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Hospital patient in bed being given a meal on a tray

A major new study conducted by Picker Institute Europe and the University of Oxford between 2012 and 2014 has found that utilising and understanding patient experience is a consistently high priority for healthcare professionals. However national initiatives need to go further in terms of their ability to deliver more granular intelligence that can be used to improve care quality at a local level.

This is just one of several implications for health policy and practice that have emerged from the unique, collaborative study, focused on the varying levels of impact and effectiveness, of measures used for patient and service user experience feedback collation.

Existing approaches were shown to be better suited to accurately understanding people’s experiences of a particular health or social care service, rather than tracing someone’s individual journey through illness and treatment (sometimes referred to as their “pathway”).

National level undertakings to measure pathways were found to be neither plausible nor practical due to the fact that truly individual patient journeys tend towards a population size of one. Currently it is therefore hard to justify the development of pathway specific surveys, at a national level, nor is there the experience and resource available to enable effective service improvement based on them. 


Commissioned by the Department of Health, the core aims of the research were to:

  • Develop a simple, conceptually grounded and unified model for assessing patient and service user experience and to evaluate that model.
  • Evaluate whether and how pathway and service line focused assessments of experiences provided added value to standard organisational surveys.

In order to achieve this, various different methods of measuring patient and service user experience were employed, to look at both the healthcare process and individual experiences of using it, in seven NHS organisations.  To support this work, a new generic questionnaire for measuring these experiences was produced and has been made freely available for use by NHS organisations. 


The research found a broad range of local and national activities being undertaken to measure patient experience within organisations, and to prioritise feedback-led improvement. This includes the new Friends and Family Test, which was launched and extended whilst this study was being conducted.  Despite this, the resources to measure and improve people’s experiences remain tight, and more support is needed for providers wishing to make best use of patient experience information locally.

While national collections provide robust data for measuring organisational performance, there is a strong demand for detailed, service-specific evidence to inform improvement. The ability to provide sub-organisation insights was revealed to be an important consideration for national patient experience collections.

By contrast, though approaches looking at individual journeys are feasible, they are complicated to plan and administer. Due to the uniqueness of individual ‘pathways’, any attempt at measurement or comparison requires different and pragmatic approaches to analysing someone’s personal care journey. These may be more suited to highly tailored local projects.

Discussing the findings, Chris Graham, Director of Research and Policy at Picker Institute Europe, said; “This study shows once again that patient experience is high on everyone’s agenda.  But whilst providers and commissioners alike are committed to improving patient experiences, the resources available for this are tight. Although it is possible to develop effective mechanisms to ensure that services at the local level are fully aware of what matters to patients, our research demonstrates that further support may be needed to ensure best use of local findings.”

Ray Fitzpatrick, Professor of Public Health and Primary Care at the University of Oxford similarly reflected; “This was a wonderful opportunity to work with Picker Institute Europe to see close up how patient experience is being addressed at local level. Commitment and enthusiasm to listen to patients was palpable.  However resources and methods to understand and act upon patients’ experiences in journeys across services were limited. That clearly is the next challenge!”