As Meghan Leaver, Co-Founder of PEP Health writes, NHS trusts can use patient feedback data to build a learning system to draw on and inform quality improvement strategies

Patient feedback is underused and underreported means of driving improvements in care delivery. Properly harnessed, feedback and comments from patients can not only highlight worrying trends in health service performance, but can also identify key areas of improvement. It is clearly an opportune time to – the concurrent challenges of Covid-19 and regular winter challenges, combined with a daunting backlog in elective care have created a cocktail of pressure for the NHS. Current trends suggest this is unlikely to ease anytime soon.

PEP’s latest report, Health’s What Patients Think shows that although patients are appreciative of the effort and support the NHS, there are some alarming indications of a postcode lottery and considerable declines in patient satisfaction with NHS services.

The PEP Health methodology involves analysing more than one million patient comments per month to learn what patients are saying about their care, in real-time. These comments are then turned into actionable insights to inform quality improvement, democratising the patient voice. This is the first time a standardised methodology has been applied to patient experience in the UK. Traditional methods, such as the Friends and Family test, can vary in terms of the quality of analysis and insights generated. They often rely on survey data which is out of date by the time it is published, making it largely unrepresentative.

What PEP Health discovered is that the experiences of care varied considerably from region to region and within integrated care systems (ICSs). The data also revealed that accident and emergency (A&E) performance often dictates levels of patient experience across the rest of the trust. With patient experience generally on the decline, this paints a worrying picture.

A&E is the canary in the coal mine for wider trust performance

For many, A&E is the front door to the healthcare system. A patient will often arrive at a busy A&E, perhaps being referred from primary care, or because of their confusion around NHS 111.  Many patients then filter into emergency services that are at or above their capacity, meaning patients become frustrated as they are unsure how long it might take for them to be seen. Overstretched staff may not have been able to give that patient the appropriate emotional support and as a result, that person’s perception may become negatively shaped – even if they go on to receive a high standard of care later on.

By analysing millions of comments, our data revealed a strong correlation between a trust’s overall patient experience score and a patient’s account of their A&E experience. For example, North West London Health and Care Partnership ICS received an overall experience score for A&E of 2.7/5, and their overall score was 2.93, both well below the national mean. Highlighting poor performance in A&E can help trusts uncover what might be causing poor performance elsewhere. Offering trusts the ability to then benchmark between their various departments gives them the power to act and ultimately improve patient experience overall.

PEP also recorded that the experience of mental health patients in A&E was comparatively worse than that of patients attending A&E with a physical condition. Nationally, A&E patients scored their experience at 3.5/5, whereas mental health patients scored it at 2.7/5. These patients felt their emotional, physical, and environmental needs were not being considered with care by A&E staff, which suggests a need for renewed focus in this area.

While our data depicts a concerning image, it can also help drive improvements. Waiting list data or average wait times for A&E quantify the pressures on health and care services but the patient voice enables us to understand the qualitative impact of such pressures. Crucially, their feedback signals what can be done to alleviate them.

How to break the chain

Recent research shows that patients want to play a more active role in their care, and one way of making that happen is by listening to them.

During the pandemic, 47 per cent of people said they avoided hospital due to social distancing measures or other anxieties related to Covid-19. As restrictions eased, people started to attend hospital again, placing pressure on A&E services and increasing the backlog of care. With winter yet again amplifying these pressures, the question remains how this vicious cycle can be broken once and for all.

Recent research shows that patients want to play a more active role in their care, and one way of making that happen is by listening to them. PEP Health data reveals that patients are well positioned and willing to identify safety issues, such as medication errors, and describe important pain points such as access, emotional support and effective treatment.

Treating A&E as the ‘canary in the coal mine’, the state of hospital care in England appears to be a bleak picture. However, certain outliers have proved that it is possible to provide high standards of care even when neighbouring trusts, ICSs or regions are suffering. More importantly, struggling trusts can leverage insights from these strong performers and understand where and how to improve, building a learning system for trusts across the country to benefit from.

The silver lining

During the pandemic some regions of the country suffered more than others; those who were struggling with patient satisfaction before the pandemic suffered greater decline than those who were performing better. For example, London saw the most dramatic decline in patient experience across England. In our patient experience rankings of all 137 England trusts, seven of the bottom 10 trusts were London based.

However, our data sets also showed that it is possible to provide exceptional levels of care despite intense pressures. Guys and St Thomas NHS Foundation Trust achieved an overall score of 4.24/5, which is above the national mean of 4. Great Ormond Street Hospital for Children NHS Foundation Trust also ranked highly, with a score of 4.38/5, making them the fourth best performing specialist trust in England. This shows that it is possible to deliver high standards of care, even if the rest of the region is suffering.

Harnessing real-time solutions, data can be used to build a learning system for trusts to draw on and inform their quality improvement strategies going forward. It enables them to improve patient experience based on existing best practice, drill down to the root cause of good and bad performance and build a structure to enable continuous improvement. A step change in the way we consider patient experience will be even more valuable in an ICS context as we look to improve the experience of patients across the entire system.