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Full-Text Articles in Social and Behavioral Sciences
Acceptability Of A New Remote Monitoring Service For Patients With Covid-19 Infection Using Wearable Biostickers™: A Mixed Methods Study, Lynne Maher Dr, Lisa K. Blake Mrs, Karol J. Czuba Dr, Mary E. Seddon Dr
Acceptability Of A New Remote Monitoring Service For Patients With Covid-19 Infection Using Wearable Biostickers™: A Mixed Methods Study, Lynne Maher Dr, Lisa K. Blake Mrs, Karol J. Czuba Dr, Mary E. Seddon Dr
Patient Experience Journal
The COVID-19 pandemic saw rapid adoption of telehealth, including remote patient monitoring (RPM). There is limited evidence about how patients and staff experience such services in New Zealand. This study aimed to understand the acceptability of the RPM experience, particularly for Maori and Pacific peoples, and identify strengths, gaps, and limitations to inform future delivery of services. A mixed methods study was undertaken between 4 July and 11 September 2022 in Auckland. We conducted telephone surveys with patients and semi-structured interviews with patients and staff. Survey, and clinical and administrative data were analysed descriptively using SPSS. Interviews were analysed using …
“Not Your Father’S Heart”: How Healthcare Discrimination For Neurodivergent Patients Taught Me About The Human Experience, Cate Murphy
Patient Experience Journal
It is easy to assume all patients who come into a hospital for acute crisis care have a clear understanding of how their experience will be facilitated. When a patient is neurodivergent, they cannot always agree to needed intervention. This is exacerbated by the “poor timing” of questions portrayed to impact the critical care received, sometimes irreparably. This is my story of watching my young, active partner suffer two massive heart attacks and refuse intervention because he was ashamed to admit he had not seen a doctor in over thirty years. Due to his neurodivergence, he could not process questions …
Investing In The Bottom Line: The Value Case For Improving Human Experience In Healthcare, Jason A. Wolf, Vishal Bhalla, Brian Carlson, Jennifer Carron, Lanie Dixon, Julie K. Oehlert, Brant J. Oliver
Investing In The Bottom Line: The Value Case For Improving Human Experience In Healthcare, Jason A. Wolf, Vishal Bhalla, Brian Carlson, Jennifer Carron, Lanie Dixon, Julie K. Oehlert, Brant J. Oliver
Patient Experience Journal
Investment in human experience is imperative for healthcare organizations. It is a strategic focus that can lead to great benefits. Those that overlook experience, seeing it as “simply” about satisfaction or survey data, do so at great cost to their organization, team members, and most importantly those we serve – patients. A commitment to human experience – integrating the patient, workforce, and community experience – is essential for all healthcare organizations in realizing the goals they strive for and the impact they aspire to achieve. It leads to high-quality outcomes for those they care for. It creates a positive environment …
The Evolution Of Patient Experience: From Holistic Care To Human Experience, Corey Adams, Reema Harrison, Jason A. Wolf
The Evolution Of Patient Experience: From Holistic Care To Human Experience, Corey Adams, Reema Harrison, Jason A. Wolf
Patient Experience Journal
Patient experience has evolved as a critical concept and outcome in health systems internationally. Evolving from consumer-led movements, coupled with shifts in the positioning of patients among clinical professions, the global focus on patient experience is now evident in nationally mandated measurement tools, the creation of dedicated institutional leadership roles, and outlets such as the Patient Experience Journal. By critically analysing the pivotal factors and milestones that have shaped its evolution throughout healthcare history, this review provides an in-depth exploration of the evolution of patient experience. In doing so, the review provides a critical analysis of the application of patient …
Looking Back To Move Forward: The Next Decade And Beyond For Human Experience, Jason A. Wolf
Looking Back To Move Forward: The Next Decade And Beyond For Human Experience, Jason A. Wolf
Patient Experience Journal
This issue comes out at an important moment for the experience conversation. It was ten years ago from the publication date of this issue on April 30, 2014, that the first issue of Patient Experience Journal (PXJ) was released. PXJ was intended to be a gathering place. A virtual town square for the experience movement where people could and would come together to share ideas and proven practice. This value of collaboration is at the foundation of our very efforts as a global community through The Beryl Institute. Experience is not some secret competitive ingredient in the world of healthcare. …
