Patient Experience Journal (PXJ, The Beryl Institute)
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Using shared mental models to conceptualize patients as professionals, decision-makers, collaborators, and members of interprofessional healthcare teams
Get PDFPatient engagement has become the buzz-phrase of 21st Century health care. Around the world, healthcare systems involve patients in a wide range of activities including drug development, research, and policy design. There are strong institutional pressures for patient engagement in healthcare activities that have been bolstered by ethical imperatives and social and organizational benefits from patient engagement. There is a trend to center efforts to cultivate engagement initiatives that are meaningful to patients and family. However, these efforts are characterized by multiple challenges, for example, tokenism and the lack of organizational support. These barriers may persist in healthcare professionals’ conceptualizations of patients as independent from the health system; healthcare professionals are active shapers of health services and patients are passive recipients. There is a growing need to address the scholarly confusion with the roles and expectations of patients in healthcare activities, and what strategies can support more meaningful and collaborative relationships between different groups. This paper uses the literature on shared mental models - knowledge structures that define the boundaries of collaboration between groups with distinct values and beliefs - to describe how the roles of patients in healthcare activities may be expanded. This paper deconstructs how technical and informal knowledge serves as a focal point for healthcare professional identity, and how this relationship between knowledge and professionalism creates an anchor for conceptualizing patients as professionals, collaborators, and decision-makers.
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
Finding common threads: How patients, physicians and nurses perceive the patient gown
Get PDFEvidence-based care is standard practice in medicine, but the patient gown has fallen outside the scope of scholarly research. The current gown renders a patient vulnerable, diminishing patients’ sense of identity, agency, and dignity with its one-size-fits-none design. The impact on providers is similarly neglected. Our objective was to explore how patients and providers derive meaning from patient gowns. A convenience sample at an academic medical center was interviewed utilizing a standardized framework developed by a medical student and two PhD-prepared researchers with experience in qualitative methods. The study was inductive in nature, seeking to understand perceptions of the patient gown through thematic analysis of transcripts within and across interviews. Participants were ten patients (5 women, 5 men; mean (SD) age = 56.4 (19.1)) years, ten nurses (9 women, 1 man; mean (SD) age = 36.5 (13.4)) years, and ten physicians (6 women, 4 men; mean (SD) age = 48.6 (14.4)) years. Themes within patients’ interviews suggest gowns are provider-driven, the design is problematic, gowns reduce self-esteem, and color options would be empowering. Themes within providers’ interviews addressed gowns theoretically vs. practically, attire biases, and distress from seeing patients in gowns. Common themes among groups included: negative first impressions of gowns, ideas for improvement, and barriers to change. This is the first study to ascertain how patients and providers perceive patient gowns and offer the opportunity to describe and sketch an “ideal” alternative. The current gown satisfies neither patients nor providers, and flaws must be addressed to improve patient and provider experiences.
Experience Framework
This article is associated with the Environment & Hospitality 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
A sociotechnical systems approach toward tailored design for personal health information management
Get PDFWe used a sociotechnical systems approach—which conceptualizes a system of interacting people, technologies, and tasks, to identify individual differences in personal health information management (PHIM) that can inform the design of patient-friendly environments, tools, and technologies. We conducted a secondary thematic analysis of data collected as part of a parent project, vizHOME. The goal of vizHOME was to improve health and health outcomes through identifying key features in the environment that will inform the design of consumer health information technology HIT. We analyzed interview data collected from 20 individuals with diabetes. We found seven dimensions of PHIM: (1) level of privacy preferred for PHIM; (2) amount of engagement in PHIM; (3) extent of guidance preferred for PHIM; (4) level of documentation preferred for PHIM; (5) degree of physical distribution of PHIM; (6) amount of flexibility in PHIM routine; and (7) use of external cues to manage PHIM. Our results suggest that each dimension exists as a continuum, which are anchored from low to high. Exploring the interaction between PHIM and the sociotechnical system in which PHIM is performed revealed key dimensions of PHIM as well as individual differences in those PHIM dimensions. Identification of individual differences in PHIM can support the creation of human-centered design considerations for tailored environments, products, processes, and technologies that support PHIM. Future research will seek to validate PHIM dimensions in a larger population and develop a PHIM-typing measure to identify PHIM types toward tailoring processes, products, and to individual needs in context.
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
Reframing innovation and technology for healthcare: A commitment to the human experience
Get PDFThis latest special issue of Patient Experience Journal focuses on the role of technology and innovation in patient experience. The articles included in this issue help us think about the ideas of innovation and health information technology (HIT) in some new and interesting ways. They also have us push the boundaries of what has framed what innovation and technology application look like in healthcare today. With this perspective, we explore the idea that HIT is not simply a process improvement tool; it is a means to elevate the human interactions at the heart of healthcare. Simultaneously in healthcare, innovation has been an essential focus in creating a safer, higher quality, more reliable and even more comfortable care experience. It has driven the capacity to ensure better care and positively impact the lives of those whom healthcare serves. At the same time, innovation as an idea has faced a challenge, for in the push to expand innovation itself, there exists the risk of diluting the concept. In addressing the opportunities we have with both HIT and innovation, we must also recognize they will forever be essential to our capacity to care for all in the care process. HIT and innovation, both distinctly and in conjunction, will drive the ability of healthcare globally to look to the future and create not only better tomorrows, but better todays. HIT and innovation at their very core support the work of healthcare, of treating illness, supporting health, creating efficiency, ensuring easier access to information and broadening knowledge. In applying HIT and pushing for innovation with the foundational idea that in healthcare we are human beings caring for human beings, those tackling these opportunities can move beyond just execution to purpose. This is the opportunity found in a reframed view of HIT and innovation and the possibility it affords; to support a growing commitment to the human experience in healthcare.
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
Co-producing healthcare in a volume vs. value-based healthcare system: perspective of a parent of a patient and a health professions’ educator
Get PDFThe Institute for Healthcare Improvement’s Triple Aim framework represents an approach to optimizing a health system’s performance by focusing on improving the patient experience of care, improving the health of populations, and reducing healthcare costs. As the US healthcare system undergoes substantial reformation and a shift from fee-for-service payment to value-based models, an approach that emphasizes the co-production of healthcare, our healthcare system must work in concert with the Triple Aim to improve the health experience for patients across multiple environments. Co-production in healthcare means that patients contribute to the provision of health services as partners of professional providers. To highlight how the current healthcare model failed a patient by delaying diagnosis and subsequent care, thus causing undue suffering, the personal experience of one of the author’s children is reported as a narrative. The purpose of communicating this patient experience is to: 1) remind healthcare providers about the importance of not only listening, but hearing the patient and their parent’s concerns; 2) readily admit when a patient’s clinical presentation falls outside of their expertise; and 3) co-produce healthcare by working with the patient and their family. This patient experience serves to reinforce the commitment to co-produce health with patients and their families in a manner that emphasizes the value of care.
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
How do healthcare staff respond to patient experience feedback online? A typology of responses published on Care Opinion
Get PDFPatients are increasingly describing their healthcare experiences publicly online. This has been facilitated by digital technology, a growing focus on transparency in healthcare and the emergence of a feedback culture in many sectors. Due to this area being previously unexplored, the objective of this study was to identify a typology of responses that healthcare staff provide on Care Opinion (www.careopinion.org.uk), a not-for-profit online platform on which patients are able to provide narrative feedback about health and social care in the UK. Framework analysis was used to qualitatively analyse a purposive sample of 486 stories regarding hospital care, and their 475 responses. Five response types were identified: non-responses, generic responses, appreciative responses, offline responses and transparent, conversational responses. The key factors that varied between these response types included the extent to which responses were specific and personal to the patient story, how much responders\u27 embraced the transparent nature of public online discussion and whether or not responders suggested that the feedback had led to learning or impacted subsequent care delivery. Staff provide varying responses to feedback from patients online, with the response types provided being likely to have strong organisational influences. The findings offer valuable insight, advancing the relatively unexplored research area. They also have both practical and theoretical implications for those looking to enable meaningful conversations between patients and staff to help inform improvement. Future research should focus on the relationship between response type, organisational culture and the ways in which feedback is used in practice.
