How to implement patient experience surveys and use their findings for service improvement: a qualitative expert consultation study in Australian general practice

Development and validation of a patient experience assessment questionnaire for evaluating hospital care in Iran

PURPOSE

Understanding patient experience is crucial for advancing patient-centered care and improving hospital service quality. This study aimed to design and validate a Persian version of a patient experience assessment questionnaire to evaluate hospital services.

METHODS

This descriptive-analytical study on tool development was conducted cross-sectionally during 2021-2022 in Iran. The study consisted of two stages: (1) In the first stage, a deductive approach and comprehensive literature review were employed to develop the initial questionnaire items, based on the framework from prior research titled "Developing a Model for Evaluating Patient Experience in Teaching Hospitals in Iran." (2) In the second stage, validation was carried out by assessing face validity, content validity (using expert panels to evaluate the Content Validity Index (CVI) and Content Validity Ratio (CVR)), and construct validity through confirmatory factor analysis. Sampling for the face validity stage included 30 randomly selected patients, while construct validity was assessed with a sample of 340 participants, of which 300 provided complete and valid data. Reliability was determined using internal consistency (Cronbach's alpha) and stability (intra-cluster correlation coefficient) measures.

RESULTS

The initial questionnaire comprised 44 items. Following expert reviews and validation processes, 10 items were removed, resulting in a final version with 33 items. The confirmatory factor analysis confirmed the five-dimensional structure, with a Cronbach's alpha of 0.97 and an intra-cluster correlation coefficient of 0.89, indicating strong internal consistency and reliability.

CONCLUSION

This study successfully developed and validated a 33-item questionnaire for assessing patient experience in Iranian hospitals, ensuring cultural relevance and robust psychometric properties.

Integrating Patient-reported Experience (PRE) in a multistage approach to study access to health services for women with chronic illness and migration experience

BACKGROUND

Patient-reported Experience (PRE) is an emerging concept integrating patient perspectives and amplifying voices often marginalized in discussions surrounding health systems. However, it remains a challenge to use and integrate PREs when studying patient agency and access to quality services, particularly with data from multiple sources. In this article, using study materials from the Swiss MIWOCA project, we present and reflect upon a multistage PRE approach to study healthcare access.

METHODS

The MIWOCA project, a study on healthcare access and quality among immigrant women with chronic illnesses living in Switzerland, provided data from multiple sources for the integration of PRE data. These sources included interviews with women (n = 48), two focus group discussions with women (n = 15), interviews with service providers (n = 12) and observations from stakeholder dialogues (n = 3). In addition, we utilized field notes, focus group illustration maps, patient vignettes and policy briefs to develop a multistage data linking model. PRE data served as starting themes and reference topics in each of the interlinked stages of knowledge production.

RESULTS

Deploying PREs, we coherently linked the data from preceding stages and used them to inform subsequent stages. This, in turn, enabled us to identify, reflect and rectify factors limiting immigrant women's agency and access to quality services. Ultimately, the approach engaged patients as knowledge co-producers for system-level changes. This knowledge was transformed into a set of practice recommendations and a policy brief addressing ways to improve health systems to better serve immigrant women in Switzerland.

CONCLUSIONS

Building on PREs to systematically combine multiple data sources and engage patients continuously can improve our understanding of barriers in health systems. Beyond individual patient-doctor encounters, a multistage PRE approach can identify structural problems and provide clues for resolving them at the systems level. The PREs approach presented may serve as an example and encourage more public health experts to consider PREs in future research and practice.

PATIENT AND PUBLIC CONTRIBUTION

Women with chronic illness and immigration experience contributed to interview-guideline development, provided PREs in interviews, identified priority areas for health-service change and actively participated in the development of practice recommendations.

