Introduction at length in a recent Kings Fund publication
3
‘Seeing the Person in the Patient:
Involving patients in service improvement in radiology is a challenge and one the point of care review paper’. This paper looks at the experiences of patients in Only patients
which hard-pressed services readily duck. Yet, without patient involvement, hospitals but much of its discussion is relevant to all patient care. An interesting
service improvement initiatives might well deliver improved performance statistics part of the discussion is an analysis of factors which shape patients’ experiences in can say what
but be much less likely to deliver improved quality of care. Improved performance hospital. The authors distinguish and discuss four levels at which healthcare affects
without improved quality of care is a recipe for a lean and uncertain financial the patient: needs to be
future in the post-Darzi world.
individual interaction between patient and staff member; done to make
Lord Darzi’s final report of the National Health Service (NHS) Next Stage Review the clinical micro-system (eg department, ward or clinical pathway);
emphasised quality of patient care and linked payment
1
specifically to improved the institution; service delivery
quality of care: “we will make payments to hospitals conditional on the quality of the wider healthcare system.
care given to patients as well as the volume.” more caring
The report claims that patients are the meeting point, and the only meeting point,
In another paragraph, the report spells out its understanding of quality of care: of all four levels. These four levels can be paralleled in any radiology or oncology
“Quality of care includes quality of caring. This means how personal care is – the department. As with the hospital setting, patients are at the intersection of these
compassion, dignity and respect with which patients are treated. It can only be levels, and only the patient can say whether or not they work together. To discover
improved by analysing and understanding patient satisfaction with their own how the factors which affect patient experience interact, and to improve the
experiences.” interaction, it is necessary to involve the patient.
The emphasis on personal care, measured by patient satisfaction with experience, A third reason for involving patients in service improvement is that only patients
is now familiar in healthcare. Less familiar is the introduction of the quality of know if their interaction with the service has produced any benefit for them.
caring, and it is this extension which points to the necessity of patient involvement Clinicians can tell an imaging department if reports were helpful in reaching a
in service improvement. For only patients can say what needs to be done to make clinical diagnosis; statistics can tell oncologists if their interventions have produced
service delivery more caring. Performance statistics and outcome measures, even positive clinical outcomes, but only patients can say whether or not the care
patient-reported outcome measures, are significant indicators of some aspects of they received helped them to feel better. There is a growing body of evidence
service delivery: they show how efficiently and effectively packages labelled ‘a suggesting that giving patients a good feeling about their care can be clinically
patient’ have been passed through the system. They do not show how the service beneficial. The Kings Fund report
3
mentioned earlier lists several studies to support
treats the people covered by the label, nor whether those people feel cared for. claims that for hospital patients ‘anxiety and fear delay healing’ and ‘good
communication with patients contributes positively to well-being and hastens
The gap in understanding the ‘feel’ of service delivery cannot be filled by recovery’. It seems reasonable to suggest that a good experience of caring will
traditional patient satisfaction surveys. These are like consumer surveys, measuring help towards positive outcomes for radiology and oncology patients, too. Only
consumer reactions to the delivery of a ‘patient experience’. Words matter here, patients can provide the evidence to support this idea, and only patients can
as Ian Kennedy has suggested
2
. Kennedy draws a distinction between the phrases provide evidence that service improvement has resulted in improvements in their
‘patient experience’ and ‘the experience of patients’. The first is abstract and clinical conditions.
impersonal; the second grounded in the real world, personal and full of feeling.
Analysis of traditional patient surveys provides data about an abstract ‘patient Challenges of patient involvement
experience’, but not about how the experience felt to the person at the centre of It seems then that there is a strong case for involving patients in service
it. Traditional surveys may generate ideas for handling the abstract patient more improvement, a case supported by both clinical and commercial considerations.
efficiently, but they are unlikely to generate ideas for relating more effectively to Moreover, patients are, apparently, a cheap and readily available resource for
the person. To bring the abstraction to life, it is necessary to involve those who live service improvement. However, making use of this resource poses challenges.
the experience.
The first challenge is to recruit ‘useful’ patients. In diagnostic imaging services,
The importance of seeing patient experience as personal experience is discussed many patients will only pay one visit to the service, and that visit will not last
2009
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IMAGING & ONCOLOGY
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