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 future of patient experience: Five thoughts on where we must go from here
Get PDFIn looking to the future, we must never forget it is grounded in today and the steps that brought us to this point. Those efforts and actions that led to where we stand now set the foundation for all we can do and what we will accomplish as we look to the future. This idea of not looking too far ahead without knowing where you stand is fundamental in human nature. Far too often we have let our gaze to the future miss the people right in front of us or overlook the significance of the moment in which we stand. As we look to the future of experience in healthcare, we must start identifying and acknowledging the bigger issues facing healthcare overall. When we look at experience as the strategic heart of healthcare where quality, safety, service, cost and access come together to ensure the best outcomes overall, we can then build a path forward that serves all in healthcare. To do so we must consider where we go from here and how we take the critical next steps. This article offers five thoughts on how experience will change in moving towards its future. Yet with all we know is possible in healthcare, if we remain committed to one another, to what is possible and to what we believe our fellow human beings want and deserve, then we will also know the right thing to do and the next steps to take. That is where the future of experience awaits.
Experience Framework
This article is associated with the Culture & Leadership 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
Effect of change in the CG CAHPS survey instrument recall period on patient experience scores on healthcare utilization
Get PDFStandardized patient experience survey instruments play an important role in informing healthcare quality and process improvement. However, any changes in standardized instruments can impact the interpretation, trending, and analysis of patient reported data. This study investigates how the change in Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG CAHPS) survey recall period, from 12- to 6-months, can impact the accuracy and quality of patient experience data. This study used primary survey data on patient experience collected in 2016. Analyses included tests of proportion and t-tests for a comparison of: 1) experience ratings, and 2) administrative data to corroborate how accurately respondents report the number of visits received within the recall period. The findings indicated that respondents, on average, underestimated their usage of care based on a 12-month recall period, apart from those who reported just one visit. A shorter 6-month recall period resulted in higher accuracy in reporting the number of actual visits that occurred. Furthermore, experiential measures showed consistently higher scores across measures for Provider Communications, Staff Communications, Timely Access to Care, and Care Coordination for a 6-month recall period compared to a 12-month period. This study showed that it would be difficult to compare CG CAHPS Version 2.0 to Version 3.0 due to recall differences in experiential measures. Given that shorter recall periods tend to be associated with higher CG CAHPS ratings, healthcare stakeholders should consider bias introduced by changes of recall periods in survey instruments.
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
Seven steps to successful change: How a large academic medical center prepared patients for organizational change
Get PDFVanderbilt University Medical Center (VUMC) launched a new electronic health record (EHR) in a “big bang” implementation that saw the new software go live across multiple hospitals, clinics and geographic locations in a single morning. The organization rightly focused most of its energy on preparing its nearly 25,000 employees for the impacts of the transition, but it also considered the effects that would be felt by its patients and families. Survey data indicate that patient satisfaction scores demonstrably dip before, during and after an EHR implementation, and take approximately a year to recover. A team at DMC employed a seven-step approach to preparing patients for the impacts of the transition, which led to a return to pre-implementation patient satisfaction scores in about half the time of its peer institutions. The article explores these seven steps in detail and offers recommendations for how healthcare organizations facing large-scale change can use a similar structured approach to mitigate negative impacts to patients.
Experience Framework
This article is associated with the Culture & Leadership 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 impact of response rate on Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) dimension scores
Get PDFPatient experience measurement is receiving considerable attention from hospital executives, healthcare leaders, purchasers such as the Centers for Medicare and Medicaid Services (CMS), and patients. It is therefore appropriate and necessary to examine the methods of survey administration, and the analysis presented here seeks to understand the impact of one particular aspect of the measurement: response rate. Utilizing publicly reported HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) data from Hospital Compare, a positive correlation between response rate and HCAHPS scores nationwide was identified and replicated. This correlation, which was most recently published by the Hospital Quality Institute (HQI) for California facilities, implies that increasing response rates can return higher HCAHPS dimension scores. Accurate patient perceptions of the inpatient experience may be hidden by insufficient representativeness of the data. In other words, publicly-reported scores may be lower than they should be, and hospitals may be mistakenly devaluing their efforts to improve the patient experience. Responses from a more representative sample of the patient population are key to capturing more accurate HCAHPS scores