Using patients' experiences to identify priorities for quality improvement in breast cancer care: patient narratives, surveys or both?
BACKGROUND
Patients' experiences have become central to assessing the performance of healthcare systems worldwide and are increasingly being used to inform quality improvement processes. This paper explores the relative value of surveys and detailed patient narratives in identifying priorities for improving breast cancer services as part of a quality improvement process.


METHODS
One dataset was collected using a narrative interview approach, (n = 13) and the other using a postal survey (n = 82). Datasets were analyzed separately and then compared to determine whether similar priorities for improving patient experiences were identified.


RESULTS
There were both similarities and differences in the improvement priorities arising from each approach. Day surgery was specifically identified as a priority in the narrative dataset but included in the survey recommendations only as part of a broader priority around improving inpatient experience. Both datasets identified appointment systems, patients spending enough time with staff, information about treatment and side effects and more information at the end of treatment as priorities. The specific priorities identified by the narrative interviews commonly related to 'relational' aspects of patient experience. Those identified by the survey typically related to more 'functional' aspects and were not always sufficiently detailed to identify specific improvement actions.


CONCLUSIONS
Our analysis suggests that whilst local survey data may act as a screening tool to identify potential problems within the breast cancer service, they do not always provide sufficient detail of what to do to improve that service. These findings may have wider applicability in other services. We recommend using an initial preliminary survey, with better use of survey open comments, followed by an in-depth qualitative analysis to help deliver improvements to relational and functional aspects of patient experience.
Florence Nightingale School of Nursing and Midwifery, King's College London, 57 Waterloo Rd, London SE1 8WA, UK.
Vicki
V
Tsianakas
Jill
J
Maben
Theresa
T
Wiseman
Glenn
G
Robert
Alison
A
Richardson
Peter
P
Madden
Mairead
M
Griffin
Elizabeth A
EA
Davies
D000288:Administrative Personnel / Q000592:standards; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology* / Q000532:radiotherapy; D002173:Cancer Care Facilities / Q000592:standards*; D019317:Evidence-Based Medicine; D005260:Female; D019538:Health Care Surveys; D006292:Health Priorities; D015285:Hospital-Patient Relations; D006801:Humans; D007407:Interviews as Topic / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000523:psychology; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods; D063545:Personal Narratives as Topic; D011368:Professional-Family Relations; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D006113:United Kingdom; D000078329:Workforce