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Just ask - The patient’s voice is key to quality healthcare

Posted: 12 February, 2018

Dr Vivienne Byers, a researcher in the Environmental, Sustainability and Health Institute at Dublin Institute of Technology (DIT), highlights the Patient Survey Programme in Tallaght Hospital as a visionary initiative that can serve as “an exemplar in Irish healthcare.”

Research - ESHI Policy - Hospital Survey

Given recent failures in the Irish healthcare system, including record highs in the shortage of hospital beds, many would say Ireland is in need of innovative healthcare solutions to help alleviate current challenges such as understaffing, an ageing population, and stretched budgets.

In 2015, Tallaght Hospital implemented the first hospital-wide survey programme of the patient experience in Ireland. The overall goal was simple – to capture the patient experience all year round in order to highlight areas for improvement and to get feedback on what was working well for patients, staff and management teams.

How it works?

As part of her research, Dr Byers wrote up a full evaluation of the survey in its first year.

Using the successful survey programme in Southampton General Hospital as a model, and working with the Picker Institute, a patient advocacy organisation that is world-renowned in the development of hospital survey programmes, it was decided that programme delivery in Tallaght would be stream-lined using hand-held tablets, which allows multiple surveys to be carried out across departments and specialities hospital-wide. 

The Hospital trains volunteers from the local community to deliver and manage the programme. The volunteers go out to the hospital wards and departments with hand-held tablets to interview patients, asking questions to capture patients’ real-time perceptions of their experience, including reviewing many aspects of care such as cleanliness, trust in those delivering treatment, how much information they are given and how they are involved in decisions about their care, as well as rating their care and suggesting improvements.

Volunteer use for patient survey feedback in healthcare is well established in the UK and the US. Dr Byers explains, “Research shows that the use of volunteers can facilitate more open feedback from patients, as they often perceive that volunteers are less affected than staff by frank comment and that it will not influence their care delivery.”

The completed survey data are stored on the tablets, and then sent remotely to the Picker Institute for analysis. The hospital gets weekly results reports from Picker and hospital staff can access the results online through a secure login.

Initial Outcomes

The Hospital scored highly in areas such as the overall quality of patient care, cleanliness, interactions with doctors, and patient confidence in doctors and nurses treating them well. Areas for improvement included those of communication about wait times, the need for written information about the hospital prior to visits, and some patients reported that they had not found someone on the hospital staff to talk to about their worries and fears.

Work on improvements progressed immediately. The hospital instigated focused changes, including enhanced information and communications through signage and website development, increased staffing levels in pastoral care to support patients’ well-being and deal with concerns, better staff communications with patients about their waiting times, and the recent launch of a new patient and visitor app. Tallaght Hospital is the first Irish public hospital to use an app to provide patients and their families with access to information on services, including facilities, wards and site map, visitor information, contact details for clinics and consultants, and news and updates.  

The survey programme in Tallaght continues to expand with patient experience data being gathered across more areas, for example, paediatrics, x-ray, emergency department, as well as topic-specific surveys on food quality and infection control. The data is continually used to improve the quality of the patient journey in the hospital.

Why is this approach needed now?

“Measuring the patient experience is crucial for organisations to understand whether they are providing good care and to identify key areas for improvement,” says Dr Byers. “Including patients in the delivery of their own care could help avert the current difficulties and crises in the health service.”

There has been a push by the government and the Health Services Executive (HSE) in Ireland towards patient-centred care for more than a decade. This model, which puts the individual’s health needs and desired health outcomes at the forefront of all decisions relating to their healthcare, is seen to respond directly to patients’ needs, increase patient satisfaction, and improve health and wellbeing and the overall quality of health services.

“Although Irish health policy pushes the concept, to date, the structures and processes of care delivery have seen only limited implementation of the patient-centred model nationally,” says Dr Byers.

Improving the patient experience is currently a high priority for many healthcare systems globally. In the UK, the high profile of policy regarding patient satisfaction and experience has resulted in a national requirement for patient surveys in hospitals, as well as local level initiatives. The UK has had an annual national survey of patient satisfaction for many years.

The Health Information and Quality Authority (HIQA) carried out Ireland’s first National Patient Experience Survey in 2017 in partnership with the HSE and the Department of Health.

“It’s a significant and much-needed development,” says Dr Byers. “Direct feedback from patients is considered the best way to measure the quality of a patient’s experiences.” However, she warns that once-off patient surveys carried out annually may not provide enough information for action and understanding of underlying system weaknesses.

“When there is an awareness of the patient experience, the overall culture of healthcare organisations can change for the better. Change will not happen without effective leadership, in order to make strategic use of the data to facilitate the improvement of the patient experience.”

The Patient Survey Programme in Tallaght Hospital is an innovative response to current health policy. It illustrates the importance of an inclusive community-focused culture with leadership both from the top as well as distributed throughout the organisation.

If Ireland is to learn from service developments such as the Tallaght Hospital Patient Survey Programme, then there is a need not only to promote such an exemplar initiative, but also to promote access to this organisational learning amongst a wider audience at a national and international level.