Page last updated at 16:52 GMT, Monday, 27 October 2008

Gauging true patient experience

By Adam Brimelow
Health correspondent, BBC News

Jennie Negus
Jennie Negus says the scheme has helped to drive up standards

A quiet revolution is taking place in the health service in England which will shape the service for years to come.

Underpinning all the talk about choice, putting patients in control and driving up standards, is a concerted effort to gather information on the quality of care.

The health service is experimenting with new techniques to record patient satisfaction.

But health campaigners are worried that the data could become discredited, undermining the whole reform process.

As patients prepare to head home from Homerton hospital in east London, they are asked if they would like to do a quick questionnaire on a hand-held computer.

Feedback

There are 36 devices dotted around the site. The questions vary from place to place. On the men's surgery ward they ask about staff friendliness and sensitivity, overall cleanliness and speed of response to the call-bell.

Up on the wall bright posters proclaim the results, displayed on pie-charts and graphs.

Health Secretary Alan Johnson says in the next year he wants a scheme like this in every hospital across the country - tracking the patient experience in real-time. Jennie Negus, Homerton's deputy director of nursing, says the scheme has helped to drive up standards.

"It's made staff really critically analyse their behaviour and how they project themselves.

"And then on a real practical level - the question around responses to call-bells - this showed that there was an issue across the wards and we've developed a specific standard now that says call-bells must be answered within a minute."


The main worry is a lack of coherence as we start to generate a whole new set of ways of measuring the patient experience

Don Redding of the Picker Institute

The Homerton started using these devices - patient experience trackers, or "PETS" - last year. Each month more than 1,200 people complete the questionnaire.

Ms Negus says: "There's going to be no foolproof system, but the numbers of patients that are using ours - the response rate we've had - is telling us that they value the system. They value the opportunity to give their feedback."

This is just one of the schemes to divine the "true patient experience". From April next year the health service will introduce a system called PROMS - patient reported outcome measures.

People having hip and knee replacements, varicose veins and hernia operations will fill in questionnaires before and after treatment. Their improvements will be assessed and published.

BUPA has been doing this for a decade. The firm's assistant medical director, Dr Sneh Khemka, says the firm has been urging the NHS to follow its lead.

"When patients choose which hospital to go to for their treatment they want to know how much their health is going to improve. And these PROMS have been a key factor in enabling that choice."

The growth in information is being powered by the internet. The website iwantgreatcare.com allows people to rate their doctors.

Founder Dr Neil Bacon says patients, as experienced consumers, are happy to sift through data before making their choice.

"We've got to remember we're talking about people who've grown up now making decisions and reading reviews from other users, reading ratings when they buy a washing machine, booking a holiday. And yet we ask them to take their child to hospital or put their life in the hands of someone without seeing the comments from other people."

'Being rushed'

But the health research group the Picker Institute says the whole process is being rushed. It's head of policy, Don Redding, is worried that it could lead to confusion.

"The main worry is a lack of coherence as we start to generate a whole new set of ways of measuring the patient experience."

He says quick feedback systems like the Homerton approach do have value - the Picker institute is working on a similar scheme in Southampton.

But he says it is vital that people can make comparisons between hospitals, based on information that's been carefully assessed and presented.

"If that information set becomes discredited, unreliable, confusing, fragmented, it doesn't allow even the system or the patients trying to act on that information to make the changes and to make the choices that will help quality to rise."

The government is forging ahead with this revolution in information. There is widespread agreement that the potential benefits are enormous. But some want ministers to take more time to get it right.



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