Measuring patients’ experiences and outcomes
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2495 (Published 02 July 2009) Cite this as: BMJ 2009;339:b2495
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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
Competing interests: No competing interests
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
Competing interests: No competing interests
A bank robbing approach to improving quality by unlocking patients views
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
Competing interests: No competing interests