What is howRwe?

howRwe is a generic measure of patient experience, suitable for most types of patient, irrespective of diagnosis and treatment, and most care settings: secondary, primary, community, social and home care.

A core aim in developing howRwe was to monitor patient experience in a way that could be built into the normal care process. For this to happen it needs to be quick and easy to use with rapid feedback to users.

The howRwe questionnaire is shown below.

howRwe is a new tool for measuring patient experience on a regular basis, focusing on patients’ perception of their relations with health staff and transactions with the organisation.  The name, howRwe, stems from the core question “How are we doing?”. 

howRwe has been designed for use in a various different ways and with different media.  The objective is to measure the patient’s experience on a routine basis, to support day-to-day management of the organisation. I is also designed to be used for secondary uses, to help care commissioners and providers manage the quality of healthcare services, using information about patient experience.

The howRwe questionnaire has four items:

• See you promptly (short label: delays) covers waiting, punctuality, access and cancellations.  
• Listen and explain (communication) covers all aspects of communication to and from health staff (communication, patient information, understanding, choice, consent)
• Care and respect (care) covers how well you are treated as a person (courtesy, empathy, compassion, dignity and privacy)
• Work as a team (teamwork) covers collaboration, teamwork, efficiency and initiative

The severity of each howRwe item is rated using four levels:

• excellent
• good
• fair
• poor

Each level is usually indicated in mutually supporting ways to minimise cognitive effort, for face validity and to avoid the need for training:

• Written labels: excellent, good,fair, and poor.
• Colour: green, yellow, orange and red.
• Position: increasing in severity from left to right.
• Pictographs based on smiley faces.

The combination of four items with four levels each creates a 4x4 matrix with 256 (4⁴) different possible combinations.  This classification is generic (i.e. not condition- or domain-specific), can be used by all types of patients and citizens, except children and those in coma, and in all health settings.

The scoring system used in howRwe is a simple aggregate score in which a higher score indicates better health.

For analysis and reporting, each level is allocated a score on a 0-3 ordinal scale, with:

• poor= 0
• fair = 1
• good = 2
• excellent = 3 

The overall howRwe score is calculated by adding the scores for each item, giving a range from the floor, 0 (4 x poor), to the ceiling, 12 (4 x excellent).  This scoring system is similar to that used by the Apgar, Glasgow Coma and Oxford Hip and Knee scores.  It is easy to understand and is transparent.  The resulting scale has ordinal properties.