Patient Experience Journal (PXJ, The Beryl Institute)
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Patient experience: Driving outcomes at the heart of healthcare
Get PDFThere is no longer a question that patient experience matters in healthcare today. It matters for those that are cared for and served and matters to all those working each and every day to provide the best in care at all touch points across the healthcare continuum. With this recognition, there too needs to be a change in mindset about patient experience itself. When addressing the topic of patient experience, the conversation is about something much broader than the “experience of care”, as identified in the triple aim. The idea of experience reflects our biggest opportunity in healthcare, where experience encompasses quality, safety and service moments, is impacted by cost and the implications of accessibility and affordability, is influenced by the health of communities and populations and by both private and public health decisions that have systemic implications. A focus on experience at the broadest sense leads to the achievement of the four outcomes leaders aspire to in varying combinations in healthcare organizations around the world: clinical outcomes, financial outcomes, consumer loyalty, and community reputation. With the rapid growth in research, a diverse and expanding global community, and a shared commitment to outcomes, patient experience has now claimed its place at the heart of healthcare
Creating a common trajectory: Shared decision making and distributed cognition in medical consultations
Get PDFThe growing literature on shared decision making and patient centered care emphasizes the patient’s role in clinical care, but research on clinical reasoning almost exclusively addresses physician cognition. In this article, we suggest clinical cognition is distributed between physicians and patients and assess how distributed clinical cognition functions during interactions between medical professionals and patients with Multiple Sclerosis (MS). A combination of cognitive task analysis and discourse analysis reveals the distribution of clinical reasoning between 24 patients and 3 medical professionals engaged in MS management. Findings suggest that cognition was distributed between patients and physicians in all major tasks except for the interpretation of MRI results. Otherwise, patients and physicians collaborated through discourse to develop a common trajectory to guide clinical reasoning. The patients’ role in clinical cognition expands the concept of patient-centered care and suggests the need to optimize physician-patient distributed cognition rather than physician cognition in isolation
Does she think she’s supported? Maternal perceptions of their experiences in the neonatal intensive care unit
Get PDFParents’ involvement in the care of their infants in the neonatal intensive care unit (NICU) is critically important, leading many NICUs to implement policies and practices of family-centered care (FCC). Analyzing narrative interviews, we examined whether mothers of premature infants who participated in an intervention to help reduce anxiety, stress, and depression felt that their NICU experience reflected four key nursing behaviors previously identified as being necessary to achieving FCC. Fifty-six narratives derived from semi-structured interviews with the mothers were analyzed qualitatively and quantitatively to examine whether the women experienced emotional support, parent empowerment, welcoming environment, and parent education, as well as whether differences in reported experiences were related to sociodemographic factors or maternal coping styles. Overall, the mothers reported more negative than positive experiences with respect to the four behaviors, and those who had negative interactions with the hospital staff felt a sense of disenfranchisement and failure as mothers. Sociodemographic factors and coping styles were significantly associated with the mothers’ perceptions of their experiences, although these relationships were not consistent. Achieving actual FCC in the NICU may require parent-informed evidence-based changes in NICU personnel training and infrastructure
Using patient value statements to develop a culture of patient-centred care: a case study of an Ontario, Canada hospital
Get PDFPatient-centred care (PCC) is not a new concept; however, in recent years it has garnered increasing attention in the research literature and clinical practice. PCC in clinical practice has been found to improve clinical outcomes, resource allocation, and the patient experience. In response to the need for PCC and quality in healthcare, the Ontario, Canada government developed the Excellent Care for All Act (ECFAA) in 2010. The ECFAA imposes six obligations to Ontario hospitals, one of which is developing and publishing a Patient Declaration of Values (PDoV). The purpose of this study was to explore how a leading patient-centred Ontario hospital operationalized their patient value statement in policy and practice. The objectives of this research were to: a) understand what role the patient value statement played in policy and practice within a leading Ontario hospital and b) to examine how a leading Ontario hospital incorporated these values into their overarching organizational structures. This was a qualitative case study, which took place in a leading patient-centred Ontario hospital. The study included 18 interviews with employees and patient/family advisors. The analysis found a five-step process including: 1) setting the stage, 2) inspiring change, 3) organizational capacity, 4) barriers, and 5) reflection and improvement. This study has highlighted the role of a patient value statement within a leading Ontario hospital. The findings provide a five-step process with 12 core strategies for creating change in a healthcare organization; to embed a culture of patient-centred care
Patient perceptions of an AIDET and hourly rounding program in a community hospital: Results of a qualitative study
Get PDFQuantitative evidence links patient satisfaction scores to the use of communication strategies such as AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank you) and Hourly Rounding. However, little is known about patient perceptions of these tools in regards to their hospital experience. Qualitative interviews were conducted with a convenience sample of 14 adult medical/surgical inpatients in one mid-sized, community hospital, following hospital discharge. The interview data was transcribed and opened coded, utilizing constant comparison to identify common themes. Themes emerged in four topical areas: (a) patient experience of hospitalization, (b) AIDET, (c) Hourly Rounding, and (d) unexpected findings. Patients placed significant value on having their emotional needs met by staff during their hospitalization. While patients felt hospital staff explained procedures well, but staff did not explain the illness or its treatment effectively. AIDET was found to be applied consistently; however patients did not understand the duration aspect of AIDET. Hourly Rounding with a purpose was not noticeable by patients; descriptions by patients of the practice included medication passes and vital checks. However, reduction of call light usage and sleep interruptions were mentioned. Unexpected findings included feelings of loneliness while hospitalized and inconsistent delivery of patient’s pain relief regimens. The results overall suggest a focus on meeting emotional needs may be necessary to improve patient experiences in the hospital. More intentional use of AIDET and Hourly Rounding may help to maximize the benefit of these tools. Further research is warranted to validate findings from this study.
Experience Framework
This article is associated with the Culture & Leadership 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
The power of patient ownership: The path from engagement to equity
Get PDFUnderstanding patient engagement from the lens of a person who is suffering, who is in pain and anguish, who is wracked with fear of the impact of this pain on their body, their family, their career, and their mortality, is a complex undertaking. The authors provide an important patient perspective in acknowledging and highlighting efforts to shift the conversation on experience from one about patients and families to one with patients and families. They challenge us to consider the power that can be found in creating ownership for patients and suggest it may be the one true path to moving beyond a mindset of engagement to real equity in healthcare
Patient centered infertility care: The health care provider’s perspective
Get PDFThis study describes what health care providers (HCPs) of fertility services perceive their patients to value most, as well as HCPs’ self-evaluation in provision of patient centered infertility care (PCIC). The Patient Centeredness Questionnaire Infertility (PCQ-I) was administered to all clinic staff and completed by approximately 60%. Mean scores and standard deviations were calculated for each dimension as well as for the global score. HCPs ranked staff communication as the highest of the dimensions and accessibility of care as the lowest, respectively indicating areas of strength and weakness. Degree of variance within scoring was used as a marker of consistency of assessment. Ranking of staff competence was the most uniform and ranking of accessibility the most varied, suggesting HCPs are confident in assessing patients’ perceptions of competence, but not with respect to accessibility. Staff communication was thought to be the most important dimension of PCIC for patients, based on the correlation with global score, while care organization was thought to be the least important, showing the lowest correlation with the global satisfaction score. This is the first study to describe North American HCPs’ perceptions of PCIC. This information will inform further professional development in provision of quality PCIC
Usefulness of a patient experience study to adjust psychosocial oncology and spiritual care services according to patients’ needs
Get PDFLittle is known about how cancer patients experience psychosocial and spiritual care services and about what services they feel should be offered in order to help them meet their actual needs. This study’s main goal was to examine how cancer patients experienced the psychosocial oncology and spiritual care (POSC) services they received, in order to adjust the service offer according to their expressed needs and expectancies. A qualitative design approach was used. The study was conducted in two phases: (1) Collection of the patients’ perspective and divulgation of the results to the clinical team and managers; and (2) assessment of the impact of the patient experience study results on the clinical team’s services and managerial decisions. Suggestions for improvement were gathered mainly around the themes of service delivery and information about services. Contrary to what was expected, delays to access service responded to patients’ needs and expectations. According to clinical managers, patients’ perspectives on their services legitimized the maintenance of certain services, and were levers that helped make coherent and targeted changes. They felt the changes they made were patient-driven instead of being driven by staff’s perception of patients’ needs. The fact that results emerged from a fairly large and structured patient experience evaluation had an impact on the motivation of stakeholders to initiate changes. These results suggest that collecting patients’ perspective will likely help clinicians and managers tailor service delivery to meet patients’ needs and expectations and may contribute to set more informative standards regarding access to care delays
Creating and integrating a new patient experience leadership role: A consultative approach for partnering with executive and clinical leaders
Get PDFMany healthcare organizations are creating new leadership roles to add subject matter expertise and structure to their patient experience improvement efforts. The patient experience field is emerging, however, so there are many questions about this role’s function and how best to structure it in the organization for maximal effectiveness.
This article explores the benefits of a consultative approach for improving the patient experience. Previous research on management consulting and the integration of new roles in established organizations is briefly reviewed. Mayo Clinic Arizona’s (MCA) comprehensive, 7-prong service model is revisited. Developed and implemented in 2008, the model is predicated on consultative relationships with executive and clinical leaders, is driven by data and accountability, and has demonstrated efficacy in improving the patient experience in specialty and primary care settings. Seven widely accepted service quality principles comprise the model: (1) multiple data sources to drive improvement; (2) accountability for service quality; (3) service consultation and improvement tools; (4) service values and behaviors; (5) education and training; (6) ongoing monitoring and control; and (7) recognition and reward.
The focus of this article is Prong 3, service consultation. MCA’s consultative approach to structuring the patient experience leader is discussed, responsibilities are defined, qualifications are suggested, and key affiliations for integrating this new leadership role are proposed
Meaningful and effective patient engagement: What matters most to stakeholders
Get PDFTo determine what resources, preparation, and support are needed for patients, providers, and leaders to meaningfully and appropriately engage in patient-centred health system redesign, researchers sought to learn what really matters to these three stakeholder groups. A qualitative descriptive design was selected using purposive participant sampling, focusing on ‘who’, ‘what’ and ‘why’ questions pertaining to stakeholder perceptions about patient engagement in their specific context as patients, providers or leaders. Four project groups were selected; each group was responsible for a strategic initiative within Alberta Health Services and represented one of three different levels of the healthcare system (i.e. program, site or governance). Semi-structured question guides were used to collect data. Thematic analysis of the transcribed participant responses revealed eleven major themes: understanding patient engagement; language, communication, information; level and timing of engagement; recruitment and retention; roles, responsibilities and expectations; reason for being; expense; time commitment; governance and structure; knowing who’s who; and evaluation. Patients, providers and leaders agreed to the importance of communication around the reasons for patient engagement including building trust through collaboration and clearly identifying goals, along with their roles and responsibilities. These stakeholder perspectives are needed to inform the development of tools, resources and education materials required to support patient engagement activities tailored to the needs, understandings and perspectives of stakeholders