Posted By Katie Joyce and Katie Ziemer,
Friday, April 20, 2018
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Better patient experience has been linked with better health outcomes, improved treatment adherence, and increased provider and staff satisfaction. It creates a continuous positive upward spiral. However, initiating that upward spiral can be difficult due to the complexities of patient experience.
To continue the dialogue around understanding and addressing these complexities, we decided to bring together experts in the field, including healthcare services researchers, technology innovators, and leaders in clinical organizational improvement. We published their perspectives in the Ipsos Understanding Society, Patient Experience edition. Below, we provide the main take-aways from this initiative.
What is not measured is not improved
Before patient experience can be improved, it must first be measured, but measured in the right way. Measuring the patient experience allows us to see what needs to be improved, and points to how to improve it. When tracked over time, it lets us see whether our improvement efforts are actually making a difference. However, a number of factors need to be taken into consideration when measuring the patient experience so that we can ensure the results are actionable and accurate.
- First, it’s important to measure the aspects of the healthcare experience that actually matter to the patient. What are their expectations? What barriers impede them from getting their needs addressed? Using a journey mapping approach, where patients describe their entire experience before, during, and after the encounter, can be a useful way to get this information.
- Second, the patient experience needs to be linked to the systems and staff that impact their experience. What procedures do the staff use to check patients in? What are the rules for family visitation in hospitals? This information points to which aspects of the system or staff need to be changed to have the biggest impact on the patient.
- Third, measuring the patient experience should place as little burden on the patient as possible. Increasingly, this can be accomplished through technology, such as online surveys and incorporating alternative data streams.
- Fourth, we need to consider and account for the factors that can influence patient experience scores to gain as accurate of a picture as possible. For instance, primary care providers who have an ongoing relationship with their patients tend to receive higher scores than emergency care providers. This context needs to be taken into account when comparing scores between providers to make them equitable. Ipsos has developed fair scorecards that provide adjusted benchmarks to account for this context.
- Fifth, while patient experience is important to measure, we also need to recognize that it represents subjective perception rather than objective clinical care. For example, patients’ satisfaction with their experiences depend on their expectations. If an experience meets or exceeds expectations, the patient will be more satisfied with the experience, whereas if the experience falls below expectations, the individual will be dissatisfied.
Making the data actionable
Once patient experience information is collected, the question then becomes what do you do with it? Again, it’s important to identify the aspects of the patient journey (good and bad) that have the biggest impact on the overall experience. Patient-provider communication, care transition, and the availability of home-based medical care are all aspects of the patient experience that tend to significantly impact perceptions of the overall experience. Patients want to feel heard and respected by their doctor, a seamless transition once they leave the hospital, and the convenience of having their care team come to them (especially for elderly patients).
Once the most important aspects of the patient experience are identified, the units and staff responsible for these aspects of care need to be engaged and part of the feedback loop and continuous improvement process. Getting the right information to the right people who can take action is essential. In addition, getting staff buy-in and having a concrete action plan with tailored guidance and defined accountability are indispensable for creating successful improvements. This is often easier said than done as improving patient experience may necessitate large-scale institutional change. For instance, the Department of Veterans Affairs (VA) is rolling out patient experience improvement initiatives such as WECARE Leadership Rounding, where hospital leaders connect with patients and staff on a regular basis. Given the time, effort, and resources these initiatives require, facility leaders need to continually assess the success of these initiatives, keeping the ones that work and discarding the ones that don’t. This continuous feedback loop ensures that only the most effective initiatives are continued and promotes the upward spiral of providing patients with a better experience.
Additional details about our findings on the challenges and solutions for improving the patient experience can be found here: https://www.ipsos.com/en-us/knowledge/society/understanding-society-us-edition-patient-experience
Katie Joyce leads the US Public Affairs Government and Healthcare Service (GHS) research portfolio, with full business management responsibility. She oversees a senior team of data scientists, Ph.D. social scientists and statisticians, technologists, and project managers, as well as a behavioral science practice. In addition, Katie leads the portfolio of private health work in consumer survey research and brand tracking – key clients include Anthem, Blue Cross Blue Shield, and Kaiser Permanente.
Katie Ziemer, PhD, is an Associate Research Scientist at Ipsos Public Affairs. She conducts behavioral science research for federal and non-federal clients, including study design, data collection, data analysis, reporting, and advising. She also co-leads the development of a Behavioral Science Community of Practice which brings behavioral science service offerings to market and builds internal capabilities. Her research interests include attitude formation, behavior change, health promotion, disease prevention, brief psychosocial interventions, and positive psychology.
Katie is a licensed clinical psychologist with a doctorate in counseling psychology from the University of Maryland.
Posted By Tejal K. Gandhi, MD, MPH, CPPS,
Monday, March 7, 2016
Updated: Monday, March 7, 2016
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Patient engagement is an essential component of safe, appropriate, high quality healthcare. But what do we mean by patient engagement and how does it relate to patients’ experience of care?
A recent report published by the National Patient Safety Foundation (NPSF) notes that most definitions of patient engagement include the common themes of "partnership, communication, information exchange and respect.”
The Beryl Institute defines patient experience as "the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.”
There are overlaps between patient experience of care and patient engagement. If patients are not respected as partners in their care and if clinicians do communicate with patients effectively, then it is highly unlikely that the patient’s experience will be a positive one. Moreover, research has linked patient experience to clinical outcomes, with a 2013 paper finding "patient experience is positively associated with clinical effectiveness and patient safety and [data] support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare.”
