BMJ 1994;309:1542-1546 (10 December)

Papers

National survey of hospital patients

Stephen Bruster, research assistant,,a Brian Jarman, professor of primary health care,,a Nick Bosanquet, professor of health policy,,a Debra Weston, research assistant,a Robert Erens, research director,b Thomas L Delbanco, associate professor of medicine c

a Department of General Practice, St Mary's Hospital Medical School, Lisson Grove Health Centre, London NW8 8EG, b Social and Community Planning Research, 35 Northampton Square, London EC1V 0AX, c Harvard Medical School, The Picker/Commonwealth Patient-Centred Care Program, Beth Israel Hospital, 330 Brookline Avenue, Boston, MA 02215, USA

Correspondence to: Professor Jarman.

Abstract

Objective: To survey patients' opinions of their experiences in hospital in order to produce data that can help managers and doctors to identify and solve problems.
Design: Random sample of 36 NHS hospitals, stratified by size of hospital (number of beds), area (north, midlands, south east, south west), and type of hospital (teaching or non-teaching, trust or directly managed). From each hospital a random sample of, on average, 143 patients was interviewed at home or the place of discharge two to four weeks after discharge by means of a structured questionnaire about their treatment in hospital.
Subjects: 5150 randomly chosen NHS patients recently discharged from acute hospitals in England. Subjects had been patients on medical and surgical wards apart from paediatric, maternity, psychiatric, and geriatric wards.
Main outcome measures: Patients' responses to direct questions about preadmission procedures, admission, communication with staff, physical care, tests and operations, help from staff, pain management, and discharge planning. Patients' responses to general questions about their degree of satisfaction in hospitals.
Results: Problems were reported by patients, particularly with regard to communication with staff (56% (2824/5020) had not been given written or printed information); pain management (33% (1042/ 3162) of those suffering pain were in pain all or most of the time); and discharge planning (70% (3599/ 5124) had not been told about warning signs and 62% (3177/5119) had not been told when to resume normal activities). Hospitals failed to reach the standards of the Patient's Charter--for example, in explaining the treatment proposed and giving patients the option of not taking part in student training. Answers to questions about patient satisfaction were, however, highly positive but of little use to managers.
Conclusions: This survey has highlighted several problems with treatment in NHS hospitals. Asking patients direct questions about what happened rather than how satisfied they were with treatment can elucidate the problems that exist and so enable them to be solved.

Clinical implications

  • Clinical implications

  • Surveying the experiences and views of patients can provide usable data for planning health care

  • This study asked patients detailed questions about what happened during their stay in hospital; the problems with care highlighted would not have been shown by asking general questions about satisfaction

  • Hospital doctors and managers have found this kind of data helpful in setting targets for improving care, as well as in helping them to fulfil the responsibilities set out in the Patient's Charter

  • Much could also be learnt from comparing these results with the results of similar surveys in North America, where fewer problems are reported in most areas of cares


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