Improving healthcare service quality through performance management

Assessing the Impact of a Service Excellence Program on Improving Patient Experience at Primary Health Care Centers

BACKGROUND

Frontline clinical staff play a crucial role in shaping patient experience and, therefore, require adequate training and education to deliver exceptional service. This study aimed to assess the impact of a service excellence and quality training program on frontline clinical staff's knowledge, perception, and attitude toward patient experience and service excellence. We also examined the effect of this intervention on patient experience scores.

METHODS

This study utilized a pre-post intervention design, where frontline clinical staff completed a questionnaire to establish baseline "knowledge and perception scores" and "attitude scores" related to patient experience. The same questionnaire was administered after the training program to measure any changes in scores. Patient experience scores were collected from existing data, comparing results from different quarters before and after the intervention. The training and education program covered various components, including effective communication, empathy, service standards, and service recovery.

RESULTS

A total of 256 staff members, including nurses, physicians, and allied healthcare professionals, participated in the training program. The study found statistically significant improvements in all components of staff knowledge, perception, and attitude. Specifically, there was a median improvement in knowledge and perception scores, which increased from 77.2% to 96.5%. Additionally, attitude scores showed a median improvement from 73.8% to 92.5%. Moreover, the overall patient experience score increased from 62% to 72.4%.

CONCLUSION

The study revealed significant improvements in staff knowledge, perception, and attitude, along with enhanced patient experience scores. These findings suggest a potential role for targeted interventions in enhancing patient experience and supporting ongoing quality improvement in primary healthcare settings.

A scale for measuring healthcare service quality incorporating patient-centred care and using a psychometric analytics framework

PURPOSE

Recent developments in healthcare contexts increasingly emphasize patient-centred approaches to service quality measures; however, few studies consider this dimension explicitly. The present study develops and psychometrically validates a scale of healthcare service quality explicitly incorporating a patient-centred care dimension from a communicational perspective. The paper also enriches the traditional content of service quality by including equity items and presents the underlying structure of service quality in an emerging country.

DESIGN/METHODOLOGY/APPROACH

The final sample consisted of 869 healthcare users (complete cases in the service quality items derived from 917 surveys received) from Colombia. The authors used a psychometric analytics framework comprising seven processes incorporating exploratory factor analysis, structural equation modelling, and machine learning methods to examine construct plausibility, reliability, construct validity, equity, and criterion/predictive validity (e.g. explaining/predicting subjective well-being and behavioural intentions).

FINDINGS

The final scale consists of 17 items and satisfies all psychometric properties. Its validation allows for the discovery and psychometrical confirmation of two essential dimensions: patient-centred communication (eight items) and process quality (nine items).

PRACTICAL IMPLICATIONS

The authors illustrate three practical uses of the scale: the possibility for diagnoses; hypothesis contrast based on confidence intervals; and estimation of the capacity of the service to satisfy specifications.

ORIGINALITY/VALUE

Both dimensions reveal users' relevant needs and complement previous studies that have focused on process aspects of healthcare service quality.

Lessons from mandated implementation of a performance management system

PURPOSE

Lean-inspired approaches and performance management systems are being implemented in public healthcare organisations internationally. However, the literature is inconclusive regarding the benefits of these management tools and there is a lack of knowledge regarding processes for large-scale implementation of these tools. This article aims to describe the implementation process and to better understand how this process influences the mandated performance management system.

DESIGN/METHODOLOGY/APPROACH

This research is based on a comparative case study of three healthcare organisations in Canada. Data consist documents, non-participant observation and semi-structured interviews with key actors (n = 30). Analysis is based on a sociotechnical approach to management tools that considers organisational context, and the tool's technical substrate, theory of action and managerial philosophy.

FINDINGS

Results show that despite a standardised national mandate, the tool as implemented varied between organisations in terms of technical substrate and managerial philosophy. These variations are explained by the flexibility of the technical substrate, the lack of clarity of the managerial philosophy, and some contextual elements. Successful implementation may rest upon high hybridization of the tool on these different dimensions. A precise and prescribed technical substrate is not sufficient to guarantee implementation of a managerial philosophy.

PRACTICAL IMPLICATIONS

Mandated implementation of management tools may be more successful if it is explicit on the managerial philosophy, the technical substrate and the link between the two, and if it provides some leeway to adapt both to the organisational context.

ORIGINALITY/VALUE

This is one of the few studies to describe and analyse the process involved in mandated large-scale implementation of performance management systems in public healthcare organisations.

Trust in Intensive Care Patients, Family, and Healthcare Professionals: The Development of a Conceptual Framework Followed by a Case Study

Intensive care patients experience anxiety, pain, uncertainty, and total dependency. In general, it is important to develop trust between the healthcare professionals (HCPs), patients, and their family. Trust building in the ICU setting is challenging because of the time sensitivity of decision making and the dependency of patients on health care professionals. The objectives of this study are the development of a trust framework and then to use this framework in a case study in the intensive care. In three steps we developed a comprehensive trust framework from the literature concerning trust. First, we identified the elements of trust. Second, we adapted and integrated the dimensions to six concepts to construct the trust framework. Third, these concepts are incorporated into a comprehensive trust framework. In a case study we explored the facilitators and barriers within this framework in eight semi-open interviews with healthcare professionals and eight patients or partners. Trust was first explored inductively and then deductively. We showed that HCPs, patients, and family have largely the same perspective regarding the facilitators of trust, in which communication emerged as the most important one. Other facilitators are maintaining an open feedback culture for HCPs and being aware of patients' physical and informational privacy. Patients want to be approached as an individual with individual needs. Dishonesty and differences in values and norms were the most important barriers. To contribute to a positive perception of health delivery and to avoid conflicts between HCP and patients or their family we formulated five practical recommendations.

Redesigning primary care in an academic medical center: lessons, challenges, and opportunities

PURPOSE

To evaluate patient access, provider productivity, and patient satisfaction during a 24-month redesign process of an academic medical center, which requires balance between clinical and educational missions.

METHODS

A series of activities were conducted to optimize primary care across 17 attending physicians, 6 Advanced Practice Providers (APPs), and 39 residents. Patient access was defined as the next available appointment for either existing/established patients or new patients. Productivity was measured using panel sizes for each provider. Patient satisfaction was based on the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS).

RESULTS

Despite decreasing clinical effort to allow faculty and APPs to participate in education and research, there was an overall increase in access for both new and established patients, and an increase the percent of each providers' panel that was full from 78.89% in 2017 to 115.29% in 2019. When comparing panel sizes for the 11 faculty present before and after strategic changes, we found significant increase in both overall panel size, and actual to expected ratios between 2017 and 2019. In addition, throughout the time period, patient satisfaction remained high with no significant changes.

CONCLUSIONS

While this project was limited to one site, the inclusion of a set of well-planned metrics, and tracking of processes over time can provide insight for ongoing primary care redesign efforts at similar sites seeking to balance the academic mission with clinical productivity and high patient satisfaction.