An evaluation of a near real-time survey for improving patients' experiences of the relational aspects of care: a mixed-methods evaluation

Background The Francis Report (2013) provided many recommendations to improve compassionate care in NHS organisations, including more wide-spread use of real-time feedback (RTF) to collect patient experience data. This research directly addressed these recommendations and aimed to provide an evidence-based toolkit to support NHS quality improvements. Objectives To develop and validate a survey of compassionate care for use in near-real time on elderly care wards and AE departments. This research also evaluated the effectiveness of the realtime feedback approach for improving relational aspects of care and provides suggestions for how the approach can be used by other hospitals to strengthen compassionate care. Design The research utilised a mixed methods design, using quantitative, qualitative and participatory research approaches to collect patients’ experiences of relational care and the views of NHS staff in an effort to evaluate the processes and impacts of NRTF data collection. Setting The research was carried out across six case study sites across England, in wards that predominately served elderly patients, and in Accident and Emergency (AE) departments Participants The 3928 participants in the patient experience survey were inpatients on elderly care wards, as well as persons who had sought medical care in AE Frontline staff, service leads, senior management and volunteers also took part in surveys (n = 274) and interviews (n = 82) designed to understand the staff perspectives and opinions of collecting patient experience data. Interventions A patient experience survey was implemented using a tablet computer-based methodology facilitated by trained volunteers. Responses were used alongside feedback from staff to evaluate the use of a NRTF approach as a method for improving patient experiences of relational aspects of care. Main Outcome Measures The patient experience survey measured relational aspects of care. Another outcome measure was improvements to care as planned, implemented and reported by staff. Data Sources Data sources included an NRTF patient experience survey, weekly volunteer diaries, staff interviews and surveys, workshops, and meetings with case study sites. Results A small but statistically significant improvement (p=.044) in relational aspects of care over the course of the study was noted overall. Staff implemented a variety of improvements to enhance communication with patients. Limitations Maintaining volunteer and staff engagement throughout the study was difficult. Few surveys were completed per ward or department each week. This made examining trends in patient experiences over time challenging. Conclusions Near real-time feedback (NRTF) offers an effective approach for monitoring and improving relational aspects of care. Future Work Staff frequently expressed a view that volunteers’ interactions with patients whilst administering the survey were themselves beneficial to patients. Future research should examine the impact of volunteer interactions with patients on their experiences of relational aspects of care.