Medicine And Kindness, A Glorious Concurrence?, Araya Gautam
Medicine And Kindness, A Glorious Concurrence?, Araya Gautam
Patient Experience Journal
This article unfolds the journey of a 28-year-old junior doctor entangled in the throes of a pernicious anemia diagnosis during her travels abroad, a scenario exacerbated by the grip of a COVID-19 lockdown. Adrift without medical insurance and distant from her family, she found herself under the care of a compassionate on-call resident, emphasizing the crucial role of kindness and compassion in her predicament. Her treatment regimen encompassed a series of CBC tests meticulously tracking cobalamin and ferritin levels, complemented by extensive examinations for iron deficiency and a regimen of vital vitamin B12 injections, all carried out under vigilant scrutiny …
Breaking The Transactional Mindset: A New Path For Healthcare Leadership Built On A Commitment To Human Experience, Kirsten Krull, Jerry Mansfield, Jennifer Gentry, Karen Grimley, Barbara Jacobs, Jason Wolf
Breaking The Transactional Mindset: A New Path For Healthcare Leadership Built On A Commitment To Human Experience, Kirsten Krull, Jerry Mansfield, Jennifer Gentry, Karen Grimley, Barbara Jacobs, Jason Wolf
Patient Experience Journal
Numerous health care publications have focused on the compelling need to improve patient experience and the associated improvements necessary to address workforce well-being. The COVID-19 pandemic exacerbated and illuminated long-standing problems in health care including workforce shortages, inequity in health care delivery outcomes, care provider burnout, and overall societal structural racism.1,2 The Beryl Institute’s Nursing Executive Council (NEC) manuscript Rebuilding a Foundation of Trust: A Call to Action in Creating a Safe Environment for Everyone3 focused on actions and behaviours to heal relationships and build trust between care providers and leaders with commitments to safety, empathy, shared decision …
Four Commitments For The Future Of Healthcare: Reflecting On A Decade Of Patient Experience Journal, Jason A. Wolf
Four Commitments For The Future Of Healthcare: Reflecting On A Decade Of Patient Experience Journal, Jason A. Wolf
Patient Experience Journal
This issue closes the first decade of Patient Experience Journal’s (PXJ) contribution to evidence and innovation, to sharing stories and research, to elevating the conversation and pushing the boundaries of the experience movement. We have never hesitated to nudge at the status quo or to respond with agility to the challenging moments we have faced. We have welcomed diverse voices as contributors, and we have seen an even more diverse readership. In reviewing the pages of PXJ over the last decade, we see a true evolution of the experience movement itself. The words of our contributors have provided a lens …
Special Issue 2024: Transforming Experience In Non-Hospital Settings, Patient Experience Journal
Special Issue 2024: Transforming Experience In Non-Hospital Settings, Patient Experience Journal
Patient Experience Journal
Patient Experience Journal(PXJ) is excited to announce the call for submissions for its July/August 2024 special issue focused on exploring how healthcare organizations are transforming experience in non-hospital settings. So much of the experience conversation has been focused on and driven by the hospital setting – from acute care, to pediatrics, safety net hospitals and more. While this focus remains essential to some of the most critical care delivered in the healthcare ecosystem, it is important to recognize the volume of care being provided in new and existing settings. This special issue seeks to uncover and elevate the practices …
Identifying Sources Of Patient Dissatisfaction When Seeking Care For A Chronic And Complex Disease, Katharine J. Head, Anna K. Forster, Amanda Harsin, Rebecca J. Bartlett Ellis
Identifying Sources Of Patient Dissatisfaction When Seeking Care For A Chronic And Complex Disease, Katharine J. Head, Anna K. Forster, Amanda Harsin, Rebecca J. Bartlett Ellis
Patient Experience Journal
Patients’ evaluations of healthcare often rely on patient satisfaction and encounter-specific approaches. Instead, valuable information can be gained by focusing on patient dissatisfaction with healthcare over time. This study examined patients’ sources of care dissatisfaction when seeking healthcare for a long-term chronic and complex disease (CCD). Participants with a CCD called polycystic kidney disease (N=387) completed an online questionnaire with an open-ended question about dissatisfying experiences. Content analysis was used to analyze responses. The coded data resulted in conceptual codes related to dissatisfaction with information, support, and care management. Analysis revealed the type of healthcare provider is often …
The Frontier For Human Experience Is Closer Than We Think, Jason A. Wolf
