Feedback from patients: potential and pitfalls in measuring health professionals' performance

Transcription

1 IAMRA, London, 9-12 September 2014 Feedback from patients: potential and pitfalls in measuring health professionals' performance Anna van der Gaag Chair Health and Care Professions Council

2 Purpose To explore the use of patient feedback in measuring performance To discuss research findings To describe pitfalls and potential of using patient feedback

3 Key questions Why seek feedback from patients? What do we want to find out? Is this a necessary and important development or just more bureaucracy?

4 Increasing use of the internet to give feedback UK based website Set up in 2005 Patients post their stories on line 85,000 stories told Many complaints about the poor quality of care and communication

5 Clear links between patient involvement and health improvement Many studies have found Significant improvements in general health, disability, social activities, communication with doctors, fatigue levels, exercise levels and ability to self manage long term health conditions Fewer days in hospital, fewer visits to the doctor Significant cost savings Kate Lorig, Stanford University

6 Origins of the concept of the Customer Feedback measures originally designed for tourism, entertainment industries to improve goods and services Those completing them usually healthy, mobile, literate Is this the same in health care? Lee (2011)

7 The patient population in the UK 21% of adults with recognized literacy difficulties 1-2% with severe communication difficulties A variety of conditions (trauma, neurological impairment, mental health, learning disabilities) influence our understanding and expressive abilities in any culture or context Patients often anxious, uncertain, vulnerable All-Party Parliamentary Group (2011) Law et al. (2007)

8 What we know about feedback from patients The majority of feedback is positive Patients may experience white coat silence Reluctance to ask questions or challenge for fear of the consequences Many variables in the doctor patient relationship such as age, diagnosis, length of relationship, type of consultation, cultural, linguistic factors which influence the feedback they give Campbell et al. (2011) Judson et al. (2013)

9 What are the solutions?

10 The Health and Care Professions Council 320,400 registrants from 16 health, psychological and social work professions 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 Social workers Physiotherapists Occupational therapists Radiographers Biomedical scientists Paramedics Practitioner psychologists Speech and language therapists Chiropodists / podiatrists Operating department practitioners Dietitians Clinical scientists Arts therapists Hearing aid dispensers Orthoptists Prosthetists / orthotists

11 Independent research: Picker Europe Methods Literature review Delphi consultation with experts Findings Identified 12 standardised measures used with 10 of the professions No evidence of link between use of standardised measures and future performance of doctors Qualitative feedback most likely to have impact

12 Obtaining feedback: different methodologies Adapting questionnaires to suit patient s abilities Supported conversations Storytelling Videoreflexive feedback

13 GMC patient questionnaire: Q4

14 GMC Q4 Adapted by Mander and Rigby (2014)

15 Independent research: Picker Europe Conclusions: Standard formats will only work for some patients There is no single method that will suit all patients Chisholm and Sheldon (2011)

16 Key questions Why seek feedback from patients? What do we want to find out? Is this a necessary and important development or just more bureaucracy?

17 Pitfalls and potential of patient feedback Pitfalls No questionnaire suits all patients Questionnaires tokenistic Focus is on comparative scores No qualitative feedback on health professional Little impact Potential. If formats varied to suit the patients needs If qualitative feedback obtained If process encourages self reflection If patient seen as an equal partner

18 Conclusions Feedback from patients works best if it is; Qualitative Patient centered Evidence based A journey not a destination

19 Final thoughts Avoid making what is measurable important and find ways of making what is important measurable. Robert MacNamara World Bank

20 References All-Party Parliamentary Group (2011). Report of the Inquiry into Overcoming the Barriers to Literacy. London: All-Party Parliamentary Group for Education. Campbell, J, Roberts, M, Wright, C, Hill, J, Greco, M, Taylor, M, Richards, S. (2011) Factors associated with variability in the assessment of doctors professionalism; analysis of survey results. British Medical Journal, 343, d6212 Chisholm, A, Sheldon H. (2011) Service user feedback tools: an evidence review and Delphi consultation. Davies, J Wright, et al (2009) By listening hard developing a service user feedback system for adopted and fostered children in receipt of mental health services. Adoption and Fostering 33 (4) Lee, F (2011) Patient Satisfaction or Patient Experience? General Medical Council (2014) Good Medical Practice London, GMC. HCPC (2013) Fitness to Practice Annual Report HCPC (2011) Professionalism in healthcare professions. Judson, T,,Detsky, A, Press, M. (2013) Encouraging patients to ask questions; how to overcome white coat silence. Journal of the American Medical Association 309 (22) Law, J., van der Gaag, A., Hardcastle, B., Beck, J., MacGregor, A., Plunkett, C. (2007) Communication Support Needs; a Review of the literature. Scottish Executive Social Research, Edinburgh. Lorig, K. The Chronic Disease Self Management Programme (CDSMP) Mander, C, Rigby, C (2014) Obtaining patient feedback for doctors revalidation using accessible resources. Papadakis MA, Arnold GK, Blank LL, Holmboe ES, Lipner RS (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards. Annals of Internal Medicine 2008;148: Reinders M et al (2010) Does patient feedback improve the consultation skills of general practise trainees? A Controlled trial. Medical Education 44(2) van der Gaag, A, Reid, D, Glass, K, (1993) Audit: a manual for speech and language therapists. Royal College of Speech and Language Therapists, London Talking Mats 2013, Widgit Symbols Widgit Software ,

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22 An example of patient feedback in an adapted format Talking Mats: adapted version of GMC Q4 Mander and Rigby (2014)

23 Talking Mat Adapted version of GMC Q4