient-experience surveys: a qualitative study of the accounts of GPs

Edwards, Adrian; Evans, Richard G.; White, Paul; Elwyn, Glyn

doi:10.3399/bjgp11x567072

Cited by 31 publications

(69 citation statements)

References 34 publications

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“…[9][10][11][12][13] It has also been suggested that if feedback elicits a negative response in doctors, it may be detrimental to their future performance. 8,[15][16][17] The current research highlights a mismatch between the conventional demonstration of the 'objectivity' of a survey tool, and the doubts and questions raised by those receiving the data, which prevented wholesale acceptance of its results. As rigorous pilot testing alone did not automatically translate into the results being trusted enough to be acted upon, the ability of the survey to bring about positive change seemed likely to be limited.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…7 Research conducted in healthcare contexts confirms that feedback from patients is not always received positively, and does not automatically result in improvement. [8][9][10][11][12][13] A recent systematic review of multi-source feedback, which includes patient feedback, concluded that evidence to support the hypothesis that patient feedback has a positive effect on practice change among doctors is inconclusive. 14 Feedback that lacks credibility, that contradicts prior knowledge, or that is experienced as a threat at the individual level, is unlikely to be effective.…”

Section: Introductionmentioning

confidence: 99%

“…14 Feedback that lacks credibility, that contradicts prior knowledge, or that is experienced as a threat at the individual level, is unlikely to be effective. 8,[15][16][17] This study was designed to capture the responses of GPs, practice nurses, and practice managers to patient feedback, using the national GP Patient Survey (www.gp-patient.co.uk/info/) as an example.…”

Section: Introductionmentioning

confidence: 99%

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Challenges to the credibility of patient feedback in primary healthcare settings: a qualitative study

Asprey

Campbell²,

Newbould³

et al. 2013

Br J Gen Pract

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BackgroundThe UK government has encouraged NHS services to obtain patient feedback to support the further development of patient-centred care. In 2009, the English GP Patient Survey included a sample of 5.5 million, but little is known about its potential utility in informing developments aimed at improving the quality of patients' experiences of primary care. AimTo investigate primary care providers' response to feedback on patient experience from a national survey. Design and settingQualitative interview study in 10 general practices from four primary care trusts in England. MethodSemi-structured interviews were conducted with GPs, practice nurses, and practice managers (n = 37). Transcripts were analysed thematically. ResultsAlthough some participants reported making changes to their practice in response to the survey data, many expressed doubts about the credibility of the results. Key issues included: concerns about practical aspects of the survey, such as the response rate and representativeness of the sample; the view that it gave insufficient detail to facilitate change and failed to address some salient issues; and unease about the influence of political influences underpinning its introduction and use. ConclusionAlthough, in general, primary care professionals have positive attitudes towards patient feedback, this study suggests a mismatch between the conventional demonstration of the objectivity of a questionnaire survey and the attitudes and experiences of those receiving the data. This is likely to prevent doctors from engaging constructively with the survey. These concerns may well militate against the potential of the survey to act as a simple means of capturing, and effectively using, feedback from patients. Keywordsprimary healthcare; qualitative research; reliability and validity; surveys.

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Section: Comparison With Existing Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Challenges to the credibility of patient feedback in primary healthcare settings: a qualitative study

Asprey

Campbell²,

Newbould³

et al. 2013

Br J Gen Pract

View full text Add to dashboard Cite

show abstract

“…Despite data on patient experience being increasingly collected worldwide, there are still questions in regards to its uses and value. There is clear evidence that although health professionals in principle have positive attitudes towards patient feedback, they raise objections to its use when presented with results that appear critical of their own care [46,47]. Improving quality requires a strategy of implementing multiple interventions, sustained over time.…”

Section: How Can Patient Experience Data Be Usedmentioning

confidence: 99%

Measuring Patient Experience: Concepts and Methods

Ahmed

Burt

Roland

2014

Patient

254

212

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Providing a good patient experience is a key part of providing high-quality medical care. This paper explains why patient experience is important in its own right, and its relationship to other domains of quality. We describe methods of measuring patient experience, including issues relating to validity, reliability and response bias. Differences in reported patient experience may sometimes reflect differences in expectations of different population groups and we describe the arguments for and against adjusting patient experience data for population characteristics. As with other quality improvement strategies, feeding back patient experience data on its own is unlikely to improve quality: sustained and multiple interventions are usually required to deliver sustained improvements in care. Key Points for Decision MakersQuality is a multi-dimensional concept, and a single indicator does not (and should not) reflect quality in other domains. Patient experience is important in its own right.Patient experience is consistently and positively associated with other quality outcomes including patient safety and clinical effectiveness across a wide range of studies, and healthcare facilities providing high-quality clinical care tend to have better experiences reported by patients. However, these associations are frequently modest in size. Clinical quality and patient experience should be considered as distinct but inter-related aspects of quality.Differences in patient experience scores between population (e.g. ethnic) groups may in part reflect differences in expectations.Adjusting patient experience scores for population characteristics (e.g. ethnicity, deprivation) increases the acceptability of the results to healthcare providers. Case-mix adjustment in general makes only small differences to scores, though the greatest positive effect is on providers serving vulnerable populations.Significant quality improvement in general requires multiple strategies which are sustained over time. The same is probably true when using patient experience measures as a quality improvement tool. Simple feedback is unlikely to produce significant improvements in care.

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“…85,86,137 Although policy initiatives such as the introduction of the QOF or revalidation highlight feedback on patient experience as a key driver of quality improvement, evidence suggests that patient experience has had only a limited impact on service delivery 45 and GPs and other health-care professionals may experience difficulties in making sense of survey-generated information. 119,200 In this strand of work, we drew on qualitative data to examine how primary health-care practitioners and their teams view and act on feedback from patient experience surveys. We examined the role that patient DOI: 10.3310/pgfar05090 PROGRAMME GRANTS FOR APPLIED RESEARCH 2017 VOL.…”

Section: Introduction and Rationalementioning

confidence: 99%

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Burt

Campbell

Abel

et al. 2017

Programme Grants Appl Res

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BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Experiencing patient-experience surveys: a qualitative study of the accounts of GPs

Cited by 31 publications

References 34 publications

Challenges to the credibility of patient feedback in primary healthcare settings: a qualitative study

Challenges to the credibility of patient feedback in primary healthcare settings: a qualitative study

Measuring Patient Experience: Concepts and Methods

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

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