The Frontier For Human Experience Is Closer Than We Think, Jason A. Wolf
Patient Experience Journal
When we think of frontiers, we think of boundaries between the known and unknown, the edge we see in the distance, something that is always just over the horizon. Yet when we step into what was once the frontier, the horizon moves on us, with new distances to cross, edges to reach. It is this dynamic of frontiers, wrapped in our individual and shared experiences of the last few years that shape this very special issue. It is also why now more than ever frontiers are an important part of our transformation. Frontiers that push us beyond where we can …
Digital Patient Engagement At A Perioperative Surgical Home Implemented Community Hospital, Srinivasan Sridhar, Amy Mount Hunter, Bernadette Mccrory
Digital Patient Engagement At A Perioperative Surgical Home Implemented Community Hospital, Srinivasan Sridhar, Amy Mount Hunter, Bernadette Mccrory
Patient Experience Journal
Patients in rural areas typically require more perioperative ‘optimization’ for surgery. The rural healthcare systems often overwhelmed with coordinating perioperative services and deliver less than optimal surgical outcomes. This is due to limited supporting microsystems and ability to effectively engage and track patients over the 120-day perioperative period to limit post-surgical complications. The study assessed longitudinal patient engagement within a newly established Perioperative Surgical Home (PSH) at a rural community hospital serving 10+ surrounding counties to identify barriers and best practices for engagement. A digital patient engagement platform was implemented and used to assess longitudinal patient outcomes and engagement from …
Patient Experience In An Interprofessional Collaborative Practice For Underserved Patients With Heart Failure, Connie White-Williams, Maria R. Shirey, Reid Eagleson, Wei Su, Terri Poe, Brittany Fitts, Vera Bittner
Patient Experience In An Interprofessional Collaborative Practice For Underserved Patients With Heart Failure, Connie White-Williams, Maria R. Shirey, Reid Eagleson, Wei Su, Terri Poe, Brittany Fitts, Vera Bittner
Patient Experience Journal
Heart failure is a complex chronic condition that results in multiple patient visits throughout the care continuum. Patient experience has associations with clinical outcomes. The purpose of this study was to examine patient experience among the underserved in a specialized interprofessional collaborative practice heart failure clinic. This prospective study utilized both qualitative and quantitative data to describe the patient experience within an interprofessional collaborative practice. Data were collected from patient experience surveys in 1128 patients seen in the Heart Failure Transitional Care Services for Adults (HRTSA) clinic between January 1, 2018, and December 31, 2021. Interprofessional collaborative practice surveys were …
A Concept Analysis Of The Patient Experience, Tanja Avlijas Rn, Mscn, Janet E. Squires Rn, Phd, Michelle Lalonde Rn, Phd, Chantal Backman Rn, Phd
A Concept Analysis Of The Patient Experience, Tanja Avlijas Rn, Mscn, Janet E. Squires Rn, Phd, Michelle Lalonde Rn, Phd, Chantal Backman Rn, Phd
Patient Experience Journal
Patient experience, an essential indicator of quality patient care, is of increasing importance to hospitals that want to improve and maintain strong patient experience metrics to remain competitive in the business of healthcare. The aim of this study was to clarify the concept of the patient experience by identifying its existing definitions, methods of measurement, and underlying themes and attributes, to differentiate it from similar concepts and propose an operational and theoretical definition to guide valid and reliable development of future assessment tools. Walker and Avant’s eight-step methodology served as the framework for this concept analysis. A literature search, using …
Living With Multiple Sclerosis As A Former Marathon Runner: Impact Of Attitude And Past Behaviour On Self-Care Maintenance And Perseverance, Michael Stephanou
Living With Multiple Sclerosis As A Former Marathon Runner: Impact Of Attitude And Past Behaviour On Self-Care Maintenance And Perseverance, Michael Stephanou
Patient Experience Journal
As healthcare professionals, we have a duty to promote the wellbeing of individuals living with chronic diseases and this could be accomplished through the establishment of self-care strategies that are both collaborative and self-directed. Insight into the complex behaviours and backgrounds of individuals who show initiative in dealing with chronic disease could help achieve this by revealing drivers of health-seeking and engaging behaviours. Therefore, by deducing the complex interactions between attitude, past experiences and disease outlook, broader patient welfare could be championed through the implementation of targeted interventions which promote self-care in chronic disease. This article aims to explore these …
