Patient Experience Journal (PXJ, The Beryl Institute)
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Partners for excellence: Committed to meaningful partnerships with patients and families in pediatrics
Get PDFAlthough the landscape in pediatrics continues to shift and change, one of the keys to our continued success remains the same… it’s about partnership. It’s clear the element of partnership is well woven through our organizations as illustrated by many of us having patient and family advisory councils, family consultants, and family partners. While this foundation is strong and essential, we must do more to truly listen, recognize the value of patient and family involvement, act upon the information shared, openly discuss issues, and strive for better together. True partnership with patients and families requires us to shift the paradigm even further by incorporating and ensuring that patients and their families are included in all aspects of our organizations - from the design of care plans, to system changes and improvement efforts, to participation on hospital committees and being recognized as the partners and thought leaders. We should recognize that patients and their families have the greatest skin in the game and will help us accelerate the advancements
Standardising the collection of patient-reported experience measures to facilitate benchmarking and drive service improvement
Get PDFPatient experience teams in NHS Wales’ Health Boards and Trusts are working across the country to collect patient experience feedback from members of the public who access health care services. Although this work is advanced in many areas, there is currently no way of benchmarking across organisations, reducing opportunities for shared learning. We aimed to work with patients and colleagues across Wales to agree a set of universal Patient Reported Experience Measures (PREMs) questions. Working with patient experience teams, patient groups and Welsh Government, the NHS Wales Patient Reported Outcome Measures (PROMs), Patient Reported Experience Measures (PREMs) and Effectiveness Programme team has agreed a national set of PREMs questions for use across Wales. This process led on from previous work and included patient focus groups, patient experience leads and clinical input. Patients using secondary care services in Wales will be invited to complete the agreed PREMs survey along with patient outcome measures, via an electronic platform. This will provide a consistent method of data collection which will allow us to benchmark across hospitals and organisations in NHS Wales, identifying areas of good practice, as well as areas where patients report poorer experiences. This will allow local patient experience teams to target more in-depth experience gathering initiatives and carry out appropriate improvement programmes, making better use of resources. Identifying and sharing good practice will allow NHS Wales to advance patient experience, while triangulation with patient and clinical outcomes will drive the Prudent Healthcare agenda
A framework for conceptualizing how narratives from health-care consumers might improve or impede the use of information about provider quality
Get PDFConsumers choosing a health-care provider have access to diverse information including narratives by patients about their prior experiences. However, little research has examined how narratives might improve or impede the use of information about the quality of providers’ performance. This paper describes a conceptual framework for examining mechanisms by which narrative information might influence consumer judgments and decisions about providers. We conducted a conceptual review of risk communication and behavioral decision research. We synthesized the literature to form the foundation of a conceptual framework for assessing how narrative information about provider quality impacts consumer decisions about providers. We identified four key characteristics of narratives (convey emotion; explain logic; provide relational information; and capture naturalistic experience) that may address four consumer needs (avoid surprise and regret; recognize dominant options; motivate to act or not act; and make multi-attribute tradeoff decisions). We also identified three main functions of narratives (provide a simple, powerful cue; imbue quality information with meaning; and stimulate cognition and behavior) in four decision contexts (short-term treatments; external disruptions; chronic illness; problematic experiences). A rigorous research program can be derived from the conceptual framework to generate evidence-based recommendations about whether and how patient narratives might encourage: (1) more reasoned decisions; (2) consistency with a patient’s own values/preferences; and (3) engagement with provider quality information. Research results can be used then to develop robust guidance for health communicators reporting diverse and often incommensurate performance metrics
Patients’ stories of encounters with doctors: Expectations and anxieties
