Patient Experience Journal (PXJ, The Beryl Institute)
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Impact of Non-Pharmacological Interventions on Patient Experience, Opioid Use, and Healthcare Utilization in Adult Cardiac Surgery: A Randomized Controlled Mixed Methods Trial
No full textNon-pharmacological techniques designed to reduce anxiety, pain, and healthcare utilization have shown effectiveness in pediatric and non-surgical adult populations; however, their application has not been widely evaluated among adult surgical patients. This study randomized opioid-naive adults undergoing first-time, elective cardiac surgery to receive either targeted interventions from a trained “comfort coach” or usual care. The primary outcome assessed was healthcare utilization, specifically measured as the number of days at home within the first 30 days post-surgery. Secondary outcomes included postoperative opioid use and patient-reported outcomes, collected via validated surveys. Additionally, 50 participants in the intervention group completed semi-structured qualitative interviews to explore their experience and acceptability of the intervention. Among the 160 randomized subjects (COACH: n = 77; USUAL CARE: n = 79), three did not undergo surgery and one was excluded for dementia, leaving 156 participants with a mean age of 63 years, 33% of whom were female. The primary outcome was not statistically different between groups, with the COACH group averaging 22.8 ± 4.4 days at home and the USUAL CARE group 22.0 ± 4.5 days (p = 0.26). Both groups exhibited similar decreases in anxiety and depression from preoperative clinic to 90-days postoperatively, and discharge pain scores averaged below 3/10. Notably, opioid prescriptions were larger than patient-reported consumption (p \u3c 0.001). Qualitative analysis revealed the comfort coach intervention was highly valued, with participants identifying positive themes regarding the role and impact of the coach. These findings suggest that a comfort coach is a valued, novel healthcare role for cardiac surgery patients, and further research should prioritize comprehensive patient-reported outcomes
Patient Experience Second Opinion: Expanded Telemed Simulation Broadens Inquiry of Health Care Provider Verbal and Nonverbal Communication Issues
No full textIn the quest to improve patient experience and health outcomes, the impact of provider consultation generally earns serious consideration. This study recruited a richly diverse pool of participants to examine how patient demographics and psychographics during a telemedicine consultation simulation impact the perceptions of the provider that contribute to patient satisfaction. Further, this study relies on a between-subject experimental design to investigate how “provider” verbal and nonverbal communication and demographics in addition to patient demographics and psychographics impact patient perceptions and outcomes of the simulated telemedicine experience. Results inform how healthcare provider verbal and nonverbal communication might be improved through training on both the full process of consultative communication and specific skills that contribute to ultimate improvement of patient experience
Effectiveness of Incident Reporting Tools in Ensuring Patient Safety: A Systematic-Narrative Hybrid Review
Get PDFBackground: Ensuring Patient Safety in healthcare is essential and requires efficient methods to reduce risks and improve the quality of care. Although incident reporting tools are commonly used to identify possible and actual care failures, their efficacy differs among various environments. The aim is to evaluate the effectiveness of incident reporting tools in enhancing patient safety. Methods: This review employed a combined methodology that integrates systematic and narrative approaches to gain a thorough understanding of incident reporting practices. In accordance with PRISMA guidelines, databases including PubMed, Embase, and Cochrane Library were systematically searched for studies published from January 2013 to December 2023, focusing on the efficacy of incident reporting systems in healthcare. The Scale for the Assessment of Narrative Review Articles (SANRA) was implemented to evaluate the quality of the studies. Finally, key topics were grouped. Results: The search strategy yielded a total of 4,305 records. Of those, 8 were included in the final analysis. The total SANRA scores varied between 9 and 11 out of 12, indicating a generally high level of scientific reasoning and clarity in objectives among the studies. The descriptive analysis focused on factors influencing effectiveness including organizational culture, system design, and follow-up procedures. Conclusion: Incident reporting tools play a crucial role in patient safety but require proper integration into healthcare systems with supportive cultures and effective feedback mechanisms to realize their full potential
Understanding the Care Experiences and Support Needs of UK Adults Treated in Hospital for Meningitis
