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Purwaningsih P, Nasronudin N, Damayanti NA, Mahmudah M, Andarini S, Qomarudin B, Chalidyanto D, Yuwono SR, Septanto AN, Zulkarnain H. Development of a Hospital-Stakeholder Collaboration Tool Using Mixed Methods to Assess Stakeholder Perspectives for Hospital Service Improvement. Ethiop J Health Sci 2023; 33:1075-1086. [PMID: 38784495 PMCID: PMC11111266 DOI: 10.4314/ejhs.v33i6.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/10/2023] [Indexed: 05/25/2024] Open
Abstract
Background The purpose of this study was to develop the Hospital-Stakeholder Collaboration (HSC) Tool and Hospital Performance Factor (HPF) Tool to explore stakeholder perception and value for hospital service improvement. Methods This exploratory mixed-method study involved three steps: initial tool development (Step 1), validity testing (Step 2), and module development (Step 3). In Step 1, qualitative data collection through literature reviews, focus group discussions, and interviews with hospital management experts led to the creation of the preliminary tools. Step 2 involved qualitative analysis by α 5-member expert panel, followed by quantitative analysis with 36 respondents for validity (Pearson correlation, α = 0.05) and reliability (Cronbach's Alpha, α = 0.6) tests. Step 3 encompassed the final module development. Results The HSC tool contains 6 domains and the HPF tool contains 4 perspectives. The 6 HSC domains were: 1) stakeholder identification, 2) interactive dialogue, 3) commitment, 4) planning, 5) implementation, 6) change in action and behavior. The 4 HPF perspectives were: 1) stakeholder perspective, 2) financial perspective, 3) internal business process, and 4) staff and organizational capacity. The values of the HSC tool validity and reliability tests were around 0,0046 and around 0,995, respectively. Additionally, the values of the HPF tool validity and reliability tests were around 0,0062 and around 0,995, respectively. Conclusion This study offers a practical tool for needs assessment for the improvement of service by analyzing direct feedback from hospital stakeholders and measuring hospital performance factors.
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Affiliation(s)
- Purwaningsih Purwaningsih
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | | | | | - Mahmudah Mahmudah
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Sri Andarini
- Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
| | - Bagus Qomarudin
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | | | - Slamet Riyadi Yuwono
- Department of Nutrition, Polytechnic of Health Ministry of Health Surabaya, Surabaya, Indonesia
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Ramsey L, O'Hara J, Lawton R, Sheard L. A glimpse behind the organisational curtain: A dramaturgical analysis exploring the ways healthcare staff engage with online patient feedback 'front' and 'backstage' at three hospital Trusts in England. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:642-665. [PMID: 36650635 DOI: 10.1111/1467-9566.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Healthcare staff are encouraged to use feedback from their patients to inform service and quality improvement. Receiving patient feedback via online channels is a relatively new phenomenon that has rarely been conceptualised. Further, the implications of a wide, varied and unknown(able) audience being able to view and interact with online patient feedback are yet to be understood. We applied a theoretical lens of dramaturgy to a large ethnographic dataset, collected across three NHS Trusts during 2019/2020. We found that organisations demonstrated varying levels of 'preparedness to perform' online, from invisibility through to engaging in public conversation with patients within a wider mission for transparency. Restrictive 'cast lists' of staff able to respond to patients was the hallmark of one organisation, whereas another devolved responding responsibility amongst a wide array of multidisciplinary staff. The visibility of patient-staff interactions had the potential to be culturally disruptive, dichotomously invoking either apprehensions of reputational threat or providing windows of opportunity. We surmise that a transparent and conversational feedback response frontstage aligns with the ability to better prioritise backstage improvement. Legitimising the autonomous frontstage activity of diverse staff groups may help shift organisational culture, and gradually ripple outwards a shared responsibility for transparent improvement.
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Affiliation(s)
- Lauren Ramsey
- Yorkshire Quality and Safety Research Group, Bradford Royal Infirmary, Bradford, UK
| | - Jane O'Hara
- Yorkshire Quality and Safety Research Group, Bradford Royal Infirmary, Bradford, UK
- School of Healthcare, University of Leeds, Leeds, UK
| | - Rebecca Lawton
- Yorkshire Quality and Safety Research Group, Bradford Royal Infirmary, Bradford, UK
- School of Psychology, University of Leeds, Leeds, UK
| | - Laura Sheard
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Learning from patient experiences of projection imaging through the use of online feedback platforms. J Med Imaging Radiat Sci 2023; 54:73-82. [PMID: 36463092 DOI: 10.1016/j.jmir.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION & BACKGROUND Projection radiography remains a well-used diagnostic tool in healthcare, and its use is continually increasing. The volume of feedback collected from patients has grown exponentially but is rarely analysed within the service to meaningfully underpin change. Professions such as nursing currently make use of patient feedback during training yet there is comparatively little use in diagnostic radiography. Research exists into the use of social media during radiotherapy treatment, highlighting how it could be embraced in future research. However, there remains a sparsity of publications discussing the experiences of patients with projection radiography despite its prominence within diagnostic imaging. Online platforms for feedback are available to most industries and readily embraced and used. They are also becoming increasingly available to healthcare providers. This study aimed to assess and analyse the patient experience of projection radiography using the stories of patients via an online platform. METHODOLOGY Recognising that humans do not experience healthcare in a binary way, the authors selected a narrative method as the most appropriate qualitative methodology to analyse and understand 181 patient stories relating to projection radiography from the Care Opinion UK website. Each story was read three times to establish codes and themes and to ensure author familiarity with the patient's words & descriptions. This resulted in 30 empirical codes with the most frequently used being split into three major themes for discussion RESULTS & CONCLUSION: The three major themes considered the radiography experience, the encounter with professionals and service provision. Online sources of feedback provide valuable data for health researchers and provide access to insights which might otherwise go unconsidered. Patients instinctively perceive radiological examinations to result in delays to their care and report surprise when discovering examinations are delivered swiftly, though it remains that innovations such as radiographer-led discharge could be better utilised to enhance the patient experience. In addition, it is evident that administrative functions in diagnostic radiology departments are considered poor and from the descriptions given in the study by patients, the administrative side of the service does not meet their needs. Patient stories demonstrate that radiography is not perceived as vital to patient care and is frequently devalued through the notion that health professions are limited to medical doctor and nurse. The work of radiographers is not valueless to the patient evidenced by their desire to thank staff for their work, but its value is poorly understood and could be further enhanced by embracing online feedback as part of continuing professional and service development.
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Ó Coimín D, Rohde D, Foley C, O’Carroll T, Murphy R. Dying, death and bereavement: developing a national survey of bereaved relatives. BMC Palliat Care 2023; 22:14. [PMID: 36823584 PMCID: PMC9947439 DOI: 10.1186/s12904-023-01135-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Assessing and measuring the experience and quality of care provided is central to the improvement of care delivery of all healthcare systems. This paper reports on the development of a survey instrument to capture the experiences of care at end of life from the perspective of bereaved relatives in the Republic of Ireland. METHODS A multi-method, multi-stakeholder, sequential approach was adopted for this study. Items for inclusion in the survey instrument bank were identified through (1) a feasibility study and scoping literature review, (2) expert panel programme board review, (3) focus groups and (4) gap analysis. The following steps were undertaken to prioritise the items for inclusion in the final survey instrument: (1) a Delphi study (2) technical expert panel review (3) cognitive interviews with bereaved relatives and an (4) expert panel programme board review. RESULTS Following an iterative process with key stakeholders, a survey instrument was developed with sections focusing on the provision of care at home, in the last nursing home / residential care facility, hospice and hospital, as well as care experience in the last 2 days of life, the relative's experiences of care and support, the circumstances of care surrounding death and demographic information. In total, a bank of 123 questions were prioritised to be included in the National End of Life Survey instrument. CONCLUSION The survey will provide a standardised national approach to capturing the experience of care of those who have died, from the perspective of bereaved relatives in the Republic of Ireland. This will allow health service providers, policy makers and regulators to gather important insights into the experiences of care at end of life and will help fulfil the requirement of healthcare services to ensure they are providing high-quality care.
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Affiliation(s)
- Diarmuid Ó Coimín
- Hospice Friendly Hospitals Programme, Quality and Patient Safety Directorate, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Daniela Rohde
- National Care Experience Programme, Health Information and Quality Authority, George’s Court, George’s Lane, Smithfield, Dublin 7, D07 E98Y Ireland
| | - Conor Foley
- National Care Experience Programme, Health Information and Quality Authority, George’s Court, George’s Lane, Smithfield, Dublin 7, D07 E98Y Ireland
| | - Tracy O’Carroll
- National Care Experience Programme, Health Information and Quality Authority, George’s Court, George’s Lane, Smithfield, Dublin 7, D07 E98Y Ireland
| | - Róisín Murphy
- National Care Experience Programme, Health Information and Quality Authority, George’s Court, George’s Lane, Smithfield, Dublin 7, D07 E98Y Ireland
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Hopkins A, Samuriwo R. Comparison of compression therapy use, lower limb wound prevalence and nursing activity in England: a multisite audit. J Wound Care 2022; 31:1016-1028. [PMID: 36475854 DOI: 10.12968/jowc.2022.31.12.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This audit was designed to identify the need of the population and the clinical activity associated with wounds and the management of lower limb swelling. The exploration focused on lower leg wound management, access to diagnostics and compression therapy across each audit site. The variation across the sites was explored to gather insight into the real-world barriers to providing evidence-based management for leg ulceration. METHOD We undertook wound prevalence audits across six diverse community provider sites in England. The audit was undertaken by the local providers, with the inclusion of tissue viability and podiatry leads and key local stakeholders, often local quality leads, primary care leads and nursing directors. Each audit was undertaken with full engagement of local clinicians. Data were collected centrally, and each audit site received their own local analysis and report, with additional analytical support from the local tissue viability lead to ensure the feedback was contextualised for their stakeholders. Analysis was provided by Accelerate CIC Lymphoedema & Leg Ulcer Clinic. RESULTS A total of 2885 patients were reviewed via an online or a paper audit tool. In total, 2721 patients had one or more active wounds. However, 1350 patients had one or more lower leg wounds, with 164 patients being managed for lower limb swelling or prevention of leg ulceration; bilateral conditions ranged from 11-43% across audit sites. Of the six sites, two included both community and primary care providers, thus generating wound point prevalence data. The remaining four sites audited community nursing and podiatry services only, with two sites collecting data on lower limb wounds only rather than all wounds, generating point prevalence for their services only. Compression usage varied across care locations, with the greatest use being seen in community leg ulcer clinics, where it was >96% for 234 residents. Compression usage was lower in the home with a range of 14-62% among 692 residents. For 263 residents, where the cause of their lower leg wound was unknown, compression usage was very low at 12%. Compression usage decreased with age; for three audit sites this was noteworthy, with 65% of those aged >80 years not in receipt of compression. Compression usage had a direct impact on nursing activity; non-use of compression increased activity by 37%. CONCLUSION Through the identification of wound location, this series of wound prevalence audits identified a greater number of patients with lower limb wounds than those recognised and classified as a leg ulcer. Substantial variation in access to diagnostics and compression therapy was observed between audit sites, and also between locations within their boroughs. The factors that reduced access to compression therapy included not classifying the lower leg wound as a leg ulcer, being cared for in the home and increasing age of the patient. Lack of compression usage increased nursing activity. Where there is lack of access to therapeutic intervention, the resultant patient harm is not systematically recognised or documented.
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Affiliation(s)
| | - Ray Samuriwo
- School of Nursing and Healthcare Leadership, Faculty of Health Studies, University of Bradford, Bradford, UK
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Ramsey L, Lawton R, Sheard L, O’Hara J. Exploring the sociocultural contexts in which healthcare staff respond to and use online patient feedback in practice: In-depth case studies of three NHS Trusts. Digit Health 2022; 8:20552076221129085. [PMID: 36276183 PMCID: PMC9580083 DOI: 10.1177/20552076221129085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 09/11/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Patients are increasingly reporting about their healthcare experiences online and NHS Trusts are adopting different approaches to responding. However, the sociocultural contexts underpinning these organisational approaches remain unclear. Therefore, we aimed to explore the sociocultural contexts underpinning three organisations who adopted different approaches to responding to online patient feedback. Methods Recruitment of three NHS Trusts was theoretically guided, and determined based on their different approaches to responding to online patient feedback (a nonresponding organisation, a generic responding organisation and an organisation providing transparent, conversational responses). Ethnographic methods were used during a year of fieldwork involving staff interviews, observations of practice and documentary analysis. Three in-depth case studies are presented. Findings The first organisation did not respond to or use online patient feedback as staff were busy firefighting volumes of concerns received in other ways. The second organisation adopted a generic responding style due to resource constraints, fears of public engagement and focus on resolving known issues raised via more traditional feedback sources. The final organisation provided transparent, conversational responses to patients online and described a 10-year journey enabling their desired culture to be embedded. Conclusions We identified a range of barriers facing organisations who ignore or provide generic responses to patient feedback online. We also demonstrated the sociocultural context in which online interactions between staff and patients can be embraced to inform improvement. However, this represented a slow and difficult organisational journey. Further research is needed to better establish how organisations can recognise and overcome barriers to engaging with online patient feedback, and at pace.
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Affiliation(s)
- Lauren Ramsey
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK,Lauren Ramsey, Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House Bradford Royal Infirmary, Duckworth Ln, Bradford BD9 6RJ UK.
| | - Rebecca Lawton
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK,School of Psychology, University of Leeds, Leeds, UK
| | | | - Jane O’Hara
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK,School of Healthcare, University of Leeds, Leeds, UK
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Kim EJ, Nam IC, Koo YR. Reframing Patient Experience Approaches and Methods to Achieve Patient-Centeredness in Healthcare: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159163. [PMID: 35954517 PMCID: PMC9367952 DOI: 10.3390/ijerph19159163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/15/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023]
Abstract
(1) There has been growing attention among healthcare researchers on new and innovative methodologies for improving patient experience. This study reviewed the approaches and methods used in current patient experience research by applying the perspective of design thinking to discuss practical methodologies for a patient-centered approach and creative problem-solving. (2) A scoping review was performed to identify research trends in healthcare. A four-stage design thinking process (“Discover”, “Define”, “Develop”, and “Deliver”) and five themes (“User focus”, “Problem-framing”, “Visualization”, “Experimentation”, and “Diversity”), characterizing the concept, were used for the analysis framework. (3) After reviewing 67 studies, the current studies show that the iterative process of divergent and convergent thinking is lacking, which is a core concept of design thinking, and it is necessary to employ an integrative methodology to actively apply collaborative, multidisciplinary, and creative attributes for a specific and tangible solution. (4) For creative problem-solving to improve patient experience, we should explore the possibilities of various solutions by an iterative process of divergent and convergent thinking. A concrete and visualized solution should be sought through active user interactions from various fields. For this, a specific methodology that allows users to collaborate by applying the integrative viewpoint of design thinking should be introduced.
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Affiliation(s)
- Eun-Jeong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic Medical Center, The Catholic University of Korea, Seoul 06591, Korea;
| | - Inn-Chul Nam
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 21431, Korea
- Correspondence: (I.-C.N.); (Y.-R.K.)
| | - Yoo-Ri Koo
- Department of Service Design, Graduate School of Industrial Arts, Hongik University, Seoul 04066, Korea
- Correspondence: (I.-C.N.); (Y.-R.K.)
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Law S, Antonacci R, Ormel I, Hidalgo M, Ma J, Dyachenko A, Laframboise D, Doucette E. Engaging patients, families and professionals at the bedside using whiteboards. J Interprof Care 2022; 37:400-409. [PMID: 35880772 DOI: 10.1080/13561820.2022.2074379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Health-care systems around the world are striving to be patient-centered, and there is growing evidence that engaging patients and families in their care, as well as in efforts to redesign services, contributes to improved outcomes and experiences for patients and providers. This patient-oriented care movement includes efforts to improve the quality of information and communication between health-care professionals and patients as well as families and caregivers. Whiteboards have emerged as a best practice in hospitals to promote engagement and improve information and communication, yet with limited empirical evidence regarding their value to patients, families, or interprofessional teams. We introduced whiteboards on an acute medical unit at a community hospital and conducted an evaluation using a pre-post design collecting both qualitative and quantitative data. Baseline and post-implementation data were collected via qualitative interviews with patients/family and providers and using the Canadian Patient Experience Survey; focus groups were held with staff and members of the care team. Qualitative results highlighted improvements in communication between the care team and patients as well as family members. Implications for practice include attention to patient/family empowerment and safety, adherence to guidance for good communication, and support for regular training and education in the use of communication tools for members of the interprofessional team.
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Affiliation(s)
- Susan Law
- Mary's Research Centre, Department of Family Medicine, McGill UniversitySt. , Montreal, QC, Canada.,Institute for Better Health, University of Toronto & Senior Scientist, Toronto, ON, Canada
| | - Rosetta Antonacci
- Teaching Unit, St. Mary's HospitalNurse Manager - Medical-Clinical, Montreal, QC, Canada.,Ingram School of Nursing & Clinical Associate, Department of Academic and University Affairs, CIUSSS ODIM, Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Ilja Ormel
- St. Mary's Research Centre, Montreal, QC, Canada
| | - Marcela Hidalgo
- Patient Engagement, St. Mary's Research Centre, Montreal, QC, Canada
| | - Julia Ma
- Biostatistician - Institute for Better Health, Trillium Health Partners.,Data Scientist, Precision Analytics, Montreal, QC, Canada
| | | | | | - Elaine Doucette
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
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Goodrich J, Ridge D, Cartwright T. A Qualitative Study Exploring Patient Shadowing as a Method to Improve Patient-Centred Care: Ten Principles for a New Gold Standard. Int J Qual Health Care 2022; 34:6551532. [PMID: 35311958 PMCID: PMC9012889 DOI: 10.1093/intqhc/mzac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/09/2022] [Accepted: 03/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In recent years there has been an increased emphasis on patient experience as a dimension of quality in healthcare, and subsequently a drive to understand care from the patient's perspective. Patient shadowing is an approach which has been used in service improvement projects, but its potential as a Quality Improvement (QI) method has not been studied in practical and replicable detail. This research aimed to do this, and to produce clear guidance for future teams. METHODS Qualitative interviews were conducted with 20 clinical and non-clinical participants of a national quality improvement programme in England, which focused on improving the experience of patients at the end of life. All participants had shadowed patients. Data were analysed using thematic analysis. RESULTS There were two broad themes: 1) The process of shadowing: how participants went about shadowing, adopting different approaches and making judgements about the care they observed, and any challenges they had encountered. 2) The impact of shadowing: on the engagement and motivation of those who shadowed, and in terms of service changes to benefit patients and their families. CONCLUSION The findings led to a new set of 'gold standard' principles to benefit both staff and patients where shadowing is used as QI method. These, together with new guidance, will ensure that shadowing is conducted as a team exercise, and that all those involved are more robustly prepared and supported, and that its purpose as a method to improve patient experience will be better understood.
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Affiliation(s)
- Joanna Goodrich
- Cicely Saunders Institute, King's College London, United Kingdom.,School of Social Sciences, University of Westminster, London, United Kingdom
| | - Damien Ridge
- School of Social Sciences, University of Westminster, London, United Kingdom
| | - Tina Cartwright
- School of Social Sciences, University of Westminster, London, United Kingdom
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Spezia N, Soncin M, Masella C, Agasisti T. Studying the Experience of Care Through Latent Class Analysis: An Application to Italian Neonatal Intensive Care Units. J Patient Exp 2022; 9:23743735221107231. [PMID: 35813241 PMCID: PMC9260577 DOI: 10.1177/23743735221107231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Though many data on the experience of care of patients and caregivers are collected, they are rarely used to improve the quality of health care delivery. One of the main causes is the widespread struggle in interpreting and enhancing these data, requiring the introduction of new techniques to extract intelligible, meaningful, and actionable information. This research explores the potentiality of the latent class analysis (LCA) statistical model in studying experience data. A cross-sectional survey was administered to 482 parents of infants hospitalized in several Italian neonatal intensive care units. Through a 3-step LCA, four subgroups of parents with specific experience profiles, sociodemographic characteristics, and levels of satisfaction were identified. These were composed of parents who reported (1) a positive experience (36%), (2) problematic communication with unit staff (30%), (3) limited access to the unit and poor participation in their baby's care (26%), and (4) a negative experience (8%). Through its explorative segmentation, LCA can provide valuable information to design quality improvement interventions tailored to the specific needs and concerns of each subgroup.
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Affiliation(s)
- Nicola Spezia
- Department of Management, Economics, and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Mara Soncin
- Department of Management, Economics, and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Cristina Masella
- Department of Management, Economics, and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Tommaso Agasisti
- Department of Management, Economics, and Industrial Engineering, Politecnico di Milano, Milan, Italy
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Yan J, Ali M, Khan MM, Shah SHH, Butt AS. The effect of promotion regulatory focus on service performance. SERVICE INDUSTRIES JOURNAL 2021. [DOI: 10.1080/02642069.2021.2003340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jiaqi Yan
- School of Business and Administration, Northeastern University, Shenyang, People’s Republic of China
| | - Muhammad Ali
- School of Economics and Management, Dongguan University of Technology, Dongguan, People’s Republic of China
- School of Management, University of Science and Technology of China, Hefei, People’s Republic of China
| | | | | | - Atif Saleem Butt
- Department of Management, School of Business, American University of Ras Al Khaimah, Ras Al Khaimah, UAE
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12
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Robert G, Donetto S. Whose data is it anyway? Patient experience and service improvement. J Health Serv Res Policy 2021; 25:139-141. [PMID: 32539636 PMCID: PMC7522767 DOI: 10.1177/1355819620921423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Glenn Robert
- Professor of Health care Quality & Innovation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, UK
| | - Sara Donetto
- Lecturer, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, UK
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Christensen V, Parker K, Cottrell E. Leveraging a qualitative data repository to integrate patient and caregiver perspectives into clinical research. J Clin Transl Sci 2021; 5:e155. [PMID: 34527294 PMCID: PMC8427548 DOI: 10.1017/cts.2021.822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/01/2021] [Accepted: 07/10/2021] [Indexed: 11/20/2022] Open
Abstract
Understanding patient and caregiver experiences is a critical component of the conception, design, and implementation of clinical research studies. The "Database of Individual Patient Experiences" (DIPEx) is an innovative, evidence-based approach for eliciting rich information about health experiences. We conducted a formative evaluation with 14 pediatric oncology researchers to assess the value of using data from a DIPEx study on patient and caregiver experiences with childhood cancer to inform patient-centered research in pediatric oncology. Participants identified barriers to incorporating patient perspectives and experiences into their research and how the DIPEx approach could be leveraged to facilitate this practice.
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Affiliation(s)
- Vivian Christensen
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health and Science University, Portland, OR, USA
| | - Kellee Parker
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Oregon Health and Science University
| | - Erika Cottrell
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health and Science University, Portland, OR, USA
- OCHIN, Inc., Portland, OR, USA
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Maston G, Franklin J, Hocking S, Swinbourne J, Gibson A, Manson E, Sainsbury A, Markovic T. Dietary adherence and program attrition during a severely energy-restricted diet among people with complex class III obesity: A qualitative exploration. PLoS One 2021; 16:e0253127. [PMID: 34138917 PMCID: PMC8211265 DOI: 10.1371/journal.pone.0253127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/01/2021] [Indexed: 12/27/2022] Open
Abstract
Meal replacement Severely Energy-Restricted Diets (SERDs) produce ≥ 10% loss of body mass when followed for 6 weeks or longer in people with class III obesity (BMI ≥ 40 kg/m2). The efficacy of SERDs continues to be questioned by healthcare professionals, with concerns about poor dietary adherence. This study explored facilitators and barriers to dietary adherence and program attrition among people with class III obesity who had attempted or completed a SERD in a specialised weight loss clinic. Participants who commenced a SERD between January 2016 to May 2018 were invited to participate. Semi-structured in-depth interviews were conducted from September to October 2018 with 20 participants (12 women and 8 men). Weight change and recounted events were validated using the participants' medical records. Data were analysed by thematic analysis using line-by-line inductive coding. The mean age ± SD of participants was 51.2 ± 11.3 years, with mean ± SD BMI at baseline 63.7 ± 12.6 kg/m2. Five themes emerged from participants' recounts that were perceived to facilitate dietary adherence: (1.1) SERD program group counselling and psychoeducation sessions, (1.2) emotionally supportive clinical staff and social networks that accommodated and championed change in dietary behaviours, (1.3) awareness of eating behaviours and the relationship between these and progression of disease, (1.4) a resilient mindset, and (1.5) dietary simplicity, planning and self-monitoring. There were five themes on factors perceived to be barriers to adherence, namely: (2.1) product unpalatability, (2.2) unrealistic weight loss expectations, (2.3) poor program accessibility, (2.4) unforeseeable circumstances and (2.5) externalised weight-related stigma. This study highlights opportunities where SERD programs can be optimised to facilitate dietary adherence and reduce barriers, thus potentially improving weight loss outcomes with such programs. Prior to the commencement of a SERD program, healthcare professionals facilitating such programs could benefit from reviewing participants to identify common barriers. This includes identifying the presence of product palatability issues, unrealistic weight loss expectations, socio-economic disadvantage, and behaviour impacting experiences of externalised weight-related stigma.
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Affiliation(s)
- Gabrielle Maston
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Janet Franklin
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Samantha Hocking
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Jessica Swinbourne
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Alice Gibson
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Elisa Manson
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Amanda Sainsbury
- School of Human Sciences, Faculty of Science, The University of Western Australia, Crawley, WA, Australia
| | - Tania Markovic
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Jiao K, Chow AY, Wang J, Chan II. Factors facilitating positive outcomes in community-based end-of-life care: A cross-sectional qualitative study of patients and family caregivers. Palliat Med 2021; 35:1181-1190. [PMID: 33947292 DOI: 10.1177/02692163211007376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Delivery of community-based end-of-life care for patients and family members has been recognized as an important public health care approach. Despite differences in different healthcare settings and the significance of a person-centered approach, little research has investigated facilitators of community-based end-of-life care from the perspective of service recipients. In particular, there has been limited exploration of strategies to ensure positive outcomes at an operational level. AIM To explore factors facilitating positive end-of-life care provision in community-based settings and how these are achieved in practice, from the perspectives of patients and family caregivers. DESIGN A qualitative cross-sectional descriptive study was undertaken through semi-structured interviews with patients and family caregivers subjected to thematic analysis. SETTING/PARTICIPANTS Ten patients and 16 family caregivers were recruited from an end-of-life community care program provided by four non-governmental organizations in Hong Kong. RESULTS Seven core themes were identified: positive emotions about the relationship, positive appraisals of the relationship, care through inquiring about recipients' circumstances, instrumentality of care (i.e. information, coaching on care, practical help, psychological support, multiple activities), comprehensiveness of care (i.e. diversity, post-death care, family-level wellbeing), structure of care (i.e. timely follow-up, well-developed system), and qualities of workers. CONCLUSIONS Improvement in service quality might be achieved through alternating the perceptions or emotional reactions of care recipients toward care providers and increased use of sensitive inquiry. Comprehensive care and positive outcomes might be facilitated by addressing the dualities of care by providing diverse choices in pre-death and post-death care.
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Affiliation(s)
- Keyuan Jiao
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Amy Ym Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China.,Jockey Club End-of-life Community Project (JCECC), Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Juan Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Iris Ik Chan
- Jockey Club End-of-life Community Project (JCECC), Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
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16
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Baines R, Underwood F, O'Keeffe K, Saunders J, Jones RB. Implementing online patient feedback in a 'special measures' acute hospital: A case study using Normalisation Process Theory. Digit Health 2021; 7:20552076211005962. [PMID: 33868704 PMCID: PMC8020246 DOI: 10.1177/20552076211005962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/06/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Online patient feedback is becoming increasingly prevalent on an
international scale. However, limited research has explored how healthcare
organisations implement such feedback. This research sought to explore how
an acute hospital, recently placed into ‘special measures’ by a regulatory
body implemented online feedback to support its improvement journey. Methods Semi-structured interviews were conducted with eleven key stakeholders
involved in the implementation and/or use of online patient feedback. Data
was analysed using deductive thematic analysis with Normalisation Process
Theory used as the analytical framework. Research findings are translated
into the Engage, Support and Promote (ESP) model, a model of rapid feedback
adoption. Results Participants viewed the implementation of online feedback as an opportunity
to learn, change and improve. Factors found to facilitate implementation
were often linked to engagement, support and promotion. Although less
frequently described, barriers to implementation included staff anxieties
about time pressures, moderation processes and responding responsibilities.
Such anxieties were often addressed by activities including the provision of
evidence based responder training. Overall, staff were overwhelmingly
positive about the value of online feedback with 24 impacts identified at an
individual and organisational level, including the ability to boost staff
morale, resilience and pride. Conclusions The rapid implementation of online patient feedback can be achieved in a
‘special measures’ organisation. However, the difficulties of implementing
such feedback should not be underestimated. In order to embed online
feedback, staff members need to be engaged and feel supported, with
opportunities to provide, respond and invite patient feedback frequently
promoted to both patients and staff members.
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Affiliation(s)
- Rebecca Baines
- Centre for Health Technology, University of Plymouth, Plymouth, UK
| | - Frazer Underwood
- South West Clinical School in Cornwall, University of Plymouth and Royal Cornwall Hospital NHS Trust.,Royal Cornwall Hospital NHS Trust, Truro, UK.,Centre for Innovations in Health and Social Care: A JBI Centre of Excellence, University of Plymouth, UK
| | - Kim O'Keeffe
- South West Clinical School in Cornwall, University of Plymouth and Royal Cornwall Hospital NHS Trust.,Royal Cornwall Hospital NHS Trust, Truro, UK
| | | | - Ray B Jones
- Centre for Health Technology, University of Plymouth, Plymouth, UK
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Haesebaert J, Samson I, Lee-Gosselin H, Guay-Bélanger S, Proteau JF, Drouin G, Guimont C, Vigneault L, Poirier A, Sanon PN, Roch G, Poitras MÈ, LeBlanc A, Légaré F. "They heard our voice!" patient engagement councils in community-based primary care practices: a participatory action research pilot study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:54. [PMID: 32974050 PMCID: PMC7507740 DOI: 10.1186/s40900-020-00232-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Patient engagement could improve the quality of primary care practices. However, we know little about effective patient engagement strategies. We aimed to assess the acceptability and feasibility of embedding advisory councils of clinicians, managers, patients and caregivers to conduct patient-oriented quality improvement projects in primary care practices. METHODS Using a participatory action research approach, we conducted our study in two non-academic primary care practices in Quebec City (Canada). Patient-experts (patients trained in research) were involved in study design, council recruitment and meeting facilitation. Advisory councils were each to include patients and/or caregivers, clinicians and managers. Over six meetings, councils would identify quality improvement priorities and plan projects accordingly. We assessed acceptability and feasibility of the councils using non-participant observations, audio-recordings and self-administered questionnaires. We used descriptive analyses, triangulated qualitative data and performed inductive thematic analysis. RESULTS Between December 2017 and June 2018, two advisory councils were formed, each with 11 patients (36% male, mean age 53.8 years), a nurse and a manager practising as a family physician (25% male, mean age 45 years). The six meetings per practice occurred within the study period with a mean of eight patients per meeting. Councils worked on two projects each: the first council on a new information leaflet about clinic organization and operation, and on communications about local public health programs; the second on methods to further engage patients in the practice, and on improving the appointment scheduling system. Median patient satisfaction was 8/10, and 66.7% perceived councils had an impact on practice operations. They considered involvement of a manager, facilitation by patient-experts, and the fostering of mutual respect as key to this impact. Clinicians and managers liked having patients as facilitators and the respect among members. Limiting factors were difficulty focusing on a single feasible project and time constraints. Managers in both practices were committed to pursuing the councils post-study. CONCLUSION Our results indicated that embedding advisory councils of clinicians, managers, patients and caregivers to conduct patient-oriented quality improvement projects in primary care practices is both acceptable and feasible. Future research should assess its transferability to other clinical contexts.
