What are patients' care experience priorities?

To cite: Iedema RA, Angell B. BMJ Qual Saf 2015;24:356–359. We are investing considerable resources in defining and measuring patients’ care expectations. Such measurement will yield insight into whether and how services are meeting patients’ experience expectations. But because measurement is inherently distanced in time and space, it does not resolve patients’ experience of feeling ‘reluctant to directly challenge healthcare professionals’ about issues that matter to them now and which may make them feel unsafe. Research has shown that when patients and family members experience concerns about their care, they want to be able to discuss these experiences with their clinicians. They often want such discussions to include explanations from professionals and dialogue about ‘what happened’ and about tensions, uncertainties and contradictions. Patients and family members interviewed for a large incident disclosure study reported that they appreciated that care is complex, and that there may be no simple answers to explain care problems. But being granted the time for dialogue with their clinicians and service representatives reassured patients and family members that their concerns and questions were taken seriously. This meant for them in turn that similar events might be prevented from happening again. They also felt that dialogue reassured them that their views on and advice about how to improve care were respected. When patients have concerns about their care, the timing and authenticity of such dialogue are seen as paramount. For its part, measuring patients’ experiences presupposes abstracting ‘what happened to you’ into a general metric that applies to ‘people like you’. Measurement is, in the first instance, about the service and the system. Dialogue is about the patient and their family. Measurement will never obviate patients’ providing feedback about their concerns to their own clinicians and their local services. What started out as satisfaction surveying in the 1970s has now morphed into a major industry, with Picker, Press Ganey and HCAHPS (the US-based ‘health consumer assessment of healthcare providers and systems’) leading the way. A number of landmark government reports has now enshrined the role of patient feedback measurement in healthcare governance and practice improvement. 10 In addition to the hundreds of ‘patient reported outcome measures’ that have to date been developed to measure whether care meets patients’ care-outcome expectations, ‘patient reported experience measures’ (PREMs) invite feedback about service features such as waiting times, admission processes, staff responsiveness, discharge processes and so forth. PREMs also elicit feedback on matters ranging from clinical team communication to service responsiveness to patient needs, accessibility of information, environmental factors (lighting, space design), equipment availability and functionality, and they have been shown to shed light on clinical outcomes. 14 It is this rapidly growing area of ‘patient experience’ research that is the focus of the article by Rebecca Lawton and colleagues. Following this team’s development of an overview of factors contributing to patient safety incidents (referred to as the Yorkshire Contributory Factors Framework (YCFF)), patient measure of safety (PMOS) was constructed from an analysis of the priorities attributed by 33 patient interviews to YCFF. The team’s most recent article reports on a comparison of PMOS against a range of other safety rating instruments. For the purpose of making such comparisons possible, data were collected from 33 hospital wards across three acute hospitals, including responses from staff for the four outcome measures in the Hospital Survey of Patient Safety Culture, patient responses to the PMOS and the so-called Friends and EDITORIAL