Does feedback influence patient - professional communication? Empirical evidence from Italy

Evaluation of Discharge Training Given to Patients Undergoing Revascularization

PURPOSE

This study aimed to evaluate the discharge training given by nurses to patients who underwent revascularization.

DESIGN

The single-centered study had a descriptive design.

METHODS

The study was conducted with 73 nurses in Turkey between February and March 2022. The data were collected using an information form regarding socio-demographic characteristics and a questionnaire that questions the discharge training given to the patients who underwent revascularization. The questionnaire consists of eight.ßclassification-type (nominal) questions. Permission for the study was received from the Non-Invasive Clinical Research Ethics Committee and voluntary consent was obtained from the participants.

FINDINGS

46.6% of study participants were in the 20 to 30 age group; 61.6% were employed in the cardiology service; 50.7% received in-service training on the care of patients undergoing cardiac catheterization. There were differences in practices regarding discharge training among nurses by gender, age, unit of work, and source of access to information.ß(P.ß<.ß.05). When the discharge training and practices of the nurses who gave discharge training to their patients were evaluated, the nurses scored 6.71.ß...ß2.23 and performed well above the average.

CONCLUSIONS

Female nurses aged 41 and over, working in the revascularization laboratory, and reading the relevant literature performed postrevascularization patient discharge training practices at a higher level compared to other nurses. The importance of nurses' field specialization training, advancing age with working years, experience, and access to current literature for better patient care is emphasized.

Including patient-reported measures in performance evaluation systems: Patient contribution in assessing and improving the healthcare systems

In healthcare, the introduction of quality standards and indicators to assess performance triggered the development of multidimensional Performance Management Systems (PMSs). The concept of performance in healthcare has recently evolved and broadened its scope. One of the current challenges of PMSs is measuring and integrating the patient perspective into traditional measures. In the regional healthcare system of Tuscany (Italy), a PMS has been implemented and used since 2005. The PMS counts on the systematic involvement of clinicians and managers. Furthermore, the PMS also includes patients' perspective. Moreover, Tuscany has recently implemented the first regional permanent Patient-Reported Outcome and Experience Measures (PROMs and PREMs) Observatory in Italy. This paper presents the results of an action research aimed at analysing the integration of patient-reported outcome and experience indicators into a consolidated PMS. The study describes the process of identifying and discussing of patient-reported indicators with practitioners and categorising findings into three domains: design of patient-reported indicators, integration process into the PMS, and goal of adoption of the patient-related indicators. The paper also describes facilitators, challenges, and lessons learnt with respect to organisational, methodological, cultural, and responsibility-linked factors. The study discusses the ability to agree on how to transform patient data, especially PROMs, into effective performance indicators. The integration of patient-reported indicators into the PMS poses two main challenges: one in terms of sustainability of the performance system itself, and another regarding the attribution of the responsibility for patient outcomes between care settings and providers. This paper provides initial insights on how the integration of patient-reported indicators can make PMSs more inclusive and focussed on the patient-centred perspective.

Health system responsiveness: a systematic evidence mapping review of the global literature

BACKGROUND

The World Health Organisation framed responsiveness, fair financing and equity as intrinsic goals of health systems. However, of the three, responsiveness received significantly less attention. Responsiveness is essential to strengthen systems' functioning; provide equitable and accountable services; and to protect the rights of citizens. There is an urgency to make systems more responsive, but our understanding of responsiveness is limited. We therefore sought to map existing evidence on health system responsiveness.

METHODS

A mixed method systemized evidence mapping review was conducted. We searched PubMed, EbscoHost, and Google Scholar. Published and grey literature; conceptual and empirical publications; published between 2000 and 2020 and English language texts were included. We screened titles and abstracts of 1119 publications and 870 full texts.

