An evaluation of a near real-time survey for improving patients’ experiences of the relational aspects of care: a mixed-methods evaluation

Abstract

BackgroundThe Francis Report (of 2013) provided many recommendations to improve compassionate care in NHS organisations, including more widespread use of real-time feedback (RTF) to collect patient experience data. This research directly addressed these recommendations and aimed to provide an evidence-based toolkit to support NHS quality improvements.ObjectivesTo develop and validate a survey of compassionate care for use in near real time on elderly care wards and accident and emergency (A&E) departments. This research also evaluated the effectiveness of the RTF approach for improving relational aspects of care and provides suggestions for how the approach can be used by other hospitals to strengthen compassionate care.DesignThe research utilised a mixed-methods design, using quantitative, qualitative and participatory research approaches to collect patients’ experiences of relational care and the views of NHS staff in an effort to evaluate the processes and impacts of near real-time feedback (NRTF) data collection. Data sources included a NRTF patient experience survey, weekly volunteer diaries, staff interviews and surveys, workshops and meetings with case study sites.SettingThe research was carried out across six case study sites across England, in wards that predominantly serve elderly patients and in A&E departments.ParticipantsThe 3928 participants in the patient experience survey were inpatients on elderly care wards, or persons who had sought medical care in A&E. Frontline staff, service leads, senior management and volunteers also took part in surveys (n = 274) and interviews (n = 82) designed to understand the staff perspectives and opinions of collecting patient experience data.InterventionsA patient experience survey was implemented using a tablet computer-based methodology, facilitated by trained volunteers. Responses were used alongside feedback from staff to evaluate the use of a NRTF approach as a method for improving patient experiences of relational aspects of care.Main outcome measuresThe patient experience survey measured relational aspects of care. Another outcome measure was improvements to care as planned, implemented and reported by staff.ResultsA small but statistically significant improvement (p = 0.044) in relational aspects of care over the course of the study was noted overall. Staff implemented a variety of improvements to enhance communication with patients.LimitationsMaintaining volunteer and staff engagement throughout the study was difficult. Few surveys were completed per ward or department each week. This made examining trends in patient experiences over time challenging.ConclusionsNear real-time feedback offers an effective approach for monitoring and improving relational aspects of care.Future workStaff frequently expressed a view that volunteers’ interactions with patients while administering the survey were themselves beneficial to patients. Future research should examine the impact of volunteer interactions with patients on their experiences of relational aspects of care.Study registrationThe project is registered on the Clinical Research Network portfolio under the primary trial identification number 18449.FundingThe National Institute for Health Research Health Services and Delivery Research programme.