How do frontline staff use patient experience data for service improvement? Findings from an ethnographic case study evaluation

Louise Locock, Catherine M. Montgomery* (Corresponding Author), Stephen Parkin, Alison Chisholm, Jennifer Bostock, Sue Dopson, Melanie Gager, Elizabeth Gibbons, Chris Graham, Jenny King, Angela Martin, John Powell, Sue Ziebland

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)
6 Downloads (Pure)



Improving patient experience is widely regarded as a key component of health care quality. However, while a considerable amount of data are collected about patient experience, there are concerns this information is not always used to improve care. This study explored whether and how frontline staff use patient experience data for service improvement.


We conducted a year-long ethnographic case study evaluation, including 299 hours of observations and 95 interviews, of how frontline staff in six medical wards at different hospital sites in the United Kingdom used patient experience data for improvement.


In every site, staff undertook quality improvement projects using a range of data sources. Teams of health care practitioners and ancillary staff engaged collectively in a process of sense-making using formal and informal sources of patient experience data. While survey data were popular, 'soft' intelligence - such as patients' stories, informal comments and observations - also informed staff's improvement plans, without always being recognized as data. Teams with staff from different professional backgrounds and grades tended to make more progress than less diverse teams, being able to draw on a wider net of practical, organizational and social resources, support and skills, which we describe as team-based capital.


Organizational recognition, or rejection, of specific forms of patient experience intelligence as 'data' affects whether staff feel the data are actionable. Teams combining a diverse range of staff generated higher levels of 'team-based capital' for quality improvement than those adopting a single disciplinary approach. This may be a key mechanism for achieving person-centred improvement in health care.

Original languageEnglish
Pages (from-to)151-161
Number of pages11
JournalJournal of Health Services Research & Policy
Issue number3
Early online date14 Feb 2020
Publication statusPublished - 1 Jul 2020

Bibliographical note

Funding Information:
The authors would like to thank the following: the ward teams and senior management teams at the six participating case study sites. Neil Churchill, Angela Coulter, Ray Fitzpatrick, Crispin Jenkinson, Trish Greenhalgh and Sian Rees who were co-investigators on the study, contributing to the original design and conduct of the study. Esther Ainley and Steve Sizmur from Picker Institute Europe, who contributed to data collection and analysis. Prof. John Gabbay and Prof. Andr? le May, University of Southampton, for facilitating the learning community meetings. The members of the lay advisory panel: Barbara Bass, Tina Lonhgurst, Georgina McMasters, Carol Munt, Gillian Richards, Tracey Richards, Gordon Sturmey, Karen Swaffield, Ann Tomlime and Paul Whitehouse. The external members of the Study Steering Committee: Joanna Foster, Tony Berendt, Caroline Shuldham, Joanna Goodrich, Leigh Kendall, Bernard Gudgin and Manoj Mistry. At the time of conducting the research LL and SP were employed by the University of Oxford. Preliminary findings from the study have been presented publicly at the following conferences: European Association for Communication in Healthcare 2016; The International Society for Quality in Healthcare 2017; Health Services Research UK 2017; Medical Sociology 2018. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Publisher Copyright:
© The Author(s) 2020.

Copyright 2020 Elsevier B.V., All rights reserved.


  • learning community
  • patient experience data
  • team-based capital


Dive into the research topics of 'How do frontline staff use patient experience data for service improvement? Findings from an ethnographic case study evaluation'. Together they form a unique fingerprint.

Cite this