Patient voices are valuable for improving healthcare services

The National Patient Experience Survey allows the evaluation of patient experience in our public acute hospitals, explains Rachel Flynn.
Patient voices are valuable for improving healthcare services

The National Patient Experience Survey allows the evaluation of patient experience in our public acute hospitals, explains Rachel Flynn.

Patients, the users of healthcare services, have long been recognised as the most critical shapers of healthcare services. Prior to 2017, there was no systematic evaluation of patient experience carried out in the country’s public acute hospitals. The National Patient Experience Survey addresses this deficiency, and is the largest survey of patient experience in public acute hospitals to be conducted in Ireland.

This new nationwide survey of acute hospital inpatient care is organised in partnership between the regulator, Health Information and Quality Authority (Hiqa); the provider of hospital services, the Health Service Executive (HSE); and the national policy and legislation developer, the Department of Health.

Throughout the month of May 2017, all patients discharged from one of the country’s 40 public acute hospitals, totalling 26,635 people, were invited to participate.

In total, 13,706 people completed the survey questionnaire, leading to a response rate of 51%.

This exceptional rate compares favourably to similar surveys in other countries — eg, in Scotland their most recent inpatient survey got a 40% response rate, and in England 44% — and indicates that patients here have a strong desire to use their voice to improve our health service.

The information gathered provides a comprehensive picture of the quality of healthcare, as reported by patients themselves.

It asked questions on whether, for example, patients had enough privacy when being examined in the emergency department or whether hospital staff wore name badges.

The survey helped to detect specific problems in the delivery of healthcare.

As the survey is repeated year on year, it will be possible to measure which aspects of patients’ experiences are improving or worsening over time.

Acknowledging that there are many different ways to measure patient experience, more and more governments are opting for national surveys.

Canada, the United States, Denmark, the Netherlands, Norway, England, Iceland, Japan, New Zealand, Turkey and Scotland all measure patient experience as part of ongoing national programmes.

The 61 questions for this survey are from an internationally validated question bank of 189 questions, originally developed by the Picker Institute in the England. An international review conducted by Hiqa in 2016 identified that many countries used questions from this library.

Six focus groups held with patients throughout the country and a Delphi study also including several patients were conducted to select the most relevant questions in the Irish context. Cognitive testing then took place with patients to ensure that the survey flowed well. The end result was a survey that could effectively capture patients’ experience.

How was a 51% response rate achieved?

A rigorous communications plan was put in place.

Firstly the model adopted allowed for the internationally recognised Halo Effect, that is asking patients about their experience after they leave hospital.

That is, the survey was distributed approximately two weeks after the patient left the hospital, ensuring respondents felt at liberty to give an honest answer and providing them with an opportunity to reflect on their care.

Another element of the communications plan was to use promotional material throughout each participating hospital, to ensure that patients and their families were aware of the survey. This included napkins with NPE branding, posters, pull up banners and animated videos.

Staff in each hospital were crucial to the success of the survey and so senior management from the HSE and HIQA visited each of the participating hospitals throughout the survey month to provide support and encourage participation.

Each visit was followed up with radio interviews and articles in local newspapers and social media was alive with reporting on the activity — ensuring that the public and patients were familiar with the survey and the branding and therefore would be comfortable participating. A national advertising campaign was also run by the HSE on several local radio stations and a national radio station.

Once the results were anonymised, each hospital had access to individual results, empowering the hospital to act as appropriate. The NPE Team also wrote a report on each of the results, including for the first time internationally an overview of the 21,500 qualitative comments, broken out by theme. They can be found on

Rachel Flynn is Hiqa director of health information and standards and programme director for the National Patient Experience Survey.

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