Health Services Research Commons^™

Evaluation Of An Advisory Committee As A Model For Patient Engagement, Cynthia Kendell, Robin Urquhart, Jill Petrella, Sarah Macdonald, Meg Mccallum

Patient Experience Journal

Patient engagement (PE) is not well defined and little guidance is available to those attempting to employ PE in decision-making relevant to health system improvement. After completing a 2-year PE project, overseen by an Advisory Committee, our objectives were: 1) to evaluate how effectively the project team engaged the Advisory Committee, 2) to examine how Advisory Committee members perceived PE and their role in PE, and 3) to identify barriers and facilitators to PE in order to improve future efforts. Five members of the Advisory Committee completed semi-structured interviews post-project about their experiences. Thematic analysis identified four themes: the approach, …

Improving The Patient Experience Through Nurse Leader Rounds, Judy C. Morton, Jodi Brekhus, Megan Reynolds, Anna Kay Dykes

Patient Experience Journal

While providing exceptional care experiences to patients is a priority for many organizations, creating and sustaining measureable success in this area remains a challenge for many. This article examines the impact of implementing nurse leader rounds on patient perception of care in the hospitals and emergency departments of a large healthcare system. Nurse leader rounds were implemented as a system-wide improvement practice at Providence Health & Services in 2012. Analysis of Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results indicates that implementation of nurse leader rounds is associated with statistically significant improvement in patient …

Creating And Sustaining A Culture Of Accountability For Patient Experience, Denise M. Kennedy Mba, Roshanak Didehban Mhs, Fache, John P. Fasolino Md

Patient Experience Journal

Improving the quality of the patient experience has become an imperative for healthcare organizations. Value-based payment models include patient perception data, and a negative experience can impact an organization’s finances. Sustainable improvement requires more than quick-fix cosmetic enhancements, ‘flavor-of-the-month’ service trainings, or bonuses for front-line staff. Organizations must actually improve the patient experience. Doing so requires a culture of accountability and a systematic framework for collecting and acting on patient perception data.

This article revisits Mayo Clinic Arizona's (MCA) "7-prong" model for improving service quality: (1) multiple data sources to drive improvement; (2) accountability; (3) service consultation and improvement tools; …

Beyond Credentialing In Physician Selection: Application Of An Instrument That Measures Behavioral Aptitude, Edgar Staren Md, Phd, Mba, Susan Hirt Ph.D., Doug Rath M.A.

Patient Experience Journal

This article explores the idea that the assessment of candidates for the role of physician caregiver can be enhanced by evaluating their inter-personal and behavioral aptitude as well as their clinical skills. The objective of this work was to determine whether results of a structured interview correlate to performance ratings for physicians. Two data sets were collected: a structured aptitude assessment for physicians (the Physician Interview) and job performance data for physicians. Analysis of performance data allowed categorization of the physicians into three groups: top performers, contrast performers, and neither. The two data sets were then analyzed to assess the …

Hindsight Is 20/20: Lessons Learned After Implementing Experience Based Design, Kate Bak, Laura Macdougall, Esther Green, Lesley Moody, Genevieve Obarski, Lori Hale, Susan Boyko, Deborah Devitt

Patient Experience Journal

Experience Based Design (EBD) uses patient and staff experiences to identify quality improvement opportunities in healthcare settings. An EBD Collaborative was established to share successes and challenges related to the EBD projects. This paper summarizes the various lessons learned. A document analysis was conducted that examined meeting minutes and audio recordings, email communications, newsletters, project updates, project spotlights and evaluation surveys and interviews. A total of ten key themes were identified. While EBD teams encountered challenges, overall the experience led to successful quality improvement initiatives. In particular, staff gained new insights from the patients’ perspective, which enhanced their understanding of …

The Patient Experience Movement Moment, William Lehrman Phd, Geoffrey Silvera Mha, Jason A. Wolf Phd

Patient Experience Journal

For years, the patient experience movement has continued to gain momentum. From a novel concept, there is an emerging consensus that the patient experience is a fundamental aspect of provider quality; one that complements established clinical process and outcome measures but is neither subsumed nor secondary to them. An increasing volume of research as encouraged by publications such as Patient Experience Journal show this to be true. As the expectation of a high-quality patient experience becomes the norm, these developments have brought us to what we call the patient experience movement moment and there is little doubt that the patient …

To Serve Patients Is Our Greatest Privilege, David T. Feinberg Md, Mba

Patient Experience Journal

In his guest editorial, Dr. David Feinberg of UCLA Health System reminds us of the power of patient voice and the lessons we should be open to learning from those we serve every day. He offers, "It is a blessing for us to work in an environment where we have the opportunity every day to touch someone’s life so deeply. We must never lose sight of that. It is our responsibility to not just treat our patients, but also to embrace them."

A Gathering Place For Patient Experience Research: The Power Of Community, Jason A. Wolf Phd

Patient Experience Journal

In introducing Issue 2, we explore the power of community and its implications in shaping not only the purpose and intent of Patient Experience Journal, but of the patient experience movement itself. Community defined in this moment is simple, yet significant, the key being unity around common interest and its focus on ownership and participation. The idea of community bears great weight and has provided strong guidance and purpose for the work of experience excellence. It supports the goal of elevating the conversation, helps align the voices engaged and provides the space for listening, learning and impact.

Experience Framework …

Caregiving And The Experience Of Health And Illness In Children Living With Hiv/Aids In Gulu District Northern Uganda: An Ethnographic Research Narrative, Constantine S.L. Loum Phd

Patient Experience Journal

In this paper we discuss the experience of caregiving for children living with HIV in a resource poor environment in Gulu municipality in northern Uganda; the main research questions of the study were: what are the perceptions of caregivers on the care of children with HIV, and what barriers and enablers exist that undermine or promote better care for children respectively? The experience of caregivers and their perceptions on managing HIV in children is believed to shape the health seeking behaviour towards treatment and efforts to cope with its negative impact on the body. Women and children are the greatest …

The Role Of Governing Boards In Improving Patient Experience: Attitudes And Activities Of Health Service Boards In Victoria, Australia, Marie Bismark, Susan Biggar, Catherine Crock, Jennifer M. Morris, David M. Studdert

Patient Experience Journal

The authors sought to determine the attitudes of public health service board members and senior executives toward patient experience and to describe the governance activities of the boards in this area. The study was based on an online survey of 322 board members from 85 public health services and semi-structured interviews with 35 board members and senior executives from 13 public health services in Victoria, Australia. The results showed that while some health service boards had high aspirations and clear plans for improving patient experience, others remained sluggish or even cynically resistant to changing their existing models of care. Interviewees …

Patients’ Experiences In The Uk: Future Strategic Directions, Sophie Staniszewska, Neil Churchill

Patient Experience Journal

Over the last decade policy has emphasised the importance of a good patient experience as a cornerstone of high quality health and social care in the UK, with many initiatives attempting to develop patient-centred practice. More recently, the Francis Inquiry has addressed the significant failings in care identified at Mid Staffordshire NHS Foundation Trust in England and has been pivotal in raising the importance of patient experience.¹ The Francis report made 290 recommendations, with many emphasizing the importance of patient experience through their focus on specific ways in which the quality of experiences can be enhanced, for example, by …

What Matters Most To Patients? Participative Provider Care And Staff Courtesy, Andrew H. Van De Ven

Patient Experience Journal

Although there is growing recognition of the importance of having satisfied patients, we know little about what aspects of care matter most to patients. The sources of patient satisfaction and how care delivery can influence them need more empirical study. The objective of this study was to identify which aspects of a patient’s experience of care are most important to patient satisfaction, and how dimensions of care relate to clinic size, economic performance, and employee job satisfaction. To explore our question, longitudinal survey data were obtained on patients and employees over two years (1996 and 1997). Relationships between patient satisfaction …

Psychometric Properties Of The New Patients’ Expectations Questionnaire, Ann Bowling Bsc, Msc, Phd, Gene Rowe Phd

Patient Experience Journal

The authors explore the development of the Patients’ Expectations Questionnaire (PEQ) and examination of psychometric characteristics it encompasses by reviewing surveys of primary care and hospital outpatients before and after their clinic visit. Three scales were developed for Pre-visit Ideal and Realistic expectations, and Post-visit Experiences (met expectations), based on literature review, semi-structured interviews, and subsequently piloted and refined. Patients completed the questionnaire about their ideal and realistic expectations before they saw the doctor, and were asked if their expectations had been met afterwards. The results show the scales met acceptability criteria for reliability (Cronbach’s alphas exceeded α 0.70), administration …

Factors In Patients’ Experience Of Hospital Care: Evidence From California, 2009–2011, Edmund R. Becker Phd, Jason M. Hockenberry Phd, Jaeyong Bae Ma, Ariel C. Avgar Phd, Sandra S. Liu Phd, Mba, Ira Wilson Md, Msc, Arnold Milstein Md, Mph

Patient Experience Journal

The use of measures of patient-centered care to evaluate hospital care is mandated by The Patient Protection and Affordable Care Act of 2010. Using three years of data from 315 California acute-care hospitals and data collected from patients via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, we seek to evaluate patients’ hospital-care experience by (1) analyzing patients’ experience-of-care scores in light of these hospitals’ patient profiles, structural characteristics, and outcomes in 2011, and (2) determining and analyzing the extent of changes in patients’ experience of care over the three-year period 2009–2011. For 2011, we find significant …

