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Munro J. Online patient feedback offers important insights into the safety and quality of care. BMJ 2024; 386:q1243. [PMID: 38991692 DOI: 10.1136/bmj.q1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
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Martino SC, Reynolds KA, Grob R, Palimaru AI, Zelazny S, Slaughter ME, Rybowski L, Parker AM, Toomey SL, Schuster MA, Schlesinger M. Evaluation of a protocol for eliciting narrative accounts of pediatric inpatient experiences of care. Health Serv Res 2023; 58:271-281. [PMID: 36645204 PMCID: PMC10012224 DOI: 10.1111/1475-6773.14134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To evaluate the measurement properties of a set of six items designed to elicit narrative accounts of pediatric inpatient experience. DATA SOURCES Data came from 163 participants recruited from a probability-based online panel of U.S. adults. Participants were family members of a child who had an overnight hospital stay in the past 12 months. STUDY DESIGN Cross-sectional survey with follow-up phone interviews. DATA COLLECTION/EXTRACTION METHODS Participants completed an online (n = 129) or phone (n = 34) survey about their child's hospitalization experience. The survey contained closed-ended items from the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) survey, followed by the six narrative items. Approximately 2 weeks after completing the survey, 47 participants additionally completed a one-hour, semi-structured phone interview, the results of which served as a "gold standard" for evaluating the fidelity of narrative responses. Qualitative content analysis was used to code narrative and interview responses for domains of patient experience and actionability. PRINCIPAL FINDINGS The average narrative was 248 words (SD = 319). Seventy-nine percent of narratives mentioned a topic included in the Child HCAHPS survey; 89% mentioned a topic not covered by that survey; and 75% included at least one detailed description of an actionable event. Overall, there was 66% correspondence between narrative and interview responses. Correspondence was higher on the phone than in the online condition (75% vs. 59%). CONCLUSIONS Narratives elicited from rigorously designed multi-item sets can provide detailed, substantive information about pediatric inpatient experiences that hospitals could use to improve child and family experiences during pediatric hospitalization. They add context to closed-ended survey item responses and provide information about experiences of care important to children and families that are not included in quantitative surveys.
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Affiliation(s)
| | | | - Rachel Grob
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin, USA
| | | | | | | | | | | | - Sara L Toomey
- Boston Children's Hospital, Boston, Massachusetts, USA.,Division of General Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Schuster
- RAND Corporation, Santa Monica, California, USA.,Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Mark Schlesinger
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
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Fylan B, Munro J, O'Hara JK, Khatoon B, Lawton R. Developing a research community within an online healthcare feedback platform. Health Expect 2023; 26:705-714. [PMID: 36661042 PMCID: PMC10010085 DOI: 10.1111/hex.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Care Opinion is an online feedback platform supporting patients to author stories about their care. It is not known whether authors would be willing to be involved in improving care through research. The aims of this study were to explore the views and preferences of Care Opinion authors about joining an online research community and to pilot new research community functionality. METHODS Five hundred and nine Care Opinion authors were invited to take part in an online survey in June 2019. Survey items included questions about participants' willingness to take part in research and their preferences for supporting processes. Data were analysed descriptively. Authors were invited to consent to join a research community and were asked to participate in three pilot studies. RESULTS One hundred and sixty-three people consented to take part in the survey (32%). Participants indicated they would like to know the time commitment to the project (146, 90%), details about the organization carrying out the research (124, 76%) and safeguarding information (124, 76%). Over half indicated that they did not know how to get involved in healthcare research (87, 53%). Subsequently, 667 authors were invited to join the research community, 183 (27%) accepted, and three studies were matched to their expressed preferences for project attributes or organization type. CONCLUSION Many people who leave online feedback about their experiences of healthcare are also willing to join a research community via that platform. They have strong preferences for supporting University and NHS research. Eligibility and acceptance rates to join pilot research studies varied. Further work is needed to grow the research community, increase its diversity, and create relevant and varied opportunities to support research. PATIENT OR PUBLIC CONTRIBUTION Four members of the Safety In Numbers patient and public involvement and engagement (PPIE) group advised about survey development.
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Affiliation(s)
- Beth Fylan
- Yorkshire Quality and Safety Research Group, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.,School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - James Munro
- Care Opinion Community Interest Company, Sheffield, UK
| | - Jane K O'Hara
- Yorkshire Quality and Safety Research Group, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | - Binish Khatoon
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - Rebecca Lawton
- Yorkshire Quality and Safety Research Group, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.,School of Psychology, University of Leeds, Leeds, UK
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Ramsey L, O'Hara J, Lawton R, Sheard L. A glimpse behind the organisational curtain: A dramaturgical analysis exploring the ways healthcare staff engage with online patient feedback 'front' and 'backstage' at three hospital Trusts in England. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:642-665. [PMID: 36650635 DOI: 10.1111/1467-9566.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Healthcare staff are encouraged to use feedback from their patients to inform service and quality improvement. Receiving patient feedback via online channels is a relatively new phenomenon that has rarely been conceptualised. Further, the implications of a wide, varied and unknown(able) audience being able to view and interact with online patient feedback are yet to be understood. We applied a theoretical lens of dramaturgy to a large ethnographic dataset, collected across three NHS Trusts during 2019/2020. We found that organisations demonstrated varying levels of 'preparedness to perform' online, from invisibility through to engaging in public conversation with patients within a wider mission for transparency. Restrictive 'cast lists' of staff able to respond to patients was the hallmark of one organisation, whereas another devolved responding responsibility amongst a wide array of multidisciplinary staff. The visibility of patient-staff interactions had the potential to be culturally disruptive, dichotomously invoking either apprehensions of reputational threat or providing windows of opportunity. We surmise that a transparent and conversational feedback response frontstage aligns with the ability to better prioritise backstage improvement. Legitimising the autonomous frontstage activity of diverse staff groups may help shift organisational culture, and gradually ripple outwards a shared responsibility for transparent improvement.
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Affiliation(s)
- Lauren Ramsey
- Yorkshire Quality and Safety Research Group, Bradford Royal Infirmary, Bradford, UK
| | - Jane O'Hara
- Yorkshire Quality and Safety Research Group, Bradford Royal Infirmary, Bradford, UK
- School of Healthcare, University of Leeds, Leeds, UK
| | - Rebecca Lawton
- Yorkshire Quality and Safety Research Group, Bradford Royal Infirmary, Bradford, UK
- School of Psychology, University of Leeds, Leeds, UK
| | - Laura Sheard
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Learning from patient experiences of projection imaging through the use of online feedback platforms. J Med Imaging Radiat Sci 2023; 54:73-82. [PMID: 36463092 DOI: 10.1016/j.jmir.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION & BACKGROUND Projection radiography remains a well-used diagnostic tool in healthcare, and its use is continually increasing. The volume of feedback collected from patients has grown exponentially but is rarely analysed within the service to meaningfully underpin change. Professions such as nursing currently make use of patient feedback during training yet there is comparatively little use in diagnostic radiography. Research exists into the use of social media during radiotherapy treatment, highlighting how it could be embraced in future research. However, there remains a sparsity of publications discussing the experiences of patients with projection radiography despite its prominence within diagnostic imaging. Online platforms for feedback are available to most industries and readily embraced and used. They are also becoming increasingly available to healthcare providers. This study aimed to assess and analyse the patient experience of projection radiography using the stories of patients via an online platform. METHODOLOGY Recognising that humans do not experience healthcare in a binary way, the authors selected a narrative method as the most appropriate qualitative methodology to analyse and understand 181 patient stories relating to projection radiography from the Care Opinion UK website. Each story was read three times to establish codes and themes and to ensure author familiarity with the patient's words & descriptions. This resulted in 30 empirical codes with the most frequently used being split into three major themes for discussion RESULTS & CONCLUSION: The three major themes considered the radiography experience, the encounter with professionals and service provision. Online sources of feedback provide valuable data for health researchers and provide access to insights which might otherwise go unconsidered. Patients instinctively perceive radiological examinations to result in delays to their care and report surprise when discovering examinations are delivered swiftly, though it remains that innovations such as radiographer-led discharge could be better utilised to enhance the patient experience. In addition, it is evident that administrative functions in diagnostic radiology departments are considered poor and from the descriptions given in the study by patients, the administrative side of the service does not meet their needs. Patient stories demonstrate that radiography is not perceived as vital to patient care and is frequently devalued through the notion that health professions are limited to medical doctor and nurse. The work of radiographers is not valueless to the patient evidenced by their desire to thank staff for their work, but its value is poorly understood and could be further enhanced by embracing online feedback as part of continuing professional and service development.
