The health care experiences that matter to patients

What health care experiences matter to patients and how can we assign value to them for policy making purposes?

Healthcare policy leaders internationally recognise that people’s experiences of healthcare delivery are important, and invest significant resources to monitor and improve these. However, the value of particular aspects of these experiences – relative to each other and to other healthcare outcomes – is unclear. This project considered how economic techniques have been and might be used to generate quantitative estimates of the value of experiences of healthcare delivery. The project first developed a conceptual map of patients’ experiences. The map reflected insights from the capabilities approach. We conducted a systematic review of applications of economic techniques to healthcare delivery. We found that these techniques have been quite widely used to estimate the value of standardised features of healthcare systems and processes (e.g. of care delivery by a nurse rather than a doctor, or of a consultation of 10 minutes rather than 15 minutes), but not to estimate the value of the (potentially diverse) implications of these for patients’ experienced capabilities. To inform future research relating to the valuation of experiences of healthcare delivery, we organised a workshop for key stakeholders. Participants undertook and discussed ‘exercises’ that explored the use of different economic techniques with capabilities-based descriptions of experiences of healthcare delivery. The workshop identified a number of methodological issues that need careful attention, and highlighted some important concerns about the ways in which quantitative estimates of value might be used in relation to aspects of healthcare delivery. However, it confirmed enthusiasm for efforts to attend to experiences of capability associated with healthcare delivery.

Outcome and Translation

It is hoped this research will provide an impetus for bodies such as NICE, and those involved in evaluation studies such as RCTs, to broaden their measure of value in line with what matters to patients in the provision of healthcare.

HERU researchers involved in this research project: Mandy Ryan, Philip Kinghorn

External collaborators: V Entwistle, J Francis and C Fraser (HSRU, University of Aberdeen)

Publications

Entwistle, V., Firnigl, D., Francis, J., Fraser, C., Kinghorn, P. and Ryan, M. (2010) How much do experiences of healthcare matter?, Voluntary Health Scotland Briefing, Summer 2010.

Entwistle, V., Firnigl, D., Ryan, M., Francis, J. and Kinghorn, P. (2012) 'Which experiences of health care delivery matter to service users and why? A critical interpretive synthesis and conceptual map', Journal of Health Services Research & Policy, 17(2), 70-78.

Ryan, M. , Kinghorn, P., Entwistle, V. A. and Francis, J. J. (2014) 'Valuing patients' experiences of healthcare processes: towards broader applications of existing methods', Social Science & Medicine, 106, 194-203.

Presentations

Ryan, M., Kinghorn, P., Entwistle, V., Francis, J. and Firnigl, D. (2011) 'The patient experience: what is it and how can we value it?', Health Economists' Study Group, York, January 2011.

Kinghorn, P. (2011) 'Valuing patients' experiences of healthcare: do we have methods for purpose?', Academic Unit of Health Economics, University of Leeds, June 2011.

Ryan, M. (2012) 'Valuing patient experiences: do we have methods fit for purpose?', Better Together Programme, Scottish Government., Glasgow, February 2012.

Ryan, M. (2013) 'The patient experience: what is it and how can we value it?', Presentation to MRC Advisory Panel, London, July 2013.

Ryan, M. (2015) 'Valuing the patient experiences and going beyond QALYs in HTA', 3rd Annual Healthcare Improvement Scotland Research Symposium: Bringing Evidence Together, The Merchants' Hall, Edinburgh, 26 March 2015.

Ryan, M. (2017) 'Valuation in health economics: going beyond Quality Adjusted Life Years (QALYs)', Department of Community Health Sciences (CHS) / O'Brien Institute for Public Health Seminar Series, University of Calgary, Calgary, Canada, 3 February 2017.