Patient Experience Journal (PXJ, The Beryl Institute)
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Developing approaches to the collection and use of evidence of patient experience below the level of national surveys
Get PDFNational approaches to collecting patient feedback provide trust level information which although can provide a benchmark for trusts often doesn’t provide information about specific services or patients experiences of pathways of care. This more granular level of data could be more informative for local service development and improvement. This research explored the feasibility and usefulness of such approaches. A conceptual model and standard questionnaire of patient experience was developed that might work across a range of services and pathways of care. Seven trusts were recruited as collaborating sites in which the model and survey instrument was tested. These were from different geographical locations and settings. The impact of the pilot and survey results on the improvement and development of services was evaluated. The service- line approach to capturing patient feedback was generally more feasible and considered of value for service improvement. The collection of patients’ experiences across pathways of care was more challenging in terms of the development of the survey and interpretation of results. However, many sites identified specific actionable areas for improvement. This study has shown that it is possible to develop and apply a standardised survey in a range of services and provides evidence that a consistent unified approach to monitoring patient experiences is feasible. However several methodological problems are acknowledged such as the availability of resources and capacity for improvements to services and care. Evidence is now particularly needed to establish how best to produce positive impact from patient feedback
Patient Advisors: How to implement a process for involvement at all levels of governance in a healthcare organization
Get PDFPatient involvement at the operational (clinical care and services), tactical (management), and strategic (board of directors and executive management) levels of establishments is increasingly sought after. To address this specific challenge, a Canadian healthcare organization, the Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec, has developed an integrated strategy based on three principles: (1) shared leadership between a patient and a manager to build the strategy; (2) a clear process for recruiting, training, and coaching patient advisors (PA) so that they can participate in decision-making at the various levels of governance of the establishment; and (3) a feedback process for improving the strategy over time. This initiative gave rise to a pool of 30 patient advisors who reviewed documentation (39.07%), presented testimonies to establishment practitioners (13.73%), participated in process improvement activities (12.97%) and committees (8.93%), and helped train students in health sciences (11.61%). It also led to the development of a request form for all persons wishing to involve PAs in their projects. This PA involvement, highly appreciated by both managers (94%) and PAs (81%), brought back the fundamental meaning of the patient–practitioner relationship and helped incorporate patients’ experiential knowledge into the care and service improvement process. This strategy can serve as a model for other organizations wishing to structure optimal patient engagement at the different levels of governance of their organization
Envisioning mechanisms for success: Evaluation of EBCD at CHEO
Get PDFTo advance patient engagement (PE) and more comprehensively involve patients, families, and staff in quality improvement (QI) at the Children’s Hospital of Eastern Ontario (CHEO), the Experience Based Co-Design (EBCD) approach was piloted. Set against the backdrop of envisioning factors that would facilitate success, an evaluation was designed to assess five domains: strengthening of mutual understanding, collaboration, and partnerships between patients/families and staff; a greater involvement of patients, families, and staff in QI; satisfaction with the process; the ability of EBCD to generate clear and useful data to ascertain the patient/family and staff experience; and the ability of EBCD to generate clear and useful data to improve patient/family and staff experience. The King’s Fund EBCD toolkit was followed to implement the approach. This involved observations and interviews to capture experiences; and feedback events to understand experiences and identify improvement areas. The resulting data was used to evaluate the process relative to the five domains of interest. The evaluation data supported the conclusion that the EBCD process usefully addressed each of the domains of interest, and facilitated PE in QI. In addition, the evaluation revealed important considerations to the success of such an initiative. Using EBCD allows for a more nuanced and comprehensive consultation than traditional methods employed. The research presented here informs the future spread and/or adaptation of EBCD by offering a case for using the approach, but also suggests modifications or considerations to integrate PE methods with existing structures for greater efficiency, success, and value
“What Matters to You?”: A pilot project for implementing patient-centered care
Get PDFThis project was intended to enhance the delivery of patient-centered care by asking patients what matters to them before and after total joint replacement (TJR) surgery. In Phase I, pre-operatively, patients undergoing total joint replacement (TJR) surgery were asked, “What matters to you before surgery, during your hospital stay, and in the first 3 months following surgery?” and “What matters to you moving forward after you’ve recovered from your joint replacement?” Four weeks post-operatively they were asked, “Now that that you’ve been through the surgery and first 4 weeks of recovery, can you identify new concerns that you didn’t have before?” and “What matters to you moving forward after you’ve recovered?” In Phase 2, 49 patients were asked pre-operatively, “Thinking ahead in this process…what matters to you?” Four weeks post-operatively, they were told, “Now that you’ve gained experience from going through a joint replacement, rank the categories in terms of how important it would have been to know in your pre-operative interview what you know now.” In Phase 1, 98% of patients answered the questions the same way pre- and post-operatively. The 2% who did not reported greater than expected surgical pain. In Phase 2, patients ranked the 3 most important categories pre- and post-operatively surgical results, quality of life, and reduction in pain. The WMTY project may increase patients’ engagement in their care, show providers how to better understand what matters to their patients, and help surgeons to define outcomes more broadly