RESULTS

Six hundred twenty-one publications were included in the review. Evidence mapping shows substantially more publications between 2011 and 2020 (n = 462/621) than earlier periods. Most of the publications were from Europe (n = 139), with more publications relating to High Income Countries (n = 241) than Low-to-Middle Income Countries (n = 217). Most were empirical studies (n = 424/621) utilized quantitative methodologies (n = 232), while qualitative (n = 127) and mixed methods (n = 63) were more rare. Thematic analysis revealed eight primary conceptualizations of 'health system responsiveness', which can be fitted into three dominant categorizations: 1) unidirectional user-service interface; 2) responsiveness as feedback loops between users and the health system; and 3) responsiveness as accountability between public and the system.

CONCLUSIONS

This evidence map shows a substantial body of available literature on health system responsiveness, but also reveals evidential gaps requiring further development, including: a clear definition and body of theory of responsiveness; the implementation and effectiveness of feedback loops; the systems responses to this feedback; context-specific mechanism-implementation experiences, particularly, of LMIC and fragile-and conflict affected states; and responsiveness as it relates to health equity, minority and vulnerable populations. Theoretical development is required, we suggest separating ideas of services and systems responsiveness, applying a stronger systems lens in future work. Further agenda-setting and resourcing of bridging work on health system responsiveness is suggested.

What does the patient have to say? Valuing the patient experience to improve the patient journey

Background

Patient-reported data—satisfaction, preferences, outcomes and experience—are increasingly studied to provide excellent patient-centred care. In particular, healthcare professionals need to understand whether and how patient experience data can more pertinently inform the design of service delivery from a patient-centred perspective when compared with other indicators. This study aims to explore whether timely patient-reported data could capture relevant issues to improve the hospital patient journey.

Methods

Between January and February 2019, a longitudinal survey was conducted in the orthopaedics department of a 250-bed Italian university hospital with patients admitted for surgery; the aim was to analyse the patient journey from the first outpatient visit to discharge. The same patients completed a paper-and-pencil questionnaire, which was created to collect timely preference, experience and main outcomes data, and the hospital patient satisfaction questionnaire. The first was completed at the time of admission to the hospital and at the end of hospitalisation, and the second questionnaire was completed at the end of hospitalisation.

Results

A total of 254 patients completed the three questionnaires. The results show the specific value of patient-reported data. Greater or less negative satisfaction may not reveal pathology-related needs, but patient experience data can detect important areas of improvement along the hospital journey. As clinical conditions and the context of care change rapidly within a single hospital stay for surgery, collecting data at two different moments of the patient journey enables researchers to capture areas of potential improvement in the patient journey that are linked to the context, clinical conditions and emotions experienced by the patient.

Conclusion

By contributing to the literature on how patient-reported data could be collected and used in hospital quality improvement, this study opens the debate about the use of real-time focused data. Further studies should explore how to use patient-reported data effectively (including what the patient reports are working well) and how to improve hospital processes by profiling patients’ needs and defining the appropriate methodologies to capture the experiences of vulnerable patients. These topics may offer new frontiers of research to achieve a patient-centred healthcare system.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06341-3.

Systematic and continuous collection of patient-reported outcomes and experience in women with cancer undergoing mastectomy and immediate breast reconstruction: a study protocol for the Tuscany Region (Italy)

INTRODUCTION

Monitoring how patients feel and what they experience during the care process gives health professionals data to improve the quality of care, and gives health systems information to better design and implement care pathways. To gain new insights about specific gaps and/or strengths in breast cancer care, we measure patient-reported outcomes (PROs) and patient-reported experiences (PREs) for women receiving immediate breast reconstruction (iBR).

METHODS AND ANALYSIS

Prospective, multicentre, cohort study with continuous and systematic web-based data collection from women diagnosed with breast cancer, who have an indication for iBR after mastectomy treated at any Breast Unit (BU) in Tuscany Region (Italy). Patients are classified into one of two groups under conditions of routine clinical practice, based on the type of iBR planned (implant and autologous reconstruction). Patient-reported information are obtained prior to and after surgery (at 3-month and 12-month follow-up). We estimate that there are around 700 annual eligible patients.Descriptive analyses are used to assess trends in PROs over time and differences between types of iBR in PROs and PREs. Additionally, econometric models are used to analyse patient and BU characteristics associated with outcomes and experiences. PREs are evaluated to assess aspects of integrated care along the care pathway.

ETHICS AND DISSEMINATION

The study has been reviewed and obtained a nihil obstat from the Tuscan Ethics Committees of the three Area Vasta in 2017. Dissemination of results will be via periodic report, journal articles and conference presentations.

Quality of Healthcare in Acute Pediatric Care Unit in a Tertiary Hospital in Tanzania: A Case of Muhimbili National Hospital

Background: Quality of care in a critical care unit is vital for the outcomes of critically ill people and especially children, who are more at risk. Although evidence is mixed, only a handful remains documented about the role of quality of care among children in the context of tertiary hospitals of low-income countries such as Tanzania. This study therefore assessed the quality of healthcare in Acute Pediatric Care Unit (APCU) at Muhimbili National Hospital in Tanzania over 3 months. Methodology: This mixed method cross sectional study employed both qualitative and quantitative approaches to gather data from 107 participants that included caregivers of children admitted, and healthcare providers in APCU at MNH. Components of the Donabedian model were used to assess quality of care. Descriptive analyses was conducted for quantitative data while thematic analyses was conducted for qualitative data. Results: A total of 24 (26.7%) of the children admitted in APCU died in the 3-month period of data collection. Of them, 41.7% died during the first 24 h of admission. The median duration of APCU admission was 5 days. Despite the noted challenges, most of the caregivers were very satisfied 34 (37.8%) or satisfied 22 (24.4%) with the quality of services provided. The physical setting in APCU had the basic requirements for management of critically ill children but was insufficient in infrastructure; healthcare providers trained in critical care and updated treatment guidelines amongst others. We noted inadequacy in on-job training of health workers, feedback process, and obvious delays in the referral system. Conclusions and Recommendations: Although one in four children admitted in the APCU at MNH died, the overall quality of care in this tertiary referral hospital was modest as it achieved the minimum acceptable standards. To enhance quality of care, it is vital to improve infrastructure, update treatment guidelines, train staff in critical care and improve the feedback process especially during emergencies and deaths.

The role of collective labor contracts and individual characteristics on job satisfaction in Tuscan nursing homes

Background:

The role played by remuneration strategies in motivating health care professionals is one of the most studied factors. Some studies of nursing home (NH) services, while considering wages and labor market characteristics, do not explicitly account for the influence of the contract itself.

Purpose:

This study investigates the relationship between the labor contracts applied in 62 Tuscan NHs and NH aides’ job satisfaction with two aims: to investigate the impact of European contracts on employee satisfaction in health care services and to determine possible limitations of research not incorporating these contracts.

Methodology:

We apply a multilevel model to data gathered from a staff survey administered in 2014 to all employees of 62 NHs to analyze two levels: individual and NH. Labor contracts were introduced into the model as a variable of NH.

Results:

Findings show that the factors influencing nursing aides’ satisfaction occur at both the individual and NH levels. Organizational characteristics explain 16% of the variation. For individual characteristics, foreign and temporary workers emerge as more satisfied than others. For NH variables, results indicate that the labor contract with the worst conditions is not associated with lower workers’ satisfaction.

Conclusion:

Although working conditions play a relevant role in the job satisfaction of aides, labor contracts do not seem to affect it. Interestingly, aides of the NHs with the contract having the best conditions register a significantly lower level of satisfaction compared to the NHs with the worst contract conditions. This suggests that organizational factors such as culture, team work, and other characteristics, which were not explicitly considered in this study, may be more powerful sources of worker satisfaction than labor contracts.

Practice Implications:

Our analysis has value as a management tool to consider alternative sources as well as the labor contract for employee incentives.

Explaining performance in health care: How and when top management competencies make the difference

One of the most distinctive management competencies is related to the ability to structure the strategic vision, develop long-term plans, and communicate them efficiently to the employees in order to empower them to enact. These managerial competencies in complex organizations are strongly related to the capacity to engage professionals as a predictor of high-performing organizations.

