Patient surveys to improve primary care services
Beverley Walsh; Dr Sarah Cooledge
Improving the patient experience and responding to patient needs has become an important indicator of health services. Patients’ evaluation of care is increasingly seen by practitioners, administrators, stakeholders and patients as a judgement of quality. Currently individual surveys are setup to identify patient experiences and opinions of a demographic or disorder specific group. The findings of a study using the data gathered from annual patient surveys over 5 years support the creation and use of a PPG to initiate regular patient surveys. In doing so this will provide practice specific data with minimum impact on practice staff workload, for the improvement and implementation of patient services and so improve the patient experience.
The practice is in a small town in a rural area of East Anglia, with just over 11,000 patients and 9 GP’s 6 of whom are part time. The population for the local area is a balanced mix by both gender and age group. Although geographically rural, the area is both sociologically and demographically complex, with a transient military population, recent inclusion in the London commuter belt, second-home ownership and non-UK citizens.
The PPG is made up of 9 members covering all age groups, genders, the travelling community, a GP, and Practice Manager.
PPG surveys 2011-2014
The surveys used in this study formed part of the annual report for this GP practice, and also gave the opportunity for the PPG, as representatives of the patients, to have a say in what aspects of the practice were surveyed and how the results were acted on if necessary.
The areas chosen for the patient surveys were as follows:
- the triage system for on the day requests for appointment/advice
- the dispensary service
- the practice nurses and the chronic disease clinics
- the significance of a named doctor and the use of technology by the patient cohort and whether it could be used as a means of contact between the patient and surgery.
How the surveys were conducted
For each survey ideas were requested at the summer PPG meeting for discussion at the autumn meeting. Once an idea was chosen and specific themes were identified a rough draft was drawn up. Once the final questions and layout for each survey were agreed by the PPG, practice manager and doctors, they were added to the practice website and made available in the waiting rooms of the practice for 2 weeks in mid-February. Each survey had up to 10 questions with set responses, an option for comments and the following demographic groups. Male/Female, Age in the following groups: Under 16, 16-30, 30-45, 45-65 and over 65. When possible, members of the PPG were on hand to help patients who were having difficulties completing the survey such as language or motor skills. At the end of the 2 weeks a member of the PPG, not present during completion, collected the completed surveys and collated the responses. These were later presented to the practice staff and at the PPG meeting.
Results and outcomes
Of the 5 surveys carried out the triage system elicited the most constructive data, giving clear evidence of issues with the triage system for certain demographic groups, and how the reception staff dealt with individual calls and the variations/deviations from the correct procedure, 44 of 81 (54%) respondents answered yes to all questions in the 2011 survey. This directly resulted in reception staff being given training in customer care and how to explain the triage system to patients. Because of the impact of this survey the PPG felt it was appropriate to run it on the subsequent occasion in 2012 to ensure that improvements had indeed been made to the triage system.
The 2012 survey had far more responses, 168 in total, and continued to show the same trend as the 2011 survey, specifically the majority of female responses in the “working” age groups and the majority of male responses in the “retired” age groups. It also showed an improvement in patients understanding of the triage system, 122 of 168 (75%) respondents answered yes to all questions. The upper limit of patients seen per week at the practice is 960, giving a response rate to the questionnaires of 4.2% and 8.75% respectively.
The practice nurses and the chronic disease clinics survey: the first part of the survey showed good usage of the clinics, 161 (8.4%) patients completed the survey, with 166 visits being recorded (some had multiple clinic visits). The suggestions show that promotion of some of the services such as the dietician need to be improved, and others need better signposting and guidance to ensure patients know where to go for treatment and advice.
The second part showed that the majority of the 161 respondents were happy with the practice nurses and felt that they were being listened to, given plenty of time and found the information provided was easy to understand.
The dispensary survey also showed that the majority of 168 respondents were equally satisfied with the dispensary staff and service provided.
The last surveys on named-doctor and use of technology showed interesting results. 170 (8.86%) responders awareness of their named doctor increased significantly at the upper range of the age-groups, most notably with male respondents. Technology usage results showed that both genders and all age groups used all 4 forms of communication technology (email, text internet & Skype) regularly except for Skype, and were equally negative about using Skype as a way of communicating with the surgery.
From the perspective of the GPs the PPG surveys have been very helpful in gaining feedback from the patients about the services offered in a much more specific way than the national surveys required of GPs for revalidation. Improvements have been made where necessary and equally where staff have received positive feedback this has been relayed to them. The PPG members have enjoyed this involvement with the practice.
By incorporating the establishment of a PPG in a practice as a representation of the patient demographic and allowing them to be the voice of the patients, a more harmonious relationship can be attained between practice staff and patients. Using a PPG to facilitate consultations regarding the patient experience and results of surveys to guide changes to practice and new services, improvements, training and funds can be focused in the right direction, thereby ensuring a more effective service tailored to the needs of the patient.