Understanding how front-line staff use patient experience data for service improvement: an exploratory case study evaluation

Staff Experience in the NHS: A National Study-An Experience-Based Design Approach

Introduction: A positive patient experience is a key component of good quality of care. Post-pandemic healthcare systems face the challenge of addressing burnout among healthcare staff, who are directly involved in the delivery of healthcare, which has implications for the patient experience. There is an established association between staff and patient experience; exploring the experience of staff may give insights into factors that negatively impact the patient experience. Experience-based design (EBD) is a quality improvement approach that uses the experience of service users to derive improvements. The purpose of this study is to design, validate, and test an EBD tool that may be used to capture the staff experience. Methods: A focus group of clinical and nonclinical staff (identified through the NHS Elect networks) and the development team coproduced an EBD survey based on nine "touch-points" of a typical working day. Once the survey questionnaire was tested and agreed with it was distributed to 1300 members of NHS networks. Results: A total of 377 NHS staff responded to the questionnaire. Analysis revealed effective teamwork had a positive psychological impact on staff. However, increased workload, missed meal breaks, and an increased administrative/IT burden were associated with the greatest negative responses by clinical and nonclinical staff. Conclusion: Overall, factors impacting staff well-being are multifaceted and varied between trusts. However, leaders in healthcare can use EBD to identify targeted improvements for the day-to-day experiences of staff.

Practising in a pandemic: A real time study of primary care practitioners' experience of working through the first year of COVID-19

This article presents reflections on the lessons learnt from developing and initiating a rapid research project in 4 weeks during the first year of the COVID-19 pandemic. The article highlights the importance of selecting methods appropriate to rapid research, discusses the challenges of data collection in a shifting context, and the importance of the research team being prepared to cede some degree of control over the data collection process. To protect staff and patients and prevent the spread of COVID-19, general practice shifted to remote service delivery and consultations occurred via the telephone or online platforms. In the study, submissions were collected from those working in general practice to capture their experiences of the first year of the COVID-19 pandemic. Participants could choose how to submit their narratives, with some preferring to be interviewed and others contributing self-recorded submissions. This article offers practical reflections in response to the challenges of carrying out rapid research during a pandemic, including the importance of constructing a research team which can respond to the demands of the study, as well as the benefits of an expedited ethical review process. The study highlighted the importance of selecting appropriate methods to facilitate the rapid collection of data. In particular, the authors reflect on the differences between participants' response to interviews, written submissions, and audio diaries. Open approaches to data collection were found to encourage participation and reflexivity and also generated rich narrative accounts. Rapid research has progressed our understanding of general practice's experience of the first year of COVID-19.

Patient experience data as enacted: Sociomaterial perspectives and 'singular-multiples' in health care quality improvement research

Over the last three decades, sociomaterial approaches to the study of health care practices have made an important contribution to the sociology of health care. Significant attention has been paid to the role of technology and artefacts in health care and the operation of actor-networks but less space has been given to questions of ontological multiplicity in health care practices. In this paper, we draw upon our study of patient experience data in five acute hospitals in England to illustrate how treating patient experience data as 'singular-multiples' can enable useful insights into patient experience data work in health care organisations. Our data was generated during 12 months of fieldwork at five participating hospitals and included organisational documents, field notes, informal and formal interviews with frontline and managerial staff and patient representatives at the study sites. We use the examples of the Friends and Family Test (FFT) and the National Cancer Patient Experience Survey (NCPES) in England to consider the multiple nature of data as it is enacted in practice and the work data does when coordinated as an entity in the singular. We argue that, and discuss how, the sociomaterial insights we discuss here are relevant to health care quality and improvement research and practice.

Wild data: how front-line hospital staff make sense of patients' experiences

Patient-centred care has become the touchstone of healthcare policy in developed healthcare systems. The ensuing commodification of patients' experiences has resulted in a mass of data but little sense of whether and how such data are used. We sought to understand how front-line staff use patient experience data for quality improvement in the National Health Service (NHS). We conducted a 12-month ethnographic case study evaluation of improvement projects in six NHS hospitals in England in 2016-2017. Drawing on the sociology of everyday life, we show how front-line staff worked with a notion of data as interpersonal and embodied. In addition to consulting organisationally sanctioned forms of data, staff used their own embodied interactions with patients, carers, other staff and the ward environment to shape improvements. The data staff found useful involved face-to-face interaction and dialogue; were visual, emotive, and allowed for immediate action. We draw on de Certeau to re-conceptualise this as 'wild data'. We conclude that patient experience data are relational, and have material, social and affective dimensions, which have been elided in the literature to date. Practice-based theories of the everyday help to envision 'patient experience' not as a disembodied tool of managerialism but as an embedded part of healthcare staff professionalism.

'Team capital' in quality improvement teams: findings from an ethnographic study of front-line quality improvement in the NHS

Background

Teamwork is important in the design and delivery of initiatives in complex healthcare systems but the specifics of quality improvement (QI) teams are not well studied.

Objective

To explain the functioning of front-line healthcare teams working on patient-centred QI using Bourdieu’s sociological construct of capital.

Methods

One medical ward from each of six NHS Trusts in England participated in the study, purposively selected for a range of performance levels on patient experience metrics. Three ethnographers conducted focused ethnography for 1 year, using interviews and observations to explore the organisation, management and delivery of patient-centred QI projects by the six front-line teams. Data were analysed using Bourdieu’s typology of the four forms of capital: economic, social, symbolic and cultural.

Results

While all teams implemented some QI activities to improve patient experience, progress was greater where teams included staff from a broad range of disciplines and levels of seniority. Teams containing both clinical and non-clinical staff, including staff on lower grades such as healthcare assistants and clerks, engaged more confidently with patient experience data than unidisciplinary teams, and implemented a more ambitious set of projects. We explain these findings in terms of ‘team capital’.

Conclusion

Teams that chose to restrict membership to particular disciplines appeared to limit their capital, whereas more varied teams were able to draw on multiple resources, skills, networks and alliances to overcome challenges. Staff of varying levels of seniority also shared and valued a broader range of insights into patient experience, including informal knowledge from daily practice. The construct of ‘team capital’ has the potential to enrich understanding of the mechanism of teamwork in QI work.