By what they measure, so shall you know them…

It’s very hard for any large organisation to change something which it doesn’t routinely monitor.  And that usually means reliable, valid data, taken seriously. 

Can we therefore answer the following questions about NHS Wales: 

  • How good is the ‘average’ patient experience?
  • How common are neglect and disrespect?
  • Which are the best and worst services, in terms of what patients’ experience?
  • Is the patient’s experience getting better?

 I don’t think we can.  Parts of the service can, because they do routinely ask a representative sample of their patients some intelligent questions about what they’ve just experienced.  But most don’t.  And we certainly have no overall picture. 

Why is this?  Is it too hard?  It certainly does take some staff time and expert resource, and there have been many poor examples of patient surveys… but the good practice shows it can be done. 

So is it because it doesn’t matter? Or it matters less than the other things we do measure?  Those are rhetorical questions. 

The Welsh Government’s commitment to ‘absolute transparency on performance’ is an excellent token of intent.  What will the NHS need to do to be absolutely transparent on its performance in this crucial area – the care patients’ experience? 

It will need to avoid the obvious pitfalls.  For example, it can be difficult to get full answers from patients on some of these issues because of their gratitude for having been treated at all, low expectations, a wish to ‘move on’, poor questioning, or even a concern that if you’re critical you’ll be made to suffer. 

Let me offer four simple steps for 2012 to make performance on the patient experience absolutely transparent: 

  1. Gather common data routinely right across Wales, from a representative sample of patients, using intelligent questions, immediately after their episode of care is over.  Properly validated telephone or postal surveys are two obvious ways to do this
  2. Include measures of both process and outcome in the questions
  3. Agree some smart performance indicators, so we know what ‘good enough’ is, and where we’re going
  4. Publish the results each year.

 That would make the year 2012 something of a watershed for NHS Wales.

 Written by Professor Marcus Longley, Director and Professor of Applied Health Policy

A PowerPoint presentation, which includes material on the subject of this blog, is available in our Resources section.  The presentation was given to the Assembly’s Health and Social Care Committee on 24 November 2011.

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