Veterans’ Experiences Of Patient-Centered Care: Learning From Guided Tours, Sara M. Locatelli Phd, Stephanie Turcios Bs, Cepep, Sherri L. Lavela Phd, Mph, Mba

Patient Experience Journal

In this paper the authors seek to examine Veterans’ experiences with patient-centered care (PCC) at 2 United States Veterans Affairs (VA) facilities. The authors conduct their research through a process of guided tours, in which the participant leads the evaluator through an environment and shares thoughts, feelings, and experiences. Tours were conducted in April 2013 with 30 Veterans receiving care at these VA facilities. Via the tours participants discussed aspects of the environment of care, and described some as ‘welcoming,’ while describing others as ‘chaotic.’ Participants provided multiple examples of PCC, frequently defining PCC in terms of accessibility of appointments, …

Patient Care Experiences And Perceptions Of The Patient-Provider Relationship: A Mixed Method Study, Jennifer Tabler Ms, Debra L. Scammon Ms, Phd, Jaewhan Kim Phd, Timothy Farrell Md, Andrada Tomoaia-Cotisel Mph, Mha, Michael K. Magill Md

Patient Experience Journal

Improving interpersonal continuity of care—the personal relationship forged between a patient and their primary care provider (PCP) over time—is often considered a goal of primary care. Continuity of care is frequently assessed in terms of longitudinal continuity, or the proportion of encounters with one practitioner, overlooking aspects of the patient-provider relationship that are key to interpersonal continuity of care. Further, few studies explore patients’ perspectives regarding which care experiences enhance or detract from the patient-provider relationship. This study, using focus group interviews, a patient experience CAHPS-PCMH survey, and electronic medical records, explored how patients’ experiences at 10 primary care clinics …

The Impact Of The Resident Duty Hour Regulations On Surgical Patients’ Perceptions Of Care, Shital Shah Phd, Mary Katherine Krause Ms, Fache, Francis Fullam Ma, Susan Vanderberg-Dent Md, Amie E. Solber Ms

Patient Experience Journal

Implementation of the 2003 Accreditation Council for Graduate Medical Education (ACGME) resident duty-hour regulations and access to publicly reported patient satisfaction measures have challenged administrators and clinicians to balance resident’s educational experience, patient care quality, and patients’ satisfaction and perceptions. A pre-post retrospective study design investigated association between implementation of ACGME regulations and patient satisfaction/perceptions using multinomial logistic regressions. The sample consisted of all surgical inpatients (July 2001 – June 2005), who responded to surveys at an academic medical center. Patients gave lower ratings for physician interactions (patient-physician interaction time, clinical updates, and courtesy) following the implementation of post-duty hour …

Physician-Led Patient Experience Improvement Efforts: The Connect Program, An Emerging Innovation, Harris P. Baden Md, Jennifer E. Scott Mha

Patient Experience Journal

In 2009, the leadership of the Children’s University Medical Group (CUMG) embarked on an effort to answer the question, “What would it take to promote and foster a culture of service amongst the medical staff?” The challenge was to engage the physician group in leading patient and family experience improvements within Seattle Children’s. In this article, an innovative, physician-designed and led approach to improving the patient experience is described. The effort focuses on encouraging local, grass roots strategies rooted in readily available and validated best practices. In support of that effort, novel tools that were developed and deployed …

Improving The Patient Experience Through Provider Communication Skills Building, Denise M. Kennedy Mba, John P. Fasolino Md, David J. Gullen Md

Patient Experience Journal

The doctor’s interpersonal skills are arguably the most important to clinical outcome and patient experience. A peer-facilitated, communication skills-building course for physicians has been provided twice annually since its inception in 2004. The course was designed to increase personal awareness, as well as to help physicians develop new communication and interpersonal skills. Satisfaction data from 3,561 patient surveys on 80 providers who attended the course between 2006 and 2010 were analyzed one year before and one year after course participation. After completing the course, the proportion of “excellent” ratings of provider service (the highest rating on a 5-point scale) increased …

Transforming The Patient Experience: Bringing To Life A Patient- And Family-Centred Interprofessional Collaborative Practice Model Of Care At Kingston General Hospital, Anndale Mctavish Ma, Cynthia Phillips Rrt, Med

Patient Experience Journal

The Kingston General Hospital strategic plan includes transforming the patient experience and bringing to life new models of interprofessional care and education. The implementation of the Interprofessional Collaborative Practice Model has been the foundation of this transformational change. Areas identified for improvement included communication, discharge planning, and purposeful engagement of patients and families in the care process. Through a system-wide approach to change, it was expected that the organization would be better prepared to deliver safer, higher quality care and enriched experiences for patients, families and practitioners. From March to October 2009, 54 representatives from various disciplines and services gathered …

Patients And Families As Partners In Safety, Quality, And Experiences Of Care, Amy Jones, Kathy Dutton

Patient Experience Journal

This case examines the highlights of Vidant Health’s journey to a more intentional focus on patient experience. Organizational inconsistencies lead to a focused long term plan putting a culture of patient centeredness at the core of Vidant’s efforts. The results show a clear and measured improvement in safety, quality and experience overall.

