Wednesday 16 April 2008
The NHS today increasingly talks about being "patient centred". NHS managers are being told to think about the patient experience, but what should they be doing? Of course the first step is to ask patients what they think of the service they receive — how do they rate their local trusts and PCTs?
The Healthcare Commission's patient surveys provide these findings on a national basis. We can easily point to those trusts that are receiving the highest patient scores and assume that these are the 'best' at keeping their patients happy. But this data gives us few clues as to what these trusts are actually doing and what factors influence patient satisfaction.
However, further analysis of the data allows us to explore the key drivers of patient perception and identify contextual factors that have significant effects on patient ratings.
The Primary Care Sector
You'd think that spending more on your patients or giving them more GPs would make your patients happier. But that's not the case! Our Frontiers analysis shows that these objective performance measures have little relationship with overall ratings of primary care services.
So what should PCTs be doing to make their patients more content with local health services? Our analysis shows the nature of local communities has far more impact on patient ratings, with PCT services in areas with high ethnic fractionalisation (the extent of different ethnic populations in an area), high deprivation, those with a younger population and those situated in London nearly always receiving lower ratings of satisfaction than those serving wealthier, older, more homogenous populations. In this, we see a similar relationship to that which affects resident satisfaction with their local area — and indeed their local authority (as explored in our series of local government "Frontiers" reports).
This means that when looking at patient perception of PCT services, we should be taking such local factors into account. For example, Lambeth and West Wiltshire PCTs look like they're performing to about the same level, but if we account for the nature of the location; Lambeth is clearly out-performing West Wiltshire.
Clearly, local knowledge in those PCTs will give some clues as to why patients rate them better than we would expect once controlling for local factors — and further research would be invaluable in drawing these lessons together for other PCTs.
The challenge for PCTs will be to make sense of this and to take account of their local situation in service delivery and communications strategies, not least when discussing their own performance.
The Acute Sector
In the acute sector, however, it's a different story. Our "Frontiers" analysis shows that the nature of the locality has much less impact, although as with PCTs, London faces particular challenges, as do trusts serving younger, more ethnically fractionalised populations.
In other words, there appear to be more opportunities for acute trusts to influence patient ratings regardless of where they are situated: patients' experience of the service they receive overrides the effects of local demographics.
Our analysis shows three key areas impacting upon overall inpatient ratings:
- treating patients with dignity and respect;
- involving patients in decisions; and
- the cleanliness of the hospital room or ward in which patients are treated.
Treating people with dignity and respect, in particular, emerges as a critical factor in how patients view services.
We explore the implications of these findings in depth in our "Frontiers of Performance in the NHS II" report.
For more information on our Frontiers analysis and what this means for your organisation, please contact Anna Quigley.