Get PDFThe study contributes to the understanding of how patients experience encounters with doctors. The study is based on the gathering and analysis of subjective stories of \u27healthy\u27 patients who live in Israel about their encounters with doctors. On the one hand, medical encounters were described as functional ritualistic events, and the doctor was described as an indifferent clerk. On the other hand, and often at the same time, medical encounters were perceived as incredibly meaningful and potentially fateful events, and the doctor as a supreme authority. Four main inter-connected expressions of this were: 1. The encounter as a ritual: A convenient but alarming arrangement; 2. Alone in the struggle to feel well: The unspoken anxiety; 3. Time concerns; 4. Paying for reassurance- Turning to physicians in private practice. The research indicated that the visit to the doctor often raises healthy patients\u27 confrontation with existential fears, and that they expect the doctor to be sensitive to their anxieties, and reassuring. Alas, these emotions and expectations often remain unspoken. There is a need for further discussion regarding the different ways patients and doctors perceive medical encounters. Acknowledging potential gaps in meanings and expectations and addressing their implications on patients\u27 experiences is crucial for patients; doctors and policy makers
How younger adults with psychosocial problems experienced person-centered health consultations
Get PDFMuch attention is focused on the social determinants of health. Family medicine is challenged with a growing number of vulnerable persons with psychosocial or lifestyle related problems. The objective of this work was to explore how vulnerable younger adults experience person-centered preventive health consultations with their general practitioner. The design and setting for this work were a secondary qualitative analysis of a randomized controlled trial (RCT) in Danish general practices. Younger adults (20-45) were consecutively invited to answer a screening questionnaire about psychosocial and lifestyle-related problems when visiting general practice (28 general practitioners (GPs)) for ordinary consultations. The 30% most vulnerable persons were invited to participate in a randomized controlled study. Intervention participants (n = 209) received a structured 1- hour ‘health consultation’ with their general practitioner focusing on resources and self-chosen goals and a 20-min follow-up after 3 months; control participants (n = 255) received usual care. At 1 year, 180 participants answered a follow-up postal questionnaire, of whom 135 answered the open-ended question: “Do you think the health consultation was worthwhile?”. This question was analyzed using qualitative content analysis. Six themes were prevalent: ‘Meeting the doctor in a different way’, ‘Supporting dialogue’, ‘Food for thought’, ‘Feeling better’, ‘Opportunity for change’, and the health consultations were ‘Not worthwhile’. Offering vulnerable younger adults a structured, person-centered preventive health consultation strengthened the doctor-patient relationship, allowed patients to reflect on their life situation, enhanced their perceived ability to cope with their problems and their belief in and ability to initiate wanted changes, thereby enhancing self-efficac
The impact of queue-controlled modified open access scheduling on no-show rate in a community mental health child psychiatry med check clinic: A pilot study
Get PDFNo-shows in child and adolescent psychiatry are a particularly concerning phenomenon that have ramifications beyond productivity and mental health outcomes. One might contend that children have a fundamental right to health care, and the failure to address the no-show phenomenon passively impedes that human right. In this study, a queue-controlled modified open access scheduling model (QCMOAS) was compared to a traditional scheduling model for the incidence of no-shows in a community mental health child psychiatric med check clinic. A six month period of QCMOAS was compared to the preceding six months of traditional scheduling and the six month period exactly one year prior to QCMOAS. Z test was used for statistical significance. For the six month period immediately after the implementation of OCMOAS, a 7.32% decrease in no-show rate was observed, and compared to the six month period exactly 1 year prior to QCMOAS, a decrease of 6.38% was noted. In both cases the result was statistically significant. Preliminary interpretation of this data suggests that the employment of OCMOAS significantly decreased the no-show rate in this community mental health center’s child and adolescent med check clinic. The findings are strengthened by the relatively large number of scheduled appointments reviewed and by the fact that statistical significance appeared to be unrelated to seasonal scheduling patterns. Limitations of this pilot study and recommendations for future investigation are discussed
The patchwork perspective: A new view for patient experience
Get PDFAs Patient Experience Journal has continued to contribute to the expanding patient experience conversation, we too recognize this has been a significant year of progress for the patient experience movement. This progress has emerged in a number of ways in research, practice and programs that reveal a comprehensive and integrated approach is now more than ever a central consideration in a commitment to experience. This idea of interwoven efforts, begins to frame an image – a patchwork of clear, critical and comprehensive pieces that while operating distinctly each have value, yet when bringing them together have an exponential opportunity to impact healthcare. The case here in raising the imagery of a patchwork is to acknowledge both the chaos and beauty of healthcare, recognize the individuality of various efforts and their power in coming together and to make the case that under this umbrella of experience we can create powerful alignment and purposeful grounding for focused action in moving forward. The idea that experience is the soft stuff of healthcare must come to an end for as intricate and challenging as the science of healthcare is, there may be no more complex opportunity than that of tackling the human experience in healthcare overall
