The Patient

Experience Book
1

A collection of the NHS Institute for Innovation

and Improvement’s guidance and support
The Patient
Experience Book
A collection of the NHS Institute for Innovation
and Improvement’s guidance and support
© Copyright NHS Institute for Innovation and Improvement 2013

The Patient Experience Book is published by the NHS Institute for Innovation and Improvement,
i-House, University of Warwick Science Park, Millburn Hill Road, COVENTRY, CV4 7HS.

Copyright in The Patient Experience Book belongs to the NHS Institute for Innovation and
Improvement.

Any third party concepts and trademarked devices have been reproduced in this document with the
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ISBN: 978-1-907805-28-8
 About the NHS Institute for Innovation and

Improvement

The NHS Institute was established in July 2005 to support the

transformation of the NHS, through innovation, improvement and the
adoption of best practice. We enable and support the NHS system to
transform health and healthcare for patients through a strategy of creating
inventive, clinically-led and tested practical ideas which will build skills and
capability for continuous improvement.

On 1 April 2013, NHS Improving Quality is being established to bring

together the wealth of knowledge, expertise and experience of a number
of NHS improvement organisations. NHS Improving Quality will be hosted
by the NHS Commissioning Board.

Why we have published this book

Change is the inspiration for this book. On 2 April 2013, a number of

people working across the health system will be in new roles, perhaps in
new organisations. Those remaining in their existing roles will need to
communicate and work with any new organisations that have been
established. We wanted to pull together our ‘institutional memory’ and
hand it over to everyone who will be working in the new landscape to
improve the experiences of people who use health and social care services,
their carers and their families. This book is, therefore, a legacy publication.

At the NHS Institute, we have worked on a number of programmes and

developed materials that aim to support the NHS to improve patient
experience, in particular: the Patient Experience Learning Programme; the
Transforming Patient Experience: essential guide; and the NHS Patient
Feedback Challenge. In this book, and the CD that accompanies it, we
have included a range of content and materials from these programmes.

1
This book is for people with designated responsibility for improving patient
experience – both as providers of services and as commissioners. It is
intended to give you the evidence you need to influence others, both at
management/board level and team level, to focus on improving patient
experience.

The content that follows provides a rich source of research evidence, stories
from patients and staff and many examples of innovation. It also illustrates
a range of well-tested techniques to help you work more closely with
patients to understand their experience and use these insights to improve
services.

2
Thank you

We would like to thank everyone who has worked with us over the years:
the patients and family members who have brought their fresh eyes,
insights and challenge to our work; the Department of Health which has
supported this agenda and ensured investment; our colleagues across the
country who have helped us to co-design what we hope are useful and
practical products; our colleagues in the NHS Institute who have always
contributed their imaginative and innovative insights and professional
services; and other partner organisations that have been vital to the
success of our programmes.

3
Foreword

Imagine an NHS service that starts with the patient – a service that listens
to patient and family needs, and then utilises the skills and expertise of
both the clinician and patient to design the experience to meet these
needs. That’s what using patient experience information is all about.

Ultimately by consistently asking people whether they are receiving the

care they need and then improving things on the basis of what they tell
you will help patients feel more supported and better cared for.

We have reached a seminal point in our efforts to improve the experience

of people who use health and social care services, and their families.

If you have been working hard to promote patient engagement and

experience, you will be only too aware that never before has this area of
work had such a high profile.

Only a few years ago, you might have focused your efforts on trying to
convince people in ‘your local area’ of the health and social care system to
focus on patient experience as much as on clinical effectiveness or safety.
Now, the need to improve experience is widely acknowledged in policy,
rhetoric and in the new systems and structures.

There have been a number of things that have brought about this shift. At
a policy level, the work of Lord Darzi in 20081 signalled a need to consider
experience alongside safety and quality. This was further cemented by the
intentions expressed in the Equity and Excellence: Liberating the NHS
2010 White Paper2. Alongside this, the Francis report into care failures at
the Mid Staffordshire NHS Foundation Trust3, published on 6 February
2013, puts the spotlight on the cultural, leadership and system changes
that are needed across the NHS.

