Ireland launches experiment in patient data

Tens of thousands of patients discharged from hospital in Ireland this month will be quizzed on their experience of the health system.

The patient experience survey, a battery of 61 questions, drawn from a tried and tested question bank used in Denmark, England and New Zealand, is being run by the Health Information and Quality Authority (HIQA), the health service watchdog, and is supported by the Health Service Executive (HSE) and Department of Health.

The survey is part of a broader effort to embrace person-centred care, said Rachel Flynn, director of health information and standards at HIQA. “More engaged people tend to be healthier,” she said. “Patient experience is also a very good indicator of how the system is doing on quality and safety.”

Using an existing set of questions will allow for international comparison, Flynn said. “We wanted a tool that was robust and valid; that will allow us to compare internally on an annual basis but also to look at results from elsewhere.”

The survey has the backing of health minister, Simon Harris, who officially launched the project in April, and from the director general of the HSE, Tony O’Brien. Both will be central to how the results of the survey are turned into action.

Flynn said improvement plans will follow the first round of the survey. “The HSE has committed to developing plans around how we can improve patient experience,” she said. “These reports will be published, along with quarterly reports, so that patients will see action.”

HIQA worked with patient associations and focus groups to whittle down a long-list of questions from 189 to 61, covering topics including pain management, nursing care, the discharge process, respect for patients and questions related to food, such as whether patients received help eating or were provided with replacement meals if they missed mealtimes while having medical procedures.

The questionnaire will be sent to all patients aged 18 years and over who are discharged from hospital this month after a stay of 24 hours or more. Two weeks after leaving hospital, patients will receive a written invitation to participate in the survey, with a reminder sent two weeks later. The invitations contain a code for a dedicated website, allowing patients to take the anonymous survey online.

Halo effect

There will be several weeks to complete the survey, thus avoiding the halo effect that can arise when patients are asked to rate their experience at the time of discharge, a moment when some may be relieved or grateful to be going home.

“There is no value in surveying patients who may be in a vulnerable position,” said Tracey Carroll, health information manager at HIQA, who responsible for managing the survey. “We want considered and practical feedback that can translate into improvements.”

Around 27,000 patients will be eligible to take part. While there is no firm target response rate, around 50 per cent of patients respond to similar questionnaires in Denmark and England. Uptake of around 40 per cent would be considered good for the first survey, according to HIQA, but it is expected response rates will increase over time as the survey becomes better known.

“The more responses we receive, the richer the data and the more powerful patients’ voices will be,” said Carroll.

Broad backing

Brigid Doherty of Patient Focus, an advocacy group, sees the survey as a chance to accelerate much-needed changes to the Irish health system, which is currently ranked 21^st out of 35 in the European Health Consumer Index.

“We had an advisory role in developing the questions and in making it user-friendly,” says Doherty. “We have never had anything like this before in Ireland so we are encouraging patients to complete it.”

The big test will be how the data is used. “The Department of Health has become more transparent and is committed to publishing action plans,” Doherty notes.

Both HIQA and patient representative organisations say the successful rollout of the questionnaire for hospital inpatients could pave the way for surveys focused on other services. This could include outpatient hospital visits and community care, but also specialities such as maternity services or cancer care, which would require the development of a new set of survey questions.

The Picker Institute, which helped to develop the questionnaire used in Ireland, has seen growing interest in the field, with patient experience become a routine part of healthcare quality control in developed countries.

CEO Chris Graham draws a distinction between probing patient experience and rating patient satisfaction. “Unlike satisfaction surveys, which ask people to rate how content they were with their care, patient experience surveys ask patients to report whether specific things did or did not happen during their stay in hospital,” he said.

“This is more useful, as responses are less subjective and can highlight specific areas for improvement. Satisfaction surveys can generally only say whether patients were dissatisfied, not why.”

Studying patient experience is only valuable if the results are acted upon, said Graham. “Measurement is just the first step. Detailed results must be provided to healthcare providers and professionals, and they must use these to plan and initiate changes.”