Research & Policy

The study aims to explore patients’ and staff attitudes towards and priorities for the built environment in community health care facilities. It was a mixed methodology study (questionnaire surveys and focus groups) conducted in General Practices in Lambeth.

Picker undertook a research programme to investigate the information needs of patients with conditions that affect appearance. This report describes the findings of a qualitative study and review of previous research. It involved interviews with patients, health professionals and representatives of the voluntary sector. Thirteen focus groups and ten one-to-one interviews were conducted. The research has provided an insight into the information needs of these patients and the complexities of the information exchange between patients and clinicians.

This study was carried out to assess any effects that the health and social care Information Accreditation Scheme (“The Scheme”) might have on information production processes and the quality of information materials. Forty information producers participating in the testing phase of the Scheme completed an online survey, submitted information materials for assessment and took part in semi-structured telephone interviews to help evaluate the potential impact.

This survey report is the culmination of a three year research programme that has investigated the information needs and experiences of patients with conditions that cause disfigurement and visible loss of function. The survey aimed to capture the similarities and the differences of views and experiences, providing a voice for information needs that is seldom offered, and on behalf of conditions that are seldom heard.

This is the second of two research studies on patients’ information produced for the Department of Health. The first found that few health information materials included a clear presentation of the likely outcomes of treatment, a discussion of clinical controversies and uncertainties, or an understanding of the patient’s decision-making role. Thus, they did not go very far to help patients make decisions. This study examines how patients, service users and carers currently find out about locally available services and how to access them.

In September 2003, Picker began a three year research programme to investigate the information needs of patients with conditions that affect appearance, that is, they cause disfigurement and/or visible loss of function. The investigation was in three parts. The three parts of the research are reported separately. This paper provides an overview of the research programme, drawing out common themes, summarising key findings and presenting recommendations.

Picker undertook a research programme to investigate the information needs of patients with conditions that affect appearance. This report describes the findings of a qualitative study and review of previous research. It involved interviews with patients, health professionals and representatives of the voluntary sector. Thirteen focus groups and ten one-to-one interviews were conducted. The research has provided an insight into the information needs of these patients and the complexities of the information exchange between patients and clinicians.

A study was carried out to determine the current quality of health information and to assess the added value of accrediting information providers. The study consisted of four components: a) a review of research evidence on patients’ information needs and the effectiveness of providing health information; b) a web search, a survey of health information specialists, and a statistical review to estimate the number of organisations providing health information; c) a detailed assessment of 40 information materials; and d) a telephone survey of information providers to obtain information on the development process.

This report describes and evaluates the implementation of an innovative programme to help patients diagnosed with either early-stage localised prostate cancer or Benign Prostatic Hyperplasia (BPH) to reach ‘good quality’ decisions about their treatment in partnership with healthcare professionals. The programme was implemented in the urology departments of four NHS Hospital Trusts in England and was monitored and evaluated by researchers at Picker.

This report was commissioned by the Department of Health to assist them in developing ways of measuring people’s experiences of integrated care, and specifically to provide: An options appraisal to assess the feasibility and cost of a number of strategies for measuring people’s experience of integrated care; and recommendations on data sources that could be used to produce measures suitable for inclusion in the NHS and Adult Social Care Outcomes Frameworks.

The Department of Health commissioned Picker and the University of Oxford to develop new questions to measure people’s experiences of integrated care. The aim of the project was to provide recommendations for a limited set of new questions to be included in up to seven existing national surveys.

Picker was commissioned by NHS Improvement (formerly the Cancer Services Collaborative ‘Improvement Partnership’) and Macmillan Cancer Support to examine patient and carer views of health and social care services following treatment for cancer. The views gathered were examined to identify both commonality and difference of opinion. In addition the views of each group were separately examined to establish both areas of consensus and disagreement between the groups.

The aim of our study was to obtain the views of women with recent birth experiences about the safety of the maternity care they received, to inform the King’s Fund inquiry into the safety of maternity services in England. The key objectives of the study were: to provide an opportunity for women to identify their own areas of concern around safety, and possible solutions to these; and to explore in more detail the extent to which women are aware of and have concerns about factors related to safety (such as communication and quality of working relationships between staff).

The research aims to improve our understanding of how chronic pain is perceived and responded to in care homes in England by exploring the views and experiences of residents from nursing homes in different parts of the country. This is the first major UK investigation to examine directly and in detail the chronic pain experiences of care home residents.

