Patient Experience Journal (PXJ, The Beryl Institute)
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Beneath the surface of talking about physicians: A statistical model of language for patient experience comments
Get PDFThis study applies natural language processing (NLP) techniques to patient experience comments. Our goal was to examine the language describing care experiences with two groups of physicians: those with scores in the top 100 and those with scores in the bottom 100 among all physicians (n=498) who received scores from patient satisfaction surveys. Our analysis showed a statistically significant difference in the language used to describe care experiences with these two distinct groups of physicians. This analysis illustrates how to apply NLP techniques in categorizing and building a statistical model for language use in order to identify meaningful language and significant phrasing in a dataset of natural language. We provide a review of limited work at the intersection of language analysis and patient experience. We present our analysis and conclude with a discussion on what care providers and patient experience leaders can learn from language used in patient experience comments for the delivery of patient-centered 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
Patient perception of telephone follow-up after resection for colorectal cancer: Is it time for an alternative to the out-patient clinic?
Get PDFThe economic reality of modern healthcare provides a timely reminder to clinicians of their duty to provide outstanding and cost-effective care. Although multiple guidelines outline investigation, management and surveillance of colorectal cancer, none advocate a particular delivery method. Nurse-led telephone follow-up in multiple specialties has demonstrated equivalent clinical outcomes and patient satisfaction when compared to traditional outpatient department follow-up. This paper aims to compare nurse-led telephone and outpatient follow-up, following surgical resection of colorectal cancer (CRC), focusing on patient perceptions. This cross-sectional study distributed adapted patient satisfaction questionnaire (PS-Q 18) to patients undergoing surveillance following CRC resection via either nurse-led telephone clinics (TC) or standard outpatient department appointments (OPD). 161 questionnaires were distributed (100 OPD, 61 TC); the response rate was 70% for the OPD group, and 87% for the TC group (p=0.02). There was no statistically significant difference between patient reported satisfaction or in preference for healthcare delivery system between groups. More patients in the TC group had serum CEA measured than OPD group. This survey demonstrates high patient satisfaction with telephone follow-up. Owing to the financial benefits on both a patient and healthcare provider level, as well as improved screening uptake (CEA) in our study, a role for this innovative specialist nurse-led telephone clinic clearly exists. The benefits of telephone follow-up in terms of health economics, health equity and adherence to screening protocols support its exclusive role in long-term CRC surveillance
NHS England Always Events® program: Developing a national model for co-production
Get PDFNHS England, the Institute for Healthcare Improvement, Picker and NHS Improvement started the work described in this article to strengthen how patients, carers and staff working together in co-design and co-production can make a real difference in improving experience of care. Always Events®, which is an improvement methodology for the co-design and consistent implementation of those aspects of patient experience that matter most to patients in a health care setting, was chosen. The approach has been to first test the methodology with three organizations then to spread to a substantial proportion of acute health care providers, with concurrent scale-up within organizations that were early adopters in single settings, and then spread to other providers including care homes, primary care and integrated care systems. For organizations to be successful in embedding and sustaining Always Events, and to have a significant impact on improving experience, we learnt that health organizations should: a) co-produce with patients/service users from the very start and throughout every phase, b) integrate quality improvement, patient experience and person-centered care, c) identify an Executive Leader champion who can support the team to gain momentum from the beginning, d) keep an open mind and not be tempted to pre-determine what changes need to be made; patients/service users & staff know the challenges and have the best, simplest and most affordable ideas for improvement and finally, e) involving point of care staff from the beginning and co-designing the Always Event with them will support engagement and reduce resistance to change
Is it fair to compare? A patient and family experience of two healthcare systems and neurosurgical teams within a two-week period
Get PDFAs the mother of a 28-year-old son with cerebral palsy and hydrocephalus, and as a healthcare consultant focused on patient experience and professional development, I have a unique perspective and skill set. Recently he experienced symptoms that included an excruciating headache, neck pain and lethargy. Fearing his ventriculoperitoneal shunt had malfunctioned, he went to the emergency room and was later admitted on the neuro inpatient floor for a three-day hospitalization. His original shunt had been placed in 1991, and he never had an issue with until August 2018. While in the hospital, he was informed that he was no longer shunt-dependent and that his headaches were a result of a pulled muscle in his neck, which would eventually resolve itself. He was discharged from the hospital with over-the-counter pain medicine for his neck pain and sent home. Thirteen days later, he was admitted to a different healthcare system, where the condition was quickly identified as hydrocephalus due to a shunt malfunction; neurosurgery was emergently performed, resulting in a six-day stay. These two hospitalizations, in such a short amount of time, provided completely different patient and family experiences, not to mention completely different clinical outcomes. When the patient satisfaction survey arrived in his mailbox following both hospitalizations, his survey answers were drastically different. This article will share examples of how healthcare professionals can positively impact the patient and family experience, even when the medical outcomes are not optimal, and how those interactions can positively impact patient satisfaction scores.
