Patient Experience Journal (PXJ, The Beryl Institute)
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Collecting child-patient feedback: A systematic review on the patient-reported outcome measures for hospitalized children
Get PDFAccurate reporting of patient experiences is a crucial resource for hospitals engaged in patient-and-family-centered care (PFCC). However, studies suggest that most children do not respond to patient satisfaction surveys and are instead represented by their parents or guardians. This study reviewed instruments used to obtain feedback from children about their healthcare experiences for two purposes: 1) To understand the limitations of current tools and 2) To determine if creating a new instrument is necessary. A systematic review was performed on PubMed, Medline, CINAHL, and Web of Science to identify peer-reviewed questionnaires designed to collect children\u27s healthcare experiences. Out of the 9,822 retrieved studies, 17 met the inclusion criteria. Among the seventeen studies, only one provided versions of the study for non-English speaking respondents. Only seven studies developed their questionnaires, nine studies used tools developed by other authors, and one study did not specify. Only 58.82% of the included studies collected both the child and their parents\u27 responses, and the remaining 41.18 % collected data solely from the child. Lastly, the included studies relied too heavily on questions that required the child to recall detailed accounts of their hospital experiences, the quality of their hospital room, and the hospital equipment used in their treatment. The study finds that these questions not only led to mixed results, it also limited self-reporting. Further, the study acknowledges the need to develop a superior instrument that asks children for their perspective of their healthcare experiences in an age-appropriate and culturally accessible way.
Experience Framework
This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens
Living with cardiovascular disease (CVD): Exploring the biggest challenges for people affected by CVD in the UK, and their use (or not) of online resources
Get PDFAs death rates decrease, people affected by cardiovascular disease (CVD) continue to live with these diseases and the associated challenges, long-term. We aimed to identify the biggest challenges for people affected by CVD in the UK and explore the sources of support and information used to help manage conditions, to inform future service provision. An online questionnaire was sent and advertised to people over 16 years old in the UK self-identifying as affected by CVD (living with CVD, had risk factors, or a carer). There were 13,885 responses. The top five challenges were: feeling down, sad, or depressed; making changes to the way or amount of exercise; anxiety, fear, and uncertainty about the future; having one member of staff to speak to about all aspects of care; and being given information on the side effects of medications. Key challenges were not restricted to a particular condition, indicated by minimal variation between types of CVD. One-quarter of respondents indicated they do not use online resources or digital technologies to help manage their health. The volume and inconsistency of online sources were reported as barriers to using these. The results highlight the psychological and physical consequences of living with CVD. Fragmented care and variable access to information and support further compound these issues. Providing holistic care needs attention; the acknowledgement of psychological needs and access to support, alongside physical challenges is necessary. Stakeholders in healthcare and information technology should work together to ensure online information and support is clear, consistent, and reliable.
Experience Framework
This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this len
Is there a correlation between the patient-doctor relationship questionnaire and other patient-reported experience measures?
Get PDFPatient reported experience measures (PREMs) can quantify the quality of the patient-clinician relationship, which is associated with adherence and improved health. However, the scales used to assess PREMs have large ceiling effects, which limits our ability to learn and improve. This study assessed the correlation of four PREMs: the patient-doctor relationship questionnaire (PDRQ), a measure of perceived empathy, a measure of satisfaction with the visit, and a measure of communication effectiveness. We also assessed ceiling effects. We prospectively enrolled 103 new and return patients in this cross-sectional study. Patients completed a demographic questionnaire, the PDRQ, Jefferson Scale of Patient Perceptions on Physician Empathy (JSPPPE), four questions assessing communication effectiveness from the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS), an 11-point ordinal measure of satisfaction with the doctor, and four psychological measures. Correlations and ceiling effects were measured. In bivariate analysis, PDRQ had large correlations with measures of perceived empathy (r=0.58, P\u3c0.001), satisfaction (r=0.59, P\u3c0.001), and communication effectiveness (r=0.66, P\u3c0.001). No PREMs correlated with psychological measures. Ceiling effects were common: PDRQ 55%, JSPPPE 35%, communication effectiveness 33%, and satisfaction 76%. These large correlations support prior evidence that these PREMs measure a common underlying construct, and a single questionnaire may suffice. To better understand factors associated with improved patient experience, we need measures with limited ceiling effect.
