Patient Experience Journal (PXJ, The Beryl Institute)
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Comparing psychiatric care experiences shared online with validated questionnaires; do they include the same content?
Get PDFPatient feedback is considered integral to patient safety and quality of care. However, limited research has compared the content of validated questionnaires with subjective patient experiences shared online. The aim of this study was to therefore identify and compare the content of psychiatric care experiences shared online with validated questionnaires. All research was conducted in co-production with a volunteer mental-health-patient-research-partner. We analysed all reviews published on the United Kingdom’s leading health and social care feedback platform Care Opinion, between 2005-2017 that discussed adult psychiatric care and compared findings with two validated questionnaires (ACP360 and General Medical Council patient feedback questionnaire). Our research findings show that patients describe some different measures of psychiatric care quality online and use different terminology to those used in validated questionnaires. Psychiatric care was also rarely discussed in relation to an individual psychiatrist alone. Multiple interactions affect patient experience and perceived care quality. Further work is needed to incorporate patient perceptions and terminology of care quality into patient feedback questionnaires and surveys. This may best be achieved through co-design although exploration of this approach is required. The current focus of patient feedback in revalidation is of limited value as patients do not typically disaggregate the care provided by an individual clinician from the wider healthcare team, system or environment. Although focused on psychiatry, research findings have clear implications for those looking to facilitate quality improvement and professional development
Interprofessional collaboration to improve and sustain patient experience outcomes in an ambulatory setting
Get PDFPatient experience is an important factor across diverse healthcare delivery settings. Despite enhanced attention to and advances in patient experience, many of the published initiatives focus on in-hospital care and opportunities have been identified to continue to strategically address patient experience in the ambulatory setting. This quality improvement initiative presents the development of an interprofessional approach to patient experience in a freestanding ambulatory oncology center. The objective of this initiative was to improve and sustain patient experience, as reflected in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores via Press Ganey. This approach consisted of redesigning a previously nurse-led patient experience team to include interprofessional providers, including physicians, physical therapists, and administrators. Interventions including specialized training in CAHPSÒ reports and scoring for both committee members and center staff, quarterly reporting of data to interprofessional teams by service line, and standardization of the communication of best practices to improve patient experience across the center. In addition to outlining the components of the interprofessional initiative, which may be readily translated across diverse care settings, this article demonstrates improved and sustained patient satisfaction data, as measured by 2 years of Consumer Assessment of Healthcare Providers and Systems (CAHPSÒ) scores. Findings from this best practice suggest that an interprofessional approach with defined interventions can improve patient experience in the ambulatory setting, resulting in sustained, measurable improvement
A patient portal push toward acceptance and utilization of the technology
Get PDFCertified electronic health record technology (c-EHRT) has the capacity to enhance person-centered care through online engagement between providers and patients. A driver to portal use is the Centers for Medicare and Medicaid (CMS) Meaningful Use (MU) benchmarks. Currently, many health care centers and providers fall short in attracting patients to register and utilize online patient portals thus influencing optimal utilization of the EHR. Barriers cited in the literature include lack of stakeholder interest, multiple government policy and mandates, and lack of resources to implement standards for health information technology (HIT) standards in daily professional workflow. This program evaluation focused on a 90-day “Portal Push” marketing and re-education initiative at a federally qualified health center (FQHC). The theoretical foundation for this program evaluation was the Technology Acceptance Model (TAM).1 Goals for this program evaluation included: enhanced marketing and re-education of stakeholders towards portal utilization; assessment of portal MU benchmark attestation numbers pre/post the marketing and education initiative; and evaluation of patients, providers, and clinical staff on portal use as related to “ease of use”, “usefulness”, and “organizational support” through quantitative surveys. Results found enhanced marketing and re-education efforts increase portal registration numbers and use as well as provider CMS MU benchmark attestation. Data reflected an increase in portal user registration and an increase in provider CMS MU benchmark attestation post the Portal Push initiative. Patient, provider/staff survey results indicate a positive relationship between portal use and “ease of use”, portal use and “usefulness”, and portal use and “organizational support”. Results reflect portal marketing efforts by health centers, individualized education of patients, providers, and staff, and continued organizational support with c-EHRT are key drivers in portal acceptance and utilization.