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
Engaging under- and/or never-engaged populations in health services: A systematic review
Get PDFPatient engagement is a mechanism used to facilitate person-centred care, however, has not been realized in all patient populations. Often, many marginalized populations still remain under- and/or never-engaged. The purpose of this systematic review was to: 1) identify methods or interventions that have been used to engage under- and/or never-engaged populations in health services and 2) identify outcomes that are associated with engaging under- and/or never-engaged populations in health services. A comprehensive search using the Ovid MEDLINE, EMBASE and CINAHL databases was conducted to examine literature between January 2002 and January 2015. Twenty-nine studies met the inclusion criteria. Data was extracted from these studies and findings are synthesized based on discrete themes that map to the research objectives. The majority of studies were quantitative, repeated-measures designs and concentrated in the United States. Hispanic and Latino/a populations were most frequently included in these studies. The main methods of recruitment included: 1) referral from a healthcare provider, 2) patient self-referral after seeing advertisements on mass media or targeted media, 3) directly approached by researcher in-person or telephone, and 4) administrative databases. Interventions occurred primarily at the individual-level, however some system-level interventions were identified. Five main outcomes resulted from the interventions, including: 1) behavioural change, 2) physiological, 3) psychosocial, 4) system and 5) process. Finally, culture-specific components were embedded in the interventions, both as surface and deep structures. This study provides future direction for patient engagement related projects, as it relates to under-and never-engaged population in healthcare.
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
Patient-initiated second opinions during acute hospital care
Get PDFSecond opinions are used in medicine in order to make better-informed decisions. Only a few studies have examined patient-initiated second opinions, and even fewer have examined it in the context of acute hospitalization. It is not clear whether patients and families are aware of this right and how often they exercise it during acute hospitalization. The objective of this paper is to identify factors associated with the awareness and utilization of patient-initiated second opinions. A survey was conducted among 92 neurosurgical patients who completed a questionnaire that included information regarding: awareness of second opinion consultations, reasons for not seeking a second opinion, satisfaction from the second opinion and sharing the results of the second opinion with the first physician. Multivariate Logistic Regression analysis was performed to identify potential confounders associated with awareness and seeking a second opinion. Findings revealed that 79% percent of the participants were aware of their right to receive a second opinion; however, only 31% opted to receive a second opinion before/during the hospitalization. Fifty-eight percent received a second opinion related to previous medical conditions. Fifty-four percent did not inform the first physician about the results. The Logistic Regression showed that health insurance, education, religiosity and gender predicted awareness and utilization of second opinions. Current findings indicate that although patients are aware of their right to a second opinion and many have used it in the past, they rarely use it during acute hospitalization. Encouraging health professionals in hospitals to refer their patients to a second opinion as part of shared decision-making, may improve the liability and efficacy of patients\u27 care.
