Using patients’ experiences to identify priorities for quality improvement in breast cancer care: patient narratives, surveys or both?

Vicki Tsianakas,Alison Richardson,Jill Maben,Theresa Wiseman,Glenn Robert,Peter Madden,Mairead Griffin,Elizabeth A Davies

doi:10.1186/1472-6963-12-271

Abstract

BackgroundPatients’ experiences have become central to assessing the performance of healthcare systems worldwide and are increasingly being used to inform quality improvement processes. This paper explores the relative value of surveys and detailed patient narratives in identifying priorities for improving breast cancer services as part of a quality improvement process.MethodsOne dataset was collected using a narrative interview approach, (n = 13) and the other using a postal survey (n = 82). Datasets were analyzed separately and then compared to determine whether similar priorities for improving patient experiences were identified.ResultsThere were both similarities and differences in the improvement priorities arising from each approach. Day surgery was specifically identified as a priority in the narrative dataset but included in the survey recommendations only as part of a broader priority around improving inpatient experience. Both datasets identified appointment systems, patients spending enough time with staff, information about treatment and side effects and more information at the end of treatment as priorities. The specific priorities identified by the narrative interviews commonly related to ‘relational’ aspects of patient experience. Those identified by the survey typically related to more ‘functional’ aspects and were not always sufficiently detailed to identify specific improvement actions.ConclusionsOur analysis suggests that whilst local survey data may act as a screening tool to identify potential problems within the breast cancer service, they do not always provide sufficient detail of what to do to improve that service. These findings may have wider applicability in other services. We recommend using an initial preliminary survey, with better use of survey open comments, followed by an in-depth qualitative analysis to help deliver improvements to relational and functional aspects of patient experience.

Highlights

Patients’ experiences have become central to assessing the performance of healthcare systems worldwide and are increasingly being used to inform quality improvement processes
The relative value of assessing patient experience using quantitative and qualitative methods remains the subject of ongoing debate
Results we compare (a) qualitative themes (‘touchpoints’ that arose from the EBCD patient narratives) and (b) key findings from the survey in the same areas

Summary

Introduction

Patients’ experiences have become central to assessing the performance of healthcare systems worldwide and are increasingly being used to inform quality improvement processes. Patients’ experiences have become increasingly central to assessing the performance of healthcare systems worldwide [1]. It is common to judge quality of care by measuring clinical quality and safety and by gathering the views of patients [2,3,4] These can be used as part of systems for developing policy, monitoring. The most commonly used patient experience surveys in the US and English health care systems [12,13] have been developed using data from interviews and focus groups with patients and staff and aim to measure how specific aspects of care were experienced by patients. Many surveys focusing on experience are still commonly referred to as “satisfaction surveys” and users of survey data do not always distinguish sufficiently clearly between these two concepts [13,14,15]

Methods

Results

Discussion

Conclusion