Global Child And Family-Centered Care Fellowship, Education And Mentorship For Pediatric Healthcare Professionals: A Literature Review, Ashley Zheng, Bobbijo Pansier
Global Child And Family-Centered Care Fellowship, Education And Mentorship For Pediatric Healthcare Professionals: A Literature Review, Ashley Zheng, Bobbijo Pansier
Patient Experience Journal
Child- and family-centered care (FCC) is increasingly accepted and implemented to optimize the healthcare experience for patients, their families, and healthcare professionals. Standish Foundation for Children, a 501(c)(3) non-profit, has designed and piloted a fellowship to educate pediatric healthcare professionals in FCC & psychosocial care via an inquiry and mentorship model in Tbilisis, Georgia. This review aimed to evaluate and synthesize existing literature on psychosocial and FCC mentorship for pediatric healthcare professionals in four parts: ongoing need, effects on healthcare professionals, effects on children and their families and/or caregivers, and in cross-country healthcare settings. Reviewers searched open-source databases for articles …
Positively Waiting: Technology As The Preferred Distractor In A Pediatric Outpatient Setting, Timothy Ernest, Victoria Maddex, Arnaldo Mejias, Lindy Davidson, Donna Ettel-Gambino
Positively Waiting: Technology As The Preferred Distractor In A Pediatric Outpatient Setting, Timothy Ernest, Victoria Maddex, Arnaldo Mejias, Lindy Davidson, Donna Ettel-Gambino
Patient Experience Journal
Visiting any pediatric outpatient clinic as a child may be considered a stressful and anxiety-inducing experience. The literature suggests that positive distractions, such as pet therapy and single-user electronic devices, may aid in reducing anxiety and maximizing patient satisfaction throughout the patient’s experience at a pediatric outpatient clinic. The aim of this pilot quality improvement project was to determine which positive distractions patients experienced and whether single-user electronic loaner devices should be provided to patients at pediatric outpatient facilities. A quantitative causal comparative approach was utilized in identifying patient exposure to key positive distraction techniques that may significantly decrease anxiety. …
Perceptions Of The Healthcare System Among Stakeholders, Michael D. Markee, Christine Ascencio, Laura Brugger, Renee Jonas, Hisako Matsuo
Perceptions Of The Healthcare System Among Stakeholders, Michael D. Markee, Christine Ascencio, Laura Brugger, Renee Jonas, Hisako Matsuo
Patient Experience Journal
The U.S. healthcare system is rife with complexities and is consistently a source of political debate. One’s interaction with the system may directly impact the understanding of the system. The objective of this research is to examine the perceptions of the United States healthcare system from the viewpoint of healthcare providers, insurers, and consumers. Using a grounded theory approach, theoretical sampling was used to explore similarities and differences between the three groups of actors in the healthcare system. Data were collected through interviews with thirty-one participants using a semi-structured interview schedule. Themes of cost, access, and inefficiency emerged from the …
In Divided Times, A Focus On Human Experience Connects Us, Jason A. Wolf
In Divided Times, A Focus On Human Experience Connects Us, Jason A. Wolf
Patient Experience Journal
The realities of the time in which we find ourselves, not only in healthcare, but in society overall, have exposed so much of what was simmering beneath the surface of our humanity. Issues of equity and inclusion, of stress and burnout, of division and misconception and even the existence of alternative “truths” have caused rifts in our connection, weakened our societal foundations and pulled on the seams of the healthcare system itself. We close our eighth volume of Patient Experience Journal (PXJ) under this veil, yet I believe we have an opportunity to use this moment as a place from …
Breaking Barriers To Equity: A Conversation With Dr. Julia Iyasere, Jason A. Wolf Phd
Breaking Barriers To Equity: A Conversation With Dr. Julia Iyasere, Jason A. Wolf Phd
Patient Experience Journal
I was honored to have the opportunity to talk to someone I've been fortunate to meet in the past few months and who has taught me incredible things about the topic of equity in healthcare and even more so the idea of health justice, Dr. Julia Iyasere, Executive Director of the NewYork-Presbyterian Dalio Center for Health Justice. As a physician, an educator, a researcher, and I suggest an evidence-based social activist, Dr. Iyasere has led the establishment and growth of the Dalio Center in just the over 9 months since its launch. But the ideas she champions in her work …
