scholarly journals Testing accelerated experience-based co-design: a qualitative study of using a national archive of patient experience narrative interviews to promote rapid patient-centred service improvement

2014 ◽  
Vol 2 (4) ◽  
pp. 1-122 ◽  
Author(s):  
Louise Locock ◽  
Glenn Robert ◽  
Annette Boaz ◽  
Sonia Vougioukalou ◽  
Caroline Shuldham ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Patient Experience ◽  
Clinical Pathways ◽  
National Archive ◽  
Service Improvement ◽  
Quality Improvements ◽  
Narrative Interviews ◽  
Video And Audio ◽  
The Cost

BackgroundMeasuring, understanding and improving patients’ experiences is of central importance to health care systems, but there is debate about the best methods for gathering and understanding patient experiences and how to then use them to improve care. Experience-based co-design (EBCD) has been evaluated as a successful approach to quality improvement in health care, drawing on video narrative interviews with local patients and involving them as equal partners in co-designing quality improvements. However, the time and cost involved have been reported as a barrier to adoption. The Health Experiences Research Group at the University of Oxford collects and analyses video and audio-recorded interviews with people about their experiences of illness. It now has a national archive of around 3000 interviews, covering around 75 different conditions or topics. Selected extracts from these interviews are disseminated for a lay audience onwww.healthtalkonline.org. In this study, we set out to investigate whether or not this archive of interviews could replace the need for discovery interviews with local patients.ObjectivesTo use a national video and audio archive of patient experience narratives to develop, test and evaluate a rapid patient-centred service improvement approach (‘accelerated experience-based co-design’ or AEBCD). By using national rather than local patient interviews, we aimed to halve the overall cycle from 12 to 6 months, allowing for EBCD to be conducted in two clinical pathways rather than one. We observed how this affected the process and outcomes of the intervention.DesignThe intervention was an adapted form of EBCD, a participatory action research approach in which patients and staff work together to identify and implement quality improvements. The intervention retained all six components of EBCD, but used national trigger films, shortened the time frame and employed local service improvement facilitators. An ethnographic process evaluation was conducted, including observations, interviews, questionnaires, cost and documentary analysis including previous EBCD evaluation reports.SettingIntensive care and lung cancer services in two English NHS hospital trusts (Royal Berkshire and Royal Brompton and Harefield).ParticipantsNinety-six clinical staff (primarily nursing and medical) and 63 patients and family members.InterventionFor this accelerated intervention, the trigger film was derived from pre-existing national patient experience interviews. Local facilitators conducted staff discovery interviews. Thereafter, the process followed the usual EBCD pattern: the film was shown to local patients in a workshop meeting, and staff had a separate meeting to discuss the results of their feedback. Staff and patients then came together in a further workshop to view the film, agree priorities for improvement and set up co-design working groups to take these priorities forward.ResultsThe accelerated approach proved readily acceptable to staff and patients; using films of national rather than local narratives did not adversely affect local NHS staff engagement, and may in some cases have made the process less threatening or challenging. Local patients felt that the national films generally reflected important themes, although a minority felt that they were more negative than their own personal experience. However, they served their purpose as a ‘trigger’ to discussion, and the resulting 48 co-design activities across the four pathways were similar in nature to those in EBCD but achieved at reduced cost. AEBCD was nearly half the cost of EBCD. However, where a trigger film already exists, pathways can be implemented for as little as 40% of the cost of traditional EBCD. It was not necessary to do additional work locally to supplement the national interviews. The intervention carried a ‘cost’ in terms of heavy workload and intensive activity for the local facilitators, but also brought benefits in terms of staff development/capacity-building. Furthermore, as in previous EBCDs, the approach was subsequently adopted in other clinical pathways in the trusts.ConclusionsAccelerated experience-based co-design delivered an accelerated version of EBCD, generating a comparable set of improvement activities. The national film acted as an effective trigger to the co-design process. Based on the results of the evaluation, AEBCD offers a rigorous and effective patient-centred quality improvement approach. We aim to develop further trigger films from the archived material as resources permit, and to investigate different ways of conducting the analysis (e.g. involving patients in doing the analysis).FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals How do frontline staff use patient experience data for service improvement? Findings from an ethnographic case study evaluation