Experience Framework
This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens
Deploying an improvement strategy across a rapidly expanding health system: A framework for repeatability and cost-effectiveness
Get PDFWith nearly 40,000 employees and physicians spread across 14 states, a robust system was needed to engage front line teams at the point of care to meaningfully enhance patient and family communication practices in Prime Healthcare, an award-winning, community hospital system with 45 hospitals. Among its key elements, Prime’s system-wide road map for deploying relationship-centered communication tools involved identification of and investment in frontline champions, education that was synchronized with leader-deployed digital rounding, and online self-reflection modules that promoted true behavior change. This economical and easy-to-follow road map is shared for others seeking a high return on investment from their patient experience efforts.
Experience Framework
This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens
Leveraging the agility of the care experience dyad partnership model during COVID-19
Get PDFThe extraordinary nature of COVID-19 has presented, and will likely continue to present, unique challenges for care delivery systems; not only in respect to delivery of care to patients, but also in respect to the ways in which health systems care for, and facilitate safe working environments for their employees. It was identified early on that COVID-19 would challenge our Health System, Henry Ford, in its ability to provide an optimal experience of care for our patients. We realized that the feelings of isolation experienced by patients, anxieties experienced by their families and impacts to the well-being of our employees would be significant. Communication was fraught, yet the need for communication had never been greater. Providing difficult news, only to be delivered by phone, injured morale for providers, nurses and support staff. Prior to COVID-19, Henry Ford Health System paired physician and administrative leaders to create high performing dyad partnerships. Clinical and administrative leaders were paired based on their diverse skill sets, competencies and representation. The goals of the Care Experience dyad are to 1) build connectivity; demonstrate support for work being done in times of complex and evolving situations, 2) provide psychological first aid through diffusion and debrief of real time situational stress, utilizing coaching resources, developed by Chief Wellness Officer, 3) assess needs and concerns; assist teams with interpretation and operationalization of rapidly evolving guidelines and protocols; co-discover solutions and escalate concerns, 4) listen with non-judgmental curiosity; normalize and validate feelings and 5) identify and link to resources; identify families who need crisis-level communication.
Experience Framework
This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens
Caring for our caregivers in body, mind and spirit during the COVID-19 pandemic
Get PDFNew York City became the epicenter of the coronavirus pandemic in March 2020. The surge of critically ill patients combined with widespread social distancing measures created extraordinary challenges for healthcare workers. Many frontline workers experienced significant physical, psychological, and emotional distress. They faced demanding patient care responsibilities while managing personal obligations and health concerns.
During the COVID-19 pandemic, it was imperative that NewYork-Presbyterian care for its workforce’s physical, psychological and emotional needs, not only because of our commitment to our colleagues as people, but also because of our obligation to continue to deliver high quality care and experience to the patients, families and communities we serve. Research shows there is a vital link between employee experience and patient experience. Employees who feel supported will be more engaged, which leads to higher quality care and a better patient experience.
At NewYork-Presbyterian, we supported our workforce holistically in body, mind and spirit so they could remain strong for the journey ahead and continue to serve our patients, families and communities throughout and at the peak of the coronavirus pandemic. We learned that proactively communicating, supporting physical health and mental health needs and acknowledging bereavement was critical to responding to this crisis.
