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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
  1. Paul Sullivan,
  2. Derek Bell
  1. NIHR CLAHRC for Northwest London, Imperial College, London, UK
  1. Correspondence to Dr Paul Sullivan; p.sullivan{at}imperial.ac.uk

Abstract

Objectives Previous studies found that hospital and specialty have limited influence on patient experience scores, and patient level factors are more important. This could be due to heterogeneity of experience delivery across subunits within organisations. We aimed to determine whether organisation level factors have greater impact if scores for the same subspecialty microsystem are analysed in each hospital.

Setting Acute medical admission units in all NHS Acute Trusts in England.

Participants We analysed patient experience data from the English Adult Inpatient Survey which is administered to 850 patients annually in each acute NHS Trusts in England. We selected all 8753 patients who returned the survey and who were emergency medical admissions and stayed in their admission unit for 1–2 nights, so as to isolate the experience delivered during the acute admission process.

Primary and secondary outcome measures We used multilevel logistic regression to determine the apportioned influence of host organisation and of organisation level factors (size and teaching status), and patient level factors (demographics, presence of long-term conditions and disabilities). We selected ‘being treated with respect and dignity’ and ‘pain control’ as primary outcome parameters. Other Picker Domain question scores were analysed as secondary parameters.

Results The proportion of overall variance attributable at organisational level was small; 0.5% (NS) for respect and dignity, 0.4% (NS) for pain control. Long-standing conditions and consequent disabilities were associated with low scores. Other item scores also showed that most influence was from patient level factors.

Conclusions When a single microsystem, the acute medical admission process, is isolated, variance in experience scores is mainly explainable by patient level factors with limited organisational level influence. This has implications for the use of generic patient experience surveys for comparison between Trusts and should prompt further research to explore if more discriminant surveys can be developed.

  • GENERAL MEDICINE (see Internal Medicine)

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/

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Footnotes

  • Contributors PS retrieved and analysed the data, and interpreted the results, and contributed to the authorship. DB involved in designing the study, interpretation and authorship.

  • Funding PS is funded by Chelsea and Westminster Hospital NHS Foundation Trust and NIHR CLAHRC for Northwest London.

  • Disclaimer This article presents independent research in part funded by the National Institute for Health Research (NIHR) under the Collaborations for Leadership in Applied Health Research and Care (CLAHRC) programme for North West London. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

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

  • Data sharing statement Data used for this study are available publicly online from the UK data archive at: http://www.data-archive.ac.uk or from the Care Quality Commission: Care Quality Commission. Acute trusts: Adult Inpatients Survey, 2008. London, 2008. doi: 10.5255/UKDA-SN-6256-1; Care Quality Commission. Acute trusts: Adult inpatients Survey, 2009. London, 2009. doi: 10.5255/UKDA-SN-6503-1; Care Quality Commission. Acute trusts: adult inpatients Survey, 2010. doi: 10.5255/UKDA-SN-6821-1.

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