The question now is, how can we make the most of this opportunity to
make a real difference for patients and how can we maintain the
momentum of that need to change? It is clear that a culture change is
1
High Quality Care for All report, 30 June 2008 http://tinyurl.com/34k7ffv
2
http://tinyurl.com/4naov6
3
http://tinyurl.com/c3y6p84 , http://tinyurl.com/cepy73t

4
required and, with the Friends and Family test4 being implemented in
hospital settings this year, closely followed by community settings, the
expectation of seeking feedback on services and seeing positive change
as a result can only increase.

Any programme intended to improve patient experience needs to influence

the behaviours both of staff who have direct patient interaction (such as
receptionists, nurses, doctors, porters) and those who work more indirectly
(such as managers and corporate staff).

Providers of services and the groups that commission them will need to
work in partnership with one another. The development of a new
landscape for commissioning is an ideal opportunity to learn from existing
effective practice and build on it in innovative ways. In fact, it could be
argued that the most ‘innovative’ thing commissioners can do is to find
the evidence-based practice and encourage it to be adopted elsewhere.

What the NHS Institute found when it introduced the NHS Patient
Feedback Challenge is that, often, we know what works and there are
pockets of excellence, but it is spreading this practice elsewhere that poses
the biggest challenge. Commissioners are in a position to act as role
models – by understanding what is important to patients in their local area
(for example, by setting up systems that enable them to have meaningful
conversations) and how the process of better understanding patient
experience can be a tool for service improvement and a lever for
performance. Commissioners will need to work in partnership with the
voluntary sector, patient groups, communities and health and social care
services to set realistic goals that enable organisations to implement
programmes and sustain improvement.
One of the most important lessons I have learnt in the last few years is that
health organisations need to be ambitious. The experience we deliver for
patients and their families will only ever improve when an entire
organisation or health and social care system examines and re-creates its
culture, leadership, service user engagement, staff engagement and
measurement systems in order to improve service experience.

4
A mandate to ensure that people have a positive experience of care http://tinyurl.com/bvwu54a

5
An incredible amount of information about what works already exists and
hundreds of people have helped to create the knowledge bank represented
in this book, and in the guidance and organisations we reference. I hope
that what follows will inspire and energise you to continue the brilliant
work that you have already started.

Sam Hudson
Head of Experience and Engagement
NHS Institute

6
Contents

Section one: What is Experience? 8

Section two: Why Should we Improve Patient Experience? 14
Section three: Who Needs to be Involved in Improving
Patient Experience? 27
Section four: How to Improve Patient Experience 34
Section five: NHS Institute Tools that Can Help You
Improve Experience 52
Section six: Measuring Experience 58
Section seven: Commissioners and Patient Experience 73
Section eight: The NHS Patient Feedback Challenge 80
Section nine: The Patient Experience Learning Programme 83
Section ten: Over to you... 88
The Patient Experience CD index 89

7
The Patient Experience Book

Section one: What is Experience?

On the face of it, experience can seem quite simple. We all have
experiences every day, both good and bad, but have you noticed that the
better or worse the experience is, the more people you tell? It’s true that
we all experience things slightly differently and each experience itself is
made up of a number of experiences, or ‘moments’, that are all measured
against our original expectations. In the retail, travel and hospitality
industries, these ‘moments’ are big business and often, without us
consciously realising it, our senses are stimulated and emotions evoked by
these carefully orchestrated ‘moments’. NHS services have the potential to
do just that – to plan for experience.

‘Patient experience’ is what the process of receiving care feels like for the
patient, their family and carers. It is a key element of quality, alongside
providing clinical excellence and safer care. The way that the health system
delivers its care and support services – from the way the phone is
answered, to the way the GP examines them or the nurse explains what is
happening – has an impact on the experience the patient has. If safe care
and clinical excellence are the ‘what’ of healthcare, then experience is the
‘how’. Starting with the patient, listening to their needs, and designing the
experience to meet these needs is achievable and results in an environment
where individual patients feel cared for and supported.

