Title: Understanding and enhancing how hospital staff learn from and act on patient experience data
Funder: Department of Health and Social Care

Abstract: Background: Patient Experience (PE) feedback from patients in hospitals is necessary in order to deliver high quality care. In the UK, significant resource is now given to the collection of this feedback, yet how ward staff make sense of, and act, on these data is largely unknown. Equally, we do not know what capacity staff have for making sense of multiple forms of PE data. Our proposed study will support ward staff to learn from and act on PE data by using qualitative and action research and participatory design approaches. We will co-design a toolkit to aid staff in acting on PE data and then evaluate how wards use the toolkit. This 32 month project brings together a multi-disciplinary team of qualitative researchers, psychologists, designers, service representatives and patient advocates to deliver on the aims and objectives. Aim: To understand and enhance how hospital staff learn from and act on PE data. Objectives: 1. To understand what PE measures are currently collected, collated, and used to inform service improvement and care delivery. 2. To co-design and implement a patient experience improvement toolkit (PEIT) using an action research methodology. 3. To identify transferable learning about how wards use the PEIT and the factors that influence this use. 4. To refine and disseminate the PEIT. Design: -Stage 1: Qualitative inquiry using a scoping review of UK PE measures, local consultation exercises with PE leads for 3 hospitals, focus groups with ward staff, interviews with hospital executives, observations of hospital Board meetings and then development of a PE conceptual framework. -Stage 2: Formation of an Action Research Hub. Participatory Design Workshops to develop the PEIT. Action research commences over the following 12 months with ward teams implementing their actions. -Stage 3: Independent process evaluation using observations, interviews, documentary methods, diaries and quantitative measurement of patient experience on the ward. -Stage 4: Refinement of PEIT through final design workshop. Sample: -Stage 1: Staff working in the 3 Trusts both at ward and executive level. -Stage 2: Six multidisciplinary teams of ward staff (6 heterogeneous wards, 2 at each Trust) alongside hospital Board representatives and patient representatives. -Stage 3: The above 6 wards subjected to process evaluation. Primary outcome: Enabling ward to staff to learn from and effectively act on PE feedback. Analysis: -Stage 1: Thematic analysis of focus group and interview discussion. Discourse analysis of Board observations. -Stage 3: Note that Stage 2 is formally evaluated by the process evaluation in this stage. Adaptive theory used to analyse observational work. Thematic analysis of interviews and content analysis of documents. All above analyses synthesised via interpretive, narrative approach focussing on context and supporting mechanisms. ANOVA analysis of quantitative measurement. Transferable knowledge will arise about how ward staff use PEIT from the process evaluation findings. Enabling ward staff to act on their PE data will have an impact on the quality of care delivered in the NHS. There will be wide dissemination of the above findings throughout the NHS via strong links with national and regional improvement and academic networks and formal peer reviewed publication and presentation of findings.

Lay abstract: In recent years, the NHS has recognised the importance of getting feedback from patients about their hospital experiences. For example, most hospitals now collect information about whether a patient would ‘recommend the hospital to their friends and family’. Patient Experience (PE) information is also available through routine surveys, the complaints patients make and via social media forums (e.g. Patient Opinion, NHS Choices and Twitter). The amount of data available is greater than ever and has the potential to be useful for ward staff and hospital management boards seeking to improve patients’ experiences of their hospital care. However, research has not kept pace with this growth in PE data, and we know little about which types of feedback staff teams use or how they use them to make improvements. Our previous research suggests that staff are overwhelmed by this data, some of which does not help them to understand what they need to do to improve (i.e. it simply provides them with a score) and even when they do have good information, they can struggle to make good use of it. The overall aim of this research is to understand and improve how hospital staff learn from and act on PE data. The research is conducted in 4 stages; each stage addresses a different purpose. In stage 1 we will look at existing measures of PE currently used in healthcare nationally and locally. We will use interviews, focus groups and observations to learn how staff in three hospitals currently use data on PE and how the managers of hospitals (the boards) refer to and use these data. We will use information from this work to develop a framework to help staff think logically about the data available. In the second stage of the research we will bring healthcare staff, patients, researchers and designers together to produce new ideas for how to present the data in a way that helps staff make sense of the feedback, and that guides them through a process of making changes to improve PE. This will result in a Patient Experience Improvement Toolkit (PEIT). Using an approach called action research we will work with 6 ward teams to use the toolkit in practice. As part of this approach we will bring teams together to think about what is and isn’t working. In stage 3 of the research, a researcher who has not been involved in stages 1 or 2 will investigate how wards use the PEIT and whether PE has improved on the ward over the course of the study. This will involve interviews with staff, observations of meetings, looking at important documents and collecting numerical data about PE. This will help us to learn lessons about the use of PE data in practice that can be used by other healthcare staff and researchers. Finally, in stage 4 we will improve the PEIT and publicise it through local and national networks. We will also write up and publish what happened in our research via publications, our website and conferences. The research will be delivered by health researchers, psychologists, sociologists and designers, as well as people well known in the UK for their interest in patient experience data. Patient representatives will play a key role in the research. They will advise, monitor and help with the development of PEIT and support hospital staff. Strong links with organisations which focus on improving hospital care will help us to spread the findings of the research across Yorkshire and the UK.

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