Doctors working in intensive care units have to deal with critical clinical problems that require high level technical skills and knowledge, and their patients are often unconscious or otherwise incapacitated. In this high-pressured environment it is often difficult to assess individual patients’ wishes, but research on their views, together with those of their families and friends, can help us to determine these preferences.

NHS East Midlands commissioned Picker to design and deliver a shared decision-making project, funded by the Department of Health’s Pathfinder allocation to the Strategic Health Authority. The work aimed to:

• build on and contribute to the evidence base for understanding and supporting shared decision-making;    
• develop recommendations for advancing shared decision-making within local health services.       

Key themes were identified and explored in-depth in a series of focus groups. This report describes these themes and the recommendations derived from all elements of the project.

NHS East Midlands commissioned Picker to design and deliver a shared decision-making project, funded by the Department of Health’s Pathfinder allocation to the Strategic Health Authority.

The work aimed to:

• build on and contribute to the evidence base for understanding and supporting shared decision-making;  
• develop recommendations for advancing shared decision-making within local health services.

Key themes were identified and explored in-depth in a series of focus groups. This report describes these themes and the recommendations derived from all elements of the project.

This report represents the findings of a study exploring patients’ engagement in their general practice consultations, and their involvement in the development of general practice services. The study has been undertaken as part of the Inquiry into the quality of general practice in England commissioned by The King’s Fund, which has aimed to examine and collect evidence on the quality of care and services provided by general practices in England (King’s Fund 2009).

This report describes a survey of 237 patients on the abdominal aortic aneurysm (AAA) screening programmes at two English acute hospital trusts. The survey was used to assess whether patients expressed any preference between the two surgical treatment options: endovascular aneurysm repair and open aneurysm repair. The patients were all male, aged 65 years or over and with an asymptomatic aortic aneurysm of between 4.0 and 5.5cm in diameter.

Engaging patients in their healthcare and encouraging people to take responsibility for protecting their health are seen as the best way to ensure the sustainability of health systems. We analysed data from the Commonwealth Fund’s international health policy surveys carried out in 2004 and 2005 to examine the extent to which health professionals support patients to play an active role in their healthcare.

A high-quality healthcare system is one that puts patients at the centre of the treatment process. Informed, active patients are one half of the partnership approach that underpins effective healthcare. So how comfortable are patients in discussing their care with professionals? What do they understand about their conditions, and the options open to them? How confident are they in managing a chronic condition, monitoring their symptoms, and handling changes and setbacks?

London Patient Choice (LPC) offered patients facing a wait of more than eight months for elective surgery the option of going to an alternative London provider that could offer faster treatment. This study, part of a wider evaluation of LPC, focused on patients’ experience of the scheme.

Many patients expect to play an active role in managing their own health care. A growing body of evidence shows that people who are actively involved in protecting their health and managing their healthcare have better health outcomes. In order to be fully engaged, patients require help from clinicians who recognise and actively support their contribution and are willing to work with them as healthcare partners. However, evidence from patient surveys suggests that appropriate support from clinicians is not always forthcoming. This study looked at the extent to which doctors are being trained to work in partnership with patients and explored gaps in both evidence and practice.

Always at the forefront of the patient experience and person-centred care conversation, Picker today issue the attached response to the Department of Health’s Consultation on the NHS Outcomes Framework.

Patients can play a distinct role in protecting their health, choosing appropriate treatments for episodes of ill health and managing chronic disease. Considerable evidence suggests that patient engagement can improve their experience and satisfaction and also can be effective clinically and economically. This policy brief outlines what the research evidence tells us about the effects of engaging patients in their clinical care, and it reviews policy interventions that have been (or could be) implemented in different health care systems across Europe.

NHS North West commissioned Picker to provide some input from staff and patients to inform their deliberations in response to ‘Our NHS our future’ (the ‘Darzi’ review). Picker ran twelve focus groups with patients, staff and the public throughout the region exploring their experience and understanding of the NHS. They were asked their views, why they think the way they do and where they got their information from. They were also asked to form a view as to priorities for development of the NHS in the near future.

This report provides a rapid review of the National Cancer Patient Experience Survey (NCPES) in England. It was produced by Picker in consultation with the national Cancer Patient Experience Advisory Group (CPEAG), and several other stakeholder representatives.

This review sought to understand how well the survey meets stakeholder needs, and to make recommendations for improvements to the current survey design, methodology, and reporting.

Overall, the review found that the survey is generally fit for current purpose. Stakeholders appreciated the high response rate; large scale; standardised approach; and access to the data. A national programme was thought to be preferable to regional and local arrangements. Whilst stakeholders supported the NCPES, they offered several suggestions for improvement.

This report uncovers the associations between NHS staff and patients’ experiences in hospitals and NHS trusts’ reliance on agency healthcare workers.

The analysis is the first of its kind to be published in the UK. It considers the relationships between the self-reported experiences and wellbeing of NHS staff, measures of workforce pressures in the health system, and patients’ experiences of their care.

The report reveals that there are relationships between staff wellbeing, patient experiences of their care, and the proportion of money NHS trusts spend on agency workers. In trusts where agency spend was higher as a proportion of overall pay, both staff wellbeing and patient experience were typically lower.

The demand for urgent and emergency care (U&EC) services continues to grow. For many patients and care providers, the system is complex and difficult to navigate, meaning that many fail to access the most appropriate service for their specific need.

To respond to the immense pressure on U&EC services, Healthy London Partnership (HLP) have worked with NHS 111 providers and Clinical Commissioning Groups (CCGs) to rapidly implement programmes across London, namely the London Winter Pilots, which aim to expand the capabilities of NHS 111.

To understand how these pilots are functioning, HLP commissioned Picker to gather feedback from staff on three pilots being implemented in London.

The first longitudinal study of patient experience by trust, Patients’ experience of using hospital services, finds that while overall there have been small improvements in patient experience reported between 2005 and 2013, the results show 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, 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.

You can download a full summary of the report here

This report presents findings from a new NHS 111 Patient Reported Experience Measure (PREM) for parents. The aim was to understand parents and carers’ overall experience of using NHS 111, as well as to investigate under what circumstances parents opt to use this service, what factors may influence parents’ decision to follow the advice given by NHS 111, and to explore whether the most appropriate care pathway is followed.  Feedback was gathered from 1000 parents who used the service in North West London. The current project forms part of a number of initiatives undertaken by the Royal College of Paediatrics and Child Health (RCPCH) to understand and improve the care pathway of children moving to primary and/or secondary care, with NHS 111 as the particular entry point.

Listening to the experiences of parents and carers can and should assist service-providers with improving their services for those who use them and to ultimately ensure the service functions effectively.

The NHS Friends and Family Test (FFT) is used across a range of services to collect feedback from adult patients and service users. From April 2015, providers will also be required to offer the FFT to children and young people. Ahead of this change, Picker and Barts Health NHS Trust explored children’s views of the FFT question to recommend a version that is suitable for a younger patient population. This report details the findings from focus groups, ward interviews, cognitive testing and a pilot study, and presents the recommended FFT question for children and young people, based on children’s preferences.

This report presents the results of the Neonatal Survey 2014, to understand the experience of parents whose baby received care in a neonatal unit, including local neonatal units, special care baby units, and neonatal intensive care units. The survey was carried out by Picker in collaboration with Bliss (the charity “for babies born too soon, too small, too sick”) and NHS England who kindly part-funded the survey. 88 neonatal units from 72 NHS trusts and across 13 neonatal networks participated in the survey and the results aim to assist units in understanding where they are doing well and what could be improved. A total of 6000 parents responded to the survey, with an overall response rate of 37.6%. The report contains overall results as well as breakdowns by network and unit type.

The ‘new models for measuring patient experience’ project was funded by the Department of Health’s Policy Research Programme and was jointly led by Picker and University of Oxford. The work aimed to:

• Develop a simple, conceptually grounded and unified model for assessing patient experience and to evaluate that model.
• Evaluate whether and how pathway and service line focused assessments of patients’ experiences provide added value to standard organisational surveys.

The findings provide evidence of the factors which influence the success of patient experience initiatives in NHS organisations. The implications for health policy and practice are presented.

Picker were contracted by Macmillan Cancer Support to investigate the relationship between the results for the Cancer Patient Experience Survey (CPES) and the NHS Staff Survey.

Comparing trusts with one another can be useful for performance monitoring and quality improvement. Three different scoring approaches were examined to determine how reliably they differentiated between trusts’ aggregated patient experience results.

This study aims to examine the association with differential patient survey responses of individual and trust level variables and identify any regional level differences in reported patient experience.

This report presents the findings of a discourse analysis of the patient voice in published documents on medical revalidation. It has been prepared in collaboration with Marion Lynch to inform the work of the South Central Strategic Health Authority Revalidation Board. The aim of the study was to analyse documents in the public domain to determine where and how the patient is located within discourses about medical revalidation.

The first national survey of parents’ experiences of neonatal care was carried out in 2010-11 with 125 neonatal units, including special care baby units, local neonatal units and neonatal intensive care units (see Appendix 2 for a list of participating units). The survey was carried out by 19 neonatal networks and was championed by Bliss, the special care baby charity, and also supported by the Department of Health.  Picker developed and co-ordinated the survey in conjunction with Bliss and neonatal network representatives.