2020 ◽  
Vol 25 (3) ◽  
pp. 151-161 ◽  
Author(s):  
Louise Locock ◽  
Catherine Montgomery ◽  
Stephen Parkin ◽  
Alison Chisholm ◽  
Jennifer Bostock ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Patient Experience ◽  
Care Quality ◽  
Service Improvement ◽  
Ethnographic Case Study ◽  
Frontline Staff ◽  
Diverse Range ◽  
Study Evaluation

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.

scholarly journals The emotional labour of quality improvement work in end of life care: a qualitative study of Patient and Family Centred Care (PFCC) in England

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Richard Boulton ◽  
Annette Boaz
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
End Of Life ◽  
Patient Experience ◽  
End Of Life Care ◽  
Care Service ◽  
Unintended Consequences ◽  
Life Care ◽  
Emotional Labour ◽  
Service Staff

Abstract Background There is a growing emphasis on understanding patient experience in order to inform efforts to support improvement. This paper reports findings from an implementation study of an evidence-based intervention called Patient and Family Centred Care (PFCC) designed to tap into patient experiences as a basis for improvement. In this study the PFCC intervention was spread to a new service area (end of life care) and delivered at scale in England. The findings presented here focus specifically on one key aspect of the intervention: staff shadowing of patients, and the experiences of staff carrying out shadowing for the purposes of service improvements. Methods The study methods were ethnographic observations of key events, semi-structured interviews with members of participating teams and the programme implementation support team and managers, and a review of the documents used in the set up and running of the programme. Results One of the key strengths of the PFCC approach is to encourage staff through shadowing to engage with patient experience of services. Many staff described the process of shadowing as a transformative experience that alerted them to immediate areas where their services could be improved. However, engaging with patient experience of end of life care services also had unintended consequences for some staff in the form of emotional labour. Furthermore, we observed difficulties encountered by staff that are not accounted for in the existing PFCC literature relating to how care service structures may unevenly distribute the amount of ‘emotional labour’ that staff members need to invest in implementing the programme. Conclusions Connecting with patient experience is a crucial aspect of a number of quality improvement interventions that aim to help staff to engage with the lived experience of their services and reconnect their motivations for working in the health care system. However, there may be unintended consequences for health care service staff, particularly in sensitive areas of service delivery such as end of life care. The ‘emotional labour’ for staff of engaging in quality improvement work informed by patient experience should be considered in planning and supporting patient experience led quality improvement.

scholarly journals Organisational strategies and practices to improve care using patient experience data in acute NHS hospital trusts: an ethnographic study

2019 ◽  
Vol 7 (34) ◽  
pp. 1-112 ◽  
Author(s):  
Sara Donetto ◽  
Amit Desai ◽  
Giulia Zoccatelli ◽  
Glenn Robert ◽  
Davina Allen ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Experience ◽  
Phase 1 ◽  
National Policy ◽  
Research Programme ◽  
Actor Network Theory ◽  
Care Quality ◽  
Ethnographic Study ◽  
Quality Improvements ◽  
Future Work

