In this study, we have observed in detail patient experience data practices and their links with quality improvements at five acute NHS hospital trusts. We have discussed these practices with key informants at the trusts during our fieldwork and also shared our emerging findings with them in the ‘sense-making’ phase of the project. We have illustrated the multiple lives of patient experience data and detailed the types of transformations they can undergo. We have foregrounded the importance of paying attention to the interactions in which data are recruited and embedded, because these bring into being qualities that make the links with action for care improvements possible. More specifically, we have discussed how patient experience data are more likely to lead to care improvements when they participate in interactions that are characterised by the three qualities of authority, autonomy and contextualisation. These interactions can involve human actors (e.g. nurses in specific roles such as CNSs) and non-human actors (e.g. external organisations such as CCGs, organisational processes such as trust-wide ward accreditation systems, and QI tools and techniques such as those used in one trust’s ‘learning sessions’). We have also drawn attention to the fact that sometimes human actors, who are in a position to bring about these qualities, can generate further patient experience data and action for improvement in response to data flaws and limitations. We have shown how nursing staff are responsible and accountable for patient experience at the trust level, and organise and conduct much of the work that leads to action to improve the quality of care in response to feedback on wards and across service areas; we have highlighted the role of the CNS as a key figure in this latter regard (both in the area of cancer care, where this is a consolidated role of responsibility for patient experience, and in the area of dementia care, where this role is less frequently in place but proves to be equally crucial). Finally, we have briefly discussed how the ANT-informed research approaches give us access to less obvious dimensions of organisational practices and illustrated the value of sense-making work along the lines of highly participative workshops (JIFs in our case) in research efforts that have a clear applied element.
Our findings have the following implications for policy and practice:
For patient experience data to lead to improvements in the quality of care, it is important to improve the data that the NHS trusts collect and to optimise the quantity that is collected. However our data suggest that this effort alone yields limited benefits if attention is not also paid to the qualities, in particular autonomy, authority and contextualisation, that need to characterise the interactions between the data and other (human and non-human) actors in order for data to lead to care improvements.
Our analysis indicates that quality improvement research and practice may benefit from approaches that take into due account the emergent nature of much improvement work and, more specifically, of the complex relationships between institutionally recognised QI efforts (formal QI) and the vast amount of unsystematised improvement work that takes place in response to patient experience data in less well-documented ways (everyday QI).
Our study has identified a frequent disconnect between the data generation and management work carried out by patient experience teams, or clerical staff with patient experience responsibilities where formally designated teams do not exist, and the action for care improvement resulting from those data, which is more often the responsibility of nursing and other clinical staff. Acute NHS hospital trusts may be able to optimise the use of patient experience data by exploring configurations of and communication between different professional figures and teams involved in patient experience work.
Organisational tools and mechanisms that include patient experience data in interactions characterised by authority, autonomy and possibility for contextualisation may make external drivers, such as national targets or the mandatory nature of data generation, less critical than they would be in the absence of such mechanisms. Accordingly, organisations that successfully establish mechanisms that embed action as a result of patient experience data work may find external drivers less important and potentially burdensome.
Finally, our analysis suggests that there are opportunities for organisational learning in the exchange of experiences within and between organisations, where some of the models orienting service response to data in the context of cancer care may prove, with due adjustments, viable and promising in the patient experience data work aimed at improving care for people with dementia.
Our recommendations for research are:
Further research examining the ways in which patient safety, patient experience and clinical outcomes data intersect and interact in the everyday practices of hospital work (e.g. care on the wards, meetings, reports) and inform particular forms of improvement work would provide useful insights to inform developments in improvement science.
Organisations external to NHS trusts such as CCGs, large charities such as Macmillan Cancer Support, and contractors such as Quality Health and Picker play an important role in the organisation of the micropractices of patient experience data work. Further research should consider exploring in more detail the ways in which these organisations enable or constrain patient experience data work and QI, especially the everyday QI we have described here.
The highly participative and practically relevant ‘sense-making’ afforded by multistakeholder workshops support an engaging framework for applied health-care research. These workshops strengthen research collaborations between academia and health-care providers and contribute to participants’ ownership of at least part of the research process. Further research into the longer-term impact of contributing to and participating in such workshops on individuals and organisations is desirable.
