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K.I.S.S. it better – evidence that using simple ratings and reviews by patients can be the quality and safety marker

February 21, 2013

There’s a lot of awful rubbish being spoken in the NHS at the moment about complicated systems of “promoters and detractors” being necessary to help us listen to the voice of the most important person in the healthcare team – the patient. Incredible that weeks after the Francis Report calls for simple, clear, comparable data that everyone can understand, some committee somewhere creates its own labyrinthine scoring system that only three people in the whole of the UK understand.

I don’t really get why anyone would wish to complicate all this and use systems such as “net promoters” which research shows to have absolutely no correlation at all to clinical quality or safety, when there are simple, proven, methods which accurately predict and monitor safety and quality – and which are understood by the vast majority of the public, patients and NHS staff. Maybe I’m just not clever enough, but I worry that using metrics known to have no relation to safety or quality could actually provide false reassurance and make it harder to detect poor standards.

So, as a simple doctor who is passionately obsessed with improving care quality and patient experience, I’ll just stick to methods for which there is lots of evidence of effectiveness, which are simple and cheap to deploy across the whole NHS and which are properly aligned with the Prime Minister’s demand that the Friends and Family Test be a clear and simple way for patients to know where they can find great care.

The list below brings together a few research publications reminding us firstly, that great patient experience – as well as being fundamental in its own right – aligns with and predicts high quality, safe care; and secondly, that simple ratings and reviews (familiar and understood by everyone who has ever used the internet) are now a proven way to measure and monitor that experience.

  1. Dr Doyle et al from Imperial, London reviewed 55 studies looking at correlation between patient experience and care quality. Their findings were unequivocal: “Patient experience is positively associated with clinical effectiveness and patient safety…Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the ‘real’ clinical work of measuring safety and effectiveness.”
  2. From the NEJM in 2008 (and still a great paper): US hospitals that deliver better experience deliver better outcomes for their patients – including mortality from myocardial infarctions and pneumonia – “Hospitals with a high level of patient satisfaction provided clinical care that was somewhat higher in quality for all conditions examined”
  3. Gao et al, 2012, from the University of Maryland and Harvard School of Public Health compared simple ratings and reviews of doctors with accepted measures of quality, post-graduate training and history of being sued. Whilst pointing out that more work needs to be done, they concluded that the findings suggest “a positive correlation between online ratings and physician quality”.
  4. Back to Imperial in London, where Felix Greaves et al showed that hospitals with good patient ratings on the internet tend to have a 5 per cent lower death rate and 11 per cent lower re-admission rates (this for NHS hospitals by UK patients).
  5. Naomi S Bardach et al from the Department of Pediatrics, UCLA took all the reviews of US hospitals on Yelp (simple star ratings from 1 to 5) and analysed the relationship with formal, complex measures of quality. Once again, same thing: if the public give a high rating the hospital is likely to be safe and you are more likely to get great care, survive your heart attack, not die from your pneumonia etc.

The picture is probably becoming clear now, but I’ll keep adding to this list in the coming months as I’m aware of many other studies that have now been completed showing the same thing, but not yet published. This is all of course great news for patients and their doctors – simple ratings and reviews show patients where to find great care, and give doctors and hospitals continuous, real-time feedback on the actual quality of what they are doing day by day.

But I’ll leave the final word to another person far cleverer than I, another Harvard Professor, Dr Ronen Rozenblum from the Division of General Internal Medicine, Brigham and Women’s Hospital:

Patient experiences acquired via the internet and social media appear destined to become of major value to the public, to healthcare organisations and possibly also to regulatory bodies…and should help identify poor care and outstanding care. Thus, in 10 years, the question may not be how to use such data, but how we ever lived without them.

 

 

 

 

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