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REFLECTIONS ON RESEARCH: We need to better evaluate services we provide

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YOU MAY think your patients are happy with their healthcare experience but what evidence do you have to back that up?

YOU MAY think your patients are happy with their healthcare experience but what evidence do you have to back that up?

Is your service effective? Does the care you deliver work? What do your patients really think about the service they receive?

Fifteen years ago my own ward counted the number of ‘Thank you’ cards from patients’ relatives as an indicator of a positive experience. I suspect it was also often an indicator of being grateful for having recovered.

Yet what about all the verbal and unrecorded sentiments? The heartfelt hand-squeeze, weak smile or look of relief.

Nonetheless, the card count was the main means of measurement. And this of course led to a degree of manipulation.

The nurses’ response when a patient would ask ‘How can I ever show my appreciation?’ shifted from that old faithful, the box of chocolates – always a good bet to keep staff going when too busy for a meal break – to ‘Well you could always send us a card’.

However, when the number of cards was compared with the number of complaints we received, it was misleading if you didn’t also look at the content.

While you can appraise the seriousness of a complaint, it is harder to determine the degree of appreciation from the wording of a card. In this era of targets, indicators and number-crunching, the issue of providing evidence for what we do
is important. In times of scrutiny over roles and services, showing our worth as nurses is paramount.

I think we should ask ourselves how we know we are delivering a high-quality service and how we demonstrate this to others. Yes, there are patient satisfaction questionnaires, yet who chooses the questions and do they elicit information that will inform our practice? Will responses provide useful information for different stakeholders? For example, managers will need different feedback from that required by clinical staff.

When devising a new role or service, plan some means of evaluation from the outset. Ask users of an existing service what they think should be measured.
I agree in part with the suggestion that we should not have to prove ourselves to others – especially to manager-types who in some cases should take a long look at their own effectiveness.

Trust me, there is much personal satisfaction to be gained from knowing what patients and carers think of you, and in being proactive by making changes to further improve their experience. The alternative is being told by others what
will be measured, which may only give part of the picture or a false picture at that.

Tracey Williamson is research fellow, older people/user involvement, Salford Centre for Nursing, Midwifery and Collaborative Research, University of Salford

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