Feature
New measures to improve patients’ experiences of care Liz Avital and colleagues outline the latest guidance and clinical standard published by the National Institute for Health and Clinical Excellence Correspondence [email protected] Liz Avital is an associate director of the National Clinical Guideline Centre, Royal College of Physicians Melanie Gager is follow-up sister in critical care, Royal Berkshire Hospital Foundation Trust Annette Gibb is nurse consultant in pain management, Royal Berkshire Hospital Foundation Trust Date of acceptance February 22 2012 Author guidelines www.nursingmanagement.co.uk
Abstract This article outlines a new guidance and quality standard for patient experience. It focuses on the generic patient experience and is aimed at all clinical and non-clinical staff providing services for adults in NHS settings. The guidance focuses on improving the patient experience and has been developed by the National Clinical Guideline Centre as part of a National Institute for Health and Clinical Excellencecommissioned portfolio of work. To support this aim, it includes quality statements that provide benchmarks against which staff can measure the care they deliver. Keywords Guidance, NICE, patient experience, quality standard, adult, patient focus The Patient experience depends on a combination of components, such as the services provided, the individual healthcare professionals involved and factors that are unique to each patient. While service developments continually strive to improve patient care, the range of factors involved means the patient experience still varies widely. The experiences of patients are being used to determine the shape of healthcare delivery and to inform commissioning decisions, so the effects of positive or negative care experiences should not be underestimated. This newly published guidance and quality standard from the National Institute for Health and Clinical Excellence (NICE 2012) focuses on generic patient experience and is based on the best available evidence. It applies to patients using adult NHS services, including primary and community care, and hospital inpatient and outpatient care.
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For mental health service users, NICE (2011) has developed a separate guidance. The latest guidance is intended for all staff involved in providing services in the NHS. While most patient contact is with clinical staff, they will also come into contact with non-clinical staff, who will also have an effect on their experience of care. The latest guidance centres on five themes which focus on issues that patients see as important: ■■ Knowing the patient as an individual. ■■ Essential requirements of care. ■■ Tailoring healthcare services for patients. ■■ Continuity of care and relationships. ■■ Enabling patients to participate in their care. This is not an exhaustive list, so some aspects of the patient experience are not covered. For example, it does not include issues relating to the physical environment in which care is delivered and issues regarding patient safety. Patient needs beyond those mentioned in the new guidance may be covered in either existing NICE documents or in appropriate quality standards that are in development. The guidance does, however, meet points embodied in the NHS constitution, with emphasis on formulating a baseline against which improvements in patient experience can be routinely measured.
Evidence From the start, the aim of the guidance has been to offer direction on how to bring about the cultural shift required to produce effective, acceptable and appropriate patient care. This change in approach is about refocusing the attention of those delivering NHS services on the themes identified as important by patients. The guidance provides the evidence and expert consensus base needed to inform commissioning NURSING MANAGEMENT
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Feature Box 1 National Institute for Health and Clinical Excellence quality statements 1. Patients are treated with dignity, kindness, compassion, courtesy, respect, understanding and honesty. 2. Patients experience effective interactions with staff who have demonstrated competency in relevant communication skills. 3. Patients are introduced to all healthcare professionals involved in their care, and are made aware of the roles and responsibilities of the members of the healthcare team. 4. Patients have opportunities to discuss their health beliefs, concerns and preferences to inform their individualised care. 5. Patients are supported by healthcare professionals to understand relevant treatment options, including benefits, risks and potential consequences.
6. Patients are actively involved in shared decision making and are supported by healthcare professionals to make fully informed choices about investigations, treatment and care that reflect what is important to them. 7. Patients are made aware that they have the right to choose, accept or decline treatment and these decisions are respected and supported. 8. Patients are made aware that they can ask for a second opinion. 9. Patients experience care that is tailored to their needs and personal preferences, taking into account their circumstances, their ability to access services and their coexisting conditions. 10. Patients have their physical and psychological needs regularly assessed and addressed, including nutrition,
hydration, pain relief, personal hygiene and anxiety. 11. Patients experience continuity of care delivered, whenever possible, by the same healthcare professional or team throughout a single episode of care. 12. Patients experience co-ordinated care with clear and accurate information exchange between relevant health and social care professionals. 13. Patients’ preferences for sharing information with their partner, family members and/or carers are established, respected and reviewed throughout their care. 14. Patients are made aware of who to contact, how to contact them and when to make contact about their ongoing healthcare needs.
