An evaluation of a near real-time survey for improving patients’ experiences of the relational aspects of care: a mixed-methods evaluation

Background The Francis Report (of 2013) provided many recommendations to improve compassionate care in NHS organisations, including more widespread use of real-time feedback (RTF) to collect patient experience data. This research directly addressed these recommendations and aimed to provide an evidence-based toolkit to support NHS quality improvements. Objectives To develop and validate a survey of compassionate care for use in near real time on elderly care wards and accident and emergency (A&E) departments. This research also evaluated the effectiveness of the RTF approach for improving relational aspects of care and provides suggestions for how the approach can be used by other hospitals to strengthen compassionate care. Design The research utilised a mixed-methods design, using quantitative, qualitative and participatory research approaches to collect patients’ experiences of relational care and the views of NHS staff in an effort to evaluate the processes and impacts of near real-time feedback (NRTF) data collection. Data sources included a NRTF patient experience survey, weekly volunteer diaries, staff interviews and surveys, workshops and meetings with case study sites. Setting The research was carried out across six case study sites across England, in wards that predominantly serve elderly patients and in A&E departments. Participants The 3928 participants in the patient experience survey were inpatients on elderly care wards, or persons who had sought medical care in A&E. Frontline staff, service leads, senior management and volunteers also took part in surveys (n = 274) and interviews (n = 82) designed to understand the staff perspectives and opinions of collecting patient experience data. Interventions A patient experience survey was implemented using a tablet computer-based methodology, facilitated by trained volunteers. Responses were used alongside feedback from staff to evaluate the use of a NRTF approach as a method for improving patient experiences of relational aspects of care. Main outcome measures The patient experience survey measured relational aspects of care. Another outcome measure was improvements to care as planned, implemented and reported by staff. Results A small but statistically significant improvement (p = 0.044) in relational aspects of care over the course of the study was noted overall. Staff implemented a variety of improvements to enhance communication with patients. Limitations Maintaining volunteer and staff engagement throughout the study was difficult. Few surveys were completed per ward or department each week. This made examining trends in patient experiences over time challenging. Conclusions Near real-time feedback offers an effective approach for monitoring and improving relational aspects of care. Future work Staff frequently expressed a view that volunteers’ interactions with patients while administering the survey were themselves beneficial to patients. Future research should examine the impact of volunteer interactions with patients on their experiences of relational aspects of care. Study registration The project is registered on the Clinical Research Network portfolio under the primary trial identification number 18449. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Pinpointing Patterns of Violence: A Comparative Genocide Studies Approach to Violence Escalation in the Ukrainian Holodomor

Genocide Studies and Prevention ◽

10.5038/1911-9933.15.2.1809 ◽

2021 ◽

Vol 15 (2) ◽

pp. 10-36

Author(s):

Kristina Hook

Keyword(s):

Mixed Methods ◽

Real Time ◽

Large Scale ◽

Cross Cultural ◽

Victim Selection ◽

Contextual Variation ◽

Genocide Studies ◽

Genocidal Intent ◽

Precise Moment

This article utilizes the case study of the 1930s Ukrainian Holodomor, an artificially induced famine under Joseph Stalin, to advance comparative genocide studies debates regarding the nature, onset, and prevention of large-scale violence. Fieldwide debates question how to 1) distinguish genocide from other forms of large-scale violence and 2) trace genocides as unfolding processes, rather than crescendoing events. To circumvent unproductive definitional arguments, methodologies that track large-scale violence according to numerically-based thresholds have substituted for dynamics-based analyses. Able to address aspects of the genocide puzzle, these methodologies struggle to incorporate cross-cultural contextual variation or elicit ripe moments for specific, real-time interventions. Demonstrating how genocide’s precise, changing dynamics can be mapped over its duration, I present and apply a new mixed methods methodology, affirming that historical cases can inform modern prevention efforts. By coding 1932–1933 Ukraine-specific correspondences to/from Stalin, I pinpoint the precise moment when genocidal intent and victim selection overlaps.

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Patient experience and predictors of improvement in a group behavioral and educational intervention for individuals with diabetes and serious mental illness: a mixed methods case study (Preprint)

Journal of Participatory Medicine ◽

10.2196/21934 ◽

2020 ◽

Author(s):

Kristina Schnitzer ◽

Corrine Cather ◽

Vanya Zvonar ◽

Alyson Dechert ◽

Rachel Plummer ◽

...

Keyword(s):

Mental Illness ◽

Mixed Methods ◽

Patient Experience ◽

Serious Mental Illness ◽

Educational Intervention ◽

Mixed Methods Case Study

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Potilaskokemuskyselyn kehittäminen lastensairaalan potilaiden vanhemmille

Finnish Journal of eHealth and eWelfare ◽

10.23996/fjhw.60998 ◽

2017 ◽

Vol 9 (2-3) ◽

pp. 149

Author(s):

Johanna Kaipio ◽

Petri Mannonen ◽

Hanna Stenhammar ◽

Pekka Lahdenne ◽

Kari Hiekkanen ◽

...

