Patient Experience Journal (PXJ, The Beryl Institute)
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The impact of provider service networks in Florida Medicaid managed care on enrollees’ satisfaction
Get PDFTwo counties in Florida were selected as pilots in 2006 for the Medicaid Demonstration Program. In reform counties, Medicaid enrollees were required to pick a managed care plan; either a Health Maintenance Organization or a Provider Service Network (PSN). PSNs are a form of managed care that provides health care services directly through a provider or network of organizations to a defined population without an intermediary. There are two types of PSNs: Physician-based PSNs and Healthcare system-based PSNs. The objective of this study is to find the differences in enrollees’ satisfaction between two different types of PSNs. To assess the differences in enrollees’ satisfaction between physician-based PSNs and health system-based PSNs over time, this study used difference-in-difference study design with CAHPS data from 2006 to 2008. The study findings showed that, compared to enrollees in physician-based PSNs, health system-based PSN enrollees had higher satisfaction during the post-reform period. However, the trends in satisfaction for enrollees in health system-based PSNs declined at a greater rate relative to the trends for enrollees in physician-based PSNs. Findings from this study may give other states, facing similar decisions to reform their Medicaid managed care system, information to decide whether to adopt a similar plan or to consider other interventions to improve Medicaid beneficiaries’ satisfaction. PSNs are structured similarly to the new accountable care organizations (ACO) models emerging as a result of the Affordable Care Act. Therefore, study findings may be helpful to in improving patient satisfaction with care in ACOs
Impact of logo wear on provider perception of patient
Get PDFPatient’s appearance affects provider perception of patients and subsequent provider behavior. Based on anecdotal information, it was hypothesized that wearing a health organization’s brand would result in a more positive perception of a patient by providers and subsequently a better patient experience. A study of 121 individuals with patient contact was conducted. Using photos of patients with and without a health care brand on their shirts, study subjects rated the attractiveness and willingness to engage with photos of patients. Patients with a Mayo brand and UK HealthCare brand showed some significant positive attractiveness over the same patient without the brand. Wearing a health organization brand may increase a patient’s attractiveness. However, no differences in provider behavior were noted. Unexpectedly providers as a group viewed some patients significantly less desirable than others and indicated it would affect the amount of time they would spend and information they would share with a patient. Health care organizations need to regularly reinforce to their providers and front line staff, the human tendency to provide lower quality service and of care to less attractive or desirable patients
Uninsured free clinic patients’ experiences and perceptions of healthcare services, community resources, and the Patient Protection and Affordable Care Act
Get PDFFree clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged. There has been a paucity of free clinic research with the few studies employing a quantitative design. The purpose of this study is to conduct an in-depth qualitative exploration of free clinic patients’ experience and perceptions of healthcare services, community resources, and the Patient Protection and Affordable Care Act (ACA). Free clinic adult patients (n=35) participated in four focus groups between June and July 2014 (one Spanish group in June, and two English groups and one Spanish group in July) in a classroom of a free clinic. More than 80% of the participants were non-US born from Mexico, Central/South America, South or East Asia, Pacific Islands, or Western Europe. While participants reported being satisfied overall with free clinic services, they indicated that they desire more specialty services and health education programs. Furthermore, they reported being frustrated by long waiting times- both in the waiting room and when making an appointment, phone communication, and interpreter services. It is necessary to find effective ways to provide information about health education opportunities and the ACA to free clinic patients because participants appeared not to have received sufficient information about available resources. Health education programs for free clinic patients should not only focus on increasing knowledge but also changing behaviors
The evaluation of an information booklet in the use of effective patient communication in the setting of thoracic anesthesia