Moving From Talk To Action: A Commitment To Ensuring Equity Must Ground Our Efforts To Transform The Human Experience, Jason A. Wolf Phd
Moving From Talk To Action: A Commitment To Ensuring Equity Must Ground Our Efforts To Transform The Human Experience, Jason A. Wolf Phd
Patient Experience Journal
When we first introduced the call for submissions for this special issue last August, we were still churning in the first wave of the COVID pandemic. Just three to four months from the start of an unending rash of unexpected and harsh realities that we were faced with in healthcare and in society at large, we too found that the moment was revealing all the weaknesses and wounds that had existed in the foundations of the healthcare system from well before the pandemic hit. Our own research at The Beryl Institute in 2020 reinforced a quiet reality: that people do …
Exploring Mental Health Experience In Individuals Living With Temporomandibular Disorders, Wafaa Safour, Richard Hovey
Exploring Mental Health Experience In Individuals Living With Temporomandibular Disorders, Wafaa Safour, Richard Hovey
Patient Experience Journal
Despite the evidence supporting deteriorating mental health because of temporomandibular disorders (TMDs) conditions, there is limited evidence of TMD patients' experience regarding how their mental health is affected by the disorders. As a sequence of these conditions, TMD patients suffer from physical and mental complications, not to mention the loss of food enjoyment. In this study, we aim to explore TMD patients' lived experiences who had changed their dietary habits concerning their mental health. Six participants were interviewed to answer open-ended questions during semi-structured interviews regarding their mental health experiences with TMD-related food routine changes. These interviews were held face-to-face …
Partnering With Patients To Design A Prehabilitation Program For Optimizing The Patient Experience Through General Surgery, Jacqueline Francis-Coad, Dale Edgar, Caroline E. Bulsara, Alix Barrett-Lennard, Kristine Owen, David Fletcher, Fiona Wood, Anne-Marie Hill
Partnering With Patients To Design A Prehabilitation Program For Optimizing The Patient Experience Through General Surgery, Jacqueline Francis-Coad, Dale Edgar, Caroline E. Bulsara, Alix Barrett-Lennard, Kristine Owen, David Fletcher, Fiona Wood, Anne-Marie Hill
Patient Experience Journal
The objective of this study was to explore patients’ experiences when preparing for and undergoing general surgery at a large tertiary hospital. Findings aimed to inform the development of a prehabilitation program to empower patients to optimize their recovery and enhance their experience of general surgery. A qualitative exploratory research approach was utilized. Patients (>18 years) attending for elective general surgery between May and July 2018 were invited to participate. Four focus groups (n=18) and an interview were conducted to reach saturation. Deductive content analysis was used to map responses against theoretical determinants of health behavior change. Patients described …
The Experiences Of Rural British Columbians Accessing Surgical And Obstetrical Care, Aria Jazdarehee, Anshu Parajulee, Jude Kornelsen
The Experiences Of Rural British Columbians Accessing Surgical And Obstetrical Care, Aria Jazdarehee, Anshu Parajulee, Jude Kornelsen
Patient Experience Journal
The attrition of small volume surgical and maternity services in rural Canada over the past three decades has made access to these services especially challenging for rural citizens. While many of these closures have occurred as consequences of regionalization, a strategy to regionally centralize healthcare services, many studies investigating outcomes of regionalization have focused on costs and medical endpoints rather than the direct experiences of the rural patients affected. In this study, we aimed to understand and document the experiences of rural residents accessing procedural and maternity care both locally and away from home. This study is part of a …
Needle Phobia: How To Improve The Child's Experience During Blood Drawing, Maria D. Navarro, Helena Illera, Bonaventura Ruíz, Montserrat Naudó, Núria Serrallonga, Sonia Tordera, David Kornmehl, Lola Crevillén, Ana Bosque, David Nadal, Mercedes Jabalera
Needle Phobia: How To Improve The Child's Experience During Blood Drawing, Maria D. Navarro, Helena Illera, Bonaventura Ruíz, Montserrat Naudó, Núria Serrallonga, Sonia Tordera, David Kornmehl, Lola Crevillén, Ana Bosque, David Nadal, Mercedes Jabalera
Patient Experience Journal