Keyword(s):

Patient Experience ◽

Development Process ◽

Data Gathering ◽

Patient Experiences ◽

Healthcare Organizations ◽

Testing Data ◽

Similar Patient ◽

Experience Survey ◽

Further Development

Compared to patient satisfaction, less research has focused on patient experience, which is a complex phenomenon by nature, thereby challenging to define and measure. Today, healthcare organizations are short of appropriate instruments surveying patient experiences. Satisfaction questionnaires are used to evaluate the quality of hospital care from the viewpoint of adult patients. However, questions remain whether the hospitals should use these results to support their development activities. This article describes the development process of a patient experience survey instrument targeted for the parents of pediatric patients, introduces the first versions of the questionnaire, and the plan for further development. The development process included several phases: interviews with 17 families, identification of aspects which influence patient experiences (5 themes), description of related potential metrics (22 metrics), formulation of the first version of the questionnaire (67 statements) and pilot testing, data gathering at a pediatric outpatient clinic (106 respondents), and based on exploratory factor analysis development of the second version of the questionnaire (22 statements). The further development includes validation with a second round data gathering and statistical analysis. The aim is to condense the number of statements into about 10 and implement the survey in an electronic format. In the Lapsus project similar patient experience questionnaires will be developed for all relevant phases of patients paths. The development work will utilize the reported process and the first version of the questionnaire. The plan is take the instruments in use in the New Children’s hospital in Helsinki and in other similar hospitals.

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Tackling the workforce crisis in district nursing: can the Dutch Buurtzorg model offer a solution and a better patient experience? A mixed methods case study

BMJ Open ◽

10.1136/bmjopen-2018-021931 ◽

2018 ◽

Vol 8 (6) ◽

pp. e021931 ◽

Cited By ~ 8

Author(s):

Vari M Drennan ◽

Melania Calestani ◽

Fiona Ross ◽

Mary Saunders ◽

Peter West

Keyword(s):

Mixed Methods ◽

Patient Experience ◽

Mixed Methods Case Study

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NHS commissioning practice and health system governance: a mixed-methods realistic evaluation

Health Services and Delivery Research ◽

10.3310/hsdr03100 ◽

2015 ◽

Vol 3 (10) ◽

pp. 1-184 ◽

Cited By ~ 7

Author(s):

Rod Sheaff ◽

Nigel Charles ◽

Ann Mahon ◽

Naomi Chambers ◽

Verdiana Morando ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mixed Methods ◽

Health Services ◽

Health System ◽

Orthopaedic Surgery ◽

Programme Theory ◽

Realistic Evaluation ◽

Study Sites

BackgroundBy 2010 English health policy-makers had concluded that the main NHS commissioners [primary care trusts (PCTs)] did not sufficiently control provider costs and performance. After the 2010 general election, they decided to replace PCTs with general practitioner (GP)-controlled Clinical Commissioning Groups (CCGs). Health-care commissioners have six main media of power for exercising control over providers, which can be used in different combinations (‘modes of commissioning’).ObjectivesTo: elicit the programme theory of NHS commissioning policy and empirically test its assumptions; explain what shaped NHS commissioning structures; examine how far current commissioning practice allowed commissioners to exercise governance over providers; examine how commissioning practices differ in different types of commissioning organisation and for specific care groups; and explain what factors influenced commissioning practice and the relationships between commissioners and providers.DesignMixed-methods realistic evaluation, comprising: Leximancer and cognitive frame analyses of policy statements to elicit the programme theory of NHS commissioning policy; exploratory cross-sectional analysis of publicly available managerial data about PCTs; systematic comparison of case studies of commissioning in four English sites – including commissioning for older people at risk of unplanned hospital admission; mental health; public health; and planned orthopaedic surgery – and of English NHS commissioning practice with that of a German sick-fund and an Italian region (Lombardy); action learning sets, to validate the findings and draw out practical implications; and two framework analyses synthesising the findings and testing the programme theory empirically.ResultsIn the four English case study sites, CCGs were formed by recycling former commissioning structures, relying on and maintaining the existing GP commissioning leaderships. The stability of distributed commissioning depended on the convergence of commissioners’ interests. Joint NHS and local government commissioning was more co-ordinated at strategic than operational level. NHS providers’ responsiveness to commissioners reflected how far their interests converged, but also providers’ own internal ability to implement agreements. Commissioning for mental health services and to prevent recurrent unplanned hospital readmissions relied more on local ‘micro-commissioning’ (collaborative care pathway design) than on competition. Service commissioning was irrelevant to intersectoral health promotion, but not clinical prevention work. On balance, the possibility of competition did not affect service outcomes in the ways that English NHS commissioning policies assumed. ‘Commodified’ planned orthopaedic surgery most lent itself to provider competition. In all three countries, tariff payments increased provider activity and commissioners’ costs. To contain costs, commissioners bundled tariff payments into blocks, agreed prospective case loads with providers and paid below-tariff rates for additional cases. Managerial performance, negotiated order and discursive control were the predominant media of power used by English, German and Italian commissioners.ConclusionsCommissioning practice worked in certain respects differently from what NHS commissioning policy assumed. It was often laborious and uncertain. In the four English case study sites financial and ‘real-side’ contract negotiations were partly decoupled, clinician involvement being least on the financial side. Tariff systems weakened commissioners’ capacity to choose providers and control costs. Commissioners adapted the systems to solve this problem. Our findings suggest a need for further research into whether or not differently owned providers (corporate, third sector, public, professional partnership, etc.) respond differently to health-care commissioners and, if so, what specific implications for commissioning practice follow. They also suggest that further work is needed to assess how commissioning practices impact on health system integration when care pathways have to be constructed across multiple providers that must tender competitively for work, perhaps against each other.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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