An investigation of the degree of organisational influence on patient experience scores in Acute Medical Admission Units in all acute hospitals in England using multilevel hierarchical regression modelling
File(s)
Published version
Author(s)
Sullivan, PJ
Bell, D
Type
Journal Article
Abstract
Objectives: Previous studies found that hospital an
d specialty have limited influence
on patient experience scores, and patient level fa
ctors are more important. This
could be due to heterogeneity of experience deliver
y across sub-units within
organisations. We aimed to determine whether organ
isation level factors have
greater impact if scores for the same sub-special
ty microsystem are analysed in
each hospital.
Setting: Acute medical admission units in all NHS A
cute Trusts in England.
Participants: We analysed patient experience data
from the English Adult In-Patient
Survey which is administered to 850 patients annua
lly in each acute NHS Trusts in
England. We selected all 8753 patients who return
ed the survey and who were
emergency medical admissions and stayed in their a
dmission unit for 1-2 nights, so
as to isolate the experience delivered during the a
cute admission process.
Primary and secondary outcome measures: We used mul
tilevel logistic regression to
determine the apportioned influence of host organ
isation and of organisation level
factors (size and teaching status), and patient lev
el factors, (demographics, presence
of long term conditions and disabilities). We sele
cted ‘being treated with respect
and dignity’ and ‘pain control’ as primary outcome
parameters. Other Picker
Domain question scores were analysed as secondary p
arameters.
Results: The proportion of overall variance attribu
table at organisational level was
small; 0.5% (NS) for respect and dignity, 0.4% (NS)
for pain control. Longstanding
conditions, and consequent disabilities were associ
ated with low scores. Other item
scores also showed that most influence was from pat
ient level factors. Conclusion:
“Conclusion: When a single microsystem, the acute m
edical admission
process, is isolated, variance in experience scores
is mainly explainable by patient level
factors with limited organisational level influence
. This has implications for use of
generic patient experience surveys for comparison b
etween Trusts, and should prompt
further research to explore if more discriminant su
rveys can be developed.”
Strengths:
•
This study analysed patient experience data for all
acute hospitals in an
entire country
•
The data included self reported medical conditions
and details of degree of
disability that provide comprehensive patient level
descriptors
•
The data are from a national survey administered wi
th standardised
methodology in all hospitals
Weaknesses
•
It is possible that questions other than those in
the Adult In Patient Survey
(AIPS) covering different aspects of care might rev
eal stronger hospital level
effects. Further research is needed to determine wh
ether more discriminant
surveys can be designed around patient sub-populati
ons.
•
The AIPS questions were validated across the whole
in-patient population,
and may neglect aspects of care that acute medical
patients would prioritise.
d specialty have limited influence
on patient experience scores, and patient level fa
ctors are more important. This
could be due to heterogeneity of experience deliver
y across sub-units within
organisations. We aimed to determine whether organ
isation level factors have
greater impact if scores for the same sub-special
ty microsystem are analysed in
each hospital.
Setting: Acute medical admission units in all NHS A
cute Trusts in England.
Participants: We analysed patient experience data
from the English Adult In-Patient
Survey which is administered to 850 patients annua
lly in each acute NHS Trusts in
England. We selected all 8753 patients who return
ed the survey and who were
emergency medical admissions and stayed in their a
dmission unit for 1-2 nights, so
as to isolate the experience delivered during the a
cute admission process.
Primary and secondary outcome measures: We used mul
tilevel logistic regression to
determine the apportioned influence of host organ
isation and of organisation level
factors (size and teaching status), and patient lev
el factors, (demographics, presence
of long term conditions and disabilities). We sele
cted ‘being treated with respect
and dignity’ and ‘pain control’ as primary outcome
parameters. Other Picker
Domain question scores were analysed as secondary p
arameters.
Results: The proportion of overall variance attribu
table at organisational level was
small; 0.5% (NS) for respect and dignity, 0.4% (NS)
for pain control. Longstanding
conditions, and consequent disabilities were associ
ated with low scores. Other item
scores also showed that most influence was from pat
ient level factors. Conclusion:
“Conclusion: When a single microsystem, the acute m
edical admission
process, is isolated, variance in experience scores
is mainly explainable by patient level
factors with limited organisational level influence
. This has implications for use of
generic patient experience surveys for comparison b
etween Trusts, and should prompt
further research to explore if more discriminant su
rveys can be developed.”
Strengths:
•
This study analysed patient experience data for all
acute hospitals in an
entire country
•
The data included self reported medical conditions
and details of degree of
disability that provide comprehensive patient level
descriptors
•
The data are from a national survey administered wi
th standardised
methodology in all hospitals
Weaknesses
•
It is possible that questions other than those in
the Adult In Patient Survey
(AIPS) covering different aspects of care might rev
eal stronger hospital level
effects. Further research is needed to determine wh
ether more discriminant
surveys can be designed around patient sub-populati
ons.
•
The AIPS questions were validated across the whole
in-patient population,
and may neglect aspects of care that acute medical
patients would prioritise.
Date Issued
2017-01-01
Date Acceptance
2016-10-18
Citation
BMJ Open, 2017, 7 (1)
ISSN
2044-6055
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open
Volume
7
Issue
1
Copyright Statement
© 2017 The Authors. Published by BMJ Publishing Group. This is an Open Access article distributed in accordance with
the terms of the Creative Commons Attribution (CC BY 4.0) license, which
permits others to distribute, remix, adapt and build upon this work, for
commercial use, provided the original work is properly cited. See: http://
creativecommons.org/licenses/by/4.0/
the terms of the Creative Commons Attribution (CC BY 4.0) license, which
permits others to distribute, remix, adapt and build upon this work, for
commercial use, provided the original work is properly cited. See: http://
creativecommons.org/licenses/by/4.0/
Sponsor
National Institute for Health Research
Grant Number
N/A
Subjects
GENERAL MEDICINE (see Internal Medicine)
Publication Status
Published
Article Number
e012133