Enhancing Patient-Centered Eye Care through Patient Reported Experience Measures

At Sankara Eye Hospitals, clinical quality indicators such as surgical outcomes, visual acuity improvement, and complication rates were routinely monitored. However, there was no standardized mechanism to measure patients experiences throughout their care journey. As a result, important aspects such as communication, counselling, patient understanding of the need for surgery, emergency instructions (i.e., what to do in case of an emergency during the hospital stay and after discharge), and overall patient-centred care were not systematically assessed.

Baseline PREMs analysis using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) methodology identified relatively lower patient experience scores in counselling related to the need for surgery (Top Box: 86.26%, Bottom Box: 4.21%) and emergency instructions (Top Box: 81.91%, Bottom Box: 4.91%), indicating opportunities for improvement.

Therefore, a structured quality improvement initiative was undertaken to implement Patient Reported Experience Measures (PREMs) across 14 Sankara Eye Hospital units and use patient feedback to drive targeted improvements in patient-centred care.

To implement a standardized Patient Reported Experience Measures (PREMs) system across Sankara Eye Hospitals to evaluate and improve patient-centred care.

To develop and implement a standardized PREMs questionnaire covering the entire patient journey from admission to discharge.

To assess patient experiences related to communication, counselling, informed consent, surgical information, emergency instructions, and overall care.

To identify opportunities for improvement through Top Box and Bottom Box analysis using the HCAHPS methodology.

To implement targeted interventions addressing identified gaps in patient education and communication.

To evaluate the effectiveness of interventions by comparing pre- and post-implementation PREMs scores.

To establish PREMs as a continuous quality improvement tool across all units.

A prospective quality improvement initiative was conducted across 14 Sankara Eye Hospital units to implement Patient Reported Experience Measures (PREMs) and evaluate patient-centred care.

A customized bilingual PREMs questionnaire based on a 5-point Likert scale was developed to assess patients’ experiences throughout the care journey, including preoperative counselling, information regarding surgery, postoperative instructions, and emergency instructions.

The questionnaire was digitized using Google Forms and linked to a QR code. QR code creatives were displayed in patient care areas, and nurses were trained to encourage patients to provide their experience during discharge.

A total of 713 patient responses were collected and analysed using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) methodology, with Top Box and Bottom Box scores used to identify opportunities for improvement.

Based on the findings, multilingual patient information leaflets, educational videos, standardized counselling protocols, and the teach-back method were introduced to improve patient understanding. Staff received training on effective communication and patient counselling, while regular review of PREMs data enabled monitoring of outcomes and reinforcement of corrective actions.

Post-implementation assessment using the same methodology demonstrated significant improvements in patient experience related to information regarding surgery and instructions on what to do in case of an emergency.

A total of 713 patient responses were collected from 14 Sankara Eye Hospital units and analysed using the HCAHPS Top Box and Bottom Box methodology. The baseline overall PREMs score showed a Top Box score of 86% and a Bottom Box score of 3% across all questionnaire domains. Following implementation of standardized patient education, multilingual information leaflets, educational videos, teach-back methodology, and staff training, the overall Top Box score improved to 92%, while the Bottom Box score reduced to 1.8%, demonstrating an overall enhancement in patient experience.

Domain-specific improvements were also observed. The Top Box score for information regarding the need for surgery increased from 86.26% to 93.41%, with the Bottom Box score decreasing from 4.21% to 1.24%. Similarly, the Top Box score for emergency instructions improved from 81.91% to 95.91%, while the Bottom Box score reduced from 4.91% to 1.31%.

These results demonstrated that structured PREMs implementation enabled data-driven improvements in communication and counselling, strengthened patient-centred care, and established a sustainable framework for continuous quality improvement across all participating hospitals.

Challenges:

Although the organization routinely collected patient feedback through Google Reviews, patient feedback forms, and grievance mechanisms, these primarily measured patient satisfaction rather than the patient’s experience throughout the care journey. Introducing PREMs required creating awareness among staff about this distinction and integrating it into existing quality practices.

Encouraging patients, particularly elderly individuals and those with limited digital literacy, to complete the QR code-based survey at discharge was another challenge. This was addressed by training nurses and counsellors to educate patients on the importance of PREMs and assist them in accessing the survey without influencing their responses.

Variations in counselling practices across hospitals were minimized through standardized counselling protocols, multilingual educational materials, and the teach-back method.

Critical Success Factors:

Strong leadership commitment, multidisciplinary collaboration, standardized implementation across all 14 units, continuous staff training, and regular review of PREMs data were key to success. Timely feedback to hospital teams, data-driven corrective actions, and integration of PREMs into routine quality monitoring ensured sustained improvements and strengthened the culture of patient-centred care.

The implementation of PREMs demonstrated that measuring patient experience provides deeper insights than traditional patient satisfaction surveys and clinical outcome indicators. A major strength of the initiative was the establishment of a standardized PREMs framework across 14 hospital units, enabling data-driven improvements in communication and counselling.

However, sustaining high response rates, particularly among elderly patients and those with limited digital literacy, remains an area requiring continued attention. Future efforts should focus on leveraging technology to simplify experience capture, such as AI-enabled voice-based feedback systems, multilingual conversational bots, and automated post-discharge feedback collection through telephone or messaging platforms.

These approaches can improve accessibility, increase response rates, and enable real-time analysis of patient experiences. Expanding PREMs to disease-specific care pathways, along with continuous staff training and regular review of patient experience data, will further strengthen patient-centred care and support a sustainable culture of continuous quality improvement across the organization.