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Affiliation(s)
- Julie Haesebaert
- VITAM – Centre de recherche en santé durable, CIUSSS de la Capitale-Nationale, Pavillon Landry-Poulin, Room A-4574, 2525, chemin de la Canardière, Quebec City, Quebec G1J 0A4 Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, Quebec Canada
| | - Isabelle Samson
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec Canada
| | - Hélène Lee-Gosselin
- Department of Management, Faculty of Business Administration, Université Laval, Quebec City, Quebec Canada
| | - Sabrina Guay-Bélanger
- VITAM – Centre de recherche en santé durable, CIUSSS de la Capitale-Nationale, Pavillon Landry-Poulin, Room A-4574, 2525, chemin de la Canardière, Quebec City, Quebec G1J 0A4 Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, Quebec Canada
| | | | - Guy Drouin
- Clinic Manager, Quebec City, Quebec Canada
| | | | | | | | | | - Geneviève Roch
- Centre Hospitalier Universitaire de Québec – Université Laval Research Center, Hôpital Saint-François d’Assise, Quebec City, Quebec Canada
- Faculty of Nursing, Université Laval, Quebec City, Quebec Canada
| | - Marie-Ève Poitras
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Chicoutimi, Quebec Canada
| | - Annie LeBlanc
- VITAM – Centre de recherche en santé durable, CIUSSS de la Capitale-Nationale, Pavillon Landry-Poulin, Room A-4574, 2525, chemin de la Canardière, Quebec City, Quebec G1J 0A4 Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec Canada
| | - France Légaré
- VITAM – Centre de recherche en santé durable, CIUSSS de la Capitale-Nationale, Pavillon Landry-Poulin, Room A-4574, 2525, chemin de la Canardière, Quebec City, Quebec G1J 0A4 Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, Quebec Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec Canada
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18
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Morales-Contreras MF, Chana-Valero P, Suárez-Barraza MF, Saldaña Díaz A, García García E. Applying Lean in Process Innovation in Healthcare: The Case of Hip Fracture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155273. [PMID: 32707826 PMCID: PMC7432005 DOI: 10.3390/ijerph17155273] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
Academic literature and practitioners acknowledge that there is a need to improve efficiency and service quality in the healthcare industry. In Spain, osteoporotic fractures represent a great cost in socio-economic and morbi-mortality terms, hip fracture being the surgical pathology with the second highest consumption of resources. The research questions that govern this study concern the use of Lean principles to identify waste, and an evaluation of the application of an innovative approach in the hip fracture surgery process. A research design based on a case study and action research was developed. Findings relate to (i) the identification of the main types of waste or muda (being the most frequent delay, transportation, over-processing and defects); (ii) the analysis of existing processes based on a Lean approach (identifying opportunities for improvement as a reduction of the number of steps and participants, improving communication, automation, standardization, etc.); and (iii) the application of an innovative process based on the Lean approach and action research in the healthcare industry. This research provides insights for academia, practitioners, management, and society: waste identification and process redesign helps to continue the improvement of operations, increase efficiency, reduce costs, and enhance services, providing benefits to patients, families, hospital employees, and the healthcare system.
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Affiliation(s)
- Manuel Francisco Morales-Contreras
- Department of Management, ICADE, Universidad Pontificia Comillas, ICADE, 28015 Madrid, Spain
- Correspondence: ; Tel.: +34-91-5422800 (ext. 2461)
| | - Pedro Chana-Valero
- Fundación San Juan de Dios, Centro de CC de la Salud San Rafael, Universidad Nebrija, 28036 Madrid, Spain; (P.C.-V.); (E.G.G.)
| | - Manuel F. Suárez-Barraza
- International Business Department, School of Business and Economy, Universidad de las Américas Puebla (UDLAP), Puebla 72810, Mexico;
| | | | - Elena García García
- Fundación San Juan de Dios, Centro de CC de la Salud San Rafael, Universidad Nebrija, 28036 Madrid, Spain; (P.C.-V.); (E.G.G.)
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Montgomery CM, Chisholm A, Parkin S, Locock L. Wild data: how front-line hospital staff make sense of patients' experiences. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1424-1440. [PMID: 32474965 PMCID: PMC8317049 DOI: 10.1111/1467-9566.13115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Patient-centred care has become the touchstone of healthcare policy in developed healthcare systems. The ensuing commodification of patients' experiences has resulted in a mass of data but little sense of whether and how such data are used. We sought to understand how front-line staff use patient experience data for quality improvement in the National Health Service (NHS). We conducted a 12-month ethnographic case study evaluation of improvement projects in six NHS hospitals in England in 2016-2017. Drawing on the sociology of everyday life, we show how front-line staff worked with a notion of data as interpersonal and embodied. In addition to consulting organisationally sanctioned forms of data, staff used their own embodied interactions with patients, carers, other staff and the ward environment to shape improvements. The data staff found useful involved face-to-face interaction and dialogue; were visual, emotive, and allowed for immediate action. We draw on de Certeau to re-conceptualise this as 'wild data'. We conclude that patient experience data are relational, and have material, social and affective dimensions, which have been elided in the literature to date. Practice-based theories of the everyday help to envision 'patient experience' not as a disembodied tool of managerialism but as an embedded part of healthcare staff professionalism.