Pediatric diseases, pain and hospitalization have an important impact on children and their families. This is especially significant when considering common invasive procedures, such as blood drawing. The objectives of the study were to assess the experience of children and families during the blood drawing procedure and suggest methods for improvement. The study was conducted in a children’s hospital in Barcelona, Spain, between 2018 and 2020. A mix-method design or combination of qualitative and quantitative methodologies was developed. We carried out a search of the literature, a design thinking approach, and a survey. Results from the qualitative approach identified areas …
Patients’ And Family Caregivers’ Perceptions Of Doctor-To-Doctor Advice And Electronic Referral Notifications In Alberta, Yong Li, Annabelle Wong
Patients’ And Family Caregivers’ Perceptions Of Doctor-To-Doctor Advice And Electronic Referral Notifications In Alberta, Yong Li, Annabelle Wong
Patient Experience Journal
Effective communication between health professionals and patients is essential to patient safety and quality care. Primary care providers seeking specialist advice to manage patients’ conditions in the community has recently been adopted to improve timely access to specialty care and increase the efficacy of the referral process. To understand patients’ and family caregivers’ perceptions on doctor-to-doctor advice for non-urgent clinical questions and electronic referral communications with patients in Alberta, a mixed method online survey was conducted by Alberta Health Services’ Access Improvement team. A total of 1,422 patients and family caregivers living in Alberta were included in the quantitative and …
Reexamining “Defining Patient Experience”: The Human Experience In Healthcare, Jason A. Wolf, Victoria Niederhauser, Dianne Marshburn, Sherri L. Lavela
Reexamining “Defining Patient Experience”: The Human Experience In Healthcare, Jason A. Wolf, Victoria Niederhauser, Dianne Marshburn, Sherri L. Lavela
Patient Experience Journal
In 2014, the authors came together with the explicit purpose of understanding how people were defining patient experience.1 Our broad review and analysis of the literature led us to a few critical points. One, as our review showed, there was an absence of a commonly used definition around patient experience in healthcare. Two, while consistency in the use of one definition was not revealed, there was great alignment around central components seen as critical to patient experience. Three, we highlighted the recurrence of key concepts from the literature that are also found in the definition offered by The Beryl …
A Call To Action For Human Experience, Jason A. Wolf
A Call To Action For Human Experience, Jason A. Wolf
Patient Experience Journal
As we open the 8th volume of Patient Experience Journal (PXJ), we all stand in a world much different than we did just a year ago. A year ago we were in the height of crisis, facing unknowns and uncertainty. We didn’t know if we were tackling an issue that was weeks, months or years in front of us. We were truly not even sure what tomorrow might bring. As I shared in opening Volume 7, we were already experiencing something special in the midst of real tragedy. We were seeing light peeking through heavy clouds. I opened that issue …
A Systems Thinking Framework To Improve Care Of The Terminally Ill: An Australian Case Study, Elizabeth Summerfield
A Systems Thinking Framework To Improve Care Of The Terminally Ill: An Australian Case Study, Elizabeth Summerfield
Patient Experience Journal
This paper argues the value of systems thinking to patients, family members and medical practitioners in end-of-life care, particularly as a mechanism for considering when palliative care should be introduced as preferred treatment. It applies a well-established set of tenets in systems thinking retrospectively to a case study of patient care in Australia. This highlights how and where different decisions might have been made, based on a holistic consideration of the patient’s best interests. The case is written from the perspective of a family caregiver. It argues that early, deliberate conversation, framed by systems thinking tenets, can support the call …
Patient Experience In Outpatient Clinics: Does Appointment Time Impact Satisfaction?, Shikha Shah Modi, Jennifer B. Costigan, Mark Lemak, Sue Feldman
Patient Experience In Outpatient Clinics: Does Appointment Time Impact Satisfaction?, Shikha Shah Modi, Jennifer B. Costigan, Mark Lemak, Sue Feldman
Patient Experience Journal
The objective of this study is to understand patient experience by appointment time by analyzing the Consumer Assessment of Hospital Provider and Systems (CAHPS) scores at a granular level across pre-determined time periods (AM and PM). This study utilized quantitative and qualitative methods. A deidentified secondary data set from the University of Alabama at Birmingham’s Press Ganey website was used to analyze the difference in CAHPS scores across AM and PM time periods. Unstructured survey responses were analyzed as a way to further enrich the quantitative findings. The data sample consisted of 821 responses from a dermatology clinic for the …