Background Although NHS organisations have access to a wealth of patient experience data in various formats (e.g. surveys, complaints and compliments, patient stories and online feedback), not enough attention has been paid to understanding how patient experience data translate into improvements in the quality of care. Objectives The main aim was to explore and enhance the organisational strategies and practices through which patient experience data are collected, interpreted and translated into quality improvements in acute NHS hospital trusts in England. The secondary aim was to understand and optimise the involvement and responsibilities of nurses in senior managerial and front-line roles with respect to such data. Design The study comprised two phases. Phase 1 consisted of an actor–network theory-informed ethnographic study of the ‘journeys’ of patient experience data in five acute NHS hospital trusts, particularly in cancer and dementia services. Phase 2 comprised a series of Joint Interpretive Forums (one cross-site and one at each trust) bringing together different stakeholders (e.g. members of staff, national policy-makers, patient/carer representatives) to distil generalisable principles to optimise the use of patient experience data. Setting Five purposively sampled acute NHS hospital trusts in England. Results The analysis points to five key themes: (1) each type of data takes multiple forms and can generate improvements in care at different stages in its complex ‘journey’ through an organisation; (2) where patient experience data participate in interactions (with human and/or non-human actors) characterised by the qualities of autonomy (to act/trigger action), authority (to ensure that action is seen as legitimate) and contextualisation (to act meaningfully in a given situation), quality improvements can take place in response to the data; (3) nurses largely have ultimate responsibility for the way in which data are collected, interpreted and used to improve care, but other professionals also have important roles that could be explored further; (4) formalised quality improvement can confer authority to patient experience data work, but the data also lead to action for improvement in ways that are not formally identified as quality improvement; (5) sense-making exercises with study participants can support organisational learning. Limitations Patient experience data practices at trusts performing ‘worse than others’ on the Care Quality Commission scores were not examined. Although attention was paid to the views of patients and carers, the study focused largely on organisational processes and practices. Finally, the processes and practices around other types of data were not examined, such as patient safety and clinical outcomes data, or how these interact with patient experience data. Conclusions NHS organisations may find it useful to identify the local roles and processes that bring about autonomy, authority and contextualisation in patient experience data work. The composition and expertise of patient experience teams could better complement the largely invisible nursing work that currently accounts for a large part of the translation of data into care improvements. Future work To date, future work has not been planned. Study registration NIHR 188882. Funding The National Institute for Health Research Health Services and Delivery Research programme.

Clinical Laboratory Quality Practices When Hemolysis Occurs

2015 ◽  
Vol 139 (7) ◽  
pp. 901-906 ◽  
Author(s):  
Peter J. Howanitz ◽  
Christopher M. Lehman ◽  
Bruce A. Jones ◽  
Frederick A. Meier ◽  
Gary L. Horowitz
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Lactate Dehydrogenase ◽  
Clinical Laboratory ◽  
Administrative Leadership ◽  
Secondary Chemistry ◽  
Quality Practices ◽  
Health Care Practices ◽  
Potassium Lactate ◽  
The Cost

Context Hemolyzed specimens delay clinical laboratory results, proliferate unnecessary testing, complicate physician decisions, injure patients indirectly, and increase health care costs. Objective To determine quality improvement practices when hemolysis occurs. Design We used the College of American Pathologists (CAP) Survey Program to distribute a Q-Probes–type questionnaire about hemolysis practices to CAP Chemistry Survey participants. Results Of 3495 participants sent the questionnaire, 846 (24%) responded. Although 85%, 69%, and 55% of participants had written hemolysis policies for potassium, lactate dehydrogenase, and glucose, respectively, only a few (46%, 40%, and 40%) had standardized hemolysis reports between their primary and secondary chemistry analyzers for these 3 analytes. Most participants (70%) had not attempted to validate the manufacturers' hemolysis data for these 3 analytes; however, essentially all who tried, succeeded. Forty-nine percent of participants had taken corrective action to reduce hemolysis during the past year and used, on average, 2.4 different actions, with collection and distribution of hemolysis data to administrative leadership (57%), troubleshooting outliers (55%), retraining phlebotomist (53%), and establishment of quality improvement teams among the laboratory and at problem locations (37%) being the most common actions. When asked to assess their progress in reducing hemolysis, 70% noted slow to no progress, and 2% gave up on improvement. Upon measuring potassium, lactate dehydrogenase, and glucose, approximately 60% of participants used the same specimen flag for hemolysis as for lipemia and icterus. Conclusions Hemolysis decreases the quality and increases the cost of health care. Practices for measuring, reporting, and decreasing hemolysis rates need improvement.

scholarly journals Measuring health care experiences that matter to Indigenous people in Australia with cancer: identifying critical gaps in existing tools