The NPSF report, Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human, makes a number of recommendations for improving patient engagement to improve patient safety:
- Training and education: Clinicians and health professionals need to be educated about concepts such as shared decision making, health literacy, cultural sensitivity and respect.
- Ease of access to information: Patients and families need timely access to medical records, test results and tools and resources that help them understand complex medical information.
- Patient representation: Members of the community served by a healthcare organization should be represented on the governing bodies and committees of those organizations. Only by such representation can we ensure that safety and quality initiatives and care processes that affect patient experience are designed with patients in mind.
- Tools and strategies: From including families in bedside rounding to the use of tools like the Ask Me 3 program, which encourages patients to ask key questions about their health and care plans, there are tools and strategies that can help engage patients and improve their experience of care.
- Reporting and measuring: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) serves to measure, to a degree, a patient’s experience of care while hospitalized. We also need ways to measure patient engagement, including ways to capture patient reports of safety lapses.
Arguing for greater patient and family engagement is not new to NPSF, and is in fact an issue that we and others have been advocating for some time now. While educational efforts such as the Agency for Healthcare Research and Quality’s Questions are the Answer campaign are useful for patients and consumers, we also know that even experienced health professionals sometimes have trouble speaking up when put in the vulnerable position of patient.
While patients should be encouraged to be full partners in their care, their clinicians are the ones who really hold the key to making that possible.
Improving patient and family engagement is one of eight recommendations in the new NPSF report, which is a focal point of Patient Safety Awareness Week, March 13-19, 2016. The theme of the week this year is United for Patient Safety, a reflection of the belief that clinicians, patients, policy makers, researchers and everyone involved in healthcare must be part of making care safer for everyone.
Tejal K. Gandhi, MD, MPH, CPPS, is President and Chief Executive Officer of the National Patient Safety Foundation, the NPSF Lucian Leape Institute and the Certification Board for Professionals in Patient Safety. She is advocating for patient safety at the national level, driving educational and professional certification efforts, and helping to create and spread innovative new safety ideas.
patient and family engagement
Posted By Ushma A. Patel, MSPH,
Thursday, November 12, 2015
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To patients. For patients. With patients. This is how the healthcare system has evolved in how we interact with and engage patients and families in their care. As a healthcare researcher, I was always drawn to the patient and family engagement field. However it wasn’t until recently that my passion for improving the healthcare system deepened. In 2014, I survived preeclampsia, HELLP syndrome and a subarachnoid brain hemorrhage after my daughter’s birth. Luckily I am doing just fine now, but my daughter went on to face multiple health challenges, including open heart surgery at 7 months, eye surgery at 15 months and a suspected genetic condition that will have lifelong implications. As a mom and patient advocate, I know firsthand how important it is to stay engaged with her providers and healthcare – not just for improving her health but also for other children who may face similar battles.
There are many perspectives of what patient and family engagement is, and despite the variations, I think we can all agree that it is critical. The more important question is exactly how we engage patients and families in meaningful ways.
Based on Carman et. al’s Framework for Patient and Family Engagement, the American Institutes for Research developed the Roadmap for Patient and Family Engagement in Healthcare Practice and Research with funding from the Gordon and Betty Moore Foundation. The Roadmap reflects collective input from over 70 stakeholders who represented a variety of perspectives - clinicians, healthcare leaders, patients, families, insurers, payers, and researchers. It includes a vision for patient and family engagement in healthcare, and 8 change strategies to drive action towards increased patient and family engagement:
- Patient and Family Preparation. Educate, prepare and empower patients and families to engage effectively in their health and healthcare
- Clinician and Leadership Preparation. Educate, prepare and empower clinicians and healthcare leaders to partner effectively with patients and families
- Care and System Redesign. Redesign care to support partnerships between patients, families, and the healthcare team
- Organizational Partnership. Redesign healthcare organizations to make patients and families part of the governance structure
- Measurement and Research. Create measures and conduct research to improve care, facilitate changes, and understand outcomes
- Transparency and Accountability. Make data and information transparent to promote accountability and enable action
- Legislation and Regulation. Encourage patient and family engagement through regulation and legislation
- Partnership in Public Policy. Identify and provide opportunities to integrate patient and family perspectives into public policy
These change strategies occur across the 3 levels of engagement – (1) direct care, (2) organizational design and governance, and (3) policy. Within each of these 3 levels, there are opportunities for engagement across a continuum, ranging from consultation to partnership and shared leadership. At the consultation end of the continuum, patients are involved but have limited power and decision-making authority. At the partnership and shared leadership end of the continuum, patients have shared power and responsibility and are active partners in defining agendas, co-creating materials, contributing information, and making decisions. And it’s at this end of the continuum where there’s an opportunity for real change to occur.
Adopting these change strategies can take time, and therefore, the Roadmap also includes 5 simple actions that different stakeholder groups can take immediately such as preparing for their healthcare appointment or inviting patients and family members to share their experience.
There may not be a clear path to how we improve population health and the patient experience or reduce health care costs, but the Roadmap provides a solid starting point to navigate the way. Click here to read more about the Roadmap and Framework.
Since 2009, Ushma Patel has worked as a health services researcher at the American Institutes for Research in their Chapel Hill, NC office. Prior to AIR, she worked for the Lewin Group. In her spare time, Ushma is an avid DIY crafter, and also volunteers as a member of the Patient Advisory Council for the Preeclampsia Foundation and for the Duke Pediatric Cardiac Surgery Center.