407The Patient Experience and Quality of Care
The importance of incorporating the patient perspective and experience in assess-
ments of quality of healthcare has long been recognized internationally by o rganiza-
tions such as the World Health Organization (WHO) [ 27 ] and the Organization for
Economic Cooperation and Development [ 28 ]. In the US, the Consumer Assessment
of Healthcare Providers and Systems (CAHPS) survey tool aims to facilitate con-
sumer (patient) choice and to offer guidance to healthcare providers on how to
improve service [ 29 ]. The Picker Institute’s hospital survey (PPE-15) is one of the
most widely used tools internationally for measuring patients’ hospital experiences
in order to benchmark quality of care [ 5 ]. PPE-15 comprises a basic set of 15 ques-
tions that are designed to be applicable in all hospitals, and relevant to all patients.
In a review of US and UK patient experience initiatives, the need to measure detailed
patient experiences instead of general patient satisfaction, to introduce an integrated
system, and to standardize questionnaires and methods has been highlighted [ 29 ].
In the UK, several government reports and initiatives have emphasized the
importance of incorporating the patient experience into the delivery of quality care
[ 30 – 34 ]. The government’s white paper “Equity and Excellence, Liberating the
NHS” puts the patient experience and patient outcomes as the metrics for quality
improvements in healthcare [ 34 ]. In addition, the annual Quality Account produced
by National Health Service (NHS) trusts incorporates three principles of safety,
effectiveness, and patient experience. The 2012/2013 NHS Operating Framework
requires frequent patient surveys and engagement with patients to enable quality.
Furthermore, the new Quality Standard and guidance on patient experience in adult
NHS services, published by the National Institute for Health and Care Excellence
(NICE) in February 2012, incorporates 14 quality statements central to patient
experience of care [ 33 ]. More recently, in May 2013, the Healthcare Quality
Improvement Partnership (HQIP) announced the award of a national clinical audit
of rheumatoid and early infl ammatory arthritis [ 35 ]. The audit aims to capture
patient-reported outcomes and experience data (where appropriate) for all patients
presenting from the 1 October 2013 to the end of September 2015. The importance
of patient experience has also been highlighted within commissioning. The UK
Department of Health’s World Class Commissioning outlines 11 competencies
required of commissioners [ 36 ]. Competency 3 requires Primary Care Trusts (PCTs)
to “proactively build continuous and meaningful engagement with the public and
patients to shape services and improve health” [ 36 ].
The NHS Outcomes Framework has been developed to drive these improve-
ments in quality. The Framework identifi es long-term conditions and patient’s expe-
rience of care as two of its fi ve domains [ 37 ]. The latest version of the Outcomes
Framework now incorporates two additional indicators within the patient experi-
ence domain. The fi rst is the “Friends and Family” test, which asks patients whether
they would recommend the hospital where they received their treatment and care to
a family member or friend. The second focuses on improving experience of inte-
grated care, following recommendations from the NHS Future Forum. From April
17 PROMs vs. PREMs (Patient-Reported Experience Measures)