What can acute medicine learn from qualitative methods?

Doctor-Patient Communication in Primary Health Care: A Mixed-Method Study in Fiji

From a clinical perspective, effective and efficient communication is part of a strategy to ensure doctors are providing high-quality care to their patients. Despite the positive impact of effective doctor–patient communication on health outcomes, limited information is available on this in Fiji. This study was carried out to determine the current patients’ perception of doctors’ communication behaviour and identify factors affecting the doctor–patient communication in Fiji. This mixed-method study was conducted in the outpatient setting of three randomly selected health centres in the Suva Subdivision, Fiji. For the quantitative phase, systematic random sampling was used to select the 375 participants who completed the structured questionnaire; of those, 20 participants were selected for the qualitative interview. From the patients’ perception, 45.6% of them perceived doctors’ communication behaviour as good, 53.6% as fair, and 0.8% as poor communication behaviour. Qualitative findings highlight factors such as the attitude of the doctors, their approach, their interaction with the patients, and them providing an explanation as important factors during doctor–patient communication. In Fiji, the majority of patients perceived doctors’ communication behaviour as fair to good and the doctors’ skills were important for effective doctor–patient communication. This study highlighted the importance of doctor–patient communication and suggested that doctors might not be practicing patient-centred care and communication; thus, they need to upgrade their patient-centred communication skills.

Emergency care under the magnifying glass: a review of ethnographic studies in the scientific literature on hospital emergency services

The article presents a review of ethnographic studies in the scientific literature on hospital emergency services, with the objective of systematizing the studies and their principal findings, referring to the health-disease-healthcare process in hospital emergency services from an ethnographic perspective. An integrative literature review was performed of studies published in Argentine and international indexed journals and in the following electronic databases: PubMed, VHL, Scopus, Redalyc, and SciELO. The corpus of the analysis consisted of a total of 69 articles, which were submitted to content analysis, having identified the following analytical dimensions: quality of care, communication and bonds, subjectivity, application of information technologies, methodological reflection, patients' experiences and practices, decision-making, and violence. The results allowed identifying a process that differs from guidelines and protocols, in which healthcare workers' subjective aspects, communication and interpersonal relations, and working conditions shape, orient, and condition the treatment and care provided in the hospital. The article thus highlights the approach to subjective aspects in health studies, to understand not only health workers' perspectives and experiences but also the persistent barriers to providing better quality of care, complexifying a problem ignored by a large share of the analyses.

Factors Associated With Patient Satisfaction in Outpatient Department of Suva Sub-divisional Health Center, Fiji, 2018: A Mixed Method Study

Background: With evolving health care industry toward patient centered orientation, inputs from the patients' perspective is valuable. Improved patient satisfaction is associated with increased levels of adherence to treatment processes and recommended prevention, and improved health outcomes. Hence, this study was conducted to assess the current level of patient satisfaction and explore its determinants in the Suva Subdivision health centers, Fiji, 2018.

Methods: This was a mixed method cross-sectional study employing both quantitative and qualitative designs. A random sample of 410 participants attending the outpatient services completed the self-administered structured questionnaire. The questionnaire focused on socio-demographic features, waiting time, doctors' communication, and patient trust. Data from 375 questionnaires (response rate of 91%) was analyzed in SPSS where descriptive analysis and univariate and multivariate logistic regression was done at 0.05 level of significance and 95% confidence interval to find the determinants of patient satisfaction. From these 375 participants, 20 participants were purposefully selected for audio recorded interview guided by a semi-structured questionnaire and data was analyzed using thematic analysis.

Results: The majority of the patients were generally fully satisfied with their consultation (69.3%). Univariate logistic regression showed that age, gender, education level, waiting time, doctors' communication behavior, and patient trust level were significantly associated with patient satisfaction independently. After controlling for all the variables, gender, number of visits, waiting time, and patient trust were significantly associated with trust. Those who had full trust in the doctors, were more likely to be fully satisfied with their consultation (aOR of 18; p = 0.0001) and those who got seen within 1 h, were more likely to be satisfied with their consultation (aOR of 3.3; p = 0.0001). Though, the patients voiced that getting a satisfying consultation was worth the wait. The doctors' attitude and way of communication also made a difference to the patient's level of satisfaction.

Conclusions: This study showed that patient satisfaction is positively associated with patient trust, doctors' interpersonal skills and communication behavior and negatively associated with waiting time. Hence, doctors upgrading their communication skills and health service managers strategizing ways to improve waiting time can contribute to better patient trust and thus lead to better patient satisfaction and positively influence health outcomes.

Comparison of complaints to the intensive care units and those to the general wards: an analysis using the Healthcare Complaint Analysis Tool in an academic medical center in Taiwan

Background

The management of complaints in the setting of intensive care may provide opportunities to understand patient and family experiences and needs. However, there are limited reports on the structured application of complaint analysis tools and comparisons between healthcare complaints in the critical care setting and other settings.

Methods

From the complaint management database of a university-affiliated medical center in Taiwan, we retrospectively identified the records of healthcare complaints to the intensive care units (ICUs) from 2008 to 2016. Complaints to the general wards in the same period were randomly selected from the database with twice the number of that of the ICU complaints. We coded, typed, and compared the complaints from the two settings according to the Healthcare Complaint Analysis Tool.

Results

We identified 343 complaints to the ICUs and randomly selected 686 complaints to the general wards during the 9-year study period. Most (94.7%) of the complaints to the ICUs came from the family members, whereas more complaints to the general wards came from the patients (44.2%). A total of 1529 problems (441 from ICU and 818 from general wards) were identified. Compared with the general ward complaints, in the ICU there were more complaints with multiple problems (25.1% vs. 16.9%, p = 0.002), complaints were referred more frequently to the nurses (28.1% vs. 17.5%, p < 0.001), and they focused more commonly on the care on the ICU/ward (60.5% vs. 54.2%, p = 0.029). The proportions of the three domains (clinical, management, and relationship) of complaints were similar between the ICU and general ward complaints (p = 0.121). However, in the management domain, the problems from ICU complaints focused more on the environment than on the institutional processes (90.9% vs. 74.5%, p < 0.001), whereas in the relationship domain, the problems focused more on communication (17.9% vs. 8.0%) and less on listening (34.6% vs. 46.5%) (p = 0.002) than the general ward complaints.

Conclusions

A structured typing and systematic analysis of the healthcare complaints to the ICUs may provide valuable insights into the improvement of care quality, especially to the perceptions of the ICU environment and communications of the patients and their families.

Electronic supplementary material

The online version of this article (10.1186/s13054-018-2271-y) contains supplementary material, which is available to authorized users.

Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature

In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs). A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs - including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos) and practices to avoid (Don'ts) when setting up MDT-driven cancer care.