Perfect ratings with negative comments: Learning from contradictory patient survey responses
Get PDFThis research explores why patients give perfect domain scores yet provide negative comments on surveys. In order to explore this phenomenon, vendor-supplied in-patient survey data from eleven different hospitals of a major U.S. health care system were utilized. The dataset included survey scores and comments from 56,900 patients, collected from January 2015 through October 2016. Of the total number of responses, 30,485 (54%) contained at least one comment. For our analysis, we use a two-step approach: a quantitative analysis on the domain scores augmented by a qualitative text analysis of patients’ comments. To focus the research, we start by building a hospital recommendation model using logistic regression that predicts a patient’s likelihood to recommend the hospital; we use this to further evaluate the top four most predictive domains. In these domains (personal issues, nurses, hospital room, and physicians), a significant percentage of patients who rated their experience with a perfect domain score left a comment categorized as not positive, thus giving rise to stark contrasts between survey scores and comments provided by patients. Within each domain, natural language analysis of patient comments shows that, despite providing perfect survey scores, patients have much to say to health care organizations about their experiences in the hospital. A summary of comments also shows that respondents provide negative comments on issues that are outside the survey domains. Results confirm that harvesting and analyzing comments from these patients is important, because much can be learned from their narratives. Implications for health care professionals and organizations are discussed
The evolution and integration of a patient-centric mapping tool (patient journey value mapping) in continuous quality improvement
Get PDFThe need to improve a healthcare system that too frequently fails to deliver benefits of care, even resulting in harm to patients, has been well established. The resulting era of quality improvement has aimed to improve the delivery of care by increasing quality while reducing cost. One approach to improving how healthcare is delivered is the application of Lean management strategies. Despite widespread investment in Lean approaches to improve healthcare delivery, evidence supports a deficiency of this approach to improve patient satisfaction with care. Identifiable operational tension between quality improvement efforts designed to streamline care processes and those targeting improvement of the patient care experience existed. We set out to address this deficiency by embedding the patient experience into improvement efforts through the introduction of a patient-centric value stream mapping approach
Increasing sustainability in co-design projects: A qualitative evaluation of a co-design programme in New Zealand
Get PDFThe Health Quality & Safety Commission New Zealand commissioned Ko Awatea, an innovation and improvement centre, to deliver a co-design programme to nine teams of healthcare providers. The co-design programme was part of Partners in Care, a broader programme developed in 2012 to support and enable patient engagement and participation across the health and disability sector. Teams received training, guidance and mentorship in Experience Based Design (EBD) methodology.1 We evaluated the co-design programme to explore barriers and facilitators to the sustainability of the co-design projects and the EBD approach. The evaluation involved seventeen semi-structured interviews with programme participants, including seven team members, five sponsors, four patients and the programme facilitator. A further two team members provided written feedback. Eight teams provided completed workbooks. Data from the interviews and workbooks was thematically analysed. Team members saw support from sponsors as important to increase visibility and successful completion of co-design projects, mitigate barriers, and to secure resources and buy-in from peers. Five of nine participating teams reported dissatisfaction with the support received. Communication and competing priorities were challenges to sponsor engagement. Sharing co-design skills with peers and alignment with organisational strategy were seen as important for sustainability. Teams identified lack of secured resources or staff time, and consumer or staff attrition as key barriers to sustainability. The conclusion: buy-in from sponsors and senior leaders, support from colleagues, user-friendliness of co-design tools, consumer and staff availability, alignment, and system or culture change were key factors that influenced project sustainability