Helping patients choose: how to improve the design of comparative scorecards of hospital quality

Objective: To understand how the public understand comparative quality information as presented on NHS Choices, the Department of Health website in England. We explore what quality information people value, how they understand different measures of quality, and their preferences for different types of information. Method: Seven focus groups were conducted. Results: Participants’ preferences for types of information changed at different stages of the focus groups. Participants attempted to compare hospitals option-wise, building up an overall picture of the hospital's performance. Faced with abundance of conflicting criteria, participants attempted to make trade offs, but found it difficult. Older and less numerate participants used summative measures to overcome this difficulty. Some indicators were poorly understood and the multiplicity of formats and labels was confusing. Missing data were mistrusted. Conclusion: The presentation of information affects what information people value, how they understand and process it. The design of scorecards is crucial in order to support use of scorecards for informed patient choice. Practice implications: We offer guidelines for changing presentation of comparative quality information with the aim to improve its use by patients when choosing between hospitals, especially online.