If you think back to your last

interaction with a health
service, either as a patient,
family member, carer or
friend, can you remember
how you felt and what made
you feel like this? Now,
imagine an NHS service that
starts with the patient – a
service that listens to patient
and family needs, and then
utilises the skills and expertise
of both the clinician and

8
 Section one: What is Experience?

patient to design the experience to meet these needs. It sounds like an

appealing idea.

While we may aspire to this on a human level, as healthcare providers it

can feel overwhelming – how on earth can the service respond to all of
these differing patient needs? How can it provide a positive experience for
all patients? And, more importantly, how can it support the provision of
care generally, including social care? This book sets out to answer these
questions and show how you can work to improve the experience of all
patients in your service.

Understanding patient experience and engagement –

what’s the difference?

The language barrier

Recent research commissioned by the NHS Institute (Gill Ereaut, Linguistic
Landscapes, 2013) in partnership with National Voices5, has revealed that
the language we use to try and describe this desire for a different
relationship with the people who use health services is often confusing and
has some significant features:

5
http://www.nationalvoices.org.uk/

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The Patient Experience Book

●● Lots of different terms are used and these are often combined– for
example ‘Patient and Public Involvement and Engagement’ (RCN);
‘Patient and Public Voice and Information’ (NCB); ‘Patient and Public
Experience and Engagement’ (a network). Terms seem to be piled up
like this because none of them quite expresses what people are
seeking to do.
●● These terms have not been found to be engaging, are often felt to
be confusing, and seem to have been unable to help bring about
real change.
●● The language changes all the time and the terms used are also
inconsistent in meaning, even amongst those within the field.
●● The language contains abstract nouns, for example; engagement;
involvement; slogans such as ‘no decision about me without me’;
and jargon or hard to decipher terms such as co-production – all of
which make it harder for people to understand what they need to
do to make change happen.

So, the language we use to talk about “patient experience and

engagement” acts as a distraction from the important issues of
professional boundaries, power sharing and the allocation of resources.

The impact of this is that, although the intention behind the language is to
support real change in the relationship between people and the health
system, the language ends up supporting the status quo. Being aware of
this and questioning our language is the first step towards making those
real issues more visible.

10
 Section one: What is Experience?

A definition: what do we mean by patient and public

engagement and patient experience?

It is sometimes helpful to think of patient experience and engagement

activities existing on a continuum, where the amount of influence people
can have over decisions varies.

Information Feedback Engagement Co-design Partnership

Patient and public engagement is the active participation of patients,

carers, community representatives, community groups and the public in
how services are planned, delivered and evaluated. It is broader and deeper
than traditional consultation. It involves the ongoing process of developing
and sustaining constructive relationships, building strong, active
partnerships and holding a meaningful dialogue with stakeholders.
Engaging with patients and the public can happen at two levels:
●● individual level – ‘my say’ in decisions about my own care and
treatment
●● collective level – ‘my’ or ‘our say’ in decisions about commissioning
and delivery of services.

Effective patient engagement means involving patient cohorts (patients

with common conditions) in helping to get the service right for them. It is
also about engaging the public in decisions about the commissioning,
planning, design and reconfiguration of health services, either pro-actively
as design partners, or reactively, through consultation.

Effective engagement leads to improvements in health services and is part

of everyone’s role in the NHS.

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The Patient Experience Book

A definition: what is patient experience?

Patient experience is what the process of receiving care feels like for your
patients. Understanding patient experience can be achieved through a
range of activities that capture direct feedback from patients, service users,
carers and wider communities. These are used alongside information on
clinical outcomes and other intelligence to inform quality improvements,
the way local services are designed and reshaped, and contractual
arrangements with providers.

There are many different ways to understand the experiences of patients

and carers – from questionnaires or analysing complaints, through to
Experience Based Design approaches6. Using experience to design better
healthcare is unique in the way that it focuses so strongly on capturing and
understanding patients’, carers’ and staff experiences of services, not just
their views of the process.

“Getting good treatment in a comfortable, caring and safe

environment, delivered in a calm and reassuring way; having
information to make choices, to feel confident and feel in control;
being talked to and listened to as an equal; and being treated with
honesty, respect and dignity”.

Department of Health (2005) ‘Now I feel tall –

what a patient-centred NHS looks like’

6
www.institute.nhs.uk/ebd

12
 Section one: What is Experience?

What this book covers: patient experience

In this book, we focus on patient

experience – how to understand it
and how to use it effectively to
improve services, and as a lever for
performance management.
There is a great deal of work going
on across health services to engage
patients in decisions about their
own care, about the running of
services and, increasingly, the
prioritisation of services. As with
patient engagement, patient
experience activities need to
focus on helping people to
understand the competing pressures within the
health system, as well as understanding the ways in which improving
patient experience, clinical effectiveness and safety are connected.

Organisations embarking on patient experience work to improve services

need to understand both why and how. So, we have set out the case for
understanding patient experience,
with reference to relevant research
evidence and the national policy
framework.
The next section of this book
explains why various parts of the
health system should improve the
experience of patients in their
care. From section four onwards,
you can read about how to
improve patient experience.

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The Patient Experience Book

Section two: Why Should we

Improve Patient Experience?

Making the case for change

Improving patient experience is about working with the people who use
services to make these services better. It is about designing services that
meet their needs and it requires a commitment to doing this on an
ongoing basis, day-by-day and year-by-year. Evidence from the commercial
sector and from across health services shows that the staff who work in
the system, at all levels, need to be engaged in the improvement process
for it to work.

Evidence from healthcare organisations

There is a growing body of evidence (see Supporting research below) to

convince business leaders across the service of the importance of investing
in improving patient experience. It is likely that structures, such as the NHS
Commissioning Board, the new Improvement Body, the NHS Trust
Development Authority and Healthwatch England will continue to add to
this body of evidence. This evidence illustrates:
●● the impact of experience on organisational reputation (ie if patients
have a poor experience of care it can damage an organisation’s
reputation)
●● that experience is improved when people have more control over
their care and the ability to make informed choices about their
treatment
●● the link between experience and health outcomes (ie patients who
have a better experience of care generally have better health
outcomes)
●● the link between experience and cost of care (ie poor experiences
generally lead to higher care costs as patients may have poorer

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 Section two: Why Should we Improve Patient Experience?

outcomes, require longer stays or be readmitted for further

treatment)
●● the relationship between staff and patient experience (ie if patients
are having a poor experience, it has a negative impact on staff
experience as well).

Supporting research

1. Feeling better? Improving patient experience in hospital

The report entitled Feeling better? Improving patient experience in
hospital, NHS Confederation, 20107 provides compelling evidence that
hospital boards can achieve better outcomes across their entire
organisation when patient experience is a priority.

It contains seven inspiring case studies of organisations that have

undertaken patient experience work and concludes that there are a
number of factors that are common across all of the organisations
featured. These include:
●● transformational leadership
●● whole-system change
●● patients and families that are engaged in care
●● an emphasis on continual feedback from patients, families and
carers, and measurement for improvement
●● an integrated programme of activities, rather than a series of small,
random projects
●● a recognition of the importance of embedding desired values and
behaviours across the organisation
●● staff who are enabled to deliver excellent patient experience and
empowered to make changes themselves
●● greater clinical engagement and professional empowerment.

7
http://tinyurl.com/a95hykt

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The Patient Experience Book

2. Costs and Benefits of Implementing a Patient Experience

Strategy; Or Why Every Director of Finance Should be
Investing in Patient Experience
The Excellence Framework for
Patient Experience forms part
of a wider piece of work on
patient experience,
commissioned by the
Department of Health and
NHS Northwest. Its report
Costs and Benefits of
Implementing a Patient
Experience Strategy; Or
Why Every Director of
Finance Should be Investing in Patient Experience8 makes the
management case for investing in patient experience, proposing that there
are sound management and financial reasons for doing so. It points out
that patient experience is now a central issue for the NHS Commissioning
Board, Clinical Commissioning Groups and service providers. The What
Matters to Patients? research, explained below, has also shown that is
imperative that we start to collect evidence of the link between experience
and the cost of care.

8
http://tinyurl.com/c8u2wng

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 Section two: Why Should we Improve Patient Experience?

3. What Matters to Patients?

In 2010, the Department of Health and the NHS Institute commissioned

King’s College London and The King’s Fund to undertake a research project
entitled: What Matters To Patients? Developing the Evidence Base
for Measuring and Improving Patient Experience9.

It was compiled following extensive interviews with patients and carers,

patient representative organisations, and NHS organisations, a review of
evidence from the voluntary sector and patient care organisations, a series
of events, literature reviews and a detailed review of five key conditions,
including mental health and long-term conditions. The report covers:
●● what matters to patients? – particularly in the non-acute sector
●● what do NHS organisations in England currently measure in relation
to what really matters to patients?
●● examples of NHS organisations that are using information and
insights into patient experience to improve the quality and
productivity of healthcare services.

The report also includes an annex comprising: a literature review, a survey

of voluntary organisations, patient and carer interviews, qualitative and
quantitative analysis of NHS Choices datasets, quantitative analysis of
Patient Opinion ratings, organisational case studies and the national
training survey.

9
http://tinyurl.com/cc6rtu7

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The Patient Experience Book

Both The Main Report10 and The Policy Recommendations11 are on the CD
(in the What Matters to Patients folder) that accompanies this book.
Key findings from What Matters to Patients?
Functional versus relational aspects of care
One of the key findings from interviews with patients with long-term
conditions (as shown in the table below) was that it is the relational
rather than the functional aspects of their care that matter most to them.
Relational aspects of care include feeling listened to, or informed, while
‘functional’ refers to the process of delivering care, such as efficient
processes. This research shows us very clearly that patients care about their
experience of care as much as clinical effectiveness and safety. People value
efficient processes, they want to feel informed, supported and listened to
so that they can make meaningful decisions and choices about their care,
and the one thing we hear again and again is they want to be ‘treated as a
person, not a number’.

The health service has tended to concentrate on improving functional

aspects of care, yet this research reveals clearly that the relational aspects
of care matter as much to patients.

10
http://tinyurl.com/cxrrnzg
11
http://tinyurl.com/bmhg7jv

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 Section two: Why Should we Improve Patient Experience?

Treating patients as people

But, what does being ‘treated
as a person’ mean in practice
for patients and how can we
make it a daily reality for the
health service?

It is about training and

focusing on staff delivering
the relational aspects of care,
such as: good communication,
emotional support, respect,
empathy, involvement in decisions and good information provision. This has
to happen alongside the development of systems that support the functional
aspects of care, like joined-up services and providing physical comfort.

Effective measurement is vital – see section six: Measuring Experience for

more information.
4. The King’s Fund Point of Care programme
The King’s Fund Point of Care Programme12 aims to help healthcare staff in
hospitals to deliver the quality of care they would want for themselves and
their own families. The programme works with patients and their families,
staff and hospital boards to research, test and share new approaches to
improving patient experience.
5. Always Events from the Picker Institute
The Picker Institute is dedicated to enhancing the delivery of patient-centred
care across healthcare. Picker has devised Always Events which can help the
system to become more patient-cantered13. These were in contrast to the
well-known Never Events, which refer to incidents that should never happen
in the delivery of care, patient-focused Always Events are aspects of the
patient and family experience that should always occur when patients
interact with healthcare professionals and the delivery system.

12
http://www.kingsfund.org.uk/projects/point-care
13
http://alwaysevents.pickerinstitute.org

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The Patient Experience Book

Themes from patient interviews Functional Relational

Being treated as a person, not a number

Staff who listen and spend time with patient

Individualised treatment and no labelling

Using language that is easy to understand

Finding out about the latest technologies and innovations medications

Feeling informed, receiving information and being given options

Patient involvement in care and being able to ask questions

More public awareness about condition

Efficient processes

Knowledgeable health professionals

Aftercare support

Positive outcomes

Continuity of care

Good relationships and positive attitudes among staff

The value of support services

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 Section two: Why Should we Improve Patient Experience?

Policy Drivers

“Patients, users and carers are the reason for the NHS existing…
and, as such, must be at the centre of all that the NHS and its
staff do.”

National Quality Board, February 2010

1. The NHS Constitution

There are a number of relevant policy documents, drivers, incentives and
sanctions that make improving patient experience an imperative, and a
useful place to start is always the NHS Constitution. The NHS Constitution
was created to protect NHS England and ensure that it will always do the
things it was set up to do in 1948 – to provide high quality healthcare that
is free and for everyone.