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Monica Green ◽  
Joan Cunningham ◽  
Kate Anderson ◽  
Kalinda Griffiths ◽  
Gail Garvey
Keyword(s):  
Health Care ◽  
Indigenous People ◽  
Patient Experience ◽  
Health Care Providers ◽  
Cancer Care ◽  
Cultural Safety ◽  
Service Improvement ◽  
Care Providers ◽  
Indigenous Worldview ◽  
Critical Aspects

Abstract Background Measurement of patients’ healthcare experiences is increasingly used as an indicator of quality of care, but there are concerns that existing measures omit information that is meaningful to patients and that results may not be used systematically to inform service improvement. Further, current approaches may be inadequate for some population groups, such as Indigenous people in Australia, whose healthcare experience is impacted by the context of colonisation and discordance between Indigenous understandings of health and the Western biomedical health system. This study aimed to assess the extent to which existing patient experience measures used in Australia collect information about critical aspects of cancer care, as previously identified by Indigenous people affected by cancer and their health care providers. Methods A two-stage process was used to examine the adequacy of existing patient experience measures for Indigenous people in Australia: (1) relevant tools and measures were identified and assessed, and four measures selected as suitable comparators; (2) comparators were examined in detail and mapped against topics identified in earlier research as important to Indigenous people with cancer. Gaps in topic coverage in comparators were identified. Results No comparators completely captured the critical aspects of cancer care identified by Indigenous people affected by cancer and their health care providers. The number of topics ‘partially’ captured by the four comparators ranged from 4 to 7 out of 9. While most topics were partially covered, the lack of questions around culture and cultural safety was notable. Conclusions Existing tools are likely to miss key aspects of Indigenous peoples’ experiences of cancer care in Australia. Failure to adequately assess care experiences related to cultural safety may compromise efforts to improve health outcomes. Addressing gaps requires development of experience measures that are strengths-based, reflect an Indigenous worldview and measure aspects of experience relevant to Indigenous people.

scholarly journals Dynamic waitlisted design for evaluating a randomized trial of evidence-based quality improvement of comprehensive women’s health care implementation in low performing VA facilities

2020 ◽  
Author(s):  
Alison B. Hamilton ◽  
Tanya Olmos-Ochoa ◽  
Ismelda Canelo ◽  
Danielle Rose ◽  
Katherine Hoggatt ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Randomized Trial ◽  
Women’S Health ◽  
Women's Health ◽  
Patient Experience ◽  
Women Veterans ◽  
Evidence Based ◽  
Staff Attitudes ◽  
Women's Health Care

Abstract Background : Women’s Health Services (WHS) in the Veterans Health Administration (VA) has long partnered with VA researchers to evaluate how VA care is organized for women Veterans. This partnership has yielded substantial evidence of 1) variations in women Veterans’ access to comprehensive healthcare services that contribute to disparities in quality and patient experience, and 2) the positive impacts of gender-specific care models for women Veterans’ quality and satisfaction. In an effort to provide support specifically to sites that were low-performing in women’s health, WHS and the VA Quality Enhancement Research Initiative co-funded an effort to roll out and evaluate evidence-based quality improvement (EBQI), an implementation strategy with demonstrated effectiveness in a prior cluster randomized trial in women’s health clinics. Methods : We will identify 21 low-performing VA facilities through a combination of WATCH data, VA quality metrics (by gender) and other indicators. In partnership with WHS, an EBQI contractor will deliver the EBQI “package” – local consensus-development and priority-setting using stakeholder panels, multilevel stakeholder engagement, practice facilitation, local EBQI team training, and formative feedback – to participating sites. We propose a dynamic wait-listed design to evaluate the WHS plans for seven EBQI launches per year over three years. The goal is to evaluate: (1) barriers and facilitators to achieving delivery of comprehensive women’s health care in low-performing VA facilities; (2) effectiveness of EBQI in supporting low-performing VA facilities achieve improved practice features (e.g., level of comprehensive services available, care coordination arrangements, Patient Aligned Care Team (PACT) features implemented, environment of care improvements), provider/staff attitudes (e.g., improved gender awareness, women’s health knowledge and practice), quality of care, and patient experience; and (3) contextual factors, local implementation processes, and organizational changes over time. Discussion : Access to comprehensive women’s health care reduces fragmentation of care, improves patient satisfaction and results in better patient outcomes. We hypothesize that EBQI implementation will result in changes in leadership awareness and buy-in, multilevel engagement in problem-solving, an enhanced culture of quality improvement, structural changes in care, improved provider/staff attitudes, and better quality and patient experience.