Using patient-reported measures to drive change in healthcare: the experience of the digital, continuous and systematic PREMs observatory in Italy

BACKGROUND

The use of Patient Reported Experience Measures (PREMs) has great potential in healthcare service improvement, but a limited use. This paper presents an empirical case of PREMs innovation in Italy, to foster patient data use up to the ward level, by keeping strengths and addressing weaknesses of previous PREMs survey experiences. The paper reports key lessons learned in this ongoing experience of action research, directly involving practitioners.

METHODS

The aim of this paper is to present the results of an ongoing action research, encompassing the innovation of PREMs collection, reporting and use, currently adopted by 21 hospitals of two Italian regions. The continuous and systematic PREMs collection has been implemented between 2017 and 2019 and includes: a continuous web-based administration, using web-services; an augmented and positive questionnaire matching standard closed-ended questions with narrative sections; the inclusion and benchmarking of patient data within a shared performance evaluation system; public disclosure of aggregated anonymized data; a multi-level and real-time web-platform for reporting PREMs to professionals. The action research was carried out with practitioners in a real-life and complex context. The authors used multiple data sources and methods: observations, feedback of practitioners, collected during several workshops and meetings, and analysis of preliminary data on the survey implementation.

RESULTS

A continuous and systematic PREMs observatory was developed and adopted in two Italian regions. PREMs participation and response rates tend to increase over time, reaching stable percentages after the first months. Narrative feedback provide a 'positive narration' of episodes and behaviours that made the difference to patients and can inform quality improvement actions. Real-time reporting of quantitative and qualitative data is enabling a gratifying process of service improvement and people management at all the hospitals' levels.

CONCLUSIONS

The PREMs presented in this paper has been recognized by healthcare professionals and managers as a strategic and positive tool for improving an actual use of PREMs at system and ward levels, by measuring and highlighting positive deviances, such as compassionate behaviours.

The Being Taken Seriously Questionnaire-Development and Psychometric Evaluation of a PREM Measure for Person-Centeredness in a High-Tech Hospital Environment

There is a need for patient-reported experience measures (PREMs) in high-tech hospital environments based on the philosophy of person-centeredness. The aim of this study was to describe the development and initial psychometric evaluation of a measure of person-centeredness by means of being taking seriously. In this cross-sectional survey, the study sample (n = 79) completed two measures, the Being Taken Seriously Questionnaire—Patient version (BTSQ-P) which was the measure undergoing psychometric evaluation, and the Person-Centered Climate Questionnaire—Patient version (PCQ-P) that was used to evaluate the climate in which the intervention was occurring. The expected scale dimensionality was examined both by the confirmatory multi-trait analysis program and by explorative principal component analysis (with oblique, varimax rotation). Scale reliability was estimated using ordinal alpha and Cronbach’s alpha. One solid factor was generated. This factor had good internal convergent validity and good item–scale reliability, covering 80.41% of the variance. The interitem correlation ranged from 0.759 to 0.908 and the alpha was 0.93 (ordinal alpha) and 0.87 (Cronbach’s alpha) respectively. There was a strong relationship between BTSQ-P and the PCQ-P dimension safety climate. In conclusion, the internal consistency, reliability and concurrent validity of the BTSQ-P was satisfactory for use in a high-tech hospital environment.

Footprints of Birth: An Innovative Educational Intervention Foregrounding Women's Voices to Improve Empathy and Reflective Practice in Maternity Care

INTRODUCTION

A global movement on respectful maternity care has arisen because of widespread accounts of dehumanized maternity care. This article considers the use of a transformative learning approach to highlight patient agency and personhood in health care. An educational intervention using patient narratives was introduced in a maternity unit to foster a culture of listening and responsiveness to women's voices. This article reports the impact on staff and student learning, empathy, and reflective practice.