The Constitution establishes the principles and values of high quality

healthcare and sets out the rights to which patients, public and staff
are entitled.

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The Patient Experience Book

One of the seven key principles is that the NHS aspires to the highest
standards of excellence and professionalism:

“In the provision of high quality care that is safe, effective and
focused on patient experience; in the planning and delivery of the
clinical and other services it provides; in the people it employs and
the education, training and development they receive; in the
leadership and management of its organisations; and through its
commitment to innovation and to the promotion and conduct of
research to improve the current and future health and care of the
population.”

Providing a poor service costs money and it is clear, from current feedback,
that the NHS is not yet providing a consistently positive experience.
2. NICE Quality Standards for Patient Experience in Adult NHS
Services
To deliver the best possible experience for patients who use NHS Services,
high quality care should be clinically effective and safe. Launched in
February 2012, these quality standards and accompanying clinical guidance
aim to ensure that patients have an excellent experience of care from
the NHS.
3. No decision about me, without me
The philosophy of ‘no decision about me, without me’ in the 2010 White
Paper now sits alongside a number of national policy drivers requiring
healthcare organisations and professionals to continually measure and
improve patient experience, such as the Outcomes Framework14 and the
NICE guidelines for patient experience15 and mental health service user
experience16. The aim of these policy imperatives is to provide a patient-
centred healthcare service which meets the physical and emotional needs
of the population.

14
http://tinyurl.com/cr8qsg6
15
http://guidance.nice.org.uk/CG138
16
http://guidance.nice.org.uk/CG136

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 Section two: Why Should we Improve Patient Experience?

4. NHS Operating Framework 2012/13

The NHS Operating Framework 2012/1317 specifically states that the NHS
should collect and use patient experience information in real time and use
it for service improvements: ‘NHS organisations must actively seek out,
respond positively and improve services in line with patient
feedback. This includes acting on complaints, patient comments,
local and national surveys and results from ‘real time’ data
techniques.’ The Operating Framework for the NHS in England 2012-13,
p.17.
5. NHS Outcomes Framework
The purpose of the NHS Outcomes Framework18 is to provide a national
level overview of how well the NHS in performing, to provide an
accountability mechanism between the Secretary of State for Health and
the proposed NHS Commissioning Board; and to act as a catalyst for
driving quality improvement and outcome measurement throughout the
NHS by encouraging a change of culture and behaviour.

The NHS Outcomes Framework is structured around five domains, which

set out the high-level national outcomes that the NHS should be aiming to
improve. One of the domains (domain 4) is about ensuring that people
have a positive experience of care.
6. Commission for Quality and Innovation Scheme (CQUIN)19
The CQUIN payment framework enables commissioners to reward
excellence, by linking a proportion of English healthcare providers’ income
to the achievement of local quality improvement goals. Since the first year
of the CQUIN framework (2009/10), many CQUIN schemes have been
developed and agreed.

17
http://tinyurl.com/coo8hbr
18
http://tinyurl.com/chygct4
19
http://tinyurl.com/c5vpzp7

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The Patient Experience Book

7. Quality Accounts20
Quality Accounts aim to enhance accountability to the public and engage
the leaders of an organisation in their quality improvement agenda.
8. Section 242: The Statutory Duty to Involve21
The Statutory Duty to Involve sets out how the NHS is expected to involve
and consult communities in the planning and development of services.
9. Essence of Care22
Essence of Care aims to support localised quality improvement, by
providing a set of established and refreshed benchmarks supporting
frontline care across care settings at a local level. The benchmarking
process outlined in Essence of Care 2010 helps practitioners to take a
structured approach to sharing and comparing practice, enabling them to
identify the best and to develop action plans to remedy poor practice.
10. Equity and Excellence: Liberating the NHS23
This White Paper and legislative framework sets out the Government’s
long-term vision for the future of the NHS. The vision builds on the core
values and principles of the NHS – a comprehensive service, available to all,
free at the point of use, based on need not ability to pay.
11. Healthy Lives, Healthy People24
This White Paper sets out the
Government’s long-term vision for the
future of public health in England. The
aim is to create a ‘wellness’ service
(Public Health England) and to
strengthen both national and local
leadership.

