Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Using PROMs to enhance health outcomes
- Jean-Jacques de Gorter (24 July 2009)
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Patient orientated care
- Mr Amir Nisar (26 July 2009)
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A bank robbing approach to improving quality by unlocking patients views
- Terry Kemple (29 July 2009)
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Jean-Jacques de Gorter, Director of Clinical Services 120 Holborn, London
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Dear Sir, I read with slight bemusement Nick Black and Crispin Jenkinson's assertion that 'until recently, patient reported outcome measures have been used only in research'. The Spire group of 36 hospitals, including the ex-Classics and ex-Bupa hospitals, have operated a PROMs programme for the past 12 years, with a large and growing database of results for many procedures and techniques. Our hospitals access their own PROMs reports on a quarterly basis, with results discussed at local clinical governance committees and reported via Spire's national clinical scorecard. We use PROMS results to identify and learn from hospitals which may be delivering care in a way that results in higher post operative health status, whether as a result of preparation, technique or follow up arrangements. Hospitals use PROMs as a means of introducing new services in a safe and responsible manner, as well as making results available to consultants to enable clinical governance. We have also published our results for hip arthroplasty, knee arthroplasty, hysterectomy, cataract surgery, hernia repair and cholecystectomy online since 2006 - before the advent of NHS Choices, World Class Commissioning and Lord Darzi's Next Stage Review. Our experience of using PROMs in a practical, rather than an academic, manner in a clinical setting over many years, was the principal reason for the invitation in 2006 by the London School of Hygiene and Tropical Medicine to contribute to their invstigations that eventually resulted in the introduction of PROMs into the NHS in April, twelve years after the launch of our own PROMs programme. Competing interests: Director of Clinical Services for Spire Healthcare |
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Mr Amir Nisar, Consultant General and Laparoscopic Surgeon Maidstone Hospital, Kent, England
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I congratulate the authors on bringing this important and so often neglected issue to attention. The only reason why we all are at the hospital is because of our patients. Still its not uncommon to see our patients feeling unhappy with the care that they get in the hospital. There is no reason why we can not offer our patients five star treatment that they rightly deserve. We will need to invest more in our system to get this to the level that are consistently achieved in the other European countries. I have a suggestion that this article or the patient questionairre should be included in the induction pack of all the doctors so that we can get a regular reminder about the importance of patient's feelings and satisfaction. In addition the hospital results should be easily accessible as well. Competing interests: None declared |
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Terry Kemple, General Medical Practitioner Horfield Health Centre, Lockleaze Road, Horfield, Bristol BS7 9RR
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Willie Sutton was asked why he robbed banks "Because that's where the money is." Channelling patients’ experiences of care through validated well designed surveys that assess patient reported outcomes either in clinical trials or after specific clinical interventions seems an exercise of important but limited benefit. It’s a bit like moving the information from a bank vault to an armoured vehicle. If we want to ‘use the money on the street today’ we have to overcome the bigger problem: the barrier between what patients experience (and could report) and the ability of their health care staff to elicit those reports and act upon them to improve quality of care. The patients have the information about their care, but because most don’t like to complain they keep it locked up. Health care staff could ask for, listen to, understand and act upon patients’ feedback on a daily basis but most don’t know how to do it. The quickest, cheapest, most direct route to quality improvement of the structure process and outcomes of care is to use the feedback from patients as they experience their care. Perhaps we need ‘Willie Suttons’ – volunteer or employed patient feedback advocates who can ask patients about their care as they experience it and facilitate use of this feedback to improve quality of care. Apart from robbing banks Willie Sutton enjoyed a reputation as both a polite and innovative man. Competing interests: None declared |
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