Patient satisfaction rating scales v. patient-related outcome and experience measures

We were pleased to read the paper by Hansen et al ¹ detailing their validation of a patient satisfaction rating scale. This sort of work is very much in keeping with the recent government paper, Equity and Excellence: Liberating the NHS. ² However, we thought that the focus of the questionnaire was too narrow: it essentially only dealt with the interaction between psychiatrist and service user in an out-patient setting. A far broader perspective would need to be taken for this instrument to be used as a service satisfaction questionnaire, because patients interact with a far greater range of people and systems as they move through a given care pathway. Even in a fairly circumscribed setting such as out-patient setting service users deal with appointment letters, receptionists, the physical environment of the waiting room, etc., even before they get to meet a psychiatrist. However, we did think that the questionnaire would make an excellent instrument for psychiatrists (and other mental health professionals) to use as part of their annual appraisal or multisource feedback, as it provides good information about the vital interaction between doctor and patient.

More pertinent to today's clinical practice are Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs). They provide richer information than patient satisfaction questionnaires, which are concerned with a relatively narrow (but obviously very important) area. It is possible for a user to have a satisfactory experience of a service (and score a satisfaction questionnaire highly) but a poor clinical outcome (which would not be identified by a satisfaction scale). On the other hand, PROMs and PREMs will capture not only the patient experience/satisfaction but also the outcome from the patient's perspective. These data complement the gathering of routine clinical outcome data, which in the UK pertain primarily to the Health of the Nation Outcome Scales. ³

Patient Reported Outcome Measures and Patient Reported Experience Measures have been established in acute trusts for quite so time now. They suit certain specialties well, for example post-hip operation PROMs are ubiquitous, but in mental health they are much rarer. To attempt to address this gap, we (and other colleagues from our trust) are in the process of validating a PROM/PREM for mental health service users. ⁴ A version of the instrument specifically for use with older patients has already been successfully piloted and preliminary results will shortly be published. ⁵

We would like to congratulate Hansen et al on their work. However, we believe that outcome data supersede patient satisfaction questionnaires in contemporary National Health Service practice. The latter can easily be incorporated into the PROMs/PREMs, which additionally provide a wider range of information.