20
http://tinyurl.com/cz85p3k
21
http://tinyurl.com/6f2l3o
22
http://tinyurl.com/3xg2mh9
23
http://tinyurl.com/3328s6x
24
http://tinyurl.com/cx9wme2

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 Section two: Why Should we Improve Patient Experience?

The NHS National Quality Board Patient Experience

Framework25

In February 2012, the NHS National Quality Board (NQB) published the NHS
Patient Experience Framework. This framework outlines those elements
that are critical if patients are to have a positive experience of NHS Services.

This framework is significant for healthcare organisations because it

provides a common evidence-based list of what matters to patients, and
can be used to direct efforts to improve services. For example, it can be
used to help define what questions to ask patients in surveys and in real-
time feedback.

The framework draws on the What Matters To Patients research published

by the King’s Fund and King’s College London. This research suggested it is
possible to apply a single generic framework for patient experience to a
wide range of health conditions and settings, and recommended that the
Department of Health adopts a common framework for this purpose.

The elements that are regarded as critical for a positive patient experience
are as follows:
1. Respect of patient-centred values, preferences, and expressed
needs, including: cultural issues; the dignity, privacy and
independence of patients and service users; an awareness of quality­
of-life issues; and shared decision-making.

2. Coordination and integration of care across the health and social

care system.

3. Information, communication, and education on clinical status,

progress, prognosis, and processes of care in order to facilitate
autonomy, self-care and health promotion.

4. Physical comfort, including pain management, help with activities of

daily living, and clean and comfortable surroundings.

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The Patient Experience Book

5. Emotional support and alleviation of fear and anxiety about such

issues as clinical status, prognosis, and the impact of illness on
patients, their families and their finances.

6. Welcoming the involvement of family and friends, on whom

patients and service users rely, in decision-making and demonstrating
awareness and accommodation of their needs as care-givers.

7. Transition and continuity as regards information that will help

patients care for themselves away from a clinical setting, and
coordination, planning, and support to ease transitions

8. Access to care, with attention, for example, to time spent waiting for
admission or time between admission and placement in a room in an
inpatient setting, also waiting time for an appointment or visit in the
outpatient, primary care or social care setting.

For expanded details of The NHS National Quality Board Patient

Experience Framework please see the CD that accompanies this book.

Future policy

It could be said that the only constant is change.

Above we have outlined a range of policies and directives that are

important right now. As time goes on, there will be new policies that build
on what exists today. The focus on patient experience can only increase,
making it imperative for organisations to fully understand how to capture
and use patient experience for service improvement.

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 Section three: Why Should we Improve Patient Experience?

Section three: Who Needs to be

Involved in Improving Patient

Experience?
Improving patient experience involves both those staff who have direct
patient interaction, such as porters, reception staff, telephonists, doctors
and nurses, and those who work more indirectly, such as managers and
corporate staff. Everyone needs to understand and subscribe to the
organisation’s commitment to improving patient experience. Commissioners
also have a crucial role to play, as outlined below, and it is impossible to
overstate the role of leadership. In section four, we detail the characteristics
shared by organisations that have successfully used patient experience to
drive service improvement. A management board that is committed to,
and accountable for, patient experience comes top of the list.

The crucial role of leaders

Like any improvement programme, strong leadership is vital for improving

patient experience.

In order for patient experience to improve across an organisation, the

person with primary responsibility for managing patient experience needs
to engage colleagues and the senior team so they understand fully what
patient experience is and what it means for the organisation. In addition,
plans need to demonstrate how to gather feedback; the process of
identifying and implementing improvements with patients and staff; and
what the benefits will be for patients, staff and the organisation.

For patient experience information to be used effectively within an

organisation, that organisation needs to be prepared to change. This
requires fully engaged leaders who can act as role models and support the
required change. The management board should make a conscious
decision to focus on patient experience and support the development of
the patient experience improvement priorities, vision and strategy for
patient experience.

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