What does the patient know about quality?

‘Hospitals aren't hotels’ and ‘Patients are seldom the best judges of their medical care’ read the letters to the New York Times Editor in mid-March 2012. Since this exchange of letters, debate has been raging about the value of the patient's views of care in relation to gauging quality. This debate has been spurred on in the USA by the approaching FY 2013 introduction of the Hospital Value-Based Purchasing programme including incentive payments for performance in patient care experience scores [1]. Patient experience will comprise 30% of the total bonus payments. The remaining 70% is for performance in the ‘clinical process of care’. This debate has raised questions in the clinical community and quality improvement arena about the relationship between ‘perceptions of care’ and safety and quality. The basic premise that focusing care around the patient and responding to patient's needs and preferences (‘patient centred care’) is a key domain of quality in healthcare has been established for over a decade [2]. Yet, many services still struggle to transform care to be patient-focused [3]. Accompanying the recognition of ‘domain of quality’ status has been an increasing interest in the patient experience of care is an indicator of quality. Measurement of quality, however, has traditionally focused on access issues and clinical care process …