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Do some trusts deliver a consistently better experience for patients? An analysis of patient experience across acute care surveys in English NHS trusts
  1. Veena S Raleigh1,
  2. Francesca Frosini1,
  3. Steve Sizmur2,
  4. Chris Graham2
  1. 1Policy, The King's Fund, London, UK
  2. 2Picker Institute Europe, Oxford, UK
  1. Correspondence to Dr Veena S Raleigh, Policy, The King's Fund, 11–13 Cavendish Square, London W1G 0AN, UK; v.raleigh{at}


Introduction Data were used from inpatient, outpatient and accident and emergency surveys in acute trusts in England to examine consistency in patient-reported experience across services, and factors associated with systematic variations in performance.

Methods Standardised mean scores for six domains of patient experience were constructed for each survey for 145 non-specialist acute trusts. Hierarchical cluster analysis was used to investigate whether and how trust performance clusters. Multilevel regression analysis was used to determine trust characteristics associated with performance.

Results Cluster analysis identified three groups: trusts that performed consistently above (30 trusts) or below (six trusts) average, and those with mixed performance. All the poor performing trusts were in London, none were foundation trusts or teaching hospitals, and they had the highest mean deprivation score and the lowest proportion of white inpatients and response rates. Foundation and teaching status, and the proportion of white inpatients, were positively associated with performance; deprivation and response rates showed less consistent positive associations. No regional effects were apparent after adjusting for independent variables.

Conclusion The results have significant implications for quality improvement in the NHS. The finding that some NHS providers consistently perform better than others suggests that there are system-wide determinants of patient experience and the potential for learning from innovators. However, there is room for improvement overall. Given the large samples of these surveys, the messages could also have relevance for healthcare systems elsewhere.

  • Healthcare quality improvement
  • quality improvement
  • patient satisfaction
  • patient-centred care
  • quality measurement
  • general practice
  • health policy
  • medical error
  • measurement/epidemiology
  • mortality (standardised mortality ratios)
  • assessment
  • reliability

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  • Competing interests Two of the authors are employees of Picker Institute Europe, which is contracted to the Care Quality Commission to develop national patient experience surveys, and was involved in developing and coordinating the surveys that provided the data for this study.

  • Patient consent This study entails secondary analysis of patient survey data. Ethics clearance for each survey was obtained by the Picker Institute on behalf of the Care Quality Commission prior to the surveys commencing, with consent provided via patient responses.

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