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Health services research
Research
Investigating the meaning of ‘good’ or ‘very good’ patient evaluations of care in English general practice: a mixed methods study
  1. Jenni Burt1,
  2. Jenny Newbould1,
  3. Gary Abel2,
  4. Marc N Elliott3,
  5. Julia Beckwith1,
  6. Nadia Llanwarne1,
  7. Natasha Elmore1,
  8. Antoinette Davey2,
  9. Chris Gibbons1,
  10. John Campbell2,
  11. Martin Roland1
  1. 1Cambridge Centre for Health Services Research, Primary Care Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
  2. 2University of Exeter Medical School, Exeter, UK
  3. 3Distinguished Chair in Statistics; Senior Principal Researcher, RAND Corporation, Santa Monica, California, USA
  1. Correspondence to Dr Jenni Burt; jab35{at}medschl.cam.ac.uk

Abstract

Objective To examine concordance between responses to patient experience survey items evaluating doctors' interpersonal skills, and subsequent patient interview accounts of their experiences of care.

Design Mixed methods study integrating data from patient questionnaires completed immediately after a video-recorded face-to-face consultation with a general practitioner (GP) and subsequent interviews with the same patients which included playback of the recording.

Setting 12 general practices in rural, urban and inner city locations in six areas in England.

Participants 50 patients (66% female, aged 19–96 years) consulting face-to-face with 32 participating GPs.

Main outcome measures Positive responses to interpersonal skills items in a postconsultation questionnaire (‘good’ and ‘very good’) were compared with experiences reported during subsequent video elicitation interview (categorised as positive, negative or neutral by independent clinical raters) when reviewing that aspect of care.

Results We extracted 230 textual statements from 50 interview transcripts which related to the evaluation of GPs' interpersonal skills. Raters classified 70.9% (n=163) of these statements as positive, 19.6% (n=45) neutral and 9.6% (n=22) negative. Comments made by individual patients during interviews did not always express the same sentiment as their responses to the questionnaire. Where questionnaire responses indicated that interpersonal skills were ‘very good’, 84.6% of interview statements concerning that item were classified as positive. However, where patients rated interpersonal skills as ‘good’, only 41.9% of interview statements were classified as positive, and 18.9% as negative.

Conclusions Positive responses on patient experience questionnaires can mask important negative experiences which patients describe in subsequent interviews. The interpretation of absolute patient experience scores in feedback and public reporting should be done with caution, and clinicians should not be complacent following receipt of ‘good’ feedback. Relative scores are more easily interpretable when used to compare the performance of providers.

  • PRIMARY CARE
  • QUALITATIVE RESEARCH

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/

https://doi.org/10.1136/bmjopen-2016-014718

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    Footnotes

    • Twitter Follow Jenni Burt @jenniaburt

    • Contributors JB designed the study, oversaw the conduct of the study, wrote the analysis plan, drafted and revised the paper and is a guarantor. JN oversaw the day-to-day conduct of the study, carried out data collection, contributed to the interpretation of the data and commented on draft versions of the paper. GA carried out the sampling of practices, conducted the statistical analysis of the data and drafted and revised the paper. MNE initiated the project, contributed to the interpretation of the data and revised the paper. JBe carried out the content analysis and commented on draft versions of the paper. NL carried out data collection, contributed to the interpretation of the data and commented on draft versions of the paper. NE and AD carried out data collection and commented on draft versions of the paper. CG contributed to the interpretation of the data and commented on draft versions of the paper. JC initiated the project, oversaw the conduct of the study and commented on draft versions of the paper. MR initiated the project, oversaw the conduct of the study and commented on draft versions of the paper.

    • Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0608-10050).

    • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The researchers confirm their independence from the study funders, the National Institute for Health Research.

    • Competing interests All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: the study was funded by the UK NIHR as an unrestricted research award; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years. John Campbell, Martin Roland and Jenni Burt have provided academic advice on the GP Patient Survey to Ipsos MORI and NHS England.

    • Ethics approval Approval for the study was obtained from the NRES Committee East of England—Hertfordshire on 11 October 2011 (ref: 11/EE/0353).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data set is available on request from the authors: please email Jenni Burt (jab35@medschl.cam.ac.uk) for details.