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In the UK there has been a shift over the last decade towards the setting of targets by commissioning or regulatory bodies so that health services provide improved levels of care. For mental health services this has occurred in three phases: phase one related to simple key performance indicators (for example collection of patients' diagnostic codes); phase two placed greater emphasis on more meaningful clinical outcome data; the third and most recent phase placed prominence on patient‐focused data collection. We report the development and preliminary findings of a piloting of a patient‐related outcome measure (PROM) and patient‐related experience measure (PREM) created specifically for older adult mental health services in Central and North West London NHS Foundation Trust. PROMs/PREMs are in keeping with an increased focus on patients' experience of health care, the provision of quality services and various key policies such as the recent government white paper Equity and Excellence: Liberating the NHS.

Successive governments have called for greater “empowerment” of the patient, reflected in the chief medical officer's call for more patient‐related outcome measures (PROM). This paper aims to bring together three‐linked studies.

First study: in 1999, the neurosurgical patient was seen as “expert” to identify PROM outcomes, based upon a patient and carer‐designed self‐administered postal questionnaire in a regional two‐year retrospective survey of subarachnoid haemorrhage (SAH) patients with a 77 per cent response rate, designated treatment‐as‐usual (TAU) cohort (n=142).Second study: in the same region, following the implementing of the specialist neuro‐vascular nurse (SNVN), the SNVN recommendation was evaluated in a two‐year prospective study (n=184) that provided family‐specific psychosocial support and a continuity of care linking hospital and community; the response rate was 87 per cent. Third study: A re‐analysis of the national SAH study (n=2,380), by projecting the TAU and SNVN results onto clinically matched patients within the National cohort to estimate the potential “savings” if all 34 neurosurgical units had an SNVN type service.

First study: respondents identified many psychosocial and fiscal problems but recommended a SNVN to reduce these difficulties. Second study: the TAU and SNVN patient's were a close clinical match and using the TAU as a control group, it was found that there were major psychosocial and fiscal benefits for SNVN patients and carers, who more speedily re‐established their lives.Third study: it was estimated that this would have produced major financial benefits, e.g. 4,165 fewer bed occupancy days, saving £2.5million; reduced time‐off work for patients and carers, saving £8.1million; and, after deducting cost of a national SNVN service, a combined saving for the service and families of an estimated £9.83 million p.a. Thus, addressing PROM outcomes, through an integrated psychosocial service in neurosurgery was cost‐effective, benefited families, the service, and the wider economy and should be a factor when considering pressurised departmental budgets.

Overall, what the two regional studies and the re‐analysis of the national study showed was that there are benefits from treating the “patient as expert” and taking on board their agendas. There is a need for a more integrated approach to treatment and care that is of value to the service, patients, families and the wider economy.

Treatment delays must be avoided, especially in oncology, to assure sustainable high-quality health care and increase the odds of survival. The purpose of this paper is to hypothesize that waiting times would decrease and patients and employees would benefit, when specific lean interventions are incorporated in an organizational improvement approach.

In 2013, 15 lean interventions were initiated to improve flow in a single radiotherapy institute. Process/waiting times, patient satisfaction, safety, employee satisfaction, and absenteeism were evaluated using a mixed methods methodology (2010-2014). Data from databases, surveys, and interviews were analyzed by time series analysis, χ², multi-level regression, and t-tests.

Median waiting/process times improved from 20.2 days in 2012 to 16.3 days in 2014 (p<0.001). The percentage of palliative patients for which waiting times had exceeded Dutch national norms (ten days) improved from 35 (six months in 2012: pre-intervention) to 16 percent (six months in 2013-2014: post-intervention; p<0.01), and the percentage exceeding national objectives (seven days) from 22 to 17 percent (p=0.44). For curative patients, exceeding of norms (28 days) improved from 17 (2012) to 8 percent (2013-2014: p=0.05), and for the objectives (21 days) from 18 to 10 percent (p<0.01). Reported safety incidents decreased 47 percent from 2009 to 2014, whereas safety culture, awareness, and intention to solve problems improved. Employee satisfaction improved slightly, and absenteeism decreased from 4.6 (2010) to 2.7 percent (2014; p<0.001).

Combining specific lean interventions with an organizational improvement approach improved waiting times, patient safety, employee satisfaction, and absenteeism on the short term. Continuing evaluation of effects should study the improvements sustainability.

The purpose of this paper is to argue that monitoring of symptoms through self‐assessed data is not only a vital part of record taking in mental health care, but can also aid patients in their recovery, giving them more of a say in their healthcare, and providing a record of progress for both patients and clinicians.

A literature search was undertaken to identify ways in which self‐assessed data is used in mental health care and to examine how successful this approach may be in aiding recovery and whether patients are able and enthusiastic to participate in this approach. Ideas for effective approaches to utilising self‐assessed data into mental health care are suggested.

There were clear indications from the literature that the use of self‐assessed data improves health outcomes and that patients enjoy the process. This approach promotes greater inclusion of individuals in the management of their health care.

Self‐assessed data can be presented to doctors which may inform their decisions about their patients and be used as a reference for patients to see their progress towards recovery. It may also aid recognition of symptoms by patients.

The paper proposes that self‐assessed data should be used routinely in mental health care to complement traditional note taking by clinicians. It sets out a unique method for recording symptoms using a simple, easy to use, symptom scale. It is also proposes to measure medication dose and type, so that progress or otherwise can be compared with medication over time.

Current performance measurement systems (PMSs) are mainly designed to measure performance at the organizational level. They tend not to assess the value created by the collaboration of multiple organizations and by the involvement of users in the value creation process, such as in healthcare. The purpose of this paper is to investigate the development of PMSs that can assess the population-based value creation process across multiple healthcare organizations while adopting a patient-based perspective.

