1 the patient’s perspective angela coulter picker institute europe
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1
The Patient’s PerspectiveThe Patient’s Perspective
Angela CoulterAngela Coulter
Picker Institute EuropePicker Institute Europe
www.pickereurope.orgwww.pickereurope.org
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Three Perspectives on QualityThree Perspectives on Quality
Professional: technical competence, Professional: technical competence, clinical outcomesclinical outcomes
Management: cost-effectiveness, risk Management: cost-effectiveness, risk management, service developmentmanagement, service development
Patient: access, responsiveness, Patient: access, responsiveness, communication, symptom relief, quality-communication, symptom relief, quality-of-lifeof-life
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Patient-Centred CarePatient-Centred Care
Prompt access Prompt access
Respect for patients’ preferencesRespect for patients’ preferences
Co-ordinated careCo-ordinated care
Information and educationInformation and education
Physical comfortPhysical comfort
Emotional supportEmotional support
Involvement of family and friendsInvolvement of family and friends
Continuity and transitionContinuity and transition
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Methods for Seeking Patients’ ViewsMethods for Seeking Patients’ Views
ObservationsObservations
InterviewsInterviews
DiariesDiaries
Focus groupsFocus groups
SurveysSurveys
MeetingsMeetings
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Uses of Patient SurveysUses of Patient Surveys
Identify priorities for quality improvementIdentify priorities for quality improvement
Reduce complaints Reduce complaints
Promote patient safetyPromote patient safety
Monitor health system performanceMonitor health system performance
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Overall, how would you rate the Overall, how would you rate the care you received?care you received?
05
10152025303540
exce
llen
t
very
go
od
go
od
fair
po
or
UK
USA
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Reporting QuestionsReporting Questions
A&E care disorganisedA&E care disorganised 38%38%
Reason for delay not explainedReason for delay not explained 6%6%
Staff gave conflicting informationStaff gave conflicting information 23%23%
Doctors talked as if I wasn’t thereDoctors talked as if I wasn’t there 30%30%
Had to wait too long for pain medicineHad to wait too long for pain medicine 9%9%
Risks and benefits not discussed Risks and benefits not discussed 24%24%
Not told when to resume activitiesNot told when to resume activities 60%60%
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Problems With Rating Problems With Rating (Satisfaction) Questions (Satisfaction) Questions
Yield positive results, which do not reflect Yield positive results, which do not reflect reported experiencereported experience
Do not discriminate well between Do not discriminate well between countries, hospitals, unitscountries, hospitals, units
Do not help to identify causes of Do not help to identify causes of dissatisfaction or priorities for quality dissatisfaction or priorities for quality improvementimprovement
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Measure Patients’ Experience, Measure Patients’ Experience, NOT Patient SatisfactionNOT Patient Satisfaction
Reporting NOT Rating.Reporting NOT Rating.
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Didn’t have enough say about Didn’t have enough say about treatment treatment (Picker Inpatient Surveys)(Picker Inpatient Surveys)
0
10
20
30
40
50
60
Switz
erla
ndUSA
Ger
man
y
Swed
en UK
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Test results not clearly explainedTest results not clearly explained(Picker Inpatient Surveys)(Picker Inpatient Surveys)
0
10
20
30
40
50
60
Switz
erla
ndUSA
Ger
man
y
Swed
en UK
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Not told about side-effects Not told about side-effects (Picker Inpatient Surveys)(Picker Inpatient Surveys)
0
10
20
30
40
50
60
Switz
erla
ndUSA
Ger
man
y
Swed
en UK
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Not told about danger signals to Not told about danger signals to watch for watch for (Picker Inpatient Surveys)(Picker Inpatient Surveys)
0
10
20
30
40
50
60
Switz
erla
ndUSA
Ger
man
y
Swed
en UK
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Most Common Problems Most Common Problems
Not enough involvement in decisionsNot enough involvement in decisions
No one to talk to about anxieties and No one to talk to about anxieties and concernsconcerns
Tests/treatments not clearly explainedTests/treatments not clearly explained
Insufficient information for family/friendsInsufficient information for family/friends
Insufficient information about recoveryInsufficient information about recovery
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Patient Feedback Should Be Used to Patient Feedback Should Be Used to Stimulate ChangeStimulate Change
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Using Patient Surveys to Improve Using Patient Surveys to Improve Quality in a Swedish Hospital (1)Quality in a Swedish Hospital (1)
0
5
10
15
20
25
30
1997 2000
Longwait forbed
Observation of Observation of admission routine and admission routine and patient pathwayspatient pathways
Changed procedureChanged procedure
Waiting reducedWaiting reduced
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Using Patient Surveys to Improve Using Patient Surveys to Improve Quality in a Swedish Hospital (2)Quality in a Swedish Hospital (2)
02468
101214161820
1997 2000
Can'ttalk tonurse
Reorganised into Reorganised into smaller groupssmaller groups
Staff training in Staff training in communicationcommunication
Nurses involved when Nurses involved when doctors talked to doctors talked to patientspatients
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Using Patient Surveys to Improve Using Patient Surveys to Improve Quality in a Swedish Hospital (3)Quality in a Swedish Hospital (3)
0
2
4
6
8
10
12
14
16
1997 2000
Notenoughpainrelief
Action planAction plan
Specialist nurseSpecialist nurse
Staff training Staff training
Self-medicationSelf-medication
Regular surveys of Regular surveys of pain controlpain control
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SummarySummary
Measure experience, not satisfactionMeasure experience, not satisfaction
Survey results should be published and Survey results should be published and usedused
Patient feedback should drive quality Patient feedback should drive quality improvementsimprovements
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Health ExpectationsHealth ExpectationsAn international Journal of Public Participation in Health Care and Health PolicyAn international Journal of Public Participation in Health Care and Health Policy
Patient-centred care and quality Patient-centred care and quality improvementimprovement
Patients’ participation in treatment decisionsPatients’ participation in treatment decisions
Eliciting users’ views of health servicesEliciting users’ views of health services
Public perceptions of health servicesPublic perceptions of health services
Citizen involvement in health care policy Citizen involvement in health care policy makingmaking
Citizen involvement in priority-settingCitizen involvement in priority-setting
Methods for monitoring and evaluating Methods for monitoring and evaluating participationparticipation
Empowerment and consumerismEmpowerment and consumerism
Editor: Angela Coulter
Deputy Editor: Vikki Entwistle
www.BlackwellPublishing.com/Journals/HEX
Published Quarterly, Paper 1369-6513, Online 1369-7625
Papers are invited for publication – for more information and Guidelines for Authors visit
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