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
“Anyone can co-design?”: A case study synthesis of six experience-based co-design (EBCD) projects for healthcare systems improvement in New South Wales, Australia
Get PDFExperience-based co-design (EBCD) is a quality improvement approach that is being used internationally to bring service users and health professionals together to improve healthcare experiences, systems and processes. Early evaluations and case studies of EBCD have shown promise in terms of improvements to experience and organisational processes, however challenges remain in participation around shared power and decision making, mobilisation for implementation, sustainment of improvements and measurement of outcomes. The objective of this case study was to explore the emergent issues in EBCD participation and implementation in six quality improvement projects conducted in mental health, rehabilitation, blood and bone marrow transplant, brain injury rehabilitation, urinary incontinence and intellectual disability settings by the Agency for Clinical Innovation (ACI), New South Wales, Australia (2015-2018). Methods: A two stage process of analysis was employed. The first stage involved a case to case synthesis using a variable-oriented approach. In this approach themes were identified within individual cases and compared across cases in workshops with all project leads. In the second stage the case themes were synthesised within an overarching thematic that was identified as the main challenge in effective participation and implementation in these EBCD projects. The results: themes identified in the first stage of analysis related to different methods for gathering experiences and the activities used for the co-design of improvements. Variability in service user participation within co-design workshops was also discussed. Four out of the six projects implemented improvements in full. The prominent thematic overarching all six EBCD cases was the need for guidance on capability development and co-design preparedness for all participants in co-design not only project leads. In conclusion, variability in EBCD implementation makes it difficult to identify which component parts are essential for improving experiences and services, and which of these lead to sustained changes and benefits for service users and health professionals. One way to address this is to develop a model for co-design capability and preparedness that is closely linked with a set of eight mechanisms that have been previously identified as essential to achieving change in healthcare improvement initiatives.
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
Original parts: Aging and reckoning with cystic fibrosis related kidney disease
Get PDFKidney disease increasingly impacts people with cystic fibrosis (CF) as adult patients continue to survive longer. Yet the literature on CF related kidney disease focuses little on amplifying the voices of people aging with the condition. This article presents perspectives on CF related kidney disease from a medical sociologist who is themselves managing these issues. It (1) gives an overview of relevant literature and trends in epidemiological data on kidney disease and CF, (2) details the author’s own process of adjusting to progressive changes in renal function, and (3) outlines opportunities for clinicians to make a positive impact for patients by centering their voices
How patients view their contribution as partners in the enhancement of patient safety in clinical care
Get PDFDespite the call from the World Health Organization for more active involvement from patients in the prevention of health care-related risks, there is still insufficient evidence about how patients can be more proactive in the safety of their own care. This study helps understand the perspective of patients as partners regarding their roles, as well as their relatively untapped potential in detecting and limiting adverse events (AEs) for patient safety. 17 patients-as-partners were interviewed on five themes: 1) Behavior of patients/relatives for avoiding AEs; 2) Competencies sought in patients/relatives to play an active role in patient safety; 3) Factors limiting or facilitating the role of patients in the safety of their own care; 4) The Partnership in Care approach as a way of limiting the occurrence of AEs. Patients-as-partners revealed several key behaviours that helped patients avoid AEs: proactivity; communication; trust; vigilance; reporting and flagging; being accompanied by relatives, being accompanied by health professionals. Furthermore, several competencies helped as well: being curious, observant, responsible, able to trust, respectful, and diplomatic. Finally, factors facilitating and limiting patient engagement in safety included personal characteristics, information, interpersonal relations, and organisational aspects. Through the Partnership in Care approach, patients-as-partners develop behaviours and competencies which are yet to be directly applied to improve patient safety. However, obstacles remain: the engagement and official training of patients-as-partners and their appropriate roles in safety, including the identification of AEs; and finally, the redefinition of AEs so as to include the patients’ point of view and experiences
The patient experience with shared decision-making in lung cancer: A survey of patients, significant others or care givers
