Patient and Family Experience in the Healthcare Value Equation

Chambers, Patricia; Benz, Lisa; Boat, Anne Christine

doi:10.1007/s40746-016-0072-6

Cited by 6 publications

(5 citation statements)

References 27 publications

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“…In paediatric medicine, the end-user construct includes the patient and caregiver. To enhance value-based paediatric care, soliciting the experience of child and caregiver for the design of healthcare interventions is essential 1 3. Design thinking (DT) is an innovative, human-centred, creative problem-solving approach aimed at understanding people, rather than processes 4.…”

Section: Introductionmentioning

confidence: 99%

Design and implementation of a novel patient-centered empowerment approach for pain optimisation in children undergoing major surgery

et al. 2022

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BackgroundPaediatric surgery is a stressful experience for patients and caregivers. While standardised protocols are the norm, patient-centred approaches are needed to empower patients/caregivers for an optimal perioperative pain experience. To address this gap, we employed a patient-centred approach using design thinking (DT) methodology to develop insights, map processes, identify opportunities and design solutions for individualised empowerment tools.MethodsIn consultation with DT experts, a multidisciplinary team of stakeholders (healthcare providers, patients who underwent pectus excavatum/scoliosis surgery and their caregivers), were invited to participate in surveys, interviews and focus groups. The project was conducted in two sequential stages each over 24 weeks—involving 7 families in stage 1 and 16 patients/17 caregivers in stage 2. Each stage consisted of three phases: design research (focus groups with key stakeholders to review and apply collective learnings, map processes, stressors, identify influencing factors and opportunities), concept ideation (benchmarking and co-creation of new solutions) and concept refinement.ResultsIn stage 1, mapping of stress/anxiety peaks identified target intervention times. We identified positive and negative influencers as well as the need for consistent messaging from the healthcare team in our design research. Current educational tools were benchmarked, parent-child engagement dyads determined and healthcare-based technology-based solutions conceived. The ‘hero’s journey’ concept which has been applied to other illness paradigms for motivation successfully the was adapted to describe surgery as a transformative experience. In stage 2, patient and caregiver expectations, distinct personas and responses to perioperative experience were categorised. Educational tools and an empowerment tool kit based on sensorial, thinking, relaxation and activity themes, tailored to parent/child categories were conceptualised.ConclusionDT methodology provided novel family centred insights, enabling design of tailored empowerment toolkits to optimise perioperative experience. Adapting the hero’s journey call to adventure may motivate and build resilience among children undergoing surgery.

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Section: Introductionmentioning

confidence: 99%

Design and implementation of a novel patient-centered empowerment approach for pain optimisation in children undergoing major surgery

et al. 2022

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“…[4][5][6] Delays in completion of the first case of the day in the OR can have a domino effect on subsequent cases, causing staffing inadequacies, parent/patient dissatisfaction, and increasing costs. 6,7 Optimizing OR scheduling, 8 adherence to the schedule 3 and timely surgery starts and finishes 9 are thus important goals to address. 10 While delayed first-case completion is likely a more important driver of OR delays than delayed starts, most studies have evaluated first-case on-time starts for short surgeries.…”

Section: Introductionmentioning

confidence: 99%

“…The Institute of Medicine identified patient‐centered care and efficiency as major areas for improvement 1,2 . Bundled and performance‐measure based reimbursement requires hospitals to simultaneously improve care and efficiency while reducing costs 3 . Operating rooms (OR) are ideal targets for quality improvement work, as costs are measured per minute and revenue is measured per case.…”

Section: Introductionmentioning

confidence: 99%

“…Delays in completion of the first case of the day in the OR can have a domino effect on subsequent cases, causing staffing inadequacies, parent/patient dissatisfaction, and increasing costs 6,7 . Optimizing OR scheduling, 8 adherence to the schedule 3 and timely surgery starts and finishes 9 are thus important goals to address 10 …”

Section: Introductionmentioning

confidence: 99%

“…1,2 Bundled and performancemeasure based reimbursement requires hospitals to simultaneously improve care and efficiency while reducing costs. 3 Operating rooms (OR) are ideal targets for quality improvement work, as costs are measured per minute and revenue is measured per case. Bias in predicting actual time in the OR can lead to underutilization or over utilization of OR time and OR inefficiency.…”

Section: Introductionmentioning

confidence: 99%

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Timely completion of spinal fusion: A multidisciplinary quality improvement initiative to improve operating room efficiency

Chidambaran

Kara

et al. 2022

Pediatric Anesthesia

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Background: Failure to complete surgery within the scheduled timeframe impairs operating room efficiency leading to patient dissatisfaction and unplanned labor costs.We sought to improve timely completion (within 30 min of scheduled time) of firstcase spine fusion surgery (for idiopathic scoliosis) from a baseline of 25%-80% over 12 months. We also targeted timely completion of perioperative stages within predetermined target completion times. Methods: The project was conducted in three overlapping phases over 16 months. A simplified process map outlining five sequential perioperative stages, preintervention baselines (N = 24) and time targets were defined. A multidisciplinary team conducted a series of tests of change addressing the aims. The key drivers included effective scheduling, team communications, family engagement, data collection veracity, standardized pathways, and situational awareness. Data collected by an independent data collector and from electronic medical records were analyzed using control charts and statistical process control methods. Results: Post-intervention, timely case completion increased from 25% to 68% (N = 49) (95% CI 15.1-62.7), (p = 0.003) and was sustained (N = 14). Implementation of prediction model for case-scheduling decreased difference between scheduled and actual case end-time (33 vs. 53 min [baseline]) and variance [lower/upper control limits ([−26, 51] vs. [−109, 216] min [baseline]). Average start time delay decreased from 6to 2 min and on-time surgical starts improved from 50% to 70% (95% CI 3.2-41.6%). Timely completion increased for anesthesia induction (60% to 85%), surgical procedure (26% to 48%) and emergence from anesthesia (44% to 80%) but not for intraoperative patient preparation (30% to 25%) perioperative stages. Families reported satisfaction with preoperative processes (N = 14), and no untoward intraoperative safety events occurred.Conclusions: Application of QI methodology reduced time variation of several tasks and improved timely completion of spine surgery. Beyond the study period, sustained team behavior, adaptive changes, and vigilant monitoring are imperative for continued success.

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Measuring Pectus Excavatum Severity, External Caliper, or Cross-Sectional Imaging: Family Perceptions

Green,

Ramos-Gonzalez,

DeRosa

et al. 2024

Journal of Surgical Research

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Patient and Family Experience in the Healthcare Value Equation

Cited by 6 publications

References 27 publications

Design and implementation of a novel patient-centered empowerment approach for pain optimisation in children undergoing major surgery

Design and implementation of a novel patient-centered empowerment approach for pain optimisation in children undergoing major surgery

Timely completion of spinal fusion: A multidisciplinary quality improvement initiative to improve operating room efficiency

Measuring Pectus Excavatum Severity, External Caliper, or Cross-Sectional Imaging: Family Perceptions

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