scholarly journals The emotional labour of quality improvement work in end of life care: a qualitative study of Patient and Family Centred Care in England

2019 ◽  
Author(s):  
Richard Boulton ◽  
Annette Boaz
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
End Of Life ◽  
Patient Experience ◽  
End Of Life Care ◽  
Care Service ◽  
Unintended Consequences ◽  
Life Care ◽  
Emotional Labour ◽  
Service Staff

Abstract BACKGROUND There is a growing emphasis on understanding patient experience in order to inform efforts to support improvement. This paper reports findings from an implementation study of an evidence-based intervention called Patient and Family Centred Care (PFCC) designed to tap into patient experiences as a basis for improvement. In this study the PFCC intervention was spread to a new service area (end of life care) and delivered at scale in England. The findings presented here focus specifically on one key aspect of the intervention: staff shadowing of patients, and the experiences of staff carrying out shadowing for the purposes of service improvements.METHODS The study methods were ethnographic observations of key events, semi-structured interviews with members of participating teams and the programme implementation support team and managers, and a review of the documents used in the set up and running of the programme.RESULTS One of the key strengths of the PFCC approach is to encourage staff through shadowing to engage with patient experience of services. Many staff described the process of shadowing as a transformative experience that alerted them to immediate areas where their services could be improved. However, engaging with patient experience of end of life care services also had unintended consequences for some staff in the form of emotional labour. Furthermore, we observed difficulties encountered by staff that are not accounted for in the existing PFCC literature relating to how care service structures may unevenly distribute the amount of ‘emotional labour’ that staff members need to invest in implementing the programme.CONCLUSIONS Connecting with patient experience is a crucial aspect of a number of quality improvement interventions that aim to help staff to engage with the lived experience of their services and reconnect their motivations for working in the health care system. However, there may be unintended consequences for health care service staff, particularly in sensitive areas of service delivery such as end of life care. The ‘emotional labour’ for staff of engaging in quality improvement work informed by patient experience should be considered in planning and supporting patient experience led quality improvement.

Building capacity and capability in patient safety, innovation and service improvement: an English case study

2011 ◽  
Vol 16 (3) ◽  
pp. 243-251 ◽  
Author(s):  
Tony Butterworth ◽  
Kate Jones ◽  
Simone Jordan
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Quality Improvement ◽  
Health Care Services ◽  
Health Care Systems ◽  
Future Research ◽  
Health Improvement ◽  
Service Improvement ◽  
Research Activity ◽  
The Impact

It is clear that for at least the next decade, funding for many health systems across the world will be challenged by serious uncertainties in country economies. In facing these challenges nurses have to respond positively to innovations in the delivery of care, increases in productivity and the eradication of errors that result in harm to patients. In committing to supporting this necessary change, quality improvement and innovation programmes are now available from national, not-for-profit organisations, such as the Health Foundation (UK) and the Institute for Health Improvement (USA) and the National Health Service Institute for Innovation an Improvement (UK) that specifically address these important issues. Although the targets for these programmes are often health care systems at the macro level, the role of nurses in understanding and delivering innovative practices at a more micro level is vital. Evidence is now available that demonstrates the outputs of such programmes and the impact from making consequent changes to nursing practice. Education programmes and research activity by nurses can also take advantage of this activity and begin to ask questions that focus on those subject areas, as well as adding positive value to people who use health care services. This paper briefly describes background developments during the last decade, offers one example of innovation programme content, describes the results of introducing patient safety, quality improvement and innovation into education curricula and suggests potential areas for future research by clinical academic nurse researchers.

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