Hospital Dr News

Inpatient survey reveals only small improvements in patient experience over time

Trusts have seen only a modest improvement in quality of care as judged by patients, says a new report.

The inpatient survey in England shows that there have only been small improvements in patient experience reported between 2005 and 2013.

The first longitudinal study of patient experience by trust, Patients’ experience of using hospital services, shows a tendency towards inertia or regression to the average. However, when this is set against tightening funding since 2010, the fact that patient experience hasn’t deteriorated is reassuring.

The report, co-written by The King’s Fund and Picker Institute Europe, analysed the inpatient survey data for nine years across 156 trusts – accounting for more than half a million inpatients – and found that generally there was a mixed pattern of performance. For most trusts there was positive improvement in some areas and deterioration in others.

Where there has been a national policy focus, improvements in patient experience can be seen at almost all trusts – for example, in ward cleanliness.

Where there have been system-wide pressures beyond the hospital, a deterioration in patient experience is often seen – for example, in lengths of wait for a bed after admission to hospital and timely discharge.

The report also shows there is a ‘ceiling effect’ whereby smaller improvements are shown by well-performing trusts compared to those which started off from a lower baseline. This can partly be explained by relatively high scores to begin with. It is, however, demotivating for trusts which started off well to hear year-on-year that they are about the same as last year. More needs to be done to find a far more sensitive measure to help trusts, it finds.

There are also significant differences between trusts in how they approach and use the data. The qualitative research highlights some trusts using data to good effect. One trust identified noise at night as a key issue for patients they had introduced night masks and ear plugs for patients and installed soft-close bins and doors on wards. This was subsequently reflected in their inpatient scores.

Trusts need to overcome the challenges that are preventing them from using the data in systematic and sustained ways to improve services – these are around leadership, culture, staff engagement, resource and system pressures and trust-wide co-ordination.

The report concluded that the inpatient survey data is underutilised at both the national and local level and needs to be used more effectively if it is going to drive better quality in inpatient care.

Veena Raleigh, Senior Fellow at The King’s Fund and the report’s author said: “At a time when the NHS is under increasing financial pressure it is good news to see that inpatient care has continued to improve in hospitals across the country. However, this improvement has been modest and it’s time for this valuable survey to be used more effectively. Many trusts are already demonstrating how they can use the survey to enhance care and we hope this analysis will enable more trusts to access the data to make patients’ experience in hospital as positive as possible.”

She added: “Policy-makers, commissioners and regulators must also recognise that sustained improvement in the experience of hospital inpatients is unlikely unless the pressures in the wider health and care system ease.”

Prof Sir Mike Richards, Chief Inspector of Hospitals at the Care Quality Commission, said: “We welcome the publication of the Kings Fund’s analysis of a decade’s worth of inpatient survey results. It is encouraging that patients are reporting improved care experiences in areas such as mixed sex accommodation and in cleanliness. While the results indicate that people’s experiences have been largely positive, overall there has not been much change over the last ten years and there have even been some areas of deterioration, such as with patient flow.

“We are clear that patient feedback should be a key driver for quality improvement in the NHS.”

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