What matters to medical ward patients, and do we measure it? A qualitative comparison of patient priorities and current practice in quality measurement, on UK NHS medical wards

TY - JOUR

T1 - What matters to medical ward patients, and do we measure it? A qualitative comparison of patient priorities and current practice in quality measurement, on UK NHS medical wards

AU - Pannick, Samuel

AU - Archer, Stephanie

AU - Long, Susannah Jane

AU - Husson, Fran

AU - Athanasiou, Thanos

AU - Sevdalis, Nick

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Objectives To compare the quality metrics selected for public display on medical wards to patients' and carers' expressed quality priorities. Methods Multimodal qualitative evaluation of general medical wards and semi-structured interviews. Setting UK tertiary National Health Service (public) hospital. Participants Fourteen patients and carers on acute medical wards and geriatric wards. Results Quality metrics on public display evaluated hand hygiene, hospital-acquired infections, nurse staffing, pressure ulcers, falls and patient feedback. The intended audience for these metrics was unclear, and the displays gave no indication as to whether performance was improving or worsening. Interviews identified three perceived key components of high-quality ward care: communication, staff attitudes and hygiene. These aligned poorly with the priorities on display. Suboptimal performance reporting had the potential to reduce patients' trust in their medical teams. More philosophically, patients' and carers' ongoing experiences of care would override any other evaluation, and they felt little need for measures relating to previous performance. The display of performance reports only served to emphasise patients' and carers' lack of control in this inpatient setting. Conclusions There is a gap between general medical inpatients' care priorities and the aspects of care that are publicly reported. Patients and carers do not act as 'informed choosers' of healthcare in the inpatient setting, and tokenistic quality measurement may have unintended consequences.

AB - Objectives To compare the quality metrics selected for public display on medical wards to patients' and carers' expressed quality priorities. Methods Multimodal qualitative evaluation of general medical wards and semi-structured interviews. Setting UK tertiary National Health Service (public) hospital. Participants Fourteen patients and carers on acute medical wards and geriatric wards. Results Quality metrics on public display evaluated hand hygiene, hospital-acquired infections, nurse staffing, pressure ulcers, falls and patient feedback. The intended audience for these metrics was unclear, and the displays gave no indication as to whether performance was improving or worsening. Interviews identified three perceived key components of high-quality ward care: communication, staff attitudes and hygiene. These aligned poorly with the priorities on display. Suboptimal performance reporting had the potential to reduce patients' trust in their medical teams. More philosophically, patients' and carers' ongoing experiences of care would override any other evaluation, and they felt little need for measures relating to previous performance. The display of performance reports only served to emphasise patients' and carers' lack of control in this inpatient setting. Conclusions There is a gap between general medical inpatients' care priorities and the aspects of care that are publicly reported. Patients and carers do not act as 'informed choosers' of healthcare in the inpatient setting, and tokenistic quality measurement may have unintended consequences.

KW - healthcare quality

KW - medical ward

KW - patient experience

UR - http://www.scopus.com/inward/record.url?scp=85063677717&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2018-024058

DO - 10.1136/bmjopen-2018-024058

M3 - Article

C2 - 30928929

AN - SCOPUS:85063677717

VL - 9

JO - BMJ Open

JF - BMJ Open

IS - 3

M1 - e024058

ER -