NICE Guidance and Quality
Standard on Patient
Dr Sophie Staniszewska,
Chair of NICE Guidance Development Group
Royal College of Nursing Research Institute
School of Health and Social Studies
University of Warwick
Key initiatives
Importance of patient experience
Darzi (2008): High quality care for all
NHS Constitution (2009-2010)
White Paper: Equity and Excellent:
Liberating the NHS
NICE Guidance – direct referral from DH
Nature of evidence
NICE Guidelines normally developed
around clinical and economic evidence
Patient experience has drawn on patientbased evidence of experiences
Patient-based evidence can sit alongside
clinical and economic forms of evidence
(Staniszewska et al 2010)
A set of recommendations focusing on key
aspects of patient experience
Informed by:
Research evidence
Recommendations in previously published
NICE guidelines
National survey data
Synthesised through consensus process
Quality standard
QS developed alongside guidance
QS are set of specific, concise statements
and associated measures
Aspirational, but achievable
Markers of high-quality, cost effective care
Derived from best available evidence
Focus of Guidance
Directed primarily at clinical staff
Patient experience is also affected by nonclinical staff such as receptionists, clerical
staff and domestic staff
Reflects entirety of patient experience
NICE Guidance: Key areas
Knowing the patient as an individual
Essential requirements of care
Tailoring healthcare services for each
Continuity of care and relationships
Enabling patients to actively participate in
their care
Knowing the patient as an
Patients value healthcare professionals
acknowledging their individuality
Values, beliefs and circumstances
influence expectations, needs and service
Recognition individuals are living with
condition, so family and broader life need
to be taken into account
Recommendation 1.1.1
“Develop an understanding of the patient,
including how the condition affects the
person, and how the person’s
circumstances and experiences affect their
condition and treatment”
Essential requirements of care
Patients have needs other than the
treatment of a specific health condition
Recognition of potential need for
psychological and emotional support
Importance of meeting fundamental needs
– nutrition and pain management
Recommendation 1.2.1
Respect for the patient: All staff providing NHS
services should:
Treat patients with respect, kindness, dignity,
compassion, understanding, courtesy and
Respect the patient’s right to confidentiality
Not discuss the patient in their presence without
involving them in the discussion
Tailoring healthcare services for
each patient
Patients wish to be seen as individuals in
the healthcare system
Services need to be tailored to respond to
needs, preferences and values of the
Advice on treatments and care, including
risks and benefits should be individualised
as much as possible
Recommendation 1.3.1
Adopt an individualised approach to
healthcare services that is tailored to the
patient’s needs and circumstances, taking
into account their ability to access
services, personal preferences and
coexisting conditions. Review the patient’s
needs and circumstances regularly
Continuity of care and
Continuity and consistency of care and
establishing trusting, empathetic and
reliable relationships with competent and
insightful healthcare professionals is key
to patients receiving effective, appropriate
Recommendation 1.4.1
Assess each patient’s requirements for
continuity of care and how that
requirement will be met. This may involve
the patient seeing the same healthcare
professional throughout a single episode
of care, or ensuring continuity within a
healthcare team
Enabling patients to actively
participate in their care
Many patients wish to be active
participants in their own healthcare, and to
be involved in creating and managing their
health strategy and use of services. Selfcare and self-management are particularly
important for people with long-term
Recommendation 1.5.4
Establish the most effective way of
communicating with each patient and
explore ways to improve communication.
Examples include using pictures, symbols,
large print, Braille, different languages,
sign language, communication aids, or
involving an interpreter, a patient advocate
or a family member
Examples of quality statements
1. Patients are treated with dignity, kindness,
compassion, courtesy, respect, understanding
and honesty
2. Patients experience effective interactions with
staff who have demonstrated competency in
relevant communication skills
3. Patients are introduced to all healthcare
professionals involved in their care, and are
made aware of the roles and responsibilities of
the members of the healthcare team
Examples of quality statements
4. Patients have opportunities to discuss
their health beliefs, concerns and
preferences to inform their individualised
5. Patients are supported by healthcare
professionals to understand relevant
treatment options, including benefits, risks
and potential consequences
Examples of quality statements
6. Patients are actively involved in shared decision
making and supported by healthcare
professionals to make fully informed choices
about investigations, treatment and care that
reflect what is important to them
12. Patients experience coordinated care with
clear and accurate information exchange
between relevant health and social care
Translating guidance into practice offers
considerable challenges
Uneven progress relates to complexity of
process, with change required at many
different levels and depends on range of
factors that influence uptake
Even more challenging for complex
Implementation support
NICE encourages commissioners in a range of
One of the factors used to judge tenders
Ask providers to evidence of systems for
collecting and using patient information
Audit of local practice
Collection of information across whole service
Implementation evidence-base
Implementation strategy needs to draw on
implementation evidence-base
Draw on existing frameworks eg. PARIHS
Promoting Action on Research Implementation
in Health Services Research
Implementation is function of nature of evidence,
context of implementation and way in which
process if facilitated
Core thinking could inform implementation
“Support for commissioners and others
using NICE Guidance and Quality
Standard on patient experiences in NHS
services” available on NICE website
Staff training and development resources
NICE Guidance
Taken together, the NICE Guidance and
Quality Standard captures the essence of
good patient experience
Implementation will ensure healthcare
services are acceptable and appropriate
Contribute to ensuring all people using
NHS have the best possible experience of
Royal College of Nursing Research
Institute, School of Health and Social
Studies, University of Warwick

Conceptualisation, measurement, impact, and outcomes …