A Daughter’S Frustration With The Dearth Of Patient- And Family-Centered Care, Cindy Brach

Patient Experience Journal

Patient involvement in decision-making is an increasingly recognized ethical imperative, one that requires attention to health literacy. Health care that is truly patient- and family-centered, however, is the exception rather than the rule. This first person account of a hospitalization describes the lack of patient and family inclusion in decision-making, failure to use plain language and other health literacy strategies, and disregard for patient and family preferences. The author concludes that if the health care system is going to shift from paternalistic to patient- and family-centered, providers must be trained how to communicate and partner with patients and families. Even …

“Working The System”: The Experience Of Being A Primary Care Patient, Michelle La Nelson Phd, Mark G. Torchia Phd, Jennifer B. Mactavish Phd, Ruby E. Grymonpre Pharmd

Patient Experience Journal

Health care providers and system administrators are in the midst of a paradigm shift; moving from paternalism toward an egalitarian approach. For patient centred care to occur, health care providers must prioritize patient needs; provide information regarding treatments while taking patient preferences and expectations into account. While there is literature regarding patient centredness, there is less information from the patient perspective about the experience of being a patient and the influence on behaviour. Using phenomenological research methods and the theory of planned behaviour as a theoretical framework, this study addressed the questions, a) what is the essence of being a …

Evaluation And Measurement Of Patient Experience, Sherri L. Lavela Phd, Mph, Mba, Andrew S. Gallan Phd

Patient Experience Journal

Despite the increasing presence of a variety of measures of patient health care experiences in research and policy, there remains a lack of consensus regarding measurement. The objectives of this paper were to: (1) explore and describe what is known about measures and measurement of patient experience and (2) describe evaluation approaches/methods used to assess patient experience.

Patient-experience does not simply reflect clinical outcomes or adherence–driven outcomes; rather it seeks to represent a unique encompassing dimension that is challenging to measure. Several challenges exist when measuring patient experience, in part, because it is a complex, ambiguous concept that lacks a …

How Does Patient Experience Fit Into The Overall Healthcare Picture?, Karen Luxford Bsc(Hons), Phd, Faim, Faaqhc, Sue Sutton Rn, Phd, Fhimss

Patient Experience Journal

Understanding the experience of patients provides insight into health care as well as being a crucial first step towards partnering with patients to drive improvement. Increasingly, health care organizations gain feedback from patients about their experience through surveys. Patients are also turning to other avenues, including the internet, to document their experiences.

Although long recognised as a domain of quality, evidence of the link between patient experience and clinical outcomes has emerged more recently. Organizations that succeed in improving patient experience have adopted a strategic approach to patient focus that incorporates both patient feedback and consumer engagement.

Adopting a patient …

Defining Patient Experience, Jason A. Wolf Phd, Cpxp, Victoria Niederhauser Drph, Rn, Dianne Marshburn Phd, Rn, Ne-Bc, Sherri L. Lavela Phd, Mph, Mba

Patient Experience Journal

In recent years, perceptions of performance and quality of healthcare organizations have begun to move beyond examining the provision of excellent clinical care, alone, and to consider and embrace the patient experience as an important indicator. There is a need to determine the extent to which clear and formal definitions exist, have common overarching themes, and/or have unique, but important constructs that should be considered more widely. In this article, we provide a 14-year synthesis of existing literature and other sources (2000-2014) that have been used to define patient experience. A total of 18 sources (articles or organizational websites) were …

Concern For The Patient’S Experience Comes Of Age, Irwin Press Phd

Patient Experience Journal

In this special guest editorial for the inaugural issue of Patient Experience Journal. Dr. Press reflects on how the focus on patient experience has evolved. He starts with a reflection, "A journal devoted exclusively to the patient’s experience? A patient satisfaction survey mandated by CMS for all hospitals and a portion of reimbursement dependent upon the scores? An Institute and an “Association” addressing Patient Experience? A new hospital administrative position labeled “Chief Experience Officer”? Some 30 years ago no one would have predicted any of these."

Dr. Press helps us explore and review how the patient experience movement has …

Expanding The Dialogue On Patient Experience, Jason A. Wolf Phd

Patient Experience Journal

It is with great excitement that I welcome you to the inaugural issue of Patient Experience Journal (PXJ). This publication in so many ways epitomizes all that is right and good about the patient experience movement itself. That being: no one individual or organization owns this conversation or can claim to have every answer, but rather it is a true effort of a community of voices from research to practice, from caregivers to patients and family members, across the care continuum and into the reaches of resources provided and concepts yet unknown.

This journal is a product of and …