Digital methods to enhance the usefulness of patient experience data in services for long-term conditions: the DEPEND mixed-methods study

Exploring the sociocultural contexts in which healthcare staff respond to and use online patient feedback in practice: In-depth case studies of three NHS Trusts

Objectives

Patients are increasingly reporting about their healthcare experiences online and NHS Trusts are adopting different approaches to responding. However, the sociocultural contexts underpinning these organisational approaches remain unclear. Therefore, we aimed to explore the sociocultural contexts underpinning three organisations who adopted different approaches to responding to online patient feedback.

Methods

Recruitment of three NHS Trusts was theoretically guided, and determined based on their different approaches to responding to online patient feedback (a nonresponding organisation, a generic responding organisation and an organisation providing transparent, conversational responses). Ethnographic methods were used during a year of fieldwork involving staff interviews, observations of practice and documentary analysis. Three in-depth case studies are presented.

Findings

The first organisation did not respond to or use online patient feedback as staff were busy firefighting volumes of concerns received in other ways. The second organisation adopted a generic responding style due to resource constraints, fears of public engagement and focus on resolving known issues raised via more traditional feedback sources. The final organisation provided transparent, conversational responses to patients online and described a 10-year journey enabling their desired culture to be embedded.

Conclusions

We identified a range of barriers facing organisations who ignore or provide generic responses to patient feedback online. We also demonstrated the sociocultural context in which online interactions between staff and patients can be embraced to inform improvement. However, this represented a slow and difficult organisational journey. Further research is needed to better establish how organisations can recognise and overcome barriers to engaging with online patient feedback, and at pace.

A Comparison of Leximancer Semi-automated Content Analysis to Manual Content Analysis: A Healthcare Exemplar Using Emotive Transcripts of COVID-19 Hospital Staff Interactive Webcasts

Effective consumer centred healthcare incorporates consumer and clinician perspectives into decision making, in addition to traditional quantitative measures. This information is usually captured in qualitative data that requires manual analysis. Healthcare systems often lack resources to systematically incorporate qualitative feedback into decision making. Semi-automated content analysis tools, such as Leximancer, provide an efficient and objective alternative to time consuming manual content analysis (MCA). Literature on the validity of Leximancer in healthcare is sparse. This study seeks to validate Leximancer against MCA on a broad emotive conversational dataset gathered in a healthcare setting. At the outset of the COVID-19 pandemic, a large Australian hospital and health service conducted interactive webcasts with staff to provide updates and answer questions. A manual thematic analysis and a Leximancer content analysis were conducted independently on 20 webcast transcripts. The findings were compared, along with the time required to the complete each analysis. The Leximancer analysis identified nine concepts, while the manual analysis identified 12 concepts. The Leximancer concepts mapped to five of the concepts identified in the manual analysis, which accounted for 74% of mentions tagged in the text through the manual analysis. Leximancer missed concepts which required an emotional or contextual interpretation. The Leximancer analysis took 21 hours (excluding time to learn the program), compared to 73 hours for the manual analysis. Semi-automated content analysis provides an efficient alternative to manual qualitative data analysis, shifting it from a small-scale research activity to a more routine operational activity, albeit with some limitations. This is critical to be able to utilise at scale the rich narratives from consumers and clinicians in healthcare decision making.

Co-designing new tools for collecting, analysing and presenting patient experience data in NHS services: working in partnership with patients and carers

BACKGROUND

The way we collect and use patient experience data is vital to optimise the quality and safety of health services. Yet, some patients and carers do not give feedback because of the limited ways data is collected, analysed and presented. In this study, we worked together with researchers, staff, patient and carer participants, and patient and public involvement and engagement (PPIE) contributors, to co-design new tools for the collection and use of patient experience data in multiple health settings. This paper outlines how the range of PPIE and research activities enabled the co-design of new tools to collect patient experience data.

METHODS

Eight public contributors represented a range of relevant patient and carer experiences in specialist services with varied levels of PPIE experience, and eleven members of Patient and Participation Groups (PPGs) from two general practices formed our PPIE group at the start of the study. Slide sets were used to trigger co-design discussions with staff, patient and carer research participants, and PPIE contributors. Feedback from PPIE contributors alongside verbatim quotes from staff, patient and carer research participants is presented in relation to the themes from the research data.

RESULTS

PPIE insights from four themes: capturing experience data; adopting digital or non-digital tools; ensuring privacy and confidentiality; and co-design of a suite of new tools with guidance, informed joint decisions on the shaping of the tools and how these were implemented. Our PPIE contributors took different roles during co-design and testing of the new tools, which supported co-production of the study.

CONCLUSIONS

Our experiences of developing multiple components of PPIE work for this complex study demonstrates the importance of tailoring PPIE to suit different settings, and to maximise individual strengths and capacity. Our study shows the value of bringing diverse experiences together, putting patients and carers at the heart of improving NHS services, and a shared approach to managing involvement in co-design, with the effects shown through the research process, outcomes and the partnership. We reflect on how we worked together to create a supportive environment when unforeseen challenges emerged (such as, sudden bereavement).