Patient Experience Journal (PXJ, The Beryl Institute)
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Concern for the patient’s experience comes of age
Get PDFIn this special guest editorial for the inaugural issue of Patient Experience Journal. Dr. Press reflects on how the focus on patient experience has evolved. He starts with a reflection, A journal devoted exclusively to the patient’s experience? A patient satisfaction survey mandated by CMS for all hospitals and a portion of reimbursement dependent upon the scores? An Institute and an “Association” addressing Patient Experience? A new hospital administrative position labeled “Chief Experience Officer”? Some 30 years ago no one would have predicted any of these.
Dr. Press helps us explore and review how the patient experience movement has evolved and the implications of both our history and current state on how we address patient and family needs moving forward. He aptly offers in closing, Concern for the patient’s experience is coming of age
Patients and families as partners in safety, quality, and experiences of care
Get PDFThis case examines the highlights of Vidant Health’s journey to a more intentional focus on patient experience. Organizational inconsistencies lead to a focused long term plan putting a culture of patient centeredness at the core of Vidant’s efforts. The results show a clear and measured improvement in safety, quality and experience overall
Veterans’ experiences of patient-centered care: Learning from guided tours
Get PDFIn this paper the authors seek to examine Veterans’ experiences with patient-centered care (PCC) at 2 United States Veterans Affairs (VA) facilities. The authors conduct their research through a process of guided tours, in which the participant leads the evaluator through an environment and shares thoughts, feelings, and experiences. Tours were conducted in April 2013 with 30 Veterans receiving care at these VA facilities. Via the tours participants discussed aspects of the environment of care, and described some as ‘welcoming,’ while describing others as ‘chaotic.’ Participants provided multiple examples of PCC, frequently defining PCC in terms of accessibility of appointments, continuity and familiarity with providers, and shared decision-making and communication. They highlighted that their identity as Veterans influenced their preferences for care, including efficiency, need for compassion, and consideration of mental and social health needs. Some suggested VA expand upon this idea of shared identity by creating a ‘Veteran community,’ and including increased opportunities for socialization with other Veterans, and access to the arts. The authors conclude that the impact of shared identity on care preferences has received limited attention in the literature; further, the impact of identity may be unique to Veterans, who represent not only a group of patients being seen at the same facilities, but a social group with shared history and characteristics, as well. These results can be utilized to expand implementation of PCC innovations, to improve health and well-being of Veterans
Transforming the patient experience: Bringing to life a patient- and family-centred interprofessional collaborative practice model of care at Kingston General Hospital
Get PDFThe Kingston General Hospital strategic plan includes transforming the patient experience and bringing to life new models of interprofessional care and education. The implementation of the Interprofessional Collaborative Practice Model has been the foundation of this transformational change. Areas identified for improvement included communication, discharge planning, and purposeful engagement of patients and families in the care process. Through a system-wide approach to change, it was expected that the organization would be better prepared to deliver safer, higher quality care and enriched experiences for patients, families and practitioners. From March to October 2009, 54 representatives from various disciplines and services gathered to design a new approach to care delivery. The resulting model was conceptualized as a system of interacting levers: People, Technology, Information, and Process. Between November 2009 and April 2012, the model was implemented on 18 inpatient units and 33 ambulatory care areas. Interprofessional collaboration and patient engagement has been vital in optimizing care through this new care delivery model. We quickly came to realize that in order to create and sustain a patient and family-centred approach to care, we needed patients and families to advise us along the way. A Patient and Family Advisory Council was formed in February 2010 and continues to provide direction. Post-implementation results on four units are encouraging, showing improvements in quality of patient care and quality of work life. Continuous monitoring of the changes and using evaluation results to advance the positive changes are the next steps in this transformation of the healthcare experience
Patient experience of care in a student-faculty collaborative practice
Get PDFStudent Run Clinics (SRCs) are a popular means of caring for the underserved while providing valuable medical education opportunities. Reports of patient experience surveys are rare in this setting. This is troublesome because it is possible that underserved patients, who are more likely to receive care at SRCs, are not receiving the same level of care as at more traditional medical practices. The purpose of this research was to measure patient experience in a student-led medical clinic. The method included the use of patient experience surveys, which were self-administered pre-visit and self- and interviewer administered post-visit. The key results, 100% of patients felt treated with respect. 81.4% of patients would “definitely” and 16.3% would “somewhat” refer their family and friends to the clinic. 87% reported being seen within 15 minutes of their appointment time; 60% reported that they knew they would be seen by medical students and a doctor. This data has been useful to our student-led clinic in streamlining clinic flow, reducing wait times and building awareness of our structure. Our hope is this study will encourage others SRCs to adopt similar student-faculty collaborative research based practices to enhance care for SRC patients while teaching students to use patient feedback to improve quality of care
Psychometric properties of the new Patients’ Expectations Questionnaire