The paper analyzes the development of a new healthcare PMS according to a constructive approach through the development of a longitudinal case study. The focus is on the re-framing process of the PMS put in place by a large group of Italian regional health systems that have adopted a collaborative assessment framework.

Framing information according to the population served and the patients’ perspective supports PMSs in assessing the value creation process by evaluating the contribution given by the multiple organizations involved. Therefore, it helps prevent each service provider from working in isolation, and avoids dysfunctional behaviors. Re-framing PMSs contributes to re-focusing stakeholders’ perspective toward value creation; legitimizes organizational units specifically aimed at managing transversal communication, cooperation and coordination; supports the alignment of professionals’ and organizations’ goals and behaviors; and fosters shared accountability among providers.

The paper contributes to the scientific debate on PMSs by investigating a case that focuses on value creation by adopting a patient-centered perspective. Although this case comes from the healthcare sector, the underlying user-centered approach may be generalized to assess other environments, processes, or contexts in which value creation stems from the collaboration of multiple providers (integrated co-production).

Healthcare is indispensable for any civilisation to attain a good quality of life and well-being on both mental and physical levels. The healthcare domain primarily falls under pharma, medical, biotechnology, and nursing. Also, other fields may be aligned with these primary fields. Healthcare amasses the contemporary trends and knowledge of upcoming techniques to improve healthcare processes. The practitioners are primarily doctors, nurses, specialists and health professionals, hospital administrators, and health insurance.

It is a fundamental attribute needed for any society to attain good quality of life and well-being in mental and physical health. It is a fundamental right of people to receive good healthcare where drug treatment and hospitalization are available at a nominal cost, as a requirement of today’s modern era. There appears to be a significant disparity in the availability of good healthcare in rural areas compared to urban in India. Even though we enter the digital era with the facilities offered in Industry 4.0 and other advanced technologies brings about a significant change of overall processing within healthcare systems. During the pandemic of COVID-19, there has been digital transformation with success globally. Healthcare cooperatives are a new norm to support the healthcare systems globally. The chapter discusses Gampaha healthcare cooperative and reviews Ayushman Sahakar scheme in India. The reforms require time to evolve.

Client satisfaction is an important outcome measure of healthcare services. The aims of the present work are to develop a tool to assess client satisfaction with the components of streamlined cataract services and to conduct a pilot study to evaluate its reliability and validity.

A validated patient satisfaction questionnaire was modified for use in a cataract service and validated by expert panel and patient focus group approach. Two versions were used to evaluate pre‐operative assessment clinic and day surgical unit. The questionnaires comprised items covering individual domains of client satisfaction plus one global satisfaction item. Together with a visual analogue scale (VAS) the questionnaires were administered to 200 consecutive cataract patients.

The questionnaires were returned by 165 patients (82.5 per cent). Median individual item and global scores in the pre‐operative group were 87 and 100 per cent, respectively. In the day‐of‐surgery group median scores were 91 and 100 per cent, respectively. Mean VAS scores were 95.5 per cent (SD 5.6) and 94.5 per cent (SD 6.4), respectively. Cronbach's alpha was 0.768 for the pre‐operative and 0.636 for the day‐of‐surgery questionnaire. Spearman's correlation coefficient between individual item score and the VAS score was 0.350 (p=0.005) for the pre‐operative and 0.302 (p=0.028) for the day‐of‐surgery questionnaire. Spearman's correlation coefficient between individual item score and the global satisfaction score was 0.566 (p<0.001) for the pre‐operative and 0.317 (p=0.004) for the day‐of‐surgery questionnaire.

The questionnaire appears to be a useful tool for measuring client satisfaction with a one‐stop cataract pre‐assessment service where surgery is performed at a second visit, which other cataract service providers might adapt for local use.

The current study is aimed at identifying the prominent influencers that affect the response behaviour of patients in a hospital environment.

The research is based on the data collected through the participant observation method while interviewing patients about the quality of healthcare services in nine community health centres of the Kashmir division. Thematic analysis was performed on the information collected from patients admitted to various hospital sections.

The analysis of the qualitative data revealed that the presence of hospital staff near respondents, perceived risk of maltreatment, social desirability, the sensitivity of the topic, risk of information sharing and attitude towards surveys are the most frequently observed factors that modulate the patient's tendency to truthfully report critical facts about the problem understudy.

These results can help researchers to exercise caution while communicating with respondents and collecting data related to serious issues in a natural setting.

The therapeutic community (TC) is an environmental intervention where principles of working together democratically can enhance self-agency. While availability of inpatient TCs within the UK National Health Service (NHS) has declined, shorter or alternative interventions using core TC approaches have shown promise in enacting change. The purpose of this paper is to report and reflect on the development and running of a pilot nano-TC.

Foundations Group was a 2-h TC group intervention set up and run within the NHS for 18 months in 2021–2022, and taking place on City Farm premises. The group was convened as part of the complex emotional needs service in a mental health NHS Trust in the South West of England. Over the study period, the group comprised 11 members, one peer member and three staff members.

The authors reflected on the TC stance of working democratically with a fluid hierarchy, taking a non-expert approach, and using support and challenge to enhance self-agency and belongingness. The authors have detailed the structure of the group session including use of community meetings, psychoeducation, creative sessions and reviews. Members took on roles within the group including chairing sessions.

This group was a novel service within the NHS Trust where it was conducted and may represent a standalone therapeutic group. The authors hope it will show that core TC principles can be applied in shorter interventions than have previously been used.