Get PDFA survey (via SurveyMonkey) was sent to lung cancer patients, their caregivers or significant others asking about their experience in making difficult treatment decisions. Of the 198 respondents, 118 (69%) indicated that they had faced a difficult decision with respect to their lung cancer treatment. Of those, 73% indicated that they would have desired that the decision be made with their physician using a shared decision-making process, and 58% perceived that such a process had occurred. In addition, only 23% of respondents indicated that they had had the right amount of information when making the decision. Fortunately, only 9% of respondents expressed regret regarding the decision they ultimately made. A Patient Decision Aid (PDA) was made available to the respondents to view, and opinions were sought regarding the usefulness of this type of format for presenting information. This format was perceived as helpful, unsure if helpful, or not helpful by 62%, 36%, and 2% of respondents, respectively. In summary, the majority of lung cancer patients want to make difficult decisions using a shared decision-making process. The patient perception is that this is not occurring often enough. Even in this fairly well-educated group of respondents, many report that they are not sure that they have all the information necessary to make that difficult decision. Physicians may need help developing their communication and shared decision-making skills. Introducing PDAs into the oncology clinic may represent a way to present complex information and improve the patient experience
Exploring workforce confidence and patient experiences: A quantitative analysis
Get PDFConfidence is recognized as one of the most influential factors to affect performance. Individual, leader, and team confidence play essential roles in achieving success and the absence of confidence has been connected with failure. While confidence is not a substitute for competency, it creates trusting relationships, empowerment, and resiliency to persevere when challenges arise. Objective: In this study, we examined workforce confidence in the patient experience and patient perceptions of their experience of care. Methods: We compared responses to the Patient-Centered Excellence Survey (PCES) from 41 United States hospitals, measuring workforce confidence in the patient experience provided, to patient’s ratings of their experience through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Results: Higher workforce confidence in the patient experience provided is related to higher patient ratings of their experience while lower workforce confidence is linked with lower patient ratings. Hospitals in the top 25% with workforce perceptions score 11.7% higher with HCAHPS Overall Rating than hospitals in the bottom 25%. Of the 10,945 workforce respondents to the PCES Overall Rating item, 24.2% rated their organization top box (9 or 10) versus 64.7% of patients rating top box. Senior leaders reported the highest degree of confidence in the patient experience, while staff and providers reported the lowest. Conclusion: Confidence is an important characteristic of the healthcare workforce. Building mastery of patient experience competencies holds promise to further elevate patient’s perceptions of their care. Gaps in confidence should be addressed - especially among those with the most direct caregiver responsibilities
Developing the first pan-Canadian acute care patient experiences survey
Get PDFThe Canadian Institute for Health Information (CIHI) in partnership with stakeholders sought to develop the first pan-Canadian patient experiences survey for inpatient care (CPES-IC). The goal was to provide a national survey standard for comparative patient experience measures to facilitate benchmarking for quality improvement. A cognitive and pilot testing study design was performed using survey data from adult inpatient care settings. Participants included the inter-jurisdictional members (IJ), survey subject matter experts and CIHI (The Group). Cognitive testing of the survey took place in three Canadian jurisdictions in English and French languages. Thirty-nine individuals participated in one-on-one interviews. During pilot testing, twenty-six percent of surveys were completed over a five-month survey period. The main outcome measure was the development of new survey dimensions and Canadian survey questions. Survey dimensions of care important to patients including internal coordination of care, patient-centred care, discharge and transition processes were identified to develop the Canadian survey questions. Following cognitive testing, changes were made to better align the English and French survey questions. In pilot testing, several updates were applied including the adjustment of response categories, reformatting of skipped pattern questions and the omission of five questions due to high response rate of the “not applicable” category and survey questions perceived to be too “vague” by respondents. The Group recommended the implementation of the survey. Consultations using a consensus building approach and rigorous methodology led to the successful implementation of the CPES-IC, which is the first Canadian standardized patient experiences survey for hospital based inpatient care
Transforming care through bedside leader rounding: Use of handheld technology leads to improvement in perceived patient satisfaction
Get PDFWhen consistently executed, leader rounding has the ability to capture actionable information ensuring delivery of safe and effective patient care, identifying excellence among staff, and bringing opportunities for improvement. Our team set out to create an effective, standardized approach to targeted, daily, technology-driven leader rounding with the goal of integrating real-time patient feedback into the care experience. An application on handheld computer tablets was tailored and integrated with the hospital’s admission, discharge, and transfer (ADT) feed, allowing for streamlining of the rounding process by creation of workflow templates. Additionally, capabilities to receive and send alerts across disciplines were integrated in order to respond to patient concerns in real-time. Patients who perceived they were rounded on had 3.53 greater odds of reporting top box scores for Overall Rating of Care compared to patients who perceived they were not rounded on (p\u3c0.001). Patients with documentation that rounding occurred, who also self-reported that rounding occurred, were at 3.43 greater odds of providing a top-box score than patients with documentation that rounding occurred but who did not perceive they were rounded on (p\u3c0.001). Efforts to round and to ensure patients know they are being rounded on may lead to improved patient experience