Implementing the NICE
Patient Experience
Guidance and Quality
Dr Sophie Staniszewska,
Chair of NICE Guidance Development Group
Member of NQB Patient Experience Subgroup
Royal College of Nursing Research Institute
Warwick Medical School
University of Warwick
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
About Evidence Updates
…a publication produced by NICE that
provides a straightforward and succinct
overview of selected evidence published
since the literature search was last conducted
for the accredited guidance it relates to…
• Programme started in April 2011
• Formerly the Annual Evidence Updates
produced by the Specialist Collections
• Now produced using a standard,
consistent process and aligned with
published NICE guidance
Scope of Evidence Updates
Evidence Updates provide an objective analysis of
recent new evidence (including cost effectiveness data if
A series of commentaries summarise the evidence,
describe its strengths and weaknesses, and discuss any
potential impact on current guidance.
All commentaries make qualified reference to the
available data as far as possible.
The need for further research may also be suggested.
Evidence Update process
Evidence hub
1 week
Evidence hub
2 weeks
Chair of the
1 week
Prioritise evidence
Evidence hub,
4 weeks
Critical appraisal
EUAG and
central team
3 weeks
Expert review
Chair, EUAG
and central
EUAG meeting
0.5 days
Central team,
Chair, EUAG,
Drafting, sign-off, and publication
9 weeks
EUAG = Evidence Update Advisory Group. MPC = Medicines and Prescribing Centre.
Study selection process
4985 records identified
through search
1021 duplicates from
3964 records after
duplicates removed
2842 records excluded
at first sift
1122 records included
after first sift
1004 records excluded
at second sift
118 records included
after second sift
79 records excluded at
critical appraisal and
evidence prioritisation
40 records discussed
14 records included by
EUAG in published
Evidence Update
1 additional record
identified by EUAG
outside original search
26 records excluded by
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, including the Evidence
Update capture 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 experience of care
Royal College of Nursing Research
Institute, School of Health and Social
Studies, University of Warwick

Conceptualisation, measurement, impact, and outcomes of