Can we help patients have a better experience? Implementing NICE guidance on patient experience
- 1RCN Research Institute, University of Warwick, UK
- 2National Clinical Guidelines Centre, Royal College of Physicians, London, UK
- Correspondence to: Dr Sophie Staniszewska
, RCN Research Institute, University of Warwick, UK;
A good-patient experience has become a key component of good-quality care, reflecting a long tradition of research and policy initiatives.1–5 However, the quality and consistency of care still needs to be improved to ensure that patients have the best possible experience. The Government signalled in its White Paper ‘Equity and excellence: liberating the NHS’4 that greater focus needs to be placed on improving patients’ experience of NHS care. In response to the need to enhance the quality of care, NICE have published new guidance. The ‘Patient experience in adult NHS services: improving the experience of care for people using adult NHS services’ Guidance and Quality Standard (GQS) aims to promote individual, organisational and professional change in culture, attitudes, beliefs and practice at all levels to create truly create patient-centred care.6
The guidance focuses on adult patient experiences and is relevant for all people using generic adult NHS. There is also guidance specifically covering the experiences of those using mental health services.7
The patient experiences guidance differs from other NICE guidance, as it is non-population and non-setting specific and so applies to all patients, conditions and settings. The GQS represent a landmark in the history of patient experience initiatives, as it tacitly acknowledges the importance of patient-based evidence (or experiences), alongside clinical and economic evidence.8 This reflects the position outlined by Richard Doll, the eminent epidemiologist, who stated that there is no point providing clinically effective and economically efficient care that no one wants.9
The Guidance Development Group, including six patients, used a range of additional sources of evidence as well as the Warwick Patient Experiences Framework,10 to establish what is important to patients when considering their experiences of healthcare. Other sources included a review of existing patient experience frameworks, a review of NHS survey results, existing NICE recommendations related to patient experience, and systematic reviews of the literature on prioritised topic areas. The dimensions of patient experience included in the guidance are: knowing the patient as an individual; essential requirements of care; tailoring healthcare services for reach patient; continuity of care and relationships and enabling patients to actively participate in their care.
A quality standard was also developed, which defines high-quality care. The aim of the quality standard is to provide the NHS and commissioners with evidence-based statements that are aspirational, but achievable, markers of a good patient experience.6 Together, the quality standard and the guidance provide the foundation for a cultural shift towards a truly patient-centred service.
With the publication of the GQS, the focus now needs to be on effective implementation across care provision. Some initial advice and support are already provided by NICE. However, the implementation of any guidance into practice is a complex process and depends on a range of factors that can influence uptake.11 Existing implementation frameworks provide a context for thinking through key elements of an implementation strategy. The Promoting Action on Research Implementation in Health Services framework is particularly useful in this context as it demonstrates the complex interplay of the factors influencing the successful implementation of evidence in practice (evidence, context and facilitation).12 We hope future research can evaluate implementation strategies to identify those that promote changes in practice that enhance patient experiences and lead to truly patient-centred care.