Improving Patient Experience of Care Providers in a Multispecialty Ambulatory Pediatrics Practice

Abstract

Patient experience is positively associated with superior medical outcomes, clinical quality, patient safety measures, physician job satisfaction, doctor-patient communication, and patient compliance with treatment recommendations. A concrete pediatrics-focused methodology for improving patient experience in a multispecialty ambulatory setting has not been described, nor has the impact on practice outcomes been assessed. The primary aim of this study was to improve patient experience care provider scores at a single multiclinic children’s hospital in the Midwest to the 70th percentile in a 5-year period. The secondary aim sought to determine the impact of quality improvement efforts on practice growth, patient complaint rate, and provider/staff engagement. Patient experience was measured by returned Press-Ganey surveys. Interventions involved establishing infrastructure, promoting feedback and transparency, providing education, and transforming culture. Provider scores improved from the 19th to the 70th percentile within 5 years. Practice volume increased by 17.1%; patient complaint/grievance frequency decreased 33-fold; and provider/staff engagement did not appreciably change.

Usefulness of Child HCAHPS Survey Data for Improving Inpatient Pediatric Care Experiences

“…Of the 12 quantitative studies, 4 (33%) were interventional and used quasi-experimental designs. [33][34][35][36] Reporting of outcome data was inadequate because none of the interventional studies included effect sizes, and they all employed uncontrolled beforeafter designs [33][34][35][36] (with patient populations that might have changed over time [33][34][35] ), which might have had practice changes not related to the intervention, 36 leading to possible overestimation of the effects of interventions.…”

“…44,45 Several articles underline the need for institutional infrastructure to foster collaborative learning, team-based work, and pediatric staff communication. 34 Best practices for evaluating QI activities centered around ensuring meticulous tracking of data, use of pediatric-only indicators, and establishing national benchmarks. 28,29,[44][45][46][47] Organizational structure and culture were identified as key facilitators of QI for inpatient pediatric care.…”

“…47 Role of Patient Experience Survey Data in QI Nine (75%) of the 12 quantitative articles included pediatric patient experience surveys. The resulting survey data were used identifying and targeting new QI initiatives (eg, aiming to improve customer service, staff courtesy, discharge workflow, physician-family communication, patient education, or patient engagement) 28,33,34,[36][37][38][39]42 and motivating cultural change (eg, setting expectations and educating staff on discipline-specific best practice and standards of care). 36 The authors of 1 study noted that although pediatric patient experience data allow organizations to prioritize improvements, they yield limited tactical insights on how to effect change.…”

“…49 Institutional policy recommendations for promoting the use of patient experience surveys include fostering an organizational culture that supports evidence-based change and QI, clearly allocating responsibility among units and departments, and ensuring that patient feedback is accurately attributed to the service level. 34,44 Patient and Family Feedback…”

A Review of Best Practices for Monitoring and Improving Inpatient Pediatric Patient Experiences

“…Nine (75%) of the 12 quantitative articles included pediatric patient experience surveys. The resulting survey data were used for identifying and targeting new QI initiatives (eg, aiming to improve customer service, staff courtesy, discharge workflow, physician-family communication, patient education, or patient engagement) 28,33,34,[36][37][38][39]42 and motivating cultural change (eg, setting expectations and educating staff on discipline-specific best practice and standards of care). 36 The authors of 1 study noted that although pediatric patient experience data allow organizations to prioritize improvements, they yield limited tactical insights on how to effect change.…”