Using a national archive of patient experience narratives to promote local patient-centered quality improvement: an ethnographic process evaluation of ‘accelerated’ experience-based co-design

Locock, Louise; Robert, Glenn; Boaz, Annette; Vougioukalou, Sofia; Shuldham, Caroline; Fielden, Jonathan; Ziébland, Sue; Gager, Melanie; Tollyfield, Ruth; Pearcey, John

doi:10.1177/1355819614531565

Cited by 88 publications

(133 citation statements)

References 22 publications

Supporting

Mentioning

130

Contrasting

Order By: Relevance

“…The search strategies yielded 1,204 articles total. In assessing the methodological quality of the 18 articles included in the review, nine articles scored > 20 (ranging 20 ‐ 23) for “good” quality, and nine scored “fair” (ranging 11‐19) . Weaknesses were noted in several studies.…”

Section: Methodsmentioning

confidence: 99%

“…In an outpatient rheumatology service, “the process [allows] patients to directly contribute to shaping the services they receive long‐term and realizing their opinions were of value to clinical staff and hospital management.” QI priorities within a microsystem can be identified when patients and health‐care professionals exchange stories and experiences in face‐to‐face meetings, co‐design discussions and jointly prioritize improvement efforts. Such an approach indicates the importance of prioritizing and conducting QI, and, in turn, this reasoning may promote QI effort sustainability …”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

How might patient involvement in healthcare quality improvement efforts work—A realist literature review

Bergerum

Thor

Josefsson

et al. 2019

Health Expectations

View full text Add to dashboard Cite

IntroductionThis realist literature review, regarding active patient involvement in healthcare quality improvement (QI), seeks to identify possible mechanisms that contribute to success or failure. Furthermore, the paper outlines key considerations for organizing and supporting patient involvement in healthcare QI efforts.MethodsTwo literature searches were performed. Altogether, 1204 articles from a healthcare context were screened, focusing on improvement efforts that involve patients, healthcare professionals and/or managers and leaders. Among these, 107 articles fulfilled the chosen study selection criteria and were further analysed. Eighteen articles underwent a full realist review. In the realist synthesis, context‐mechanism‐outcome configurations were articulated as middle‐range theories and organized thematically to generate a program theory on how active patient involvement in QI efforts might work.ResultsThe articles exhibited a diversity of patient involvement approaches at different levels of healthcare organizations. To be successful, organizations’ support of QI efforts that actively involved patients tailored the QI efforts to their context to achieve the desired outcomes, and involved the relevant microsystem members. Furthermore, it promoted interaction and partnership within the microsystem, and supported the behavioural change that follows.ConclusionThis realist synthesis generates a program theory for active patient involvement in QI efforts; active patient involvement can be a tool (resource), if tailored for interaction and partnership (reasoning), that leads to behaviour change (outcome) within healthcare QI efforts. The theory explains essential resource and reasoning mechanisms, and outcomes that together form guidance for healthcare organizations when managing active patient involvement in QI efforts.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

How might patient involvement in healthcare quality improvement efforts work—A realist literature review

Bergerum

Thor

Josefsson

et al. 2019

Health Expectations

View full text Add to dashboard Cite

show abstract

“…Furthermore, there is said to be a ‘chasm’ between hospital management and frontline clinicians with the former investing heavily in providing the means to collect patient feedback but providing little structure in how the latter can act on this data to improve patient experience (Rozenblum et al., 2013). It has been said that an ever growing battery of targets, tools, metrics and inspections simply allows organisations to measure how compassionate their staff are rather than the task of changing the culture to enable more compassionate care to be delivered (Locock et al., 2014). Expansion of metrics to measure quality, safety and experience could become counterproductive with the unintended consequence being that they “add more to the noise without amplifying the signal” (Martin et al., 2015).…”

Section: Introductionmentioning

confidence: 99%

The Patient Feedback Response Framework – Understanding why UK hospital staff find it difficult to make improvements based on patient feedback: A qualitative study

Sheard¹,

Marsh²,

O’Hara

et al. 2017

Social Science & Medicine

126

View full text Add to dashboard Cite

Patients are increasingly being asked for feedback about their healthcare experiences. However, healthcare staff often find it difficult to act on this feedback in order to make improvements to services. This paper draws upon notions of legitimacy and readiness to develop a conceptual framework (Patient Feedback Response Framework – PFRF) which outlines why staff may find it problematic to respond to patient feedback.A large qualitative study was conducted with 17 ward based teams between 2013 and 2014, across three hospital Trusts in the North of England. This was a process evaluation of a wider study where ward staff were encouraged to make action plans based on patient feedback. We focus on three methods here: i) examination of taped discussion between ward staff during action planning meetings ii) facilitators notes of these meetings iii) telephone interviews with staff focusing on whether action plans had been achieved six months later. Analysis employed an abductive approach.Through the development of the PFRF, we found that making changes based on patient feedback is a complex multi-tiered process and not something that ward staff can simply ‘do’. First, staff must exhibit normative legitimacy – the belief that listening to patients is a worthwhile exercise. Second, structural legitimacy has to be in place – ward teams need adequate autonomy, ownership and resource to enact change. Some ward teams are able to make improvements within their immediate control and environment. Third, for those staff who require interdepartmental co-operation or high level assistance to achieve change, organisational readiness must exist at the level of the hospital otherwise improvement will rarely be enacted. Case studies drawn from our empirical data demonstrate the above. It is only when appropriate levels of individual and organisational capacity to change exist, that patient feedback is likely to be acted upon to improve services.

show abstract

“…Qualitative approaches may be judged to offer greater depth of feedback than quantitative approaches, 45 but such approaches are intensive in respect of data collection, although Locock et al 46 have drawn on secondary analysis of a large national qualitative data archive to inform service improvements.…”

Section: Capturing Patient Experience Of Carementioning

confidence: 99%

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Burt

Campbell

Abel

et al. 2017

Programme Grants Appl Res

View full text Add to dashboard Cite

BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

show abstract

Using a national archive of patient experience narratives to promote local patient-centered quality improvement: an ethnographic process evaluation of ‘accelerated’ experience-based co-design

Abstract: Accelerated EBCD offers a rigorous and relatively cost-effective patient-centered quality improvement approach.

Cited by 88 publications

References 22 publications

How might patient involvement in healthcare quality improvement efforts work—A realist literature review

How might patient involvement in healthcare quality improvement efforts work—A realist literature review

The Patient Feedback Response Framework – Understanding why UK hospital staff find it difficult to make improvements based on patient feedback: A qualitative study

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Contact Info

Product

Resources

About