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Affiliation(s)
| | - Alison Chisholm
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Stephen Parkin
- National Addiction CentreInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Louise Locock
- Health Services Research UnitUniversity of AberdeenAberdeenUK
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20
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Montgomery C, Parkin S, Chisholm A, Locock L. 'Team capital' in quality improvement teams: findings from an ethnographic study of front-line quality improvement in the NHS. BMJ Open Qual 2020; 9:bmjoq-2020-000948. [PMID: 32461250 PMCID: PMC7259840 DOI: 10.1136/bmjoq-2020-000948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/22/2020] [Accepted: 05/04/2020] [Indexed: 11/16/2022] Open
Abstract
Background Teamwork is important in the design and delivery of initiatives in complex healthcare systems but the specifics of quality improvement (QI) teams are not well studied. Objective To explain the functioning of front-line healthcare teams working on patient-centred QI using Bourdieu’s sociological construct of capital. Methods One medical ward from each of six NHS Trusts in England participated in the study, purposively selected for a range of performance levels on patient experience metrics. Three ethnographers conducted focused ethnography for 1 year, using interviews and observations to explore the organisation, management and delivery of patient-centred QI projects by the six front-line teams. Data were analysed using Bourdieu’s typology of the four forms of capital: economic, social, symbolic and cultural. Results While all teams implemented some QI activities to improve patient experience, progress was greater where teams included staff from a broad range of disciplines and levels of seniority. Teams containing both clinical and non-clinical staff, including staff on lower grades such as healthcare assistants and clerks, engaged more confidently with patient experience data than unidisciplinary teams, and implemented a more ambitious set of projects. We explain these findings in terms of ‘team capital’. Conclusion Teams that chose to restrict membership to particular disciplines appeared to limit their capital, whereas more varied teams were able to draw on multiple resources, skills, networks and alliances to overcome challenges. Staff of varying levels of seniority also shared and valued a broader range of insights into patient experience, including informal knowledge from daily practice. The construct of ‘team capital’ has the potential to enrich understanding of the mechanism of teamwork in QI work.
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Affiliation(s)
- Catherine Montgomery
- Centre for Biomedicine, Self and Society, University of Edinburgh, Edinburgh, UK
| | - Stephen Parkin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alison Chisholm
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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21
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Locock L, Montgomery C, Parkin S, Chisholm A, Bostock J, Dopson S, Gager M, Gibbons E, Graham C, King J, Martin A, Powell J, Ziebland S. How do frontline staff use patient experience data for service improvement? Findings from an ethnographic case study evaluation. J Health Serv Res Policy 2020; 25:151-161. [PMID: 32056464 PMCID: PMC7307415 DOI: 10.1177/1355819619888675] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Improving patient experience is widely regarded as a key component of health care quality. However, while a considerable amount of data are collected about patient experience, there are concerns this information is not always used to improve care. This study explored whether and how frontline staff use patient experience data for service improvement. METHODS We conducted a year-long ethnographic case study evaluation, including 299 hours of observations and 95 interviews, of how frontline staff in six medical wards at different hospital sites in the United Kingdom used patient experience data for improvement. RESULTS In every site, staff undertook quality improvement projects using a range of data sources. Teams of health care practitioners and ancillary staff engaged collectively in a process of sense-making using formal and informal sources of patient experience data. While survey data were popular, 'soft' intelligence - such as patients' stories, informal comments and observations - also informed staff's improvement plans, without always being recognized as data. Teams with staff from different professional backgrounds and grades tended to make more progress than less diverse teams, being able to draw on a wider net of practical, organizational and social resources, support and skills, which we describe as team-based capital. CONCLUSIONS Organizational recognition, or rejection, of specific forms of patient experience intelligence as 'data' affects whether staff feel the data are actionable. Teams combining a diverse range of staff generated higher levels of 'team-based capital' for quality improvement than those adopting a single disciplinary approach. This may be a key mechanism for achieving person-centred improvement in health care.
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Affiliation(s)
- Louise Locock
- Professor of Health Services Research, Health Services Research Unit, University of Aberdeen, UK
| | - Catherine Montgomery
- Senior Researcher, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Stephen Parkin
- Research Fellow, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Alison Chisholm
- Qualitative Researcher, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Jennifer Bostock
- Lay Research Advisor, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Sue Dopson
- Rhodes Trust Professor of Organisational Behaviour, Saïd Business School, University of Oxford, UK
| | - Melanie Gager
- Follow-up Sister in Critical Care, Royal Berkshire NHS Foundation Trust, UK
| | - Elizabeth Gibbons
- Senior Research Scientist, Nuffield Department of Population Health, University of Oxford, UK
| | | | - Jenny King
- Chief Research Officer, Picker Institute Europe, UK
| | - Angela Martin
- Programme Coordinator, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - John Powell
- Associate Professor, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Sue Ziebland
- Professor of Medical Sociology, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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