Patient Experience Journal (PXJ, The Beryl Institute)
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Health equity and quantifying the patient experience: A case study
Get PDFThe COVID-19 pandemic has invigorated efforts to address health inequities disproportionately burdened by racial/ethnic groups and individuals of low socioeconomic status. Measuring and monitoring patient experience is crucial to understanding why the gaps exist and identifying mechanisms necessary to close them. Electronic health records and digital health tools hold much promise in this regard and can lead to change. We present a case study describing the innovative efforts undertaken at Sutter Health, a large integrated health network in Northern California, to quantify gaps in health equity using electronic platforms and visualization modalities. More work is needed to identify and address barriers rooted in social context and structural inequities and ultimately impact health equity.
Experience Framework
This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens
Special Issue – July/August 2022: Elevating the human experience through caring for the healthcare workforce
Get PDFPatient Experience Journal (PXJ) is excited to announce the call for submissions for its July/August 2022 special issue on the impact that caring for the healthcare workforce can have on transforming the human experience. Well before the pandemic and elevated by it, the importance of the healthcare workforce in ensuing the best in experience has been essential. It is why at the heart of the definition of patient experience itself, that culture is identified as an essential element. More so, the Declaration for Human Experience (https://transformhx.org/) reinforced this through a foundational commitment to “understand and act on the needs and vulnerabilities of the healthcare workforce to honor their commitment and reaffirm and reenergize their purpose.” This special issue will look for pieces that address evidence-based efforts at addressing workforce experience, reveal practices that are focused on caring for the healthcare workforce and share personal stories of the impact these issues have had. Through this special issue, PXJ looks to not only build a foundational collection of knowledge and information that will continue to push the conversation on experience forward, but also create a platform for action in addressing this issue that rests firmly at the heart of healthcare
The influence of COVID-19 visitation restrictions on patient experience and safety outcomes: A critical role for subjective advocates
Get PDFWith the emergence of the coronavirus (COVID-19) pandemic in the United States in early 2020, hospitals across the country made the difficult decision to alter visitation policies, by either limiting visitations or restricting visitations altogether by closing access to family, friends and care partners in an effort to reduce further spread of the virus. While there is foundational research on the impact of family and care partner presence on the experience of patients and patient safety outcomes, the actions driven by the pandemic allowed for a real-time comparison of the impact of family or care partner presence or lack thereof. Patient and family engagement has long been a part of patient experience scholarship where the role of family members and care partners as patient advocates and a presence of support has been reinforced. Scholarship and practice have also encouraged movement from restricted visiting hours to having open visitation based on findings that, in addition to better patient outcomes, there is a benefit in nurse job satisfaction and communication when visitations are unrestricted. The purpose of this study is to examine the degree to which hospital visitation restrictions in U.S. hospitals during the COVID-19 pandemic help to explain changes in patient experience and patient safety outcomes. To examine this relationship, patient experience and safety outcomes of a national sample of hospitals (n=32) during the pandemic is compared to previous corresponding performance. The results indicate that hospital performance was negatively impacted on average during the pandemic for hospitals in the sample. However, differences in hospital performance during the pandemic were driven by hospitals that disallowed patient visitations. Hospitals with closed visitations saw most pronounced deficits in their performance with regard to patient ratings of medical staff responsiveness, fall rates and sepsis rates. Performance in hospitals that either remained unrestricted or partially limited their visitations was not appreciably different from pre-pandemic performance, and in some cases performance even improved marginally. The findings of this study indicate that the policy to allow for visitors, or subjective advocates, individuals with a vested interest in the well-being of the patient, is beneficial not only for the patient, but also in sustaining high quality of care. Recommendations are given for how hospitals might achieve improved quality and safety outcomes even in instances when organizations believe visitation needs to be disallowed or restricted. The results of this study suggest those decisions should be made with great care and in only the most extreme circumstances.
Experience Framework
This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens
Patient engagement in an academic community-based primary care practice’s management committee: A case study
Get PDFPatient engagement in primary care has been the focus of many studies; however, little research has evaluated its added value to organisational management in an academic community-based primary care practice (ACBPCP). In 2017, managers of an ACBPCP in Montreal, Canada, decided to integrate patients into the organization’s management committee to enhance the quality and relevance of decision-making for clinical services, education and research.