Get PDFBackground: Meningitis often results in ongoing and multifaceted after-effects, which can impact many aspects of people\u27s lives, yet relatively little support and follow-up is offered. This study explored post-treatment care experiences of UK adults aged 16 and over following a recent stay in hospital for meningitis. Methods: A survey was designed to ask about hospital discharge, recovery, information provision and aftercare support. The research involved 5 semi-structured, in-depth interviews and a 15-participant online asynchronous focus group. The themes arising from this qualitative stage informed the development of a quantitative 32-item questionnaire which was hosted and promoted online between September 2022 and February 2023. Results: Two hundred and twenty-eight survey responses were received. Respondents reported ongoing impact to many aspects of their lives. Many did not feel they received enough information or signposting to appropriate and tailored support services, despite reporting they would have liked this. A lack of care continuity was reported at discharge through to primary, secondary, and tertiary care. Conclusions: Although meningitis affects a small proportion of adults, it can have a substantial impact on the lives of those who have suffered from it. Regardless of the cause of meningitis, the findings highlighted gaps in information provision, awareness, follow-up care, and support for adults. We recognise the limitations of recruiting for and hosting the survey solely online. Findings have been submitted to the National Institute for Care and Excellence (NICE) for consideration in the current development of new guidelines for bacterial meningitis and meningococcal disease
We Are Not THERE Yet! Why the Journey for Experience Excellence Must Persist
No full textI am concerned, that many in healthcare think they have gotten to a “THERE” in experience excellence. That the survey scores they received are good enough, that the outcomes they are achieving reflect what they sought to accomplish. And with this in the face of today’s tumultuous healthcare landscape, decisions are being made to sustain efforts at best and in more cases now to reduce investment with the belief that things are ok. Now is NOT the time to cut short our efforts for experience excellence, or to believe there is a “there” to which we have arrived. It must be a journey of purpose, driven by an unwavering commitment to how each of our healthcare organizations chooses to show up each day, through its culture and the people that deliver on its promise. Now is not the time to believe we’ve made it. This may seem like an interesting declaration from someone who fought for these ideas in my own days in healthcare leadership and then turned to try and expand this conversation globally for the last 15 years. I can say even with all that we have done together, through the experience community and beyond, there is still much more to do. Are we in a better place then we have ever been on the experience journey? Yes, we are. And at the same time new people and organizations are discovering this work for the first time in places all around the world or bringing innovations and ideas to the fore that will only help us care for one another a little better each day. So, this may be the tension I hope we can all hold in suggesting “We are NOT there yet!”. For as much as we have done to succeed, there is so much more to learn and give
Beyond the Numbers: Elevating Meaning through Metrics in Patient Experience
No full textThis commentary submitted by Patient Experience Journal (PXJ) Associate Editor begins with a simple observation: sometimes, in our effort to measure everything, we miss what’s right in front of us. We look up at the data but fail to notice the larger shape taking form above it, something tall, quiet, and graceful that changes how we see the landscape. Patient experience work demands that we hold both the precision of metrics and the wonder of narrative to truly understand of patients’ experiences of care. Numbers tell us how we are performing and stories remind us why it matters. When we bring the two into focus, we begin to see the patterns that make transformative patient experiences possible
Understanding Patient Experiences: A Qualitative Study on Communication and Cultural Competence in Multiple Sclerosis Care
Get PDFObjective: Effective communication is crucial in multiple sclerosis (MS) care, influencing patient satisfaction, self-management, and health outcomes. This study explores the experiences of people with MS (PwMS) regarding communication with healthcare providers and between providers within healthcare systems. Methods: This qualitative study analyzed open-ended responses from 590 participants in a national cross-sectional survey. Thematic content analysis was conducted to explore MS patients’ experiences with healthcare communication and care delivery. Results: Three major themes emerged: (1) Patient-provider communication, where 62.9% of participants reported positive experiences, citing responsiveness and empathy, while 37.1% noted issues such as inattentiveness and rushed consultations. (2) Provider-system communication, with 69% of responses highlighting poor coordination between healthcare teams, leading to patient burden and care delays. (3) Cultural (in)competence, where 71.7% of participants felt their providers demonstrated cultural awareness, while 28.3% reported racial discordance, linguistic barriers, and biases affecting their care experience. Conclusions: While many patients with MS report positive communication experiences, gaps in provider responsiveness, care coordination, and cultural competence remain. Strengthening communication training, integrating electronic health records for improved coordination, and enhancing cultural competence initiatives can foster more patient-centered MS care, improving both patient satisfaction and health outcomes
