What do we need to think about before asking for patient feedback? Andrew Thompson University of Edinburgh

Policy background Consensus on patient involvement in definitions, development and management of quality of health care Focus on patient-centredness Continuum of political control: central command and control laissez-faire centralised regulatory frameworks (3rd Way) Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

What is the purpose? Public accountability Quality improvement Macro-level: system performance management benchmarking competition/contestability through markets Micro-level: feedback to professionals and managers acceptability of processes / social model of health Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

Which patients? Specific services Sub-populations; e.g. sociodemography, illness/condition, geographical Complainants Problems: - exclusion of important groups - appropriate attribution of responsibility Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

What kind of data is needed? Existing (secondary) data available? it probably needs to be modified Developmental / interpretative study? qualitative methods; e.g. interviews, focus groups, narratives, patient panels, etc. Measurement and enumeration? quantitative methods; e.g. structured surveys Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

What kind of information is needed? Clarification of concepts / issues Description of current situation Description of change Analysis interpretation explanation prediction generalisation Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

Reports or ratings? Problems with measuring satisfaction lack of coherent theory lack of utility for quality improvement high reported levels and lack of variation This has led some to abandon satisfaction in favour or patient reports Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

Problems in satisfaction measures : 1 Theoretical concentration on cognitive aspects assumption of continuum from satisfaction to dissatisfaction Philosophical scientific reliability and validity context and interaction between variables Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

Problems in satisfaction measures : 2 Methodological direct vs indirect evaluation general vs specific aspects weak measures – non-discriminating distorted measures – skewed simplifying analytical assumption Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

Problems with patient reports Assumption of objectivity scientific/bio-medical objectivity vs humanistic/social scientific subjectivity Who decides on acceptability, if not patients? patient-centredness gives primary role to patients Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

Horses for courses Micro-level: service quality improvement professionals and managers need to know where to focus (ratings) and how to improve services (reports) need information on what is important, as well as the most satisfying/dissatisfying Macro-level: public accountability need for a parsimonious set of indicators evidence (limited) of superiority of ratings Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

Conclusions In attempting to solve apparent methodological problems, a focus on reports alone raises problems of an ethical and political nature Need to embrace subjectivity and work to understand it to create patient-centred services and a coherent theory of patient satisfaction To decide on value of patient judgements, there is a need to know: causes of satisfaction and dissatisfaction meanings and importance of health care and quality Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006