Get PDFEffective communication is crucial in assuring a good patient experience during an in-hospital stay. In some settings, such as thoracic anaesthesia, patients are given a heavy load of new complex information, in a very limited space of time. Written information, such as patient information booklets, could help as an aid memoir and improve patient’s subjective understanding and preparedness for procedures. This study aims to produce a booklet, specifically targeted at thoracic anaesthesia, and to evaluate it using a linguistics framework in relation to the patient experience and clinical communication. For the study, a booklet was produced in the context of thoracic anaesthesia – a setting where the doctor-patient interaction is limited by time factors. The booklet was produced with reference to the BALD criteria. A questionnaire was given to patients with the booklet, focussing on patient’s subjective reflections on the effects of the booklet. The patient questionnaires showed that readability and comprehensibility of the booklet were high (96% and 93%, respectively). After having read the booklet, there was a statistically significant increase in patients feeling well informed, knowing about side-effects, what would happen in the anaesthetic room, and who to contact regarding any questions, compared to before. According to patients, giving information booklets at the time of admission could benefit patients. They are seen as an effective way of enhancing doctor-patient communication, in a setting where time could limit this interaction. They can be used effectively as a means of increasing patient’s perceived knowledge and thus improving the patient experience
Relationship-centred care in health: A 20-year scoping review
Get PDFRelationship-centred care (RCC) is a framework for conceptualizing health care which recognizes that the nature and quality of relationships in health care influence the process and outcomes of health care. Our goal was to undertake a scoping review of the peer-reviewed and grey literature on RCC in health. Using Arksey and O’Malley’s scoping review methodology we identified literature about RCC in teaching, learning and clinical practice. Electronic databases were searched, and targeted searches were also conducted for grey literature to capture unpublished material. Subsequently, data abstraction tools were used with eligible studies for analysis. Sixty-nine publications originated mainly from the United States and the United Kingdom by authors from various academic disciplines, of which medicine and nursing were dominant. Thematic analysis revealed that the most commonly cited definition of RCC emerged from the Pew-Fetzer report and focused on the central role of relationships between practitioners and their patients, the community and other practitioners in providing quality care and improving outcomes. The concept of RCC was found to be influenced by theories of sociology, social psychology and psychiatry. The practice of RCC was demonstrated through organizational environments that model RCC, practice settings that focus on the patient or family in care planning, and health professional education that is based on RCC principles. RCC is important to: humanize health care and improve patient care. Our review identified three sub-categories that could add to the relational dimension of the practitioner-organization: practitioner–education, practitioner–profession, and practitioner–practice. Recommendations for future research include: outcome and process studies of health professions education and health care that focuses on RCC. The RCC approach provides a paradigm to move beyond the patient-centred care model by focusing on the central role of all relationships in the delivery and outcomes of care
Showcasing patient experience and engagement best practices through an innovative forum celebrating patients, families, and multidisciplinary care teams
Get PDFA platform was designed for interdisciplinary teams to learn from colleagues, patients, and their families, about what creates and sustains positive, lasting impressions from their care team. A forum focused on positive experiences designed to highlight the relationships between patients and care teams was utilized. A Best Practices Forum was designed to share methods for generating positive patient experiences across the institution. These quarterly conferences featured patient stories and highlighted best practices such as empathic communications, collaboration, and teamwork used by caregivers throughout the institution. The patient experience team invited various well-performing departments to share best practices, as well as assisted in identifying patients willing to share their healthcare journey in front of an audience of clinical and non-clinical staff. The forum serves as an innovative learning lab using our patients and care team members as instructors of best practices in patient experience and patient engagement
Young adult perspectives on the selection of pharmaceuticals for mental health treatment
Get PDFShared decision making places an emphasis on patient understanding and engagement. However, when it comes to treatment selection, research tends to focus on how doctors select pharmaceutical treatments. The current study is a qualitative assessment of how patients choose among three common treatments that have varying degrees of scientific support and side effects. We used qualitative data from 157 undergraduates (44 males, 113 females; mean age = 21.89 years) that was collected as part of a larger correlational study of depression and critical thinking skills. Qualitative analysis revealed three major themes: shared versus independent decision making, confidence in the research and the drug, and cost and availability. Some participants preferred to rely on informal networks such as consumer testimonials while others expressed a false sense of security for over-the-counter treatments because they believe the drugs are regulated. Many indicated that they avoid seeking mental health services because of the time and money needed. The results indicate several factors influence selection of common depression treatments. Young adults indicate that when reading prescription information, they most often rely on perceptions including ease of access, price, and beliefs about drug regulations. General guidelines for treatment descriptions were created based on the qualitative analysis
