An Intervention Model That Promotes Accountability: Peer Messengers and Patient/Family Complaints

Pichert, James W.; Moore, Ilene N.; Karrass, Jan; Jay, Jeffrey S.; Westlake, Margaret W.; Catron, Thomas F.; Hickson, Gerald B.

doi:10.1016/s1553-7250(13)39057-6

Cited by 64 publications

(121 citation statements)

References 46 publications

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“…This was done in recognition that complaints are often linked to specific physicians. Complaints data can therefore be harnessed by leaders to identify staff receiving a disproportionate number of complaints, to offer specific support and training [99,113]. …”

Section: Resultsmentioning

confidence: 99%

Key strategies to improve systems for managing patient complaints within health facilities – what can we learn from the existing literature?

Mirzoev

Kane

2018

Global Health Action

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Background: Information from patient complaints – a widely accepted measure of patient satisfaction with services – can inform improvements in service quality, and contribute towards overall health systems performance. While analyses of data from patient complaints received much emphasis, there is limited published literature on key interventions to improve complaint management systems. Objectives: The objectives are two-fold: first, to synthesise existing evidence and provide practical options to inform future policy and practice and, second, to identify key outstanding gaps in the existing literature to inform agenda for future research. Methods: We report results of review of the existing literature. Peer-reviewed published literature was searched in OVID Medline, OVID Global Health and PubMed. In addition, relevant citations from the reviewed articles were followed up, and we also report grey literature from the UK and the Netherlands. Results: Effective interventions can improve collection of complaints (e.g. establishing easy-to-use channels and raising patients’ awareness of these), analysis of complaint data (e.g. creating structures and spaces for analysis and learning from complaints data), and subsequent action (e.g. timely feedback to complainants and integrating learning from complaints into service quality improvement). No one single measure can be sufficient, and any intervention to improve patient complaint management system must include different components, which need to be feasible, effective, scalable, and sustainable within local context. Conclusions: Effective interventions to strengthen patient complaints systems need to be: comprehensive, integrated within existing systems, context-specific and cognizant of the information asymmetry and the unequal power relations between the key actors. Four gaps in the published literature represent an agenda for future research: limited understanding of contexts of effective interventions, absence of system-wide approaches, lack of evidence from low- and middle-income countries and absence of focused empirical assessments of behaviour of staff who manage patient complaints.

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Section: Resultsmentioning

confidence: 99%

Key strategies to improve systems for managing patient complaints within health facilities – what can we learn from the existing literature?

Mirzoev

Kane

2018

Global Health Action

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“…; Pichert et al. ; Reeves, West, and Barron ); initiatives lacking that support induce only minimal changes in clinical practice (Rybowski et al. ).…”

Section: Why Patient Experience Must Be At the Heart Of Incentive‐basmentioning

confidence: 99%

“…Proliferating metrics exacerbate challenges that clinicians face in interpreting and responding to feedback. As a result, incentives based on patient experience have induced the most consistently positive responses when the organizations within which clinicians practice (e.g., hospitals, physician groups) dedicate resources to assist with interpretation (Luxford, Safran, and Delbanco 2011;Geissler et al 2013;Pichert et al 2013;Reeves, West, and Barron 2013); initiatives lacking that support induce only minimal changes in clinical practice .…”

Section: Well-designed Pay-for-performance Programs Can Protect and Pmentioning

confidence: 99%

Using Patient‐Reported Information to Improve Clinical Practice

Schlesinger

Grob

Shaller³

2015

Health Services Research

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ObjectiveTo assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient‐valued outcomes in health systems with strong financial incentives.Data Sources/Study SettingExisting literature (gray and peer‐reviewed) on measuring patient experience and patient‐reported outcomes, identified from Medline and Cochrane databases; evaluations of pay‐for‐performance programs in the United States, Europe, and the Commonwealth countries.Study Design/Data CollectionWe analyzed (1) studies of pay‐for‐performance, to identify those including metrics for patient experience, and (2) studies of patient experience and of patient‐reported outcomes to identify evidence of influence on clinical practice, whether through public reporting or private reporting to clinicians.Principal FindingsFirst, we identify four forms of “patient‐reported information” (PRI), each with distinctive roles shaping clinical practice: (1) patient‐reported outcomes measuring self‐assessed physical and mental well‐being, (2) surveys of patient experience with clinicians and staff, (3) narrative accounts describing encounters with clinicians in patients' own words, and (4) complaints/grievances signaling patients' distress when treatment or outcomes fall short of expectations. Because these forms vary in crucial ways, each must be distinctively measured, deployed, and linked with financial incentives. Second, although the literature linking incentives to patients experience is limited, implementing pay‐for‐performance systems appears to threaten certain patient‐valued aspects of health care. But incentives can be made compatible with the outcomes patients value if: (a) a sufficient portion of incentives is tied to patient‐reported outcomes and experiences, (b) incentivized forms of PRI are complemented by other forms of patient feedback, and (c) health care organizations assist clinicians to interpret and respond to PRI. Finally, we identify roles for the public and private sectors in financing PRI and orchestrating an appropriate balance among its four forms.ConclusionsUnless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value. Certain policy parameters are already clear, but additional research is required to clarify how best to collect patient narratives in varied settings, how to report narratives to consumers in conjunction with quantified metrics, and how to promote a “culture of learning” at the practice level that incorporates patient feedback.

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“…Simple measures, such as giving formal peer feedback to the physician about the effects of problematic behaviors, with concurrently offered educational support, frequently allow the physician to understand and correct the dysfunctional behavior [37]. More specific approaches such as leadership training, professional coaching or practice management review may be employed to improve quality of care.…”

Section: Discussionmentioning

confidence: 99%

Restoring professionalism: the physician fitness-for-duty evaluation

Finlayson

Dietrich

Neufeld

et al. 2013

General Hospital Psychiatry

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Objectives We compare findings from 10 years of experience evaluating physicians referred for fitness-to-practice assessment to determine whether those referred for disruptive behavior are more or less likely to be declared fit for duty than those referred for mental health, substance abuse or sexual misconduct. Method Deidentified data from 381 physicians evaluated by the Vanderbilt Comprehensive Assessment Program (2001–2012) were analyzed and compared to general physician population data and also to previous reports of physician psychiatric diagnosis found by MEDLINE search. Results Compared to the physicians referred for disruptive behavior (37.5% of evaluations), each of the other groups was statistically significantly less likely to be assessed as fit for practice [substance use, %: odds ratio (OR)=0.22, 95% confidence interval (CI)=0.10–0.47, P<.001; mental health, %: OR=0.14, 95% CI=0.06–0.31, P<.001; sexual boundaries, %: OR=0.27, 95% CI=0.13–0.58, P=.001]. Conclusions The number of referrals to evaluate physicians presenting with behavior alleged to be disruptive to clinical care increased following the 2008 Joint Commission guidelines that extended responsibility for professional conduct outside the profession itself to the institutions wherein physicians work. Better strategies to identify and manage disruptive physician behavior may allow those physicians to return to practice safely in the workplace.

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An Intervention Model That Promotes Accountability: Peer Messengers and Patient/Family Complaints

Cited by 64 publications

References 46 publications

Key strategies to improve systems for managing patient complaints within health facilities – what can we learn from the existing literature?

Key strategies to improve systems for managing patient complaints within health facilities – what can we learn from the existing literature?

Using Patient‐Reported Information to Improve Clinical Practice

Restoring professionalism: the physician fitness-for-duty evaluation

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