METHODS

A total of 245 interprofessional providers participated in 14 workshops over a 16-month period. Participants represented a range of health professions including medicine, midwifery, nursing, and allied professions. Senior management, administrators, and peer support volunteers also attended. Session sizes ranged from 5 to 60 attendees. The format included documentary-style videos of patient feedback followed by audience discussion. Discussion points were collected and qualitatively analyzed for participants' critical reflection, emotional engagement, cognitive dissonance, and perspective transformation.

RESULTS

Learners reflected on the client-caregiver relationship and care provision. Staff and students showed empathy for the women sharing their stories. Learners were disturbed by failings in care and wished to improve services. All provider groups highlighted the importance of communication, compassion, and patient autonomy as key elements of maternity care.

DISCUSSION

Multiprofessional learners engaged emotionally with women's narratives and reflected critically on their roles in maternity care. Learners' responses showed evidence of transformative learning. Staff and students recognized the value of providing respectful, empathic care. Educational interventions highlighting patients' voices may promote patient autonomy by reducing dehumanization in health care.

Implementing successful systematic Patient Reported Outcome and Experience Measures (PROMs and PREMs) in robotic oncological surgery-The role of physicians

Patient Reported Outcome and Experience Measures (PROMs and PREMs) play an increasingly important role in monitoring the quality of the oncological pathway. The aim of this study is to describe the case of five hospitals a year after the adoption of PROMs and PREMs for robotic oncological colorectal surgery in Tuscany and to investigate how the clinicians can impact the process of implementation and the efficacy of such measures. We used 14 months of data from the five robotic centers in Tuscany. Above all, the physician's personal motivation to improve the treatment of patients, the teamwork, and the possibility to use data for research purposes proved to be the essential factors for their engagement and the successful implementation of patient reported measures. Physicians play a key role in the adoption of systematic PROMs and PREMs. The higher their level of engagement, the higher the collection success, both in terms of number of patients enrolled and response rates. Moreover, the collection of patient reported measures may become part of physicians' daily practice and may lead to a change in their relationship and communication with patients, as clinicians accept to have their job reviewed and are not afraid to be evaluated by their patients.

Reputations count: why benchmarking performance is improving health care across the world

This paper explores what motivates improved health care performance. Previously, many have thought that performance would either improve via choice and competition or by relying on trust and altruism. But neither assumption is supported by available evidence. So instead we explore a third approach of reciprocal altruism with sanctions for unacceptably poor performance and rewards for high performance. These rewards and sanctions, however, are not monetary, but in the form of reputational effects through public reporting of benchmarking of performance. Drawing on natural experiments in Italy and the United Kingdom, we illustrate how public benchmarking can improve poor performance at the national level through ‘naming and shaming’ and enhance good performance at the sub-national level through ‘competitive benchmarking’ and peer learning. Ethnographic research in Zambia also showed how reputations count. Policy-makers could use these effects in different ways to improve public services.

Patient satisfaction, patients leaving hospital against medical advice and mortality in Italian university hospitals: a cross-sectional analysis

Background

Healthcare systems are increasingly focusing on outcomes that are the endpoints of care: patient health status and patient satisfaction. The availability of patient satisfaction (PS) data has encouraged research on its relationship with other outcomes, such as mortality. In Italy, an inter-regional performance evaluation system (IRPES) provides 13 regional healthcare systems with a multidimensional assessment of appropriateness, efficiency, financial sustainability, effectiveness, and equity. For university hospitals, IRPES includes the percentage of patients leaving hospital against medical advice (PLHAMA) and mortality rates at the ward level. This paper investigates the relationship between PS and PLHAMA across and within regional healthcare systems in Italy. Secondly, PLHAMA is used as a PS proxy to investigate its relationship with mortality at the ward level in the IRPES university hospitals.

