[London, UK/ Medicine] - NHS foundation trusts and teaching hospitals consistently outperform other trusts on a range of measures of patient experience, according to research published online in BMJ Quality & Safety. Patient experience is one of the five domains for assessing NHS performance in the current NHS Outcomes Framework and is recognised internationally as a key dimension of healthcare quality.
The authors, from health think-tank The King′s Fund, and the Picker Institute Europe, used data from inpatient, outpatient and emergency care surveys from 145 hospital trusts in England for 2008 and 2009. To reflect patient experience they looked at six ′domains′ that were common to the various surveys: cleanliness; dignity and respect; consistency of communication; patient involvement in decisions; information provision; and confidence in staff.
A series of statistical techniques were used to examine whether or not trust performance was consistent across the different surveys, and to identify factors associated with performance, such as foundation trust status and deprivation levels among the trust′s patients.
Analysis showed that, overall, trusts scored an average of 70 or higher out of 100 across all the surveys for patient experience, with the exception of information provision on issues such as drug side effects and danger signals to look out for after discharge. Trusts performed best overall in the domains ′dignity and respect′ and ′consistency of communication′, while the domains ′information provision′ and ′confidence in staff′ had the highest number of trusts showing poor performance.
Some trusts consistently good or bad
Cluster analysis of the data identified certain trusts that performed consistently above or below average on all six domains in all three surveys. One in five (21%) trusts performed above average in all the surveys. Most had foundation trust status, but not one was in London. At the other end of the scale, six trusts (4%) performed below average in all the surveys. All these trusts were in London, and none had foundation trust or teaching hospital status. Below average performers also had the highest average deprivation scores and the lowest proportion of patients from white backgrounds.
Feedback from patients from black and minority ethnic backgrounds shows that they are often less satisfied with the healthcare they receive than their white peers, which may have to do with language and cultural factors, say the authors. But they add that population differences should never be seen as an excuse or justification for poor patient experience.
The authors suggest that the findings show there are system-wide successes or failures in trusts, which means some trusts are more successful than others at fostering a culture or mechanisms for delivering a good experience for their patients. They also concluded that the data analysis shows there is room for improvement in all areas. [hw] [Photo: University College London Hospital]
Raleigh VS, Frosini F, Sizmur S, et al. Do some trusts deliver a consistently better experience for patients? An analysis of patient experience across acute care surveys in English NHS trusts. BMJ Quality & Safety.