Title: Understanding how frontline staff use patient experience data for service improvement - an exploratory case study evaluation and national survey (US-PEx)
Funder: Department of Health and Social Care

Abstract: Aims: To explore and analyse how NHS frontline teams use different types of patient experience data for improvement To develop a practical toolkit for the NHS on strategies for making patient experience data more convincing, credible & useful for frontline teams & Trusts. Background: Patient experience - alongside patient safety & clinical effectiveness - is a key component of quality of care. Improving patient experience is thus a priority for the NHS, which has led the way in developing measures of patient experience such as the NHS Inpatient Survey. There is considerable quantitative & qualitative evidence on what matters to patients & how they experience care. However, whilst the Inpatient Survey shows small improvements in some aspects of experience, the pace of change remains slow on some of the most important questions for person-centred care. There is a need to move beyond collecting patient experience data to using it to improve care, but the evidence for the most effective ways to do this remains weak. We know little about how frontline staff make sense of or contest the data, what supports or hinders them in making person-centred improvements & what motivates staff - & patients & families - to get involved in improvement work. Methods: This proposal combines quantitative & qualitative components, involving analysis of existing national survey data, a new survey of NHS Trust patient experience leads, followed by a formative & exploratory case study evaluation of how frontline staff in 6 sites use patient experience data for improvement, with baseline & follow-up surveys of the experience of medical patients in each site. We will analyse existing data from the NHS Adult Inpatient Survey, NHS Staff Survey questions on patient experience, Friends & Family Test (FFT) response rates, & Patient Opinion usage data. (The FFT analysis is limited to response rates because variability in collection methods has been shown to skew the response data to the actual question - making meaningful comparisons between organisations impossible). The chief nurse or other designated patient experience lead in all NHS acute Trusts will be surveyed about what data they currently collect, how often, & how it is used for improvement. Results will be used to put together an assessment of Trusts' performance on patient experience & inform selection of 6 case study sites (3 high performing & 3 with more mixed performance). From each site a frontline general medical ward team will be invited to work with us. We will conduct a baseline patient experience survey in the 6 wards, plus in-depth interviews. The 6 frontline teams, including patients, will join a learning community hosted by the Oxford Health Experiences Institute. Different approaches to learning from & improving patient experience will be presented with facilitated discussion of the issues involved. Teams will be supported to develop & implement their own interventions and measures. We will observe what happens in each site using focused ethnographic case study data collecion & analysis. Emerging findings from the case studies will be shared formatively with frontline teams to help them identify problems & maximise their chances of effective person-centred service improvement. A follow-up survey of medical ward patients' experiences will be conducted. Outputs: Practical toolkit for the NHS on using patient experience data (disseminated online & through NHS England)

Lay abstract: Patient experience is a key component of quality of care, & improving it is a priority for the NHS, especially after recent serious issues such as those at Mid Staffordshire Hospital & Winterbourne View. There is much evidence about what matters to patients about their experience of care - e.g. that it should be delivered in a way that is convenient for them; that they are well informed about their diagnosis & treatment & involved in decisions; that staff communicate kindly & respectfully; & that people's privacy, dignity & comfort are attended to. Yet the pace of change is slow; both survey & interview evidence demonstrates that there is still a long way to go to make care genuinely & consistently person-centred. Collecting data about patients' experiences is not enough; we need to use the data to improve care. Many of the things that matter most to patients are about relationships with & behaviour of frontline staff. Not enough is yet known about the best ways to support staff to use information about patient experience to improve care. There is some promising but limited evidence of approaches which have made a difference, such as facilitated feedback & discussion with ward staff of numerical survey findings, & use of filmed personal stories to trigger change as part of an approach called experience-based co-design, in which staff & patients work together to improve care. We need to add to this evidence by improving our understanding of how frontline staff use different types of patient experience data for quality improvement; what motivates them to get involved in improvement; what helps or hinders; & what can be done to make patient experience data more convincing, credible & practically useful. These are our main research questions. To help us provide answers, we plan to work with 6 frontline medical ward teams as case studies, supporting them to plan how to use patient experience data for improvement & then observing what happens. We will start by analysing existing national survey data & conduct a new organisational survey of patient experience leads in all acute Trusts to create a national picture of how Trusts are performing on patient experience, & how they are collect & use experience data. From this we will select 3 high performing & 3 less well performing trusts to work with us as case studies. Frontline medical ward teams (with patient members) from each site will join a 'learning community', with presentations from expert co-applicants from the Oxford Health Experiences Institute on the range & type of data available & what we know about how to use such data for improvement. Teams will then decide what topic to work on & design & implement their own interventions. We will observe & analyse what happens, using interviews, documentary analysis & on-site observation. We will also complete a baseline & follow-up survey of medical patients from each site. We will discuss emerging findings during the study with the frontline teams so they can adapt & improve what they do, & provide ongoing opportunities to discuss progress. From our analysis, we will develop a practical toolkit for the NHS on strategies for making patient experience data more convincing, credible & useful for frontline teams (& the likely organisational conditions for successful implementation) as well as how to involve patients & families in the process. We will share the guide online & through NHS England so other hospitals can learn from the results

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