A discussion paper designed to stimulate debate and support practical action to improve the experience of outpatients in NHS trusts in England. The key issues examined are; which aspects of outpatients’ experience of care and treatment relate most strongly to satisfaction with services; can these be grouped into ‘core domains’ of experience; and which domains should be prioritised for quality improvement.

National indicators and survey questions are available for many care settings and patient conditions. But ‘patient experience’ can cover a very wide range of aspects of the organisation and delivery of patient care. This leaves those who are responsible for establishing local measures facing many questions. The purpose of this discussion paper is to help the NHS to answer those queries. It specifically addresses the care and treatment of acute hospital inpatients, although we would argue it has wider relevance to other patient groups.

This report presents the findings of a patient experience survey conducted as part of the evaluation of the National Cancer Survivorship Initiative (NCSI) test community projects. It describes the baseline survey conducted during July – October 2009 and presents the results of analysis of 1284 questionnaires completed by patients receiving care at seventeen test community projects.

The purpose of the Patient-Centred Professionalism project was “to define patient-centred professionalism in medicine, and to help embed the essential principles in the culture of the medical profession so that in due course these will be reflected in the practice of every doctor and in the institutional arrangements for medical education and regulation.” It was a three-year research and development programme designed to improve patient care by enhancing understanding of the patient’s perspective on doctors and medical care. The aim was to ensure that medical practice standards, education and regulation are truly patient-centred.

North London Cancer Network commissioned Picker to carry out a survey of cancer patients to gain feedback on the quality of service provided. The survey was conducted in October 2008 – January 2009, using a postal questionnaire. A total of 1,390 patients returned a questionnaire. The response rate from ‘eligible’ patients was 51%.

During the late part of 2007, as part of the development of the National Service Framework (NSF) Picker undertook research with Chronic Obstructive Pulmonary Disease (COPD) patients (and their carers) across England on behalf of the Department of Health. Picker staff used a mixture of focus group and individual interview techniques to gather evidence from September to December 2007; what appears below is a synopsis of that data.

The research sought to explore the views of members of the public on the value to patients of the revised version of Good Medical Practice, the General Medical Council’s ethical guidance to doctors on the standards of behaviour expected of them. The study was a qualitative investigation involving six focus groups drawn from a cross section of the population in 3 different areas of the country. A total of forty-six participants were recruited.

This paper provides an overview of the evidence base for key recommendations made by the Patient Experience Working Group: Providing information at key points along the care pathway; Offering patients a choice of treatment and care packages; Providing support for self-care and self-management; Obtaining systematic feedback from patients by means of surveys; Involving service users in decisions about reconfiguration and service development.

Picker has available a great deal of expertise in conducting and analysing patient experience surveys. As part of the research being carried out for the National Association for Patient Participation it was agreed to perform some secondary analysis on the data collected for the Healthcare Commission’s Primary Care patient’s survey. The aim was to explore whether there were significant differences in the experience of patients from different ethnic groups.

This paper examines professional codes of medical bodies which perform the de facto regulatory functions of certification or licensure in the UK, USA and Canada. The choice of these three developed countries with long-established healthcare systems allowed us to focus on a particular set of commonalities and differences. Our aim was first to assess how patient-centred the codes are, and whether some are more patient-focused than others and can therefore serve as models of good practice.

The need has never been greater for rigorous assessment of individual doctors’ performance against clearly defined standards. Many of the core qualities of a doctor’s performance are best judged by patients, and using questionnaires to gather patient feedback can be an effective approach to assessment which presents a low burden to doctors and patients. This paper reviews a selection of questionnaires designed to gather feedback from patients on individual doctors.

This research identifies eight aspects of healthcare that patients consider most important: Fast access to reliable health advice; Effective treatment delivered by trusted professionals; Involvement in decisions and respect for preferences; Clear, comprehensible information and support for self-care; Attention to physical and environmental needs; Emotional support, empathy and respect; Involvement of, and support for, family and carers; and continuity of care and smooth transitions.

Since 1998 Picker has been involved in running the national patient survey programme for the NHS in England, developing the survey methodology and questionnaires, implementing the surveys and analysing the results. This report draws together key findings from 15 national (England only) patient surveys carried out between 1998 and 2005. The individual surveys were commissioned and published by the Department of Health, the Commission for Health Improvement, the Healthcare Commission and the National Audit Office.