Methods

PLHAMA and mortality rates were gathered from administrative data, and PS scores from patient surveys. We explored the association between PS and PLHAMA through a correlation analysis, using data for the 13 IRPES regions. We tested this relationship also at the clinical directorate level in 28 hospitals in Tuscany (5482 interviewed patients in 100 clinical directorates). Secondly, we explored the association between PLHAMA and mortality at the ward level through correlation and regression analyses, using data of 405 wards of eight clinical specialties within 24 IRPES university hospitals.

Results

Lower PLHAMA rates were associated with a higher PS in both regional and clinical directorate levels. A positive association between PLHAMA and mortality was shown at the ward level for IRPES university hospitals, with different results for medical and surgical clinical specialties.

Conclusions

PS is an important performance dimension that provides healthcare managers and professionals with useful insights for improving care quality and effectiveness. Based on the study results, the PLHAMA rate could be regularly measured to highlight patient dissatisfaction. Due to the association between PLHAMA and mortality, this study also provides evidence of the importance of the patient perspective in assessing the quality of healthcare services. This relationship proved to be significant for surgical clinical units, suggesting the need for further analysing outcomes considering their different determinants in medical and surgical care.

Is the co-location of GPs in primary care centres associated with a higher patient satisfaction? Evidence from a population survey in Italy

Background

Several countries have co-located General Practitioners (GPs) in Primary Care Centres (PCCs) with other health and social care professionals in order to improve integrated care. It is not clear whether the co-location of a multidisciplinary team actually facilitates a positive patient experience concerning GP care. The aim of this study was to verify whether the co-location of GPs in PCCs is associated positively with patient satisfaction with their GP when patients have experience of a multidisciplinary team. We also investigated whether patients who frequently use health services, due to their complex needs, benefitted the most from the co-location of a multidisciplinary team.

Methods

The study used data from a population survey carried out in Tuscany (central Italy) at the beginning of 2015 to evaluate the patients’ experience and satisfaction with their GPs. Multilevel linear regression models were implemented to verify the relationship between patient satisfaction and co-location. This key explanatory variable was measured by considering both the list of GPs working in PCCs and the answers of surveyed patients who had experienced the co-location of their GP in a multidisciplinary team. We also explored the effect modification on patient satisfaction due to the use of hospitalisation, access to emergency departments and visits with specialists, by performing the multilevel modelling on two strata of patient data: frequent and non-frequent health service users.

Results

A sample of 2025 GP patients were included in the study, 757 of which were patients of GPs working in a PCC. Patient satisfaction with their GP was generally positive. Results showed that having a GP working within a PCC and the experience of the co-located multidisciplinary team were associated with a higher satisfaction (p < 0.01). For non-frequent users of health services on the other hand, the co-location of multidisciplinary team in PCCs was not significantly associated with patient satisfaction, whereas for frequent users, the strength of relationships identified in the overall model increased (p < 0.01).

Conclusion

The co-location of GPs with other professionals and their joint working as experienced in PCCs seems to represent a greater benefit for patients, especially for those with complex needs who use primary care, hospitals, emergency care and specialized care frequently.

How to set challenging goals and conduct fair evaluation in regional public health systems. Insights from Valencia and Tuscany Regions

The definition of "the right targets" and the way the evaluation of results is performed affect the willingness to commit to new challenges, which is a factor that influences the relationship between goal setting and performance results. Indeed, some authors claim that the choice of an inappropriate goal-setting procedure is a major cause of failure of management control systems. Goal setting theorists found that assigning a specific and challenging goal leads to higher performance than (a) an easy goal, (b) a general goal or (c) no goal setting. Despite this evidence, yet, few proposals concern the definition of what is "challenging". This paper focuses on two issues: (a) what is to be considered a challenging goal and (b) what is a "fair evaluation" in the health care sector. This work suggests that benchmarking is a valid support to solve the previous dilemmas. Relying on two Regional European advanced experiences - Valencia in Spain and Tuscany in Italy -, this paper aims to provide conceptual methods that can help managers define challenging goals and conduct fair evaluation about their achievement. Although these Regions adopted different governance models, both of them applied very similar techniques, which seem to be associated to an improvement of their performance and a reduction of unwarranted variation.