Thursday, 6 October 2011

Patient experience: how to measure it?

No decision about me without me” has put the patient firmly the centre of the many hundreds of millions of individual clinical encounters in the NHS each year and patient experience is now one of the 5 domains of the Outcomes Framework. Up there with amenable mortality, long-term conditions, rehabilitation/recovery and safety; patient experience is set to become a cornerstone of quality of care. So how do we measure it? What counts, what’s important to the patient?

Already, patient feedback tools and services to rate GPs are increasingly available, not least on NHS Choices which attracts 5.7 million users per month - showing how channels for knowledge and comment are fast becoming central to how service users appraise their care choices.

Organisations such as NHS Direct have adopted the Net Promoter Score (NPS) which is widely used across many industry sectors. It focuses on understanding whether a patient would or would not promote the service they receive. NHS Direct found the system simple to deploy, simple to understand and simple to respond to.

At first glance, it may seem more appropriate to customer care rather than clinical encounters but there are many ways in which it’s relevant to healthcare providers. A clear understanding of whether a patient would or would not promote a provider based on a service they received should enable provider organisations and clinical teams within those organisations to identify where key service provision is lacking and to implement steps to address these issues.

For example, a detractor score could be the result of a patient returning to clinic to review various results and investigations that then turn out not to be available. There could be a failure to communicate. They may have to travel a long distance to have intravenous iron that could quite easily have been given in their local community. The specific response allows the provider team to then look into the issues and address them to avoid the same situation arising again.



In summary, net promoter scores is based on the principle that every service’s users can be divided into 3 categories: promoters, passives and detractors. By asking one simple question “how likely is it that you would recommend the service to a friend or colleague?” you can track these groups and get a clear measure of a service’s performance through its users’ eyes. Results can be used for the purpose of tracking performance in individual services over time or for comparison across similar services. The NPS questions can be used in a face to face, remote access such as telephone or self service such as web environment. Users respond on a 0-10 point rating scale and the categories are as follows:

• Promoters (score 9-10) are loyal enthusiasts who will advocate on behalf of the service.
• Passives (score 7-8) are satisfied but unenthusiastic customers who are vulnerable to competitive offerings.
• Detractors (score 0-6) are unhappy customers who can damage your brand and impede growth through negative word-of-mouth.

To calculate NPS take the percentage of customers who are promoters and subtract the percentage who are detractors (the calculation ignores passives).

If you choose to use this in your kidney service or are using something similar, do let me know.

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