Understanding trends in NHS Inpatient survey data can support trusts to realise their potential
NHS trusts can make a difference to patients’ experience in hospital, but this potential has not always been realised. Their impact on patient experience over the history of the national inpatient survey has been positive but limited. The National Patient Survey Programme has been in existence since 2002 when the first national adult inpatient survey was run and is commonly thought of as the ‘flagship’ survey within the programme. To date this survey has collected over 900,000 responses from patients across England providing valuable insight to regulators, trusts, hospitals, researchers and data enthusiasts alike to drive forward improvements in the quality of care at both a national and local level. However, if we’re saying that NHS trusts can make a difference to patients’ experience then where do we find those differences and what does this mean for the future of service improvement?
In partnership with the King’s Fund, Picker has analysed inpatient survey data going back to 2005. We focused on the questions making up the NHSE Patient Experience Indicator, as these have been used consistently over the years.
Using sophisticated regression models, controlling for changes in the demography of inpatients, we looked at trust-level results and identified how these are reflected in national trends. In essence, we wanted to isolate the ‘real’ trends in the data and focus on what that meant in real terms: what changes have we seen and what does this mean for the future of patient experience?
National level change
At the national level, changes have been modest: usually just a few points out of 100. We found scores increased overall for 14 questions with the largest improvement centring on ward cleanliness. Should we be surprised by this? A major initiative to reduce hospital-acquired infections was launched nationally to try and address the spread of infections in hospitals. Whilst the positive impact of national initiatives such as these are impressive, and should be recognised, local level change is of equal importance in improving care, so how can these changes make a difference to people’s experiences?
Small local improvements can have big impact
Whilst there was some difficulty in seeing evidence of consistent change over time, we found examples of where staff had identified issues using the survey results and introduced targeted initiatives to improve their patients’ experience. Noise at night is a common complaint for patients. Trusts that had identified this as a problem put in place measures such as soft-closing doors and waste bins, offering patients’ ear plugs, and halting internal transfers at 8pm. One trust, in particular, worked hard at their values-based programme ‘building better relationships’ to reduce the incidence of ‘nurses talking on front of you as if you weren’t there’.
Encouraging best practice
So how can we learn from these local improvements and how do we encourage more trusts to adopt positive practices? One recommendation would be to remove the barriers to change at an organisational level. Staff we talked to cited pressures on resources and conflicting priorities, but also lack of clarity on who was responsible for action, scepticism among clinicians, and the existence of a ‘blame culture’. What can we do to change this? Strong leadership, trust-wide co-ordination, and staff engagement at all levels, are fundamental in getting an organisation talking about what needs improving and how to do it. Our research has shown that awareness of the patterns in the survey data, and not focusing exclusively on the latest benchmark report, can help put improvement planning on a firmer basis.
Good can always be better
Moreover, expectations concerning performance improvement need to be realistic; large changes and consistent increases are the exception, and the pattern of ‘significant’ differences for a trust can vary from year to year. Reacting to changes between one round of the survey and another can therefore be wasteful unless these are examined in the light of longer-term trends and local knowledge. There can also be a lag before the impact of an initiative can clearly be seen. But even in the high-performing trusts there is still scope to improve. Overall high ratings can mask pockets of poor experience, such as whether the few who need help in eating, actually get the help they need. In short, good care and experience can always be better. Taking a complacent attitude towards the standards delivered, is to stop learning and inviting new challenges. No matter how strong their performance, when a trust stops reviewing their survey data, learning from people’s experiences and trying to better their results, they risk slipping behind the curve, potentially leading to deteriorating patient experiences and care quality.
By Steve Sizmur and Caroline Killpack