Title: Exploring the impact of patient experience data in acute NHS hospital trusts in England: using Actor-Network Theory to optimise organisational strategies and practices for improving patients’ experiences of care
Funder: Department of Health and Social Care

Abstract: Recent overviews have highlighted that not enough attention has been paid to understanding and using patient experience data in NHS organisations; the evidence on how these data translate into quality improvement is still lacking (1, 2). This study will explore the mechanisms and processes through which acute hospitals in England currently translate the wealth of patient experience data they collect into quality improvement efforts. It will focus, in part, on the nursing contribution to these processes given that in acute NHS hospital trusts formal Board-level responsibility for patient experience often resides with the Directors of Nursing, and that frontline nurses are involved in collecting and collating patient experience data as well as implementing any resulting quality improvement priorities into their day-to-day practice. The study has two inter-related phases: Phase 1 - ethnographic work. A socio-material analysis (3, 4) of the practices related to patient experience data (including at Board-level and within two clinical services in each trust: cancer and dementia) in four acute NHS hospital trusts. Drawing upon Actor-Network Theory (ANT) (3,5), this phase will characterise patient experience data as an ‘actor’ within the socio-material system which is a hospital. Through ethnographic observation and individual interviews, the objects – or ‘artefacts’ – used to collect and report patient experiences of services, will be studied as they move through the organisation and are ‘translated’ into action (quality improvements). We will select the artefacts we will examine in each service guided by local practices at the participating sites; possible artefacts include data from national patient experience surveys, patient stories or real-time devices used to collect patient feedback including the Friends & Family Test. ANT will enable us to (a) explore what happens to the various forms of experiential data when they are 'captured' through an artefact in the selected clinical services; (b) examine how the different data formats then travel to particular actors, networks and settings; and (c) assess the extent to which these journeys lead to quality improvements. In tracing the journeys of the selected artefacts, particular attention will be given to their intersections and interactions with nurses and nursing practices. Phase 2 - 'sense-making'. A series of Joint Interpretive Forums (6) (JIFs) with multiple stakeholders around findings from Phase 1. This phase will lead to the distillation of actionable recommendations for service managers, practitioners, policymakers, and patients and carers.

Lay abstract: Patients’ and carers’ experiences of hospital care are an important aspect of healthcare quality. In the NHS, whether as part of internal and external quality inspections or regulatory processes, information about the quality of patients’ experiences is collected continually in various ways. This information is also known as patient experience data and it is collected through a variety of tools, for example questionnaires (including the National Patient Experience Survey), simple questions (including the nationally required ‘Friends & Family test’ –FFT), formal and informal complaints and compliments, digital hand-held devices given to patients on wards (‘real-time’ data), and written accounts or video/audio recordings of patient stories recorded through face-to-face interviews, patient/public websites (including NHS Choices, Patient Opinion), and/or social media. Recent research has highlighted that despite the vast quantity of information that is collected about patients’ experiences and which is available to NHS organisations, it is not clear how this information is used to plan and achieve improvement in the quality of care. This study will explore how patient experience data translate into quality improvements in acute NHS hospital services. Given that in NHS organisations nurses (whether in senior managerial or frontline roles) are often responsible for improving the patient experience on the basis of what patient experience data reveal, the study will pay particular attention to the role of nurses. The study is organised in two phases. In Phase 1 we will use a research approach that focuses on the tools used to capture information on patient experience to study the journeys and the impact on practice of patient experience data in four NHS hospitals in England. In each of these hospitals we will examine the journeys of patient experience data in the context of two clinical services - dementia and cancer care – to explore similarities and differences between services. In Phase 2 we will hold a set of meetings with hospital managers, frontline staff, and patients and carers from the four hospitals involved in the study to discuss the findings from Phase 1 and develop practical recommendations for NHS managers, clinical staff, policymakers and patients. The study will generate important new understandings and recommendations at three different levels of healthcare services: 1) everyday practices - it will help us to understand what difference the collection of patient experience data actually makes to patients' and carers' experiences; 2) organisational management - it will provide information on the managerial resources and limitations that influence the impact of patient experience data on NHS services; 3) policy – it will look at how strategies and practices at levels 1 and 2 are shaped by national healthcare policies.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE