Exploring patient participation in reducing health-care-related safety risks

Exploring patient participation in reducing health-care-related safety risks
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Questionnaires almost always address process aspects of health care quality, such as
information, communication and interpersonal contact. Whether they also cover aspects
of patient safety is analysed in the sections below.
Data collection
Patient experience surveys such as the surveys of the Commonwealth Fund are used
to measure the performance of a health care system as a whole; CAHPS, CQC and
CQI surveys measure the performance of health care providers; and CQI looks at the
experiences of patients with a certain disease. Depending on the unit of analysis, samples
are drawn from the general population (Commonwealth Fund) or from the patient
populations of health care providers (CAHPS, CQC and CQI). Sample sizes depend
on factors such as the reliability of the questionnaire, the expected response rate and
the aim of the survey. In studies comparing patient experiences across countries, sample
sizes are usually 1000–2000 citizens/patients per country. Studies comparing patient
experiences between hospitals usually work with sample sizes of at least 500 patients
per hospital. Data are collected mostly by postal questionnaires but also through faceto-face
interviews, telephone interviews or online surveys. The best method depends
on the study population and financial resources available for the survey. Face-to-face
and telephone interviews require more human resources than postal surveys and are
therefore usually more expensive. Online questionnaires are comparatively cheap but can
only be used in populations with good access to, and experience with, the Internet. At
present, this makes online surveys less appropriate for use with older populations.
Purpose and use
There is growing interest in Europe in measuring patients’ health care experiences
(60). Surveys are being carried out in several European countries to map the quality
of care as perceived by patients. In a number of these countries (Denmark, Norway,
United Kingdom (England) and the Netherlands), such surveys are part of a systematic
programme of work that takes place at regular intervals.
Patient experience surveys often serve multiple purposes. Surveys in the NHS in United
Kingdom (England), for example, aim to provide comparative information for the
CQC and the public. They are used for external accountability purposes and to inform
consumer choice, but providers also use the results for internal quality improvement.
The Picker Institute, which develops and conducts these surveys, consequently offers
providers so-called “guides to improvement”. Recently, the CAHPS Consortium in the
United States has also developed a “CAHPS improvement guide” for providers seeking
to upgrade their performance in the domains of quality measured by CAHPS surveys.
According to Berwick et al. (61), measuring quality indicators can improve the quality
of care along two lines: selection or change. Selection takes place if public reporting of
quality indicators stimulates individual consumers or their agents to choose providers
that perform better over those that perform less well. Change takes place if (internal)
feedback on performance stimulates providers to engage in quality improvement
activities. Fung et al. (62) reviewed experiences with public reporting of performance
indicators in the United States. They found that evidence of a relationship between
public reporting of performance indicators and the quality of patient care was scant. The