Evaluating recall of key safety messages, and attitudes and perceptions of a patient safety initiative at a pediatric hospital
Get PDFInvolving inpatients in their safety and well-being is becoming increasingly common. Interventions have been developed to encourage patients to be active in their own safety, but published evaluations are scarce. The Patient Safety Ambassador (PSA) program was developed to increase patient and parent/guardian engagement and knowledge in patient safety. This study aimed to determine recall ability of key safety messages and explore attitudes and perceptions towards the PSA program, hence obtaining feedback for program improvements. Participants were pediatric inpatients and parents of inpatients. Face-to-face semi-structured interviews were conducted. Cued and non-cued recall ability was determined using questions with and without specific cues, while attitudes and perceptions were explored using open-ended questions regarding patient safety. QSR NVivo 10 software was used to analyze interviews for recall ability and major themes. 95% of parents could remember all safety messages with cues, but could only remember one (35%) or two (32.5%) messages without cues. Inpatient participants could remember up to 4 messages with cues, no messages without cues, and, unlike parents, were unable to discuss their attitudes and perceptions towards safety. Five major themes emerged from analysis of interviews with parents: the importance of medication knowledge, parental involvement in care, having trust in healthcare team, asking questions, and advocacy. Use of cues appears beneficial in facilitating recall of safety messages. Parents had varied attitudes and perceptions to safety. Future research can explore methods to engage pediatric inpatients, integrate cues to increase recall, and examine resulting behavioural changes
‘First, do no harm’: shifting the paradigm towards a culture of health
Get PDFOver the past 17 years since the release of the Institute of Medicine report ‘To Err is Human’,1 health services and agencies around the world have increasingly focused on improving the safety and quality of health care. Historically, the commitment by health care professionals to ‘first do no harm’ has produced a focus on the absence of interventions that may cause adverse outcomes. This clinical approach links to the Hippocratic Oath which includes the promise to abstain from doing harm . The Oath reminds clinicians to first consider the possible harm that any intervention might do. This approach to interactions with patients leads to an emphasis on the ‘absence of harm’ rather than a focus on the ‘creation of health’. To improve the care of patients, a paradigm shift is required in the health care services from a ‘disease-based intervention’ model to a supportive ‘health’ model. Just as ‘health’ is not the absence of illness, preventing patient harm is not simply avoiding interventions. To ‘first do no harm’ health services need to actively improve their focus on health and the entire patient experience
Exploring patient satisfaction with interdisciplinary care of complex feeding problems
Get PDFMeasures of patient satisfaction with health care experiences are recognized as essential in the healthcare market environment. To our knowledge, there are no specific patient experience measures that assess patient and caregiver satisfaction with a multidisciplinary approach to management of complex feeding and swallowing issues in pediatric patients. In order to explore patient experience and to identify opportunities for improvement, a pilot patient satisfaction survey was developed in an interdisciplinary feeding team clinic. Patients and families were surveyed following clinic encounters between July of 2014 and January of 2015. Likert style questions were used to assess experience with ease of scheduling, perception of the team’s ability to understand feeding concerns, and to identify agreement with the appropriateness of recommendations. Two open-ended questions were used to elicit qualitative responses regarding what was positive about the experience and what could be improved or done differently. Qualitative responses were categorized by opportunities for improvement and affirmative statements. Analysis of survey results indicated high levels of satisfaction (96%) with the team’s ability to understand feeding concerns and to provide feasible recommendations for treatment options. Satisfaction scores for scheduling were lower (92%); dissatisfaction with the next available options for appointments and with the overall length of the visit was identified. The pilot patient satisfaction project confirmed satisfaction with a multidisciplinary approach to feeding problems in pediatric patients, and identified opportunities for future quality improvement. Ongoing patient satisfaction measures will provide a mechanism to identify the effects of future improvement measures