(National Institute for Health and Clinical Excellence 2012)
and the behaviours of healthcare providers to create sustainable change that meets this challenge. It is accompanied by a quality standard that sets specific, concise statements and associated measures that outline the level of service people using the NHS should expect to receive. These quality statements are aspirational, but achievable; each can dovetail with existing ways of working underpinned by professional codes of conduct. Many of the recommendations of the guidance concur with those set out in policy documents and codes of professional organisations. Their distillation into a quality standard will allow the NHS to he held to account for the delivery of thee key areas for patient experience. The five central themes include 68 recommendations. This advice has been further condensed into 14 quality statements (NICE 2012), which are included in the guidance (Box 1). The statements set out in the quality standard aim to improve the patient experience for people using adult NHS services and highlight what makes a good patient experience. The descriptive patient-focused quality statements aimed at service providers, healthcare professionals, commissioners and patients to help each group identify how the statements apply to them. Each quality statement is accompanied by quality measures to improve the structure, process and outcomes of health care. NURSING MANAGEMENT
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Conclusion The power in the guidance and quality standard lies in its authenticity, because it has been developed by patients and professionals. The quality statements provide high level indicators against which to measure care to ensure a good patient experience. Where national quality indicators do not exist, the quality measures should form the basis for audit criteria developed and used locally to improve health and social care. Implementation of these recommendations will ensure that healthcare services are acceptable and appropriate, and that all people using the NHS have the best possible experience of care.
References National Institute for Health and Clinical Excellence (2011) Service User Experience in Adult Mental Health: Improving the Experience of Care for People Using Adult NHS Mental Health Services. NICE Clinical Guideline 136. www.nice.org.uk/cg136 (Last accessed: March 1 2012.) National Institute for Health and Clinical Excellence (2012) Patient Experience in Adult NHS Services: Improving the Experience of Care for People Using Adult Nhs Services. NICE Clinical Guideline 138. www.nice.org.uk/cg138 (Last accessed: March 1 2012.)
Find out more For more information, go to: ■■ Guidance, http://guidance.nice.org.uk/CG138 ■■ Quality standards, http://tinyurl.com/6m4vynb
Online archive For related information, visit our online archive of more than 6,000 articles and search using the keywords Conflict of interest The authors were members of the guidance and quality standard development group. None of them declared any conflict of interest during the development of the guidance and quality standard
April 2012 | Volume 19 | Number 1 23
23/03/2012 16:33
New measures to improve patients’ experiences of care Liz Avital and colleagues outline the latest guidance and clinical standard published by the National Institute for Health and Clinical Excellence Correspondence [email protected] Liz Avital is an associate director of the National Clinical Guideline Centre, Royal College of Physicians Melanie Gager is follow-up sister in critical care, Royal Berkshire Hospital Foundation Trust Annette Gibb is nurse consultant in pain management, Royal Berkshire Hospital Foundation Trust Date of acceptance February 22 2012 Author guidelines www.nursingmanagement.co.uk
Abstract This article outlines a new guidance and quality standard for patient experience. It focuses on the generic patient experience and is aimed at all clinical and non-clinical staff providing services for adults in NHS settings. The guidance focuses on improving the patient experience and has been developed by the National Clinical Guideline Centre as part of a National Institute for Health and Clinical Excellencecommissioned portfolio of work. To support this aim, it includes quality statements that provide benchmarks against which staff can measure the care they deliver. Keywords Guidance, NICE, patient experience, quality standard, adult, patient focus The Patient experience depends on a combination of components, such as the services provided, the individual healthcare professionals involved and factors that are unique to each patient. While service developments continually strive to improve patient care, the range of factors involved means the patient experience still varies widely. The experiences of patients are being used to determine the shape of healthcare delivery and to inform commissioning decisions, so the effects of positive or negative care experiences should not be underestimated. This newly published guidance and quality standard from the National Institute for Health and Clinical Excellence (NICE 2012) focuses on generic patient experience and is based on the best available evidence. It applies to patients using adult NHS services, including primary and community care, and hospital inpatient and outpatient care.
22 April 2012 | Volume 19| Number 1
NM April 2012 22-23NEW.indd 22
For mental health service users, NICE (2011) has developed a separate guidance. The latest guidance is intended for all staff involved in providing services in the NHS. While most patient contact is with clinical staff, they will also come into contact with non-clinical staff, who will also have an effect on their experience of care. The latest guidance centres on five themes which focus on issues that patients see as important: ■■ Knowing the patient as an individual. ■■ Essential requirements of care. ■■ Tailoring healthcare services for patients. ■■ Continuity of care and relationships. ■■ Enabling patients to participate in their care. This is not an exhaustive list, so some aspects of the patient experience are not covered. For example, it does not include issues relating to the physical environment in which care is delivered and issues regarding patient safety. Patient needs beyond those mentioned in the new guidance may be covered in either existing NICE documents or in appropriate quality standards that are in development. The guidance does, however, meet points embodied in the NHS constitution, with emphasis on formulating a baseline against which improvements in patient experience can be routinely measured.
Evidence From the start, the aim of the guidance has been to offer direction on how to bring about the cultural shift required to produce effective, acceptable and appropriate patient care. This change in approach is about refocusing the attention of those delivering NHS services on the themes identified as important by patients. The guidance provides the evidence and expert consensus base needed to inform commissioning NURSING MANAGEMENT
23/03/2012 16:33
Feature Box 1 National Institute for Health and Clinical Excellence quality statements 1. Patients are treated with dignity, kindness, compassion, courtesy, respect, understanding and honesty. 2. Patients experience effective interactions with staff who have demonstrated competency in relevant communication skills. 3. Patients are introduced to all healthcare professionals involved in their care, and are made aware of the roles and responsibilities of the members of the healthcare team. 4. Patients have opportunities to discuss their health beliefs, concerns and preferences to inform their individualised care. 5. Patients are supported by healthcare professionals to understand relevant treatment options, including benefits, risks and potential consequences.
6. Patients are actively involved in shared decision making and are supported by healthcare professionals to make fully informed choices about investigations, treatment and care that reflect what is important to them. 7. Patients are made aware that they have the right to choose, accept or decline treatment and these decisions are respected and supported. 8. Patients are made aware that they can ask for a second opinion. 9. Patients experience care that is tailored to their needs and personal preferences, taking into account their circumstances, their ability to access services and their coexisting conditions. 10. Patients have their physical and psychological needs regularly assessed and addressed, including nutrition,
hydration, pain relief, personal hygiene and anxiety. 11. Patients experience continuity of care delivered, whenever possible, by the same healthcare professional or team throughout a single episode of care. 12. Patients experience co-ordinated care with clear and accurate information exchange between relevant health and social care professionals. 13. Patients’ preferences for sharing information with their partner, family members and/or carers are established, respected and reviewed throughout their care. 14. Patients are made aware of who to contact, how to contact them and when to make contact about their ongoing healthcare needs.
(National Institute for Health and Clinical Excellence 2012)
and the behaviours of healthcare providers to create sustainable change that meets this challenge. It is accompanied by a quality standard that sets specific, concise statements and associated measures that outline the level of service people using the NHS should expect to receive. These quality statements are aspirational, but achievable; each can dovetail with existing ways of working underpinned by professional codes of conduct. Many of the recommendations of the guidance concur with those set out in policy documents and codes of professional organisations. Their distillation into a quality standard will allow the NHS to he held to account for the delivery of thee key areas for patient experience. The five central themes include 68 recommendations. This advice has been further condensed into 14 quality statements (NICE 2012), which are included in the guidance (Box 1). The statements set out in the quality standard aim to improve the patient experience for people using adult NHS services and highlight what makes a good patient experience. The descriptive patient-focused quality statements aimed at service providers, healthcare professionals, commissioners and patients to help each group identify how the statements apply to them. Each quality statement is accompanied by quality measures to improve the structure, process and outcomes of health care. NURSING MANAGEMENT
NM April 2012 22-23NEW.indd 23
Conclusion The power in the guidance and quality standard lies in its authenticity, because it has been developed by patients and professionals. The quality statements provide high level indicators against which to measure care to ensure a good patient experience. Where national quality indicators do not exist, the quality measures should form the basis for audit criteria developed and used locally to improve health and social care. Implementation of these recommendations will ensure that healthcare services are acceptable and appropriate, and that all people using the NHS have the best possible experience of care.
References National Institute for Health and Clinical Excellence (2011) Service User Experience in Adult Mental Health: Improving the Experience of Care for People Using Adult NHS Mental Health Services. NICE Clinical Guideline 136. www.nice.org.uk/cg136 (Last accessed: March 1 2012.) National Institute for Health and Clinical Excellence (2012) Patient Experience in Adult NHS Services: Improving the Experience of Care for People Using Adult Nhs Services. NICE Clinical Guideline 138. www.nice.org.uk/cg138 (Last accessed: March 1 2012.)
Find out more For more information, go to: ■■ Guidance, http://guidance.nice.org.uk/CG138 ■■ Quality standards, http://tinyurl.com/6m4vynb
Online archive For related information, visit our online archive of more than 6,000 articles and search using the keywords Conflict of interest The authors were members of the guidance and quality standard development group. None of them declared any conflict of interest during the development of the guidance and quality standard
April 2012 | Volume 19 | Number 1 23
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