I felt more confident that it would work for me: A Grounded Theory of Person-centered Interprofessional Collaboration Based on Patients’ Lived Experiences
Get PDFInterprofessional collaboration (IPC) is considered the highest standard of practice for delivering care to patients with multiple, complex, and chronic conditions. Despite reported benefits of IPC, the voice of the care receiver and how or whether they experience IPC is underexplored. Our objective was to examine patients’ experiences with IPC in two rural primary care settings in the U.S., where the burden of multiple chronic conditions (MCCs) is coupled with lower life expectancies and reduced access to care. We used a semi-structured interview to assess patients’ experiences within 72 hours after an IPC healthcare visit. This study, conducted in two federally qualified health centers in rural Appalachia with a university partner, explored the narratives of 21 people with MCCs. Through inductive analysis, findings were categorized as 1) Person-Centered Care Behaviors, 2) IPC Inquiry, 3) IPC Problem-Solving, and 4) IPC Consensus on a Plan of Care. Our grounded theory proposes a model of person-centered IPC that increases patients’ confidence in the IPC plan of care. This study presents evidence that IPC offers powerful inquiry and problem-solving capacity, while placing the patient at the center of the team, practicing collaboratively, and building consensus on goals and planning. Patients enjoyed working with students, an indication that mutually beneficial opportunities exist for patients, clinicians, and trainees in settings where IPC can augment care by providing interprofessional consultations in remote and underserved areas. Our findings are consistent with person-centered care, and the benefit patients find in an IPC-created care plan
Patient Perspectives on Implementing a Person-Centered Care System: Experiences From the U.S. Veterans Health Administration\u27s Whole Health System of Care
Get PDFObjectives. Replacing the disease-centered, paternalistic approach in healthcare with a person-centered model has become a widely recognized imperative. However, patients\u27 perspectives on and experiences with real-life efforts to implement this approach to care are rarely studied. We examined this issue at a health system with a prominent record of commitment to implementing person-centered care on the system level – the U.S. Veterans Health Administration (VHA). For over a decade, VHA has been transforming itself into a Whole Health (WH) system of care that is person-centered, holistic, and empowering. Methods. We conducted semi-structured qualitative interviews with 19 patients recruited from a single VA medical center and used a combination of qualitative content analysis and thematic analysis to generate themes. Results. We generated three themes. First, patients were largely unaware of WH as a concept or initiative, although some were able to retroactively use the newly introduced concept of WH to reflect on their past care. Second, whereas some patients grasped the meaning of WH easily, others displayed a lack of understanding, conflating WH with other models of care. Finally, when asked about their interest in experiencing WH care, some patients were enthusiastic; others were disinterested or expressed reservations. Conclusions. Patient perspectives from the VHA illustrate that implementing person-centered care requires a paradigm shift not only for clinicians but also for patients, who may be similarly accustomed to a biomedical approach and/or unaware of alternatives. To improve patient engagement in person-centered care, health systems ought to undertake targeted, iterative, multi-pronged education efforts
Study on Doctor-Patient Identity Construction from the Perspective of Narrative Medicine
Get PDFThis study delves into the construction of identities and the linguistic strategies employed within the doctor-patient interactions through the lens of narrative medicine, with text analysis methodology utilized. The research findings unveil linguistic strategies employed by doctors and patients within the narrative medicine framework in shaping their identities during communication. In the establishment of their collective identity, doctors concentrate on minimizing hierarchical disparities with patients. While establishing relational identities, doctors display attentiveness to patients\u27 emotional states, primarily utilizing medium and low modality. They consciously avoid using imperatives with assertive tones, creating space for collaborative negotiation. When shaping personal identities, doctors cultivate a warm, intimate, and amicable persona, which helps to foster a sense of empathy and bridge the connection between doctors and patients. Patients, in turn, employ various linguistic forms to express respect towards doctors, thus contributing to the maintenance of a harmonious relational identity. Additionally, in cultivating their personal identities, patients may share personal experiences and express negative emotions to garner more attention from doctors. In summary, the communication between doctors and patients involves the construction of multiple identities, collaboratively fostering a harmonious doctor-patient relationship within the narrative medicine framework. The linguistic strategies employed by both parties contribute to the establishment and maintenance of these identities