Facilitated patient experience feedback can improve nursing care: a pilot study for a phase III cluster randomised controlled trial

BACKGROUND: England’s extensive NHS patient survey programme has not fulfilled NHS white paper promises of improvements in patients’ experiences. Impediments to the surveys’ impact may include: surveys not being specific to departments, so staff claim “that doesn’t happen here”; clinicians not knowing how to improve; insufficient understanding of survey methods; delays in communicating survey results; and over-emphasis on data collection per se, rather than using results to improve care. METHODS: Over two years, patient surveys were conducted at four-monthly intervals in 18 wards in two NHS Trusts in England. Wards were randomly allocated to Basic Feedback (ward-level patient survey results including patients’ written comments sent to nurses by letter); Feedback Plus (in addition to letters, ward meetings to discuss results and plan improvements) or Control (no active feedback of survey results). Patient survey responses to survey questions about nursing care were used to compute wards’ average Nursing Care Scores at each survey interval. RESULTS: 4,236 (47%) of the patients surveyed returned questionnaires. Nursing Care Scores improved more for Feedback Plus than Basic Feedback or Control (difference between Control and Feedback Plus = 8.28 ± 7.2 (p = 0.02)). Feedback Plus meetings were effective in engaging nurses, correcting methodological misunderstandings and challenging “excuses”. Patients’ written comments stimulated interest. CONCLUSION: Merely informing nurses of patient survey results in writing does not stimulate improvements, even if results are disaggregated by ward. The addition of ward meetings had a significant impact. Effective patient feedback can be achieved with: validated patient experience surveys; ward-specific results; information that includes a combination of numerical data and patients’ comments; and facilitated ward meetings. This study provides preliminary evidence that facilitated patient feedback can improve patients’ experiences such that a full trial is justified