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
Can doctors improve the patient experience by rearranging the furniture and equipment in their office? A video recorded simulation
Get PDFThe design of this study is a video-recorded simulated consultation. Its aim is to evaluate the effect of changing seating arrangements and stethoscope visibility on patient enablement and non-verbal behaviour. Twelve simulated consultations with six actor-patients and a ‘real’ doctor were video recorded. Either the ‘real’ doctor or actor-patient, blind to the hypothesis sat in large executive office chair during the consult. The patient entered the room afresh for each consult. Consultation quality and outcomes were independently evaluated on three measures: The Patient Enablement Index (PEI), the Leicester Assessment Package (LAP); Non-Verbal Communication (NVC). Both expert reviewers were also blind to the study aim. The results: the doctor’s performance was consistent on the LAP score (P \u3e 0.05). There was a significant improvement in patient enablement (p=0.03) and non-verbal communication (p=0.003) when the actor-patients occupied the executive chair. The visibility of the stethoscope did not have a measurable effect on these measures. There was evidence that when patients occupy the larger chair in the consulting room there is significant objective improvement in the measures of patient experience of the meeting
A next-day, brief e-survey overcomes the excessive variability seen in CAHPS-style emergency department surveys so that individual physician performance can be assessed on a regular basis
Get PDFTraditional CAHPS-style emergency department (ED) surveys result in excessive variability when assessing individual physician performance. The objective of this study is to measure the variability of a brief, electronic survey (e-survey). The study team also measured the association of individual physicians to demographic data, physician and patient factors, and a physician burnout assessment tool. Data from SmartContact (SmartER, La Grange, IL) is a next-day, e-survey that takes about 30-seconds to complete. This tool was used by a hospital-employed emergency department (ED) group during calendar year 2017 across 2 EDs and 37 physicians.1,2 Variability was estimated regarding raw patient experience (PX) scores and top box scores by using intraclass correlation coefficients (ICCs). Pearson correlations were used to measure the interaction between PX scores, physician factors, and patient factors. Analysis of the 2017 calendar year showed statistically significant differences between physician PX performance on a bimonthly and quarterly basis. As well, there was lower PX in patients presenting at night. No correlation was found with a burnout assessment tool. This study demonstrates statistically valid performance differences among physicians using a next-day e-survey, which conforms to the recommendations of ED professional organizations for use in driving provider PX improvement, enhancing patient trust, and improving patient outcomes.
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
One patient\u27s experiences and expectations in the healthcare system: Complicated and critical illness with rare diagnosis described by his advocate
Get PDFThe health care business serves as a profession in the art of human illness. But unlike other businesses there is the human side, the patient experience. These patients are the “customers” receiving the care, but they, unlike customers at a retail store, are vulnerable and scared and must trust their lives in the hands of people they don’t know. The paradigm must change to reflect how the health care business is handled from the eyes of the person receiving the care from the first office visit, through the inpatient stay, to follow up visits. Patient focused training on all levels with the goal of seamless healthcare from phone to discharge to future visits to reach Value Based Health Care will help empower healthcare professionals and meet the expectations of patients [Lateef 2011]. As a health care provider for 25 years I have witnessed health care from a support staff perspective to a bedside RN to a Nurse Practitioner caring for complicated inpatients and outpatients. But the greatest learning curve for me was that as the wife of a complicated patient, my husband
Conceptual frameworks and degrees of patient engagement in the planning and designing of health services: A scoping review of qualitative studies
Get PDFIncreasingly, patients are being recognized as essential partners in the solutions to healthcare system problems. Patient engagement has been referred to as the “holy grail” and next “blockbuster drug” of health care because it may be revolutionary for transforming the design, delivery, and responsiveness of health services. Patients engage in a variety of healthcare activities, and there are multiple frameworks that depict the degrees of patient engagement in these activities. The literature also uses a variety of terms and concepts to depict the degrees of patient engagement. Moreover, meaningful patient engagement is a concept widely utilized in the literature without a clear definition. The conceptual boundaries and differences between degrees of engagement are unclear. This scoping review summarizes the descriptive characteristics, the degrees of engagement, and examines the terms used to depict meaningful engagement as conceptualized by studies on planning and designing of administrative or health services and interventions. The research questions for this study are: What are the descriptive and study characteristics of studies where patients engage in planning and designing activities? What terms do studies use to depict meaningful patient engagement? This review found a variety of terms used by the literature to depict meaningful engagement: collaboration, cooperation, co-production, active involvement, partnership, and consumer and peer leadership. This review also found that studies seldom use patient engagement frameworks to identify the degree of engagement. The implications of these findings are discussed in light of the literature on patient engagement and recommendations for future practice are provided.
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