QUALICOPC in the UK, the patient
perspective
Prof. Niro Siriwardena, Dr Coral Sirdifield, Ana Godoy Caballero
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Introduction & Aims
• To discuss various approaches for defining and
measuring patient satisfaction with primary care
• To present an approach for measuring satisfaction
• To show patients’ perspectives of primary care for:
o All patients participating in QUALICOPC UK
o Different population subgroups, such as age, health status
and education
• To discuss how the levels of satisfaction that patients
report could be improved
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What is patient satisfaction?
How is it measured?
?
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What is patient satisfaction?
• Satisfaction’ is defined in numerous ways in the literature
– Used interchangeably with ‘experience’ (Ahmed et al., 2014)
– Differentiated from ‘experience’ (Coulter et al., 2009)
– Viewed as “a multidimensional concept, based on a relationship
between experiences and expectations” (Delnoij, 2009)
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How is it measured?
• Surveys
• Interviews
• Focus groups
• Patient forums
• Formal complaints
• Comments on websites
• Feedback in appraisals
• Compliments received by staff
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Our approach
• We follow Delnoij’s definition “a multidimensional
concept, based on a relationship between
experiences and expectations”
• We defined ‘expectations’ as what a patient desires
– ideal expectations
• We defined ‘experiences’ as what patients report
occurred in the consultation (as opposed to their
feelings about them)
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Our approach
Concentrate here
Attributes that patients value very highly but that currently
receive a low (poor) experience rating after service users
see their GP. Providers should concentrate on these
attributes to optimise patients’ experience of primary care
services
Maintain performance
Attributes are highly valued by patients, and patients
report good experiences with regard to these attributes
after they have seen their GP, so the performance should
be kept as it is
IMPORTANCE
High
PERFORMANCE
Low
High
Low
Low priority
Attributes that are relatively unimportant to patients and
also receive low (poor) experience ratings. From a patient
perspective we should not concentrate on these attributes
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Possible overkill
Attributes that are rated as relatively unimportant to patients but
nevertheless receive high (good) experience ratings. As these
attributes are not that important, efforts could be made to use these
“idle” resources in other aspects of the service
Our approach
• Where we obtained the data from
• QUALICOPC study
o 3 English regions
o It includes 4 types of questionnaires:
o
o
o
o
Fieldworker
GP
Patient experience
Patient values (expectations)
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Attributes Used in the Analysis
Attribute
1. Doctor has the patient’s medical records at hand
Theme
Informational continuity
2. Doctor is polite
Communication
3. Doctor listens carefully to patients
Communication
4. Doctor takes sufficient time/doesn’t make the patient feel under pressure
Communication
5. Doctor involves patients in making treatment decisions
6. Doctor asks patients about other possible problems besides the one s/he came for
7. Doctor knows important information about the patient’s background
8. Doctor knows about the patient’s living situation
9. After the visit the patient feels s/he can cope better with his/her health problem/illness
Empowerment
Comprehensiveness
Informational continuity
Continuity
Empowerment
10. Extensive opening hours
Accessibility
11. Proximity of the practice to the patient’s house
Accessibility
12. Short waiting time when contacting the practice
Accessibility
13. The patient knows how to get evening, night and weekend services
Accessibility
14. Reception staff are polite and helpful
15. Ease of getting an appointment
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Communication
Accessibility
What we found
Most valued items
Least valued items
Ease of getting an appointment
Doctor knows about the patient’s living situation
Doctor knows important information about the patient’s
background
Doctor asks patients about other possible problems
besides the one s/he came for
Doctor has the patient’s medical records at hand
Short waiting time when contacting the practice
Doctor listens carefully to patients
Extensive opening hours
Doctor takes sufficient time/doesn’t make the patient feel
under pressure
Proximity of the practice to the patient’s house
Doctor involves patients in making treatment decisions
Doctor is polite
After the visit the patient feels s/he can cope better with
his/her health problem/illness
The patient knows how to get evening, night and weekend
services
Reception staff are polite and helpful
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What we found
Most positive experiences
Least positive experiences
Doctor is polite
Doctor knows about the patient’s living situation
Doctor listens carefully to patients
Doctor asks patients about other possible problems
besides the one s/he came for
Doctor has patients’ medical records at hand
The patient knows how to get evening, night and weekend
services
Proximity of practice to patient’s house
After the visit the patient feels that s/he can cope better
with his/her health problem/illness
Reception staff are polite and helpful
Ease of getting an appointment
Doctor takes sufficient time/doesn’t make the patient feel
under pressure
Doctor knows important information about the patient’s
background
Short waiting time when contacting the practice
Doctor involves patients in making treatment decisions
Extensive opening hours
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Questions
• How does this compare with experiences and
values in your settings?
• How does this compare with policies in your
countries?