Objectives were to 1) assess patients’ role and influence on an ACBPCP management committee’s decision-making process; 2) identify the facilitators of and obstacles to patient involvement in this context; and 3) evaluate the impact of this innovative approach in promoting a patient partnership culture throughout the organization. Using a single case study, qualitative and quantitative data was collected between June 2017 and May 2019 from three levels: 1) professionals in charge of patient partnership working within the territorial health care organization’s quality division; 2) management committee; and 3) ACBPCP’s staff outside the committee. Successful patient governance relies on a structured engagement approach, including a rigorous recruitment process, joined training and coaching of all committee members and the development of work modalities that facilitate co-construction. Multilevel leadership is also fundamental to support a partnership culture throughout the organisation. The results of this study illustrate opportunities and challenges related to patient involvement at an ACBPCP’s organizational level. They can guide other community-based primary care practices interested in involving patients in their management activities.
Experience Framework
This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens
Measuring cancer care experiences of Aboriginal and Torres Strait Islander people in Australia: Trial of a new approach that privileges patient voices
Get PDFThis study examined a new method for measuring the care experiences of Aboriginal and Torres Strait Islander people with cancer: the Indigenous People’s Experiences of Cancer Care Survey (IPECCS). The study assessed IPECCS’s: 1) performance; 2) ability to elicit information useful for service improvements; and 3) implementation potential. Three participant groups were recruited from five Australian cancer treatment sites: 1) Aboriginal and Torres Strait Islander people with cancer (+/- support person); 2) interviewers; and 3) health services staff. Trained interviewers administered IPECCS to participants with cancer in audiotaped sessions. Paper forms and transcripts were compared to assess performance, and problems/potential solutions reported by participants with cancer were assessed for actionability. All participant groups completed separate interviews regarding IPECCS. Selected implementation measures were assessed based on interviews and IPECCS administration. Participants (n=31) included 11 Aboriginal people with cancer, 7 support people, 4 interviewers, and 9 health staff. Aboriginal people with cancer spoke at length about their cancer care experiences and identified problems and potential solutions that could be acted upon by health services. Although some parts of the IPECCS form were well-completed, recording was inconsistent and inadequate. Aboriginal people with cancer and interviewers predominantly supported the IPECCS process; while most health staff supported the aims, they questioned its feasibility. Capturing domains of patient experience relevant to Aboriginal and Torres Strait Islander people requires a culturally safe, strengths-based approach. The tension between facilitating meaningful patient engagement and maximizing the efficiency of data collection and use must be resolved to realise the benefits of such an approach.
Experience Framework
This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens
How to address fear: A patient’s perspective of seeking care during COVID-19
Get PDFThis article is a narrative of one patient’s experience during COVID-19. As a non-COVID patient, she shares her personal fears, the fears of others in her family and the fears of the healthcare professionals. These fears have made navigating the healthcare systems stressful for patients but also caused patients to avoid them completely. In some cases, this avoidance led to delayed diagnosis, missed diagnosis and death. When healthcare providers guide patients through the process of seeking in-person healthcare, the outcomes were more positive for everyone involved but especially for the patients and their care partners. The patient’s voice is needed to help healthcare professionals understand their fears and how to provide the best healthcare for all.
Experience Framework
This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens
Using design-thinking to investigate and improve patient experience
Get PDFUnderstanding and enhancing the patient experience can lead to improved healthcare outcomes. The purpose of this study was to capture a comprehensive and nuanced understanding of the patient experience on an inpatient medical teaching unit in order to identify key deficiencies and unmet needs. We then aim to implement a design-thinking methodology to find innovative ways to solve these deficiencies. Here we present the first two phases of this four-phased study. We retrospectively and prospectively collected quantitative data about patient experience with the Canadian Patient Experiences Survey-Inpatient Care. We then used this data to guide patient interviews. We identified several key deficiencies including call bell response times, noise levels at night, pain control, education about medication side effects, communication between healthcare team members, and how well healthcare team members remain up to date about patient care. In the final two phases of our study, we will select one or more of these deficiencies and collaborate with patients and other stakeholders to rapidly create, employ, and assess the impact of prototypes through an iterative action cycle until effective and sustainable solutions are found.
