Seven Key considerations

This field is developing rapidly and considerable experience is being gathered by NHS organisations. This section brings together some of the available literature and resources. Use the seven key considerations below as a starting point.

1. Be clear about what patient involvement means.

• The whole practice should share the same understanding of what is meant by involvement
• and its purpose.
• Be clear about the difference between working for and working with patients and the public.
• Be clear about the purpose and objectives, for example, is it to raise awareness or gain feedback on a new system?

2. Be clear about why you are involving patients and the public.

• Involvement is a means of improving services, not a problem to be solved.
• It’s not enough to be more engaged. Practices need to demonstrate change as a result of patient engagement.
• Be clear about the objectives of the work. What is the rationale, relevance and connection to other practice priorities?
• Be honest about what can change and the reasons why. Also do this for what you are not prepared to change.
• Find out and use what is already known about people’s views and experiences.
• Be clear about what is being measured and why. How it will be measured?
• Make sure you measure what matters to patients, not what you think matters to patients - involving them in the design phase is a good idea.

3. Identify your ‘patients and public’.

Define who needs to be involved, who needs to be informed and who is likely to be affected by the issue under consideration. You may need to think outside the practice as well as within the practice. Patient and public engagement should always seek to be as inclusive as possible.

Practices can include:

• individual patients;
• patient groups based around a particular service or therapy area, eg asthma;
• people who care for someone who uses the practice services;
• local people, individuals or groups who do not necessarily attend the practice regularly; or
• local voluntary and community sector organisations.

Particular consideration will need to given to seeking feedback from:

• people who do not speak English as a first language;
• people with hearing, speech or visual impairments;
• people with learning, communication or cognitive difficulties;
• people with physical disabilities;
• mental health service users;
• older people;
• young people – ie teenagers and children; and
• people who are housebound.

4. Design your approach

Consider the benefits and practical constraints of qualitative versus quantitative methods.

Quantitative methods	Qualitative methods
Postal surveys	In-depth interviews
Face-to-face surveys	Discovery interviews
Telephone surveys (interviewer administered)	Cognitive interviews
Automated telephone surveys	Focus groups
Online surveys using web-based or email questionnaires	Web-based feedback
Surveys using touch-screen kiosks	Comments cards and suggestion boxes
Surveys using bedside terminals	Complaints and compliments
Staff surveys	Patient diaries
Administrative data	Mystery shopping
	Customer journey mapping

Key considerations before you start

• Build in your sampling and data collection strategies.
• Make sure the sampling will realistically give you the response rate you want to achieve.
• Have all data protection aspects been considered?
• Before you collect any data, set some aims or benchmarks. What constitutes a good score now and in the future? Good quality improvement schemes are based on achieving step-by-step changes.
• Survey questions are best developed with patients and staff.
• Always test and carefully pilot the questions before launch. What seems like a sensible question to one person can be interpreted in a very different way by someone else.
• Cognitive testing helps you to understand the range and diversity of ways in which people answer survey questions. It will help you know if questions are working as intended and whether the wording and layout of questionnaires is clear and unambiguous.

5. Getting the most from feedback 3,4

• Use feedback as a tool to help identify priorities for the practice.
• Avoid trying to focus on everything at once – pick one or two areas to begin with.
• Focus on the issues where patients give you least praise.
• It is better to make a small difference for many people, than a large difference for just a few.
• Use feedback as a way of evaluating the success of improvement work.
• Avoid measuring progress too narrowly.
• Avoid ‘paralysis by analysis’ – resist the temptation to gather ever more data before taking action.

6. Measure improvements

A good idea is to re-run elements of your engagement approach to measure how much the patient experience has improved. Use positive data to communicate with patients as this is invaluable in demonstrating the value of the process. It also boosts practice staff as they find it rewarding and motivating to be moving in the right direction.

7. Keep people involved

Promote opportunities for people to be involved. Find out how people prefer to do this. Make sure your methods suit the purpose of the involvement exercise. Make special efforts to involve people whose voices are seldom heard. Provide feedback to people about what you have learned from them and what action you intend to take and have taken in response.

Resources available to practices

NHS Institute for Innovation and Improvement Patient and Public Engagement Toolkit for World Class Commissioning.

NHS Centre for Involvement Key Principles of Effective Patient and Public Involvement.

NHS Institute for Innovation and Improvement Experience based design approach guide and toolkit.

Department of Health - Local Involvement Networks (LINks)

References

1. NHS Centre for Involvement Key Principles of Effective Patient and Public Involvement
2. NHS Institute for Innovation and Improvement Patient and Public Engagement Toolkit for World Class Commissioning
3. Frampton, S. et al (2008) Patient-Centered Care Improvement Guide. Planetree Inc: Derby, USA
4. Picker Institute Europe, Patients Accelerating Change Programme