Reframing Patient Experience Approaches and Methods to Achieve Patient-Centeredness in Healthcare: Scoping Review

(1) There has been growing attention among healthcare researchers on new and innovative methodologies for improving patient experience. This study reviewed the approaches and methods used in current patient experience research by applying the perspective of design thinking to discuss practical methodologies for a patient-centered approach and creative problem-solving. (2) A scoping review was performed to identify research trends in healthcare. A four-stage design thinking process ("Discover", "Define", "Develop", and "Deliver") and five themes ("User focus", "Problem-framing", "Visualization", "Experimentation", and "Diversity"), characterizing the concept, were used for the analysis framework. (3) After reviewing 67 studies, the current studies show that the iterative process of divergent and convergent thinking is lacking, which is a core concept of design thinking, and it is necessary to employ an integrative methodology to actively apply collaborative, multidisciplinary, and creative attributes for a specific and tangible solution. (4) For creative problem-solving to improve patient experience, we should explore the possibilities of various solutions by an iterative process of divergent and convergent thinking. A concrete and visualized solution should be sought through active user interactions from various fields. For this, a specific methodology that allows users to collaborate by applying the integrative viewpoint of design thinking should be introduced.

Patients' Opinions towards the Services of Pharmacists Based in General Practice

Pharmacists have been included in general practice teams to provide non-dispensing services for patients. In Australia, pharmacists' role in general practice has been slowly expanding. However, there is a paucity of research to explore patients' opinions toward pharmacist-led services in general practice. This study aimed to assess patient awareness, perceived needs, and satisfaction with these services. A cross-sectional survey was conducted with a purposeful sample of patients who visited six general practices in the Australian Capital Territory that included pharmacists in their team. The survey was informed by the literature and pre-tested. The survey was distributed to two samples: patients who had seen a pharmacist and those who had not seen a pharmacist. Of 100 responses received, 86 responses were included in the analysis: patients who had seen a pharmacist (n = 46) and patients who had not seen a pharmacist (n = 40). Almost all the patients who utilised pharmacist-led services were highly satisfied with those services. Among patients who had not seen a pharmacist, 50% were aware of the existence of general practice pharmacists. Patients who had visited the pharmacist rated higher scores for perceived needs. Patient satisfaction towards the pharmacist-led services in general practices was very high, and patients supported the expansion of these services. However, awareness of the availability of general practice pharmacist services could be improved.

How nurses and midwives engage with patient experience data to inform person-centred quality and safety improvements

AIMS AND OBJECTIVES

To explore how nurses and midwives engage with patient experience data collected via a mobile health app to inform person-centred practice improvements.

BACKGROUND

A large amount of data is collected in healthcare, yet there is limited evidence outlining how nursing and midwifery staff utilise patient experience data to inform person-centred quality and safety improvements.

METHODS

This study utilised action research, underpinned by Practice Development methodology and has been reported using the SQUIRE 2.0 checklist. Six clinical units (medical short stay, acute medical, surgical, oncology/haematology, day surgery and maternity) in a large health district in Australia engaged in three cycles of data collection using a mobile health app. The app captured patient experience data relating to the person-centred KPIs developed and tested by McCance et al. (2012). Staff used the data to develop and evaluate person-centred practice.

RESULTS

A number of improvements in scores and practice occurred through engaging with the data in a cyclical way. All six clinical units saw an improvement in four or more of the KPIs in the patient survey results from cycle one to cycle three, with two clinical units improving in all eight. On average across the six units, there was also an increase in time nurses/midwives were visible to their patients, an increase in clinical documentation reflecting the patients' needs and what was important to them, an increase in positive comments and a decrease in negative comments in patient stories.

CONCLUSION

This study shows that collecting and utilising data from the person-centred KPIs in a collaborative and cyclical way lead to enhanced patient experience and the development and implementation of person-centred quality and safety improvements.

RELEVANCE TO CLINICAL PRACTICE

Capturing and utilising data that are meaningful to nursing/midwifery teams in a cyclical, action-orientated approach result in person-centred practice improvements that enhance the experience of those that are receiving and delivering patient care.