Get PDFThe authors explore the development of the Patients’ Expectations Questionnaire (PEQ) and examination of psychometric characteristics it encompasses by reviewing surveys of primary care and hospital outpatients before and after their clinic visit. Three scales were developed for Pre-visit Ideal and Realistic expectations, and Post-visit Experiences (met expectations), based on literature review, semi-structured interviews, and subsequently piloted and refined. Patients completed the questionnaire about their ideal and realistic expectations before they saw the doctor, and were asked if their expectations had been met afterwards. The results show the scales met acceptability criteria for reliability (Cronbach’s alphas exceeded α 0.70), administration mode (interview and self-completion), and sample type (general practice and hospital). Split-half reliability was also acceptable. Adjusted odds ratios showed that post-visit experiences (met expectations), followed by feelings of control in life, and age, were the most powerful independent predictors of overall patient satisfaction ratings with the clinic visit, and independent self-ratings of whether their expectations had been met overall. This leads the authors to conclude that the PEQ as a self-report instrument, has good reliability and validity and covers the main types of patient expectations of ambulatory health care. It has policy potential for monitoring expectation management, and is thus of potential benefit to providers and purchasers of health services, and ultimately to patients
The relationships between HCAHPS communication and discharge satisfaction items and hospital readmissions
Get PDFThe Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has become a key metric used by organizations and patients to evaluate patient experience. Readmissions also continue to be a metric used to evaluate performance because of the added cost to both healthcare systems and patients. Both measures are also seen in programs such as Value Based Purchasing that have an effect on hospital reimbursements. Previous studies have demonstrated a relationship between patient perceptions and quality of care, and have found patients to be reliable evaluators of their care. While good communication and positive provider relationships have been related to higher satisfaction and higher rates of treatment compliance, past research has been limited to evaluating the relationship between readmissions and satisfaction at an organizational level. This retrospective, cross-sectional study will examine the relationship between communication and discharge HCAHPS questions and readmissions at 30 days, specifically at the patient level. Of the eight HCAHPS questions analyzed, higher scores on questions regarding “nurses listening” and “doctors explaining information” were linked to a decreased risk of readmission, while higher scores regarding “help after discharge” were linked to an increased risk for readmission. These results show the importance that a patient’s severity of illness and hospital procedures have on explaining HCAHPS results. This study’s seemingly paradoxical findings suggest the need to recognize potential trade-offs when reviewing HCAHPS results and using them to drive patient experience initiatives
Hearing the patient voice: Using video intervention/prevention assessment to understand teens with cystic fibrosis
Get PDFThis qualitative study asked two questions: 1) How do teens with cystic fibrosis (CF) feel about their treatments; and 2) What factors lead teens to adhere, or not adhere, to treatments. To answer these questions we used an innovative approach (Video Intervention/Prevention Assessment or VIA), to learn about the experiences of teens with CF. We loaned video camcorders to teens with CF and asked them to create visual narratives of their lives. Researchers logged and coded videotapes, identifying themes that arose from the material. A primary theme was “Doctors don’t understand.” Participants also highlighted the value of routines and parental support in consistently doing treatments. We identify and discuss themes that emerged and discuss how findings can be used to help providers improve care, develop partnerships with patients and increase adherence
The impact of the resident duty hour regulations on surgical patients’ perceptions of care
Get PDFImplementation of the 2003 Accreditation Council for Graduate Medical Education (ACGME) resident duty-hour regulations and access to publicly reported patient satisfaction measures have challenged administrators and clinicians to balance resident’s educational experience, patient care quality, and patients’ satisfaction and perceptions. A pre-post retrospective study design investigated association between implementation of ACGME regulations and patient satisfaction/perceptions using multinomial logistic regressions. The sample consisted of all surgical inpatients (July 2001 – June 2005), who responded to surveys at an academic medical center. Patients gave lower ratings for physician interactions (patient-physician interaction time, clinical updates, and courtesy) following the implementation of post-duty hour regulations. While the odds of patients rating “below good” post-implementation for physician survey questions (i.e., related to time spent, kept informed, and friendliness/ courtesy) were higher (i.e., 1.25 to 1.3) as compared to odds of rating “very good”, the overall rating of quality care improved post-implementation. This difference could be due to increased interaction of patients with other hospital personnel. To improve patient satisfactions and in turn their perceptions, initiatives such as workload balancing, hand-off protocols, patient communication, and interactive training for care providers are recommended. Finally, residency programs and institutions need to develop strategies for implementation of current and future ACGME duty hour regulations so as to balance patient safety, patient perceptions, and resident well-being
The patient experience movement moment
Get PDFFor years, the patient experience movement has continued to gain momentum. From a novel concept, there is an emerging consensus that the patient experience is a fundamental aspect of provider quality; one that complements established clinical process and outcome measures but is neither subsumed nor secondary to them. An increasing volume of research as encouraged by publications such as Patient Experience Journal show this to be true. As the expectation of a high-quality patient experience becomes the norm, these developments have brought us to what we call the patient experience movement moment and there is little doubt that the patient experience has become, and is poised to remain, a central concern in healthcare for many years to come