Person-centred care

This report provides a snapshot of the extent of person-centred care, based on how people report their experience of treatment, care and support.  The report concludes there is a need for person-centred care to be given greater priority and a need for a strategic overhaul of what is measured.

Key findings:

  • Person-centred care is inadequately measured
  • A mixed picture: people’s experiences can be highly variable
  • Some aspects of person-centred care have improved
  • Progress towards involvement in decisions and being in control
  • Steady progress is now deteriorating, both for general practice and inpatient care
  • Little evidence of personalised care and support planning
  • Coordination of care is not measured
  • Family involvement is not central, and most carers need better support

Full report: Person-centred care in 2017: Evidence from service users

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Communication difficulties experienced by deaf male patients during their in-hospital stay

Studies available have described several specific issues affecting healthcare accessibility by deaf people, but to date, no research has reported the experience of deaf patients with in-hospital communication | Scandinavian Journal of Caring Sciences

The aim of the study was to explore the communication experience of deaf patients with regard to their in-hospital stay. A purposeful sample of participants was selected. The data collection process was based on a focus group. The focus groups were conducted in Italian sign language and videorecorded; subsequently, the entire conversation was faithfully transcribed. A qualitative content analysis of the transcription was performed and the findings are reported using the Consolidated Criteria for Reporting Qualitative Research approach.

Four themes have emerged:

  • experiencing a common vulnerability: the need for reciprocal understanding and sensitivity,
  • being outside the comfort zone: feeling discriminated against once again,
  • perceiving a lack of consonance between care and needs and
  • developing a sense of progressively disempowerment.

The experience of deaf individuals during their in-hospital stay may be critical: they are exposed to protracted communication and interaction with healthcare providers and an environment that is not prepared and designed for these vulnerable patients. Two levels of strategies should be identified, implemented and developed to increase the quality of communication with deaf people during hospitalisation, both at the hospital/health system level and at the healthcare professional/clinical level.

Full reference: Sirch, L. et al. (2017) Communication difficulties experienced by deaf male patients during their in-hospital stay: findings from a qualitative descriptive study. Scandinavian Journal of Caring Sciences. Vol. 31 (no. 2) pp. 368–377

8 out of 10 patients are positive about GPs

As the NHS treats more patients than ever before, a new nationwide survey shows the majority of people are positive about their GP care – with almost 85 per cent rating their overall experience of their GP surgery as good | NHS England

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The GP Patient Survey 2017 compiled responses from more than 800,000 people across the country on their experience of healthcare services provided by GP surgeries, including access to GPs, making appointments, the quality of care received from GPs and practice nurses, satisfaction with opening hours and out-of-hours NHS services.

The majority of patients (84.3%) say they were able to get an appointment the last time they tried and around seven in ten patients (68%) say it is very or fairly easy to get through to someone at their GP surgery on the phone.

The survey found that confidence and trust in GPs remains extremely high at 91.9%, while almost three in four patients (77.4%) would recommend their GP surgery to someone who has just moved to the local area and 72.7% of patients rated their overall experience of making an appointment as good.

There has also been a marked improvement in the awareness of online GP services, with more patients saying they are aware of how to book appointments (up 3.8% on last year to 36.1%), ordering repeat prescriptions (up 2.6% to 34.1%) and access to medical records (up to 8.9%).

However, it also suggests areas for improvement, with one in ten patients (11.3%) saying they weren’t able to get an appointment – an increase of 0.5% on the 10.7% in 2016. And the number of patients reporting they can usually see their preferred GP dropping to 46.2% – down by 2.4% on last year.

Why UK hospital staff find it difficult to make improvements based on patient feedback

Patients are increasingly being asked for feedback about their healthcare experiences. However, healthcare staff often find it difficult to act on this feedback in order to make improvements to services | Social Science and Medicine

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This paper draws upon notions of legitimacy and readiness to develop a conceptual framework (Patient Feedback Response Framework – PFRF) which outlines why staff may find it problematic to respond to patient feedback.

