Patient-centred medicine
A systematic review of evidence on the links between patient experience and clinical safety and effectiveness

1NIHR CLAHRC for North West London, Chelsea and Westminster Hospital, London, UK
2Department of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK

Abstract
Objective :To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes.

Design Systematic review.

Setting A wide range of settings within primary and secondary care including hospitals and primary care centres.

Participants A wide range of demographic groups and age groups.

Primary and secondary outcome measures
A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment.

Results
This study, summarising evidence from 55 studies, indicates consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs.
It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits).
There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events.
Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations.

Conclusions
The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare.
It supports the argument that the three dimensions of quality should be looked at as a group and not in isolation. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the ‘real’ clinical work of measuring safety and effectiveness.

Key messages
The results show that patient experience is consistently positively associated with patient safety and clinical effectiveness across a wide range of disease areas, study designs, settings, population groups and outcome measures.

Patient experience is positively associated with self-rated and objectively measured health outcomes; adherence to recommended medication and treatments; preventative care such as use of screening services and immunisations; healthcare resource use such as hospitalisation and primary-care visits; technical quality-of-care delivery and adverse events.

This study supports the argument that patient experience, clinical effectiveness and patient safety are linked and should be looked at as a group.

Strengths and limitations of this study
This study demonstrates an approach to designing a systematic review for the ‘catch-all’ term patient experience, and brings together evidence from a variety of sources that may otherwise remain dispersed.

This was a time-limited review and there is scope to expand this search based on the results and broaden the search terms to uncover further evidence.

G Mohan.