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Walsh L, Hyett N, Juniper N, Li C, Hill S. The Experiences of Stakeholders Using Social Media as a Tool for Health Service Design and Quality Improvement: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192214851. [PMID: 36429570 PMCID: PMC9690250 DOI: 10.3390/ijerph192214851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Health organisations and stakeholders use social media for a range of functions, including engaging stakeholders in the design and quality improvement (QI) of services. Social media may help overcome some of the limitations of traditional stakeholder engagement methods. This scoping review explores the benefits, risks, barriers and enablers for using social media as a tool for stakeholder engagement in health service design and QI. METHODS The searches were conducted on 16 August 2022. Inclusion criteria were: studies of any health service stakeholders, in any health setting, where social media was used as a tool for service design or QI. Data was analysed using deductive content analysis. A committee of stakeholders provided input on research questions, data analysis and key findings. RESULTS 61 studies were included. Benefits included improved organisational communication and relationship building. Risks/limitations included low quality of engagement and harms to users. Limited access and familiarity with social media were frequently reported barriers. Making discussions safe and facilitating access were common enablers. CONCLUSION The benefits, risks, barriers and enablers identified highlight the complexity of social media as an engagement tool for health service design and QI. Understanding these experiences may help implementers design more effective social media-based engagement activities.
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Affiliation(s)
- Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3083, Australia
- Correspondence: ; Tel.: +61-3-9479-1578
| | - Nerida Hyett
- La Trobe Rural Health School, La Trobe University, Bendigo, VIC 3550, Australia
| | | | - Chi Li
- Albury Wodonga Health, Wodonga, VIC 3690, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3083, Australia
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Gillespie A, Reader TW. Online patient feedback as a safety valve: An automated language analysis of unnoticed and unresolved safety incidents. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2022; 43:1463-1477. [PMID: 35945156 DOI: 10.1111/risa.14002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Safety reporting systems are widely used in healthcare to identify risks to patient safety. But, their effectiveness is undermined if staff do not notice or report incidents. Patients, however, might observe and report these overlooked incidents because they experience the consequences, are highly motivated, and independent of the organization. Online patient feedback may be especially valuable because it is a channel of reporting that allows patients to report without fear of consequence (e.g., anonymously). Harnessing this potential is challenging because online feedback is unstructured and lacks demonstrable validity and added value. Accordingly, we developed an automated language analysis method for measuring the likelihood of patient-reported safety incidents in online patient feedback. Feedback from patients and families (n = 146,685, words = 22,191,427, years = 2013-2019) about acute NHS trusts (hospital conglomerates; n = 134) in England were analyzed. The automated measure had good precision (0.69) and excellent recall (0.98) in identifying incidents; was independent of staff-reported incidents (r = -0.04 to 0.19); and was associated with hospital-level mortality rates (z = 3.87; p < 0.001). The identified safety incidents were often reported as unnoticed (89%) or unresolved (21%), suggesting that patients use online platforms to give visibility to safety concerns they believe have been missed or ignored. Online stakeholder feedback is akin to a safety valve; being independent and unconstrained it provides an outlet for reporting safety issues that may have been unnoticed or unresolved within formal channels.
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Affiliation(s)
- Alex Gillespie
- Department of Psychological & Behavioural Science, London School of Economics, London, UK
- Department of Psychology, Oslo New University College, Oslo, Norway
| | - Tom W Reader
- Department of Psychological & Behavioural Science, London School of Economics, London, UK
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Montgomery CM, Powell J, Mahtani K, Boylan AM. Turning the gaze: Digital patient feedback and the silent pathology of the NHS. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:290-307. [PMID: 34862794 PMCID: PMC7616249 DOI: 10.1111/1467-9566.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/19/2021] [Indexed: 05/17/2023]
Abstract
Online review and rating sites, where patients can leave feedback on their experience of the health-care encounter, are becoming an increasing feature of primary care in the NHS. Previous research has analysed how digital surveillance is re-shaping the clinical gaze, as health-care professionals are subject to increased public monitoring. Here, we draw on an empirical study of 41 GP practice staff to show how the gaze is turning, not simply from the patient to the health-care provider, but additionally to the body politic of the NHS. Drawing on focus group and interview data conducted in five UK practices, we show how discourses of online reviews and ratings are producing new professional subjectivities among health-care professionals and the extent to which the gaze extends not only to individual health-care interactions but to the health-care service writ large. We identify three counter-discourses characterising the evolving ways in which online reviews and ratings are creating new subjects in primary care practices: victimhood, prosumption versus traditional values and taking control. We show how the ways in which staff speak about online feedback are patterned by the social environment in which they work and the constraints of the NHS they encounter on a day-to-day basis.
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Affiliation(s)
- Catherine M. Montgomery
- Science, Technology and Innovation Studies, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
- Centre for Biomedicine, Self and Society, University of Edinburgh, Edinburgh, UK
| | - John Powell
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kamal Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anne-Marie Boylan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Rashid A. Yonder: Online feedback, simulated telephone consultations, BMI, and grit. Br J Gen Pract 2021; 71:560. [PMID: 34824073 PMCID: PMC8686439 DOI: 10.3399/bjgp21x717905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Ahmed Rashid
- GP and Clinical Associate Professor, UCL Medical School, UCL, London. @Dr_A_Rashid
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