In 2018 we joined an NHS England and King’s Fund initiative. The projects aim was to develop new tools for gathering and utilising insight from patients to support health and care service design and improvement.
In Dorset, over the past year we worked with Picker, a charity that promotes person-centred care, to design a new tool we could use in Dorset. We wanted to work with members of the public to find out what was important to you in providing feedback.
Picker conducted surveys, a focus group and telephone interviews with people from Dorset to help design the survey. Picker used this information to develop a set of survey questions to gather feedback on their care from patients.
NHS England partnered with the King’s Fund on a project comprising six insight pilot areas. This followed exploratory work with stakeholders by the King’s Fund in 2017/18. They explored the challenges and opportunities that using patient insight in a more dynamic way could bring, especially in the context of integrated care systems.
The six pilots each had a different focus, and collectively these pieces of work will inform an Action Learning Report produced by the King’s Fund.
The pilot projects ran in:
- Bedford, Luton and Milton Keynes
- North West London
- Surrey Heartlands
- West Yorkshire.
Find out more about the national patient insight project.
The project in Dorset – working with Picker
The goal was to explore new tools for generating and utilising insight from patients across the Dorset Integrated Care System (ICS) to support system transformation, service design, service evaluation, and quality improvement.
The project explored how we could remove barriers between organisations in an Integrated Care System to listen to feedback from patients across their entire experience of health and social care.
We didn’t want to assume we knew what people wanted and wanted to create a feedback mechanism which had been design with the people who would be responding.
We began working with Picker, an independent health research charity with expertise in understanding patient experiences of care. Working with an independent research company meant the project could proceed without pre-existing assumptions or organisational bias.
How the patient feedback survey was developed
Picker used an approach that combined patient and public involvement, question development, and cognitive testing.
All opportunities to get involved were publicised widely via social media, newsletters, staff communications and shared with our networks and groups. Participation was open to Dorset patients, members of the public and health and social care staff.
Picker created a core set of 81 topics on the quality of health and social care based on the Picker Principles of Person Centred Care and insights gathered from previous work.
The initial topics were entered into the first online survey, which ran from April to May 2019.
Respondents were asked to rate each topic on how important they felt it was for measuring the quality of care they receive. Picker then used a scoring system to eliminate topics for the next stage of development.
Five members of the public from Dorset participated in a Public Advisory Group meeting in June 2019. The Public Advisory Group provided feedback to refine the topics further and to help ensure the questions were easy for members of the public to understand.
The feedback from the Public Advisory group was used to develop a second online survey, which was open from July to August 2019. Like the first survey, participants were asked to rate each topic.
The topics remaining were then converted into a draft patient feedback survey.
Picker held telephone interviews with 16 people who had accessed health or social care services in Dorset within the past six months.
Participants were asked to answer the questions thinking aloud as they answered to allow the researcher to explore their thought processes and ask further questions. This allowed researchers to understand and ensure accurate comprehension and retrieval, evaluation and response.
The interviews were conducted in three rounds, with evaluation of changes needed and subsequent edits after every round.
A final patient feedback survey and recommendations were presented to Dorset CCG in late 2019.
What you told us/ what we learnt
The feedback provided to Picker has been valuable in not only developing the patient survey, but also in increasing our understanding of how you want to give feedback and the way we ask for feedback.
Alongside the survey, based on the insights gathered from this project, Picker made the following recommendations for consideration when implementing a new patient feedback survey.
- How we conduct the survey:
o Available in both online and paper formats.
o The online survey should be easily completed on both a web browser and a mobile phone.
- Survey distribution:
o The majority of survey, advisory group and interview participants expressed a preference for receiving an email with a link to the online survey.
o The email survey invitation could also include details for participants to request a paper version.
o Another option that was popular among participants was offering paper copies of the questionnaire within services.
- Frequency of survey:
o The survey should be conducted once or twice a year. This gives people enough time to fully evaluate aspects of their integrated care and how their various care teams interacted while balancing their recall of events.
o An annual/biannual survey also provides sufficient time for Dorset staff absorbing the results and identifying and initiating improvement activities based on the findings.
o We should also consider when the NHS national patient surveys are being run in order to avoid additional burden on survey respondents.
- Additional sections in the survey:
o The Advisory group and interview participants were open to completing a small sub-section of service-specific questions in addition to the core questionnaire asking about experiences across services, provided that they were focussed.
o Dorset CCG may wish to consider future development of a carer’s version of the survey.
We are now exploring how we could implement this patient feedback survey. We’ll begin by running a pilot of the survey to evaluate how the survey works and then look to establish an annual patient feedback survey.