Can social media reduce discrimination and ignorance towards patients with long term conditions? A chronic kidney disease example in the UK and more widely
Get PDFLong Term Conditions (LTCs) are increasing in prevalence and cost in Western healthcare. Patients with such conditions are often classed as “disabled”, because of impacts of self-care on “activities of daily life” or secondary consequences of conditions (impairments) affecting factors such as mobility, concentration and communications. Disability needs are often ignored in the design of services and treatment of individuals. It manifests as services which some find difficult to use and lack of personal respect (discrimination) often based on lack of understanding by the healthcare profession itself (ignorance). This paper explores how Social Media (SM), an example “Assistive Technology” in an increasingly digital age, might help. The focus is Chronic Kidney Disease with two, specific illustrations in the UK beginning to spread worldwide. Support mechanisms now emerging may go well beyond healthcare, and even beyond kidney problems. They may also find additional assistance via the new, English Accessible Information Standard
The story of Emily
Get PDFThis case study describes Bluewater Health’s quest to weave the philosophy and practice of patient and family-centered care from the boardroom to the bedside by introducing Emily. Emily’s image is a composite of photographs of staff, physicians, volunteers, patients and families exemplifying that each has a role in Emily’s care. Emily represents every patient and family of the past, present, and future. Emily’s journey started with the launch of Bluewater Health‘s 2013-2015 strategic plan and moved throughout the organization as patient councils were established and the organization embedded three foundational patient and family-centered RNAO Best Practice Guidelines into daily practice with the support of over 100 best practice champions. The successful implementation of RNAO’s best practice guidelines earned Bluewater Health designation as a Best Practice Spotlight Organization. The organization took a risk in introducing the notion of Emily knowing that Emily could become a cliché. No one was prepared for what has come to be known as “the Emily effect.” Emily’s effect is now being realized in increased patient satisfaction and improved employee engagement scores helping to deliver on our Mission, We create exemplary healthcare experiences for patients and families every time. Bluewater Health is a fully accredited, 326-bed community hospital that cares for the residents of Sarnia-Lambton, Ontario
A call to excellence in patient experience
Get PDFIn this address, the incoming associate editor describes his early experience with the Patient Experience Journal (PXJ) and issues a call to action to the PXJ community. In the call to action, the PXJ community is asked to build upon our collective history of scholastic and practical excellence. The combination of practical relevance and methodological rigor in our contributions will help to ensure a future in which patient experience is paramount in health service delivery conversations. In addition, gaps in the patient experience literature and emergent opportunities for theoretical and practical contributions are recommended
Patient evaluations of the interpersonal care experience (ICE) in U.S. hospitals: A factor analysis of the HCAHPS survey
Get PDFThe Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS) is widely used to evaluate patients’ perceptions of their inpatient healthcare experiences. The HCAHPS is organized into 10 measures: six composite measures, two individual measures, and two global measures.1 In prior research on the link between patients’ care experiences and hospital’s quality and cost outcomes, scholars have grouped these measures in a variety of ways. The evident lack of consistency in these groupings along with the persistent lack of empirical justification for these groupings suggests a need to empirically examine the relational structure of HCAHPS measures. Accordingly, the purpose of this study is to determine the degree to which patient care evaluations captured by HCAHPS reflect unmeasured aspects of the patient experience. We use two-step factor analytic process on a nationally representative split sample of HCAHPS performance from 2007-2011. The results of the analysis reveal a single latent factor consisting of five measures that correspond conceptually to patients’ evaluations of care provider behaviors during their interpersonal interactions with them. We label this factor Interpersonal Care Experience (I.C.E) and argue that it may prove useful in future practical and scholarly explorations of the link between patient experience and other performance outcomes
The experience era is upon us
Get PDFIn this moment in healthcare, the challenges for those in the system are dynamically shifting and the perspectives, desires and needs of the healthcare consumer are putting positive and lasting pressures on how healthcare works that will shift healthcare from where it has been to where it must go. At the heart of this transition are the ideas framing an experience era, where collaborative, consumer-focused and purposeful actions can and will lead to a healthcare system returning to its fundamental calling, that of human beings caring for human beings. In doing so we can change the nature of healthcare and reignite the purpose that brought people to this work and that have individuals seek it for care. In this framing is also the call to action to contribute new insights and perspectives to expand the dialogue, reinforcing the critical and lasting nature of the experience conversation for all it has influenced and all it will impact for many years to come
Why human resources policies and practices are critical to improving the patient experience
Get PDFWhile providing patient-centered care seems to be a goal for many organizations, delivering on this goal requires practices which are embedded in the organization, which incent patient-centered behavior. The author argues Human Resources (HR) policies, procedures and programs are key to supporting an organizations’ vision and culture. This means an HR executive partnering with the CEO who sets the vision and HR builds programs to support the vision. As the organization understands what is important to patients and how to best serve them, HR can build patient care improvement into every aspect of the organization. The author describes how competency based hiring, training and development, performance reviews, compensation and retention strategies should reflect patient-centered values