1. NICE Guidance and Quality Standard on Patient Experience
Dr Sophie Staniszewska,
Chair of NICE Guidance Development Group
Royal College of Nursing Research Institute
School of Health and Social Studies
University of Warwick

2. Key initiatives Importance of patient experience
Darzi (2008): High quality care for all
NHS Constitution ( )
White Paper: Equity and Excellent: Liberating the NHS
NICE Guidance – direct referral from DH

3. Nature of evidence
NICE Guidelines normally developed around clinical and economic evidence
Patient experience has drawn on patient-based evidence of experiences
Patient-based evidence can sit alongside clinical and economic forms of evidence (Staniszewska et al 2010)

4. Guidance
A set of recommendations focusing on key aspects of patient experience
Informed by:
Research evidence
Recommendations in previously published NICE guidelines
National survey data
Synthesised through consensus process

5. Quality standard QS developed alongside guidance
QS are set of specific, concise statements and associated measures
Aspirational, but achievable
Markers of high-quality, cost effective care
Derived from best available evidence

6. Focus of Guidance Directed primarily at clinical staff
Patient experience is also affected by non-clinical staff such as receptionists, clerical staff and domestic staff
Reflects entirety of patient experience

7. NICE Guidance: Key areas
Knowing the patient as an individual
Essential requirements of care
Tailoring healthcare services for each patient
Continuity of care and relationships
Enabling patients to actively participate in their care

8. Knowing the patient as an individual
Patients value healthcare professionals acknowledging their individuality
Values, beliefs and circumstances influence expectations, needs and service use
Recognition individuals are living with condition, so family and broader life need to be taken into account

9. Example: Recommendation 1.1.1
“Develop an understanding of the patient, including how the condition affects the person, and how the person’s circumstances and experiences affect their condition and treatment”

10. Essential requirements of care
Patients have needs other than the treatment of a specific health condition
Recognition of potential need for psychological and emotional support
Importance of meeting fundamental needs – nutrition and pain management

11. Example: Recommendation 1.2.1
Respect for the patient: All staff providing NHS services should:
Treat patients with respect, kindness, dignity, compassion, understanding, courtesy and honesty
Respect the patient’s right to confidentiality
Not discuss the patient in their presence without involving them in the discussion

12. Tailoring healthcare services for each patient
Patients wish to be seen as individuals in the healthcare system
Services need to be tailored to respond to needs, preferences and values of the patient
Advice on treatments and care, including risks and benefits should be individualised as much as possible

13. Example: Recommendation 1.3.1
Adopt an individualised approach to healthcare services that is tailored to the patient’s needs and circumstances, taking into account their ability to access services, personal preferences and coexisting conditions. Review the patient’s needs and circumstances regularly

14. Continuity of care and relationships
Continuity and consistency of care and establishing trusting, empathetic and reliable relationships with competent and insightful healthcare professionals is key to patients receiving effective, appropriate care

15. Example: Recommendation 1.4.1
Assess each patient’s requirements for continuity of care and how that requirement will be met. This may involve the patient seeing the same healthcare professional throughout a single episode of care, or ensuring continuity within a healthcare team

16. Enabling patients to actively participate in their care
Many patients wish to be active participants in their own healthcare, and to be involved in creating and managing their health strategy and use of services. Self-care and self-management are particularly important for people with long-term conditions

17. Example: Recommendation 1.5.4
Establish the most effective way of communicating with each patient and explore ways to improve communication. Examples include using pictures, symbols, large print, Braille, different languages, sign language, communication aids, or involving an interpreter, a patient advocate or a family member

18. Examples of quality statements
1. Patients are treated with dignity, kindness, compassion, courtesy, respect, understanding and honesty 2. Patients experience effective interactions with staff who have demonstrated competency in relevant communication skills 3. Patients are introduced to all healthcare professionals involved in their care, and are made aware of the roles and responsibilities of the members of the healthcare team

19. Examples of quality statements
4. Patients have opportunities to discuss their health beliefs, concerns and preferences to inform their individualised care
5. Patients are supported by healthcare professionals to understand relevant treatment options, including benefits, risks and potential consequences

20. Examples of quality statements
6. Patients are actively involved in shared decision making and supported by healthcare professionals to make fully informed choices about investigations, treatment and care that reflect what is important to them 12. Patients experience coordinated care with clear and accurate information exchange between relevant health and social care professionals

21. Implementation
Translating guidance into practice offers considerable challenges
Uneven progress relates to complexity of process, with change required at many different levels and depends on range of factors that influence uptake
Even more challenging for complex guidance

22. Implementation support
NICE encourages commissioners in a range of ways:
One of the factors used to judge tenders
Ask providers to evidence of systems for collecting and using patient information
Audit of local practice
Collection of information across whole service pathway

23. Implementation evidence-base
Implementation strategy needs to draw on implementation evidence-base
Draw on existing frameworks eg. PARIHS Promoting Action on Research Implementation in Health Services Research
Implementation is function of nature of evidence, context of implementation and way in which process if facilitated
Core thinking could inform implementation strategies

24. Implementation
“Support for commissioners and others using NICE Guidance and Quality Standard on patient experiences in NHS services” available on NICE website
Staff training and development resources

25. NICE Guidance
Taken together, the NICE Guidance and Quality Standard captures the essence of good patient experience
Implementation will ensure healthcare services are acceptable and appropriate
Contribute to ensuring all people using NHS have the best possible experience of care

26. Contact sophie.staniszewska@warwick.ac.uk
Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick