When the patient is the expert: measuring patient experience and satisfaction with care
The four researchers who co-wrote the article define how to choose a quality measure for person-centred care, as well as the precautions to be taken in connection with this measure, so that the results obtained are clear and actionable. The article distinguishes the following two broad categories of care measures: measuring patient experience (the interactions that patients have with the health system) and measuring patient satisfaction (patients’ evaluation of the care provided relative to their expectations).
Clarifying the design of measures to enhance their utility.
Quality is a necessary component of modern health systems, with a view to improving patient care. In addition, measuring the care provided to the patient, based on their own judgement, is a key step towards improving the quality of care provided. As a result, many patient-centred measures have been proposed in the scientific literature.
However, when measures do not have a clear purpose or are incorrectly specified or interpreted, they risk conveying an inaccurate and unreliable assessment of quality of care. This inappropriate use of measures can waste time and resources, both in the initial collection of data and also in actions taken resulting from poor measurement. In fact, three aspects concerning the choice and analysis of the measures are presented in the article, in order to ultimately obtain clear and actionable results:
- • The choice of measures to be used will depend on the intended purpose of the analysis
- • Take patient subjectivity into account when interpreting measures
- • Take time to validate and test the measures before deploying them
1st aspect: The choice of measures to be used will depend on the intended purpose of the analysis
From the start, we need a clear purpose on what the measures will be used for, even before choosing them. There are two main categories of purposes, and depending on them, two types of measures:
- • If the purpose is to make changes in order to improve the care provided: choose measures based on the patient experience
- • If the purpose is to find out the expectations of a patient or certain type of patient, to then meet their expectations in terms of the health system: choose measures of patient satisfaction.
2nd aspect: Take patient subjectivity into account when interpreting measures
How questions are framed influences the degree of subjectivity within the results. Questions that ask patients to provide a direct report of what happened tend to be less subjective than those that ask patients to evaluate or rate their experience, as is the case for all satisfaction measures.
Consider, for example, the following question, found in a patient experience survey in the United States: “Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?”. By including the phrase “in a way you could understand” the question changes from asking patients to report on care that was provided to asking them to evaluate their experience of care; this inclusion makes the question more subjective.
Taking into account whether the question involves subjectivity makes it possible to consider whether results should be adjusted, for example taking into account factors like age, health status or type of care received. However, these adjustments should not be used to improve scores obtained, but rather to understand which populations may be having sub-optimal experiences of care and how their experiences can be improved.
3rd aspect: Take time to validate and test the measures before deploying them
Patient-centred measures often use self-reporting. However, self-reporting does not exempt the people managing the measures from validating, or at least testing, their measures: check that the measures reflect a larger model that has already been built and established (construct validity), that the measures are representative of the different types of care or population (content validity), or even to what extent and within which population the result can be generalised.
In conclusion, thoughtful and framed patient-centred measures achieve clear and precise results, helping health services progress towards greater respect and efficiency.
Source : Larson E., Sharma J., A Bohren M., Tunçalp O. When the patient is the expert: measuring patient experience and satisfaction with care. Department of Biostatistics and Department of Global Health and Population, Harvard (United States of America) ; Centre for Health Equity, Melbourne (Australia) ; Department of Reproductive Health and Research, World Health Organization, Geneva (Switzerland). Bulletin of the World Health Organization, 97:563-569 ; 2019. (Available at http://dx.doi.org/10.2471/BLT.18.225201)