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1. Doctor has the patient’s medical records at
hand
2. Doctor is polite
3. Doctor listens carefully to patients
4. Doctor takes sufficient time/doesn’t make the
patient feel under pressure
5. Doctor involves patients in making treatment
decisions
6. Doctor asks patients about other possible
problems besides the one s/he came for
7. Doctor knows important information about the
patient’s background
8. Doctor knows about the patient’s living
situation
9. After the visit the patient feels s/he can cope
better with his/her health problem/illness
10. Extensive opening hours
11. Proximity of the practice to the patient’s
house
12. Short waiting time when contacting the
practice
13. The patient knows how to get evening, night
and weekend services
14. Reception staff are polite and helpful
15. Ease of getting an appointment
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The IPA
Possible Overkill Quadrant
o
Extensive opening hours
o
Proximity of the practice to
the patient’s house
o
Short
waiting
time
contacting the practice
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when
Low Priority Quadrant
o
Doctor
knows
about
patient’s living situation
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the
Maintain Performance Quadrant
o
Doctor has patient’s medical
records at hand
o
Doctor listens carefully to
patients
o
Doctor is polite
o
Reception staff are polite and
helpful
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Concentrate Here Quadrant
o
The patient knows how to get evening,
night and weekend services
o
Ease of getting an appointment
o
After the visit the patient feels that s/he
can cope better with his/her health
problem/illness
o
Doctor involves patients in making
decisions about treatment
o
Doctor know important information
about the patient’s background
o
Doctor
asks
patients
about
other
possible problems besides the one s/he
came for
o
Doctor takes sufficient time/doesn’t
make the patient feel under pressure
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Questions
• How could you change policy/practice based on
these findings?
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ANALYSES BY PATIENT
CHARACTERISTICS
BY AGE
Patients aged < 65
Patients aged ≥ 65
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BY HEALTH STATUS
Good health
Poor health
What do the patients expect?
Patients < 65/Good health
Patients ≥ 65/Poor health
Most valued
Most valued
?
?
Least valued
Least valued
?
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?
What experiences do patients report?
Patients < 65/Good health
Patients ≥ 65/Poor health
Best experience
Best experience
?
?
Worst experience
Worst experience
?
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?
ANALYSES BY PATIENT
CHARACTERISTICS
BY AGE
Patients aged < 65
Patients aged ≥ 65
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What do the patients expect?
Patients < 65
Patients ≥ 65
Most valued
Most valued
Ease of getting an appointment
Ease of getting an appointment
Doctor knows important information
about the patient’s background
Least valued
Doctor knows about the patient’s living
situation
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Least valued
Doctor knows about the patient’s living
situation
What experiences do patients report?
Patients < 65
Best experience
Doctor is polite
Doctor listens carefully to patients
Worst experience
Doctor know about the patient’s living
situation
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Patients ≥ 65
Best experience
Staff at the reception are polite and
helpful
Worst experience
Doctor know about the patient’s living
situation
Differences in the IPA charts
Age < 65
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Age ≥ 65
Differences in the IPA charts
Age < 65
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Age ≥ 65
Differences in the IPA charts
Age < 65
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Age ≥ 65
Differences in the IPA charts
Age < 65
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Age ≥ 65
Summary of changes
Attribute
Age < 65
Age ≥ 65
Doctor has the patient’s medical records at hand
Concentrate here
Maintain performance
Doctor listens carefully to patients
Concentrate here
Maintain performance
Extensive opening hours
Possible overkill
Low priority
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ANALYSES BY PATIENT
CHARACTERISTICS
BY HEALTH STATUS
Good health
Poor health
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What do the patients expect?
Good health
Poor health
Most valued
Most valued
Doctor listens carefully to patients
Ease of getting an appointment
Least valued
Doctor know about the patient’s living
situation
[email protected]
Ease of getting an appointment
Doctor knows important information
about the patient’s background
Least valued
Doctor know about the patient’s living
situation
What experiences do patients report?
Good health
Poor health
Best experience
Best experience
Doctor is polite
Doctor is polite
Doctor has patient’s medical records at hand
Staff at the reception are polite and helpful
Worst experience
Doctor know about the patient’s living
situation
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Worst experience
Doctor know about the patient’s living
situation
Differences in the IPA charts
Good health
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Poor health
Differences in the IPA charts
Good health
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Poor health
Differences in the IPA charts
Good health
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Poor health
Differences in the IPA charts
Good health
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Poor health
Differences in the IPA charts
Good health
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Poor health
Summary of changes
Attribute
Good health
Poor health
Doctor has patient’s medical records at hand
Concentrate here
Maintain performance
Doctor listens carefully to patients
Concentrate here
Maintain performance
Extensive opening hours
Possible overkill
Low priority
Proximity of practice
Possible overkill
Maintain performance
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How satisfaction could be improved
• In all analyses focusing on these three aspects of accessibility
and empowerment is likely to improve patient satisfaction:
o The patient knows how to get evening, night and weekend
services
o Ease of getting an appointment
o After the visit the patient feels that s/he can cope better with
his/her health problem/illness
o Item 5 (doctor involves patients in making treatment
decisions) also needs improvement for those age ≥ 65
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Implications for practice
• Measuring satisfaction as patients’ subjective perceptions of the quality of
aspects of care often results in high reported satisfaction levels
• This makes it difficult for practices to decide where they should focus
their improvement efforts
• Instead we could use patient questionnaires with questions on both ideal
expectations and experiences
• This would make it easier to identify areas for improvement for the whole
practice population and for patients with particular characteristics
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Thank you for listening!
Find out more about our research at:
www.CaHRU.org.uk
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