Patient input key to health service provision, says Hiqa

Patient survey drew on overseas questions and is largest inquiry outside Irish census

The first National Patient Experience Survey has its origins in a desire by the Health Information and Quality Authority (Hiqa) to see what was happening in other countries where patient input has helped improve health service provision, according to Hiqa director of health information and standards Rachel Flynn.

Ms Flynn said Hiqa began looking at what other health service regulators were doing in places like New Zealand, England, Scotland and Wales because patient experience is generally recognised as "a very good proxy for quality and safety in the healthcare system".

With this in mind, Hiqa approached both Health Service Executive chief executive Tony O'Brien and Department of Health chief medical officer Dr Tony Holohan. Both were supportive of the idea of collecting patient experiences, leading to a collaboration between all three organisations in gathering and collating data.

"We purchased internationally validated questions from the Picker Institute which is a not- profit organisation dedicated to developing a patient-centred approach to healthcare and they supplied us with 190 questions," said Ms Flynn who is also director of the National Patient Experience Survey.

Focus group

“We needed to get those 190 questions into something more meaningful for the Irish healthcare system so we decided to ask patients. We conducted eight focus groups with 10 people in each focus group and they then identified the themes in the patient experience survey.”

In addition to the focus groups, Hiqa also consulted with healthcare professionals using an internationally recognised method known as the "Delphi method". The result was a consensus on some 61 questions which formed the questionnaire to be given to patients.

According to Ms Flynn, they tested the questionnaire and found it took 20 minutes to complete. The only change they made to the questions supplied by the Picker Institute was a new category on waiting times of “More than 48 hours” to take account of the Irish experience.

The questionnaire was circulated to some 40 hospitals, organised into six hospital groups. A total of 26,635 patients were invited to participate during May 2017, with a total of 13,706 people taking part, giving a response rate of 51 per cent, said Ms Flynn.

Large response

"This was an exceptional response rate relative to other countries – in New Zealand for example the response rate is 26 per cent and England has a 44 per cent response rate and Scotland 40 per cent - we set ourselves a target of 40 per cent so to get 51 per cent was very encouraging and shows how people really engaged with us. It's the largest survey of health in Ireland and the largest of any type bar the census."

Among the factors which Hiqa had to take account of was the “halo effect” whereby patients still in hospital tend to display a positive bias towards those caring for them, so they asked patients to wait two weeks after their discharge before fi

lling in the questionnaire to get a more accurate picture.

Barry Roche

Barry Roche

Barry Roche is Southern Correspondent of The Irish Times