Experience Framework
This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this len
Implementing PODS (Patient Oriented Discharge Summary) in an acute medical urban health setting in Vancouver, Canada
Get PDFThe transition from hospital to home or community is a vulnerable time for patients and families, who face risks associated with misunderstanding instructions about medications, self-monitoring and when to seek emergency care. The quality of the discharge process can have a significant impact on patient confidence, overall patient experience, ability to manage health at home, and hospital readmission rates. Patient Oriented Discharge Summary (PODS) is a standardized form and set of process changes, utilized to overcome communication barriers faced at discharge. We implemented PODS in two Acute Medicine units of a tertiary care hospital in western Canada and used a mixed-methods approach to evaluate the four process changes (PODS form, use of teach-back, engagement of caregivers in discharge teaching, follow-up phone calls). Evaluation showed that 60% of patients received PODS and 87% found the form helpful. There was a large increase in the percentage of patients who felt adequately prepared at the time of discharge, and a 10% increase in the number of patients who rated their overall hospital experience positively. Healthcare providers reported that using PODS they were more confident that patients were adequately prepared to return home. The update of PODS on the implementation units has been sustained at 60% for 18 months. Implementation of the PODS form and process can be accomplished with an interdisciplinary team, leadership support and by working closely with Patient Family Partners. PODS can improve the discharge process even in the complex urban acute medical environment in ways that offer wide-reaching benefits.
Experience Framework
This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens
Comparing patient experience survey scores between telehealth and in-person ambulatory pediatric subspecialty visits
Get PDFTo determine the effect of encounter methods on patient experience, we evaluated patient experience survey data comparing scores between telehealth and in-person visits and pre-COVID-19 and COVID-19 time periods. Pediatric subspecialty visits were either in-person or via telehealth and received the same 16-question patient experience survey. Top box (5/5) scores were compared between in-person and telehealth visits for pre-COVID-19 and COVID-19 periods as well as between periods for in-person and telehealth visits. In addition, for both time periods and encounter methods, correlation analysis was performed to evaluate best correlation between likelihood to recommend practice and the 15 other survey questions. Comparing the COVID-19 period data, there was a statistically significant difference in the top box likelihood to recommend practice score comparing in-person to telehealth numbers (81.01% vs 87.13%, p = 0.0003). Comparing pre-COVID-19 with COVID-19, this was not true for in-person scores (79.97% vs 81.01%, p = 0.4060) or telehealth scores (82.50% vs 87.13%, p = 0.2084). The question with the highest correlation coefficient to likelihood to recommend practice was how well staff worked together in both time periods and visit methods. We conclude that Likelihood to recommend experience scores were statistically significantly higher for telehealth as compared to in-person pediatric subspecialty ambulatory visits during the COVID-19 pandemic. There were no such differences in likelihood to recommend comparing pre- vs COVID-19 time periods for either in-person or telehealth visits so the change in scoring seems to be related to the mode of care delivery.
Experience Framework
This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens
In divided times, a focus on human experience connects us
Get PDFThe realities of the time in which we find ourselves, not only in healthcare, but in society overall, have exposed so much of what was simmering beneath the surface of our humanity. Issues of equity and inclusion, of stress and burnout, of division and misconception and even the existence of alternative “truths” have caused rifts in our connection, weakened our societal foundations and pulled on the seams of the healthcare system itself. We close our eighth volume of Patient Experience Journal (PXJ) under this veil, yet I believe we have an opportunity to use this moment as a place from which to build. I do not suggest this work will be easy., but a conversation on experience is a clear and common ground. It challenges those who seek to dismantle versus build. It provides a space to look and act above the noise and does not let us overlook that it needs to be challenged and addressed. When we focus on the human experience found underneath all the rhetoric, we find opportunity and inspiration. A focus on human experience connects us