A large qualitative study was conducted with 17 ward based teams between 2013 and 2014, across three hospital Trusts in the North of England. This was a process evaluation of a wider study where ward staff were encouraged to make action plans based on patient feedback.

Through the development of the PFRF, we found that making changes based on patient feedback is a complex multi-tiered process and not something that ward staff can simply ‘do’.

  • First, staff must exhibit normative legitimacy – the belief that listening to patients is a worthwhile exercise.
  • Second, structural legitimacy has to be in place – ward teams need adequate autonomy, ownership and resource to enact change. Some ward teams are able to make improvements within their immediate control and environment.
  • Third, for those staff who require interdepartmental co-operation or high level assistance to achieve change, organisational readiness must exist at the level of the hospital otherwise improvement will rarely be enacted.

Case studies drawn from our empirical data demonstrate the above. It is only when appropriate levels of individual and organisational capacity to change exist, that patient feedback is likely to be acted upon to improve services.

Full reference: Sheard, L. et al. (2017) The Patient Feedback Response Framework – understanding why UK hospital staff find it difficult to make improvements based on patient feedback: A qualitative study. Social Science & Medicine. 178. pp. 19-27.

 

Treatments and technologies matter, but patients most want to be seen as people

Patient stories are a raw and compelling new kind of online feedback. They can prompt rapid improvements in services – if the NHS is willing to embrace them | The Guardian Healthcare Network

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People have always shared their experiences of healthcare, usually privately, with family, neighbours or workmates. But online, patients and carers are increasingly willing to share accounts of their health service encounters with the wider world, often in intimate detail. There are websites devoted to collecting and publicising patient ratings and reviews of healthcare professionals, services, diagnoses and treatments.

The stories of patients and carers are becoming an unavoidable part of modern healthcare. In the US, people searching online for information about local services are more likely to read patient comments than official clinical outcome measures or patient experience metrics. In the UK, staff routinely read online patient feedback and share it on social media. NHS regulators have even started to think in terms of monitoring and analysing patient stories to provide an “early warning” for when things might be going wrong.

Read the full news story here

CQC Adult inpatient survey 2016

Read the results of the latest analysis, which looks at the experiences of adult patients in hospital | CQC

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The results of the 2016 inpatient survey indicate that there have been small, but statistically significant improvements in a number of questions, compared with results dating back to the 2006, 2011 and 2015 surveys. This includes patients’ perceptions of:

  • the quality of communication between medical professionals (doctors and nurses) and patients
  • the standards of hospital cleanliness
  • quality of food

However, the results also indicate that the results of some questions have been less positive. This includes patients’ perceptions of:

  • being involved in decisions about their care and treatment
  • information sharing when leaving hospital
  • waiting times
  • support after leaving hospital

The full overview is available here

What does patient feedback reveal about the NHS?

Research finds that staff are likely to be evaluated both positively and negatively according to their interpersonal skills.

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Objective: To examine the key themes of positive and negative feedback in patients’ online feedback on NHS (National Health Service) services in England and to understand the specific issues within these themes and how they drive positive and negative evaluation.

Results: Overall, NHS services were evaluated positively approximately three times more often than negatively. The four key areas of focus were: treatment, communication, interpersonal skills and system/organisation. Treatment exhibited the highest proportion of positive evaluative comments (87%), followed by communication (77%), interpersonal skills (44%) and, finally, system/organisation (41%). Qualitative analysis revealed that reference to staff interpersonal skills featured prominently, even in comments relating to treatment and system/organisational issues. Positive feedback was elicited in cases of staff being caring, compassionate and knowing patients’’ names, while rudeness, apathy and not listening were frequent drivers of negative feedback.

Conclusions: Although technical competence constitutes an undoubtedly fundamental aspect of healthcare provision, staff members were much more likely to be evaluated both positively and negatively according to their interpersonal skills. Therefore, the findings reported in this study highlight the salience of such ‘soft’ skills to patients and emphasise the need for these to be focused upon and developed in staff training programmes, as well as ensuring that decisions around NHS funding do not result in demotivated and rushed staff. The findings also reveal a significant overlap between the four key themes in the ways that care is evaluated by patients.