Experience Framework
This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens
Management of frequent ED users by community paramedics improves patient experiences and reduces EMS utilization
Get PDFThis study examined a suburban emergency medical system (EMS)-led community paramedicine (CP) program in terms of adherence to protocol, patient-paramedic interactions, patient experience, and cost. Participants (n=57) are frequent emergency department (ED) users (≥ 4 ED visits/year), with a mean age of 59.8±17.6 years and have multiple chronic conditions. Of these, 36 completed a modified Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey at 3- and 6-months following program enrollment. The main outcome measures were adherence to intake goals; types, modes, and frequencies of CP interventions; CG-CAHPS patient experience scores; and cost savings. Cost savings compared EMS transports, ED visits, and hospital admissions during CP enrollment versus the previous year. Analysis also correlated participant demographics with the type and frequency of interventions. Adherence to enrollee intake protocols range from 5.3% for medication reconciliation to 78.9% for assessments of daily living (ADL) and home safety. The most popular interventions were follow-up and wellness checks occurring primarily in patients’ homes, and 97% of participants would recommend the program to friends/relatives. Females and African-Americans had increased CP interventions (p \u3c.0001). Mean post-program 911 calls decreased significantly from pre-program levels, from 14.1 to 7.8 (p = .0012), as did ED transports (10.1 to 5.6, p = .002), and non-ED transports (4 to 2.2, p = .0380). The estimated annual return on investment (ROI) is \u3e51%. This study objectively illustrates program success, showing that carefully designed and managed CP programs can deliver Triple Aim objectives.
Experience Framework
This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this len
The use of organizational assessments in improving patient and staff experiences in the ambulatory care setting
Get PDFAs the needs of patients evolve, healthcare organizations must diversify their approach to improving patient experience. Their programs should encompass the medical, mental, spiritual, and emotional needs of patients and their family members and the staff who care for patients. This case study examines the results of the evaluation to assess the effectiveness of organizational patient experience efforts. The Beryl Institute’s Experience Assessment was the evaluation tool administered and revealed the areas in which the organization was performing well and where improvements were needed. In collaboration with Ambulatory Care and Finance, the Office of Patient Experience targeted the Adult Primary Care and Orthopedic outpatient clinics for this assessment and followed-up with improvement projects to address the areas of opportunities identified. We administered the Extended DiSC® Assessment to the leaders in all departments that function within Ambulatory Care, to support the success of the improvement projects. The DiSC® assessment enables each leader to understand their communication style and gain an understanding of the ways they could improve communication with the leaders they collaborated with, who have different communication styles. Both assessments are geared towards self-examination and prodded the organization towards taking an honest look at how they functioned collectively and on an individual level and helped to clarify their perspective and reiterate their core values as a patient experience organization. The use of the Experience Assessment enabled an objective evaluation of the team’s readiness for patient experience improvements, in conjunction with the insights gleaned from the Extended DiSC® assessment.
Experience Framework
This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens
Implementing inter-professional patient-family centered plan of care meetings on an inpatient hospital unit
Get PDFInpatient plan of care meetings support efforts to encourage collaborative practice and patient-family centered care and result in an effective strategy to enhance communication and patient satisfaction. Clinical team members participated in patient/family centered plan of care meetings at a community hospital in a selected inpatient unit with full time hospitalist physicians. Quantitative data were gathered pre/post implementation from the external Hospital Consumer Assessment of Health Care Providers (HCAHPS) survey. HCAHPS data were collected independently, specifically for questions related to communication between patients, family members/guardians and the medical team and also the effects of care transition. There was a slow but steady upward trend in selected domains that reflected the standpoint of patients/families specific to patient communication and patient experience in care transition(s) during hospitalization. A greater upward trend was noted in the domain of communication with doctors. Qualitative data analysis revealed positive attitudes towards the plan of care meetings, and team members expressed concern regarding redundancy of information. Sharing amongst providers throughout the day identified a need for clearer criteria in patient selection for these meetings to maximize efforts and resources. A major concern was lack of direct feedback from the patient and family, the end users of the meetings. From this study, inter-professional collaboration in patient family centered care can be viewed as a positive aspect of efficient and innovative care delivery. More evidence-based research is needed to guide how inpatient hospital clinical care planning can be standardized to optimize the way in which patient family centered care can be supported by a collaborative coordinated effort among clinical team members.
Experience Framework
This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens
Thoughts of a palliative care nurse in times of pandemic
Get PDFThis narrative presents a series of stories (interactions) lived by a palliative care nurse during the time of COVID-19, a time when we tirelessly prepare to help the services that need us, but we have little preparation of ourselves for the changes that we will have to face in the care of our patients and families. It shares the lived experiences, difficulties, emotions lived by me but shared by so many around the world. It also tries to show that despite the scarcity of physical presence, creativity and commitment to patients and families make us go beyond ourselves and continue to make a difference by saying we are here!
Experience Framework
This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens