Patient Experience Journal (PXJ, The Beryl Institute)
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Reframing the work on patient experience improvement
Get PDFIn reframing the work on patient experience improvement Dr. Jocelyn Cornwell, chief executive of The Point of Care Foundation, challenges us to broaden our view on what is necessary to impact patient experience efforts. From a defined need to reduce avoidable suffering associated with health care delivery dysfunction, she suggests we extend the discussion in two ways: First, to include a concern for staff engagement, experience and well-being, and second, to position patient experience improvement as one type of quality improvement (QI) in healthcare, and urge practitioners to pay more attention to the lessons from QI in other domains. High quality, reliable patient experience is a primary goal in healthcare alongside others; too often it is treated as separate from other quality goals, deprived of the resources those goals command and taken less seriously. By broadening our view on patient experience improvement, Dr. Cornwell offers we will find not only greater engagement from all participants in healthcare, but also positive and sustained outcomes
Patient complaints as predictors of patient safety incidents
Get PDFPatients remain an underused resource in efforts to improve quality and safety in healthcare, despite evidence that they can provide valuable insights into the care they receive. This study aimed to establish whether high-level patient safety incidents (HLIs) were predictable from preceding complaints, enabling complaints to be used to prevent HLIs. For this study complaints received from November 2011 through June 2012 and HLI incident reports from April through September 2012 were examined. Complaints and HLIs were categorised according to location or specialty and the themes they included. Data were analysed to look for correlations between number of complaints and HLIs in a given area. A qualitative analysis was carried out to determine whether any complaints contained information that, if acted upon earlier, could have prevented later HLIs. In the data a total of 52 complaints and 16 HLIs were included. No correlation was established between location of HLIs and complaints. Complaints commonly focused on staff attitude, diagnostic problems and delayed treatment. HLIs most often arose from failure to recognise a patient’s deterioration and escalate appropriately or incorrect patient identification. Most HLIs were not preceded by similar complaints. However, in two instances complaints did signpost future HLIs. Patient complaints can highlight specific risks to patient safety and act as an early warning system. There is a need to devise reliable means of identifying the minority of complaints that do precede serious incidents
Variations in the patients’ hospital care experience by states’ strategy for Medicaid expansion: 2009-2013
Get PDFOur investigation evaluates the extent of differences in the patient’s hospital experience due to variations among state strategies to adopt, or not adopt, their Medicaid plans to the 2010 ACA legislation. Using ten HCAHPS measures, we analyze patient hospital experience data for the 2009 - 2013 period for all 50 states and the District of Columbia grouped by those states that (1) did not expand, (2) expanded Medicaid through Section 1115 waivers, (3) expanders early, and (4) expanded Medicaid concurrent with the new ACA legislation.
Our findings reveal that those states that opted out of Medicaid expansion typically started with higher patient experience scores in 2009 on all 10 HCAHPS hospital measures and maintained their higher scores levels for all five years over the other three state expansion strategies for most measures. While states that were early expanders and those that expanded concurrent with the ACA implementation generally show higher growth rates over the five-year period for most HCAHPS measures when compared to states that opted out of the Medicaid expansion, our multivariate results indicate that their rates of growth were not statistically superior to those states that opted out of the expansion.
We conclude that while there have been concerns that the patients in opt-out states would experience lower levels of satisfaction from their state’s actions, the patient experience scores in these states show that they perform better or as well as those states that expanded early, expanded under waivers, and expanded with the implementation of the ACA legislation
Managing patient expectations at emergency department triage
Get PDFEmergency departments (ED) overcrowding, long wait, and uncomfortable waiting room conditions may lower perceived quality of the patient experience and satisfaction. This study investigates the relationship between patient satisfaction and communication of expected wait times, at the point of triage. A pre-post (11/4/ 2008 – 2/5/2009) group design with convenience sample (n=1,209) of all discharge adult ED patients was utilized for this study. A static expected wait time model (i.e., average wait time + one standard deviation) based on time of the day, day of the week and triage levels was employed to communicating expected wait time at triage while an in-house survey with five-point Likert-scale patient satisfaction questions (satisfied with wait time in triage, informed about delays, and overall rating of ED visit) was administrated at the discharge desk. The communication of delays intervention was significant for only overall rating of ED, while binary communication status was significantly associated with all three patient satisfaction questions. The patients who didn’t receive any communication about delays, were between 1.42 to 5.48 times more likely to rate the three satisfaction questions lower than very good. With communication about delays, the percentage of patients responding very good and very poor/poor were 14.6% higher and 5.9% lower, respectively, for the satisfied with wait time in triage question. Although communication of delays intervention was not significant, the patients who received wait times information were significantly more satisfied. This indicates that patients are more likely to accept longer wait times provided their expectations are managed via communication. Future studies should explore technological solutions for communication of delays and operational improvement initiatives along with alignment of incentives for ED staff to further improve the patient experience.
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
Patient partnership in quality improvement of healthcare services: Patients’ inputs and challenges faced
Get PDFThis research focuses on the perception of patients who participated in Continuous Quality Improvement Committees (CIC) regarding their contribution, lessons learned, and challenges encountered. The committees are engaged in a care partnership approach where patients are recognized for their experiential knowledge and treated as full members of the clinical team. Based on patient interviews, we conclude that they bring a structured and thoughtful vision of their experience. They identify themselves as real partners in the care process and are grateful for the opportunity to improve the care provided to other patients by using their own experience and by bringing changes to the patient-professional relationship, particularly in terms of communication. They also become better acquainted with the complexity of the health system and its organization. However, their participation in CICs raised two challenges. The first was their availability, as their professional schedules did not always allow them to participate in meetings. The second was their frustration with the slow decision-making process and implementation of necessary measures for quality improvement of healthcare and services. This study highlights the contribution of successful patient participation to quality of care improvement.
Experience Framework
This article is associated with the Patient, Family & Community Engagement 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 lens
Building national consensus on experiences of care
Get PDFThe NHS in England is measured against specific indicators that focus on ‘ensuring that people have a positive experience of care,’ yet there was a lack of organisational alignment across the new national health and care organisations regarding their understanding of what constitutes a positive experience of care. This represents a major barrier to achieving an aligned and consistent system-wide approach to improving experiences. To address the need to create national alignment in definition and approach, we worked with the Patient Experience Sub-group of the National Quality Board to develop consensus on how national organisations define ‘experience of care’ and what constitutes a good experience of care, drawing on relevant evidence and guidance. Working in collaboration, we developed a ‘Narrative’ to describe this consensus and highlight resources and examples of good practice on improving experiences of care for the wider system, including commissioners and providers, to support broader improvement and implementation efforts
A single, complete touch: Population health, the health contact center, and the patient experience
Get PDFAs healthcare organizations turn to population health in order to more effectively manage the health and well-being of their patients, many need to ensure that these new strategies include a directive to improve the patient experience. Fortunately, healthcare systems can turn to an existing entity within its ranks, the health contact center, in order to execute a successful strategy and ensure that the individual patient never feels lost amongst the population crowd. Fran Horner from Singola Consulting and Susan Marks from Amati Health explore the ways in which population health and the health contact center work collaboratively to keep patient populations well cared for, healthy, and ultimately improve the patient experience for every individual
The patient experience movement moves on
Get PDFAs we present Volume 2 of Patient Experience Journal (PXJ) we both recognize the contributions that helped launch this publication and acknowledge the work that helped build the foundation of the broader research exploration in the emerging field of patient experience. On this base of knowledge we have worked to establish a new home for expanding the exploration of new ideas and practices through this publication. The importance of building, supporting and sustaining an outlet for research in patient experience is grounded in the belief that positive patient experience is good for healthcare, it is good for the people who comprise it and it should be of greatest benefit for those who are cared for and served. If we do our work as scholars and practitioners, in linking new ideas and solid proven practice, we have the potential to profoundly change the nature of healthcare. It is why we ask you as readers and researchers to continue to push the boundaries of what we believe is possible; understanding that at the end of the day, there is not only great opportunity, but great responsibility in focusing on excellence in patient experience and continuing to ensure the patient experience movement moves on
Using a process improvement tool to improve staff skills & enhance the urgent needs patient experience in a women’s health center
Get PDFNYC Health + Hospitals / Gouverneur serves more patients than any other diagnostic and treatment center in New York State. As part of the NYC Health + Hospitals public health care system, which serves 1.4 million patients and is the largest municipal health care delivery system in the United States, Gouverneur strives to serve the needs of both scheduled and unscheduled patients. Within Gouverneur, the Women’s Health department treats approximately 1,600 patients per month through approximately 2,100 visits. In September 2014, Gouverneur’s Women’s Health department launched a weeklong process improvement initiative known as a Rapid Improvement Event (RIE). Structured through Breakthrough, the RIE focused on improving the process of serving urgent needs patients, including those that arrive without an appointment or miss their appointment time, or those who call with an urgent issue. As the team examined problems faced by urgent needs patients – including the amount of time required to complete a visit, and barriers to having an appointment scheduled the same day with a provider – they discovered that the root of many issues was simply variability in how staff members approached the unexpected patient. To solve the issues in a low-cost, sustainable way, the team set to work designing staff trainings to enhance staff skills and improve the experiences of urgent and unscheduled patients. As a result, staff members were better able to support the needs of patients with urgent needs, ultimately improving the patient experience
Impact of hospital characteristics on patients’ experience of hospital care: Evidence from 14 states, 2009-2011
Get PDFThis paper uses patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for three years (2009-2011) from 1,333 acute-care hospitals in fourteen states to analyze patterns in 10 hospital-reported patient experience-of-care scores by 29 characteristics classified as: patient characteristics, payer source, patient severity, hospital characteristics, hospital operations, and market characteristics. We also evaluate how scores have changed over the three-year period. We find significant differences in patient experience-of-care scores by hospital characteristics for 250 out of 290 HCAHPS-hospital characteristic combinations measured. We find fewer significant differences in changes in scores from 2009-2011 (135 out of 290), with hospitals categorized as high scoring also reporting consistently greater improvement. We conclude that patient experience-of-care scores vary by hospital characteristics, although improvements in scores show less variety by hospital categorization