What do patients really want? An in-depth examination of patient experience in four Australian hospitals

BACKGROUND

Patient satisfaction is an important outcome measure guiding quality improvement in the healthcare setting while the patient-centred care movement places increasing importance on patient engagement in clinical decision-making. However, the concept of patient satisfaction is not clearly defined, and beliefs of patients are not always evident in health surveys. Researchers rarely follow up on surveys to explore patient views and what they mean in greater depth. This study set out to examine perceptions of hospital care, through in-depth, qualitative data capture and as a result, to gather rich, patient-driven information on user experience and satisfaction in the Australian healthcare setting; and identify influencing factors.

METHODS

Focus groups were undertaken in four St Vincent's Health Australia (SVHA) hospitals in 2017 where participants discussed responses to eight questions from the Press Ganey Patient Experience Survey. Thirty people who were inpatients at SVHA.

RESULTS

Good communication and high-quality information at arrival and discharge were found to be important to patients. Communication breakdown was also evident, further exacerbated by a range of environmental factors such as sharing a room with others. Overall, patients' felt that while their spiritual needs were well-supported by the hospital staff at all SVHA hospitals, it was the clinical teams prioritised their emotional needs. Good communication and environments can improve patient experience and follow-up at home is vital.

CONCLUSIONS

Patient-centred care needs careful planning with patients involved at entry and exit from hospital. Focused communication, environmental changes, attending to complaints, and clearer discharge strategies are recommended.

How do emergency ambulance paramedics view the care they provide to people who self harm?: Ways and means

The UK has one of the highest rates of self harm (SH) in Europe, and almost four times more people die by suicide than in road traffic collisions. Emergency ambulance paramedics are often the first health professionals involved in the care of people who have self-harmed, yet little is known about the care provided or issues raised in these encounters. The aim of this study is to explore paramedics' perceptions and experiences of caring for people who SH, to inform education and policy. Semi structured interviews were conducted with paramedics, and themes generated by constant comparison coding. This paper reports two emerging themes: Firstly, professional, legal, clinical and ethical tensions, linked to limited decision support, referral options and education. The second theme of relationships with police, revealed practices and surreptitious strategies related to care and detention, aimed at overcoming complexities of care. In the absence of tailored education, guidance or support for self-harm care, 'ways and means' have evolved which may negatively influence care and challenge ethical and legal frameworks. There is an urgent need to include evidence from this study in revised guidance and educational materials for paramedics working with people who self-harm in the prehospital emergency setting.

The impact of shift patterns on junior doctors' perceptions of fatigue, training, work/life balance and the role of social support

BACKGROUND

The organisation of junior doctors' work hours has been radically altered following the partial implementation of the European Working Time Directive. Poorly designed shift schedules cause excessive disruption to shift workers' circadian rhythms.

METHOD

Interviews and focus groups were used to explore perceptions among junior doctors and hospital managers regarding the impact of the European Working Time Directive on patient care and doctors' well-being.

RESULTS

Four main themes were identified. Under "Doctors shift rotas", doctors deliberated the merits and demerits of working seven nights in row. They also discussed the impact on fatigue of long sequences of day shifts. "Education and training" focused on concerns about reduced on-the-job learning opportunities under the new working time arrangements and also about the difficulties of finding time and energy to study. "Work/life balance" reflected the conflict between the positive aspects of working on-call or at night and the impact on life outside work. "Social support structures" focused on the role of morale and team spirit. Good support structures in the work place counteracted and compensated for the effects of negative role stressors, and arduous and unsocial work schedules.

CONCLUSIONS

The impact of junior doctors' work schedules is influenced by the nature of specific shift sequences, educational considerations, issues of work/life balance and by social support systems. Poorly designed shift rotas can have negative impacts on junior doctors' professional performance and educational training, with implications for clinical practice, patient care and the welfare of junior doctors.

Narrating the Holocaust: in pursuit of poetic representations of health

This paper considers the scope of poetic representation for exploring notions of health and wellbeing in the testimony of Holocaust survivors. The paper is based on the representation, through poetic form, of testimony derived from multiple in-depth interviews with a Holocaust survivor, Anka, in south-east Wales. This paper concentrates on two of those interviews, the first a life story and the second an interview focusing on health, illness and wellbeing. Two poetic representations, one derived from each interview, provide examples of the principal investigator's response to the oral testimony, and the authors explore how these forms can present authentic and rigorous data distillates without detracting from the emotive, contextualised and powerful messages of the original text. The poetic representations offer an analysis of the survivor's life experiences, especially in Auschwitz concentration camp, and her personal perspective on her health and wellbeing. The authors discuss the value of poetic representation as a methodological approach, consider the poetic form for working with survivor stories and suggest how others might judge these pieces, to highlight the strengths and weaknesses of these alternative forms of data representation. They also consider the role of the researcher and Anka in creating the final product and the effect of Anka's voice on the researchers' work.

"Convenient space" or "a tight squeeze": insider views on the community pharmacy

This paper presents research aimed at identifying the extent to which pharmacy spaces are aligned to good professional practice, enhance a professional's sense of self and meet the demands of the public. Findings from a novel, qualitative, mixed-methods approach employing biographic and photographic techniques indicate that UK pharmacy spaces are less accessible than intended by the Department of Health's pharmacy contract. Pharmacists escape to the dispensary to preserve their professional self-identity and to avoid the expectations of a demanding public. Recent innovations such as consultation rooms lack clarity of intent amid the multiple functions that a busy community pharmacy demands.

"Of the edgelands": broadening the scope of qualitative methodology

In an editorial in a previous issue of this journal Rapport et al introduced the metaphor of the edgelands, arguing that the area between urban and rural landscapes serves to illustrate some of the difficulties of interdisciplinarity experienced by those who work in the medical humanities. In this paper the authors explore some specific issues of qualitative research methodology in health care research. The paper describes a broadening out of the scope of qualitative inquiry in social scientific research in health and social care. The paper explains why some new methodologies have emerged and how both old and new methodologies are grouped around three interlocking strands: narrative based, arts based, and redefined, methodology. In order to illustrate developments in this field, the authors present three examples of the use of these methodologies in practice: photo elicitation technique; discourse analytic, and interpretive anthropological, method. Finally the authors illustrate how these methodologies can give added value to health services research.

Oral history and content analysis using Ethnograph

The oral testimony is a well-established tool for the historian of the recent past and there is a considerable body of literature on the techniques for collecting oral testimony, the pitfalls to be avoided, as well as the conceptual issues involved. There is, however, little to guide the researcher on the analysis of oral testimony and this paper presents a computer-based technique for analysing taped recollections. It uses one example to demonstrate how Ethnograph can assist in a more rapid, but nevertheless equally valid, analysis of oral testimony.

Measuring care: the case of district nursing

This paper describes a district nursing study that considered the experiences and responses of primary health care professionals and their patients to changes taking place within the community. As a qualitative study it employed interviews as the main method of data collection and was informed by both ethnography and interpretative phenomenology. Forty-three study participants were interviewed, eliciting opinion on whether care is more than just a hands-on activity, whether patient need is being met and to what extent service policy is in tune with care delivery. Describing the views of primary health care professionals and patients in order to illustrate the complexity of the district nursing service and professional roles, the paper finds little shared vision between staff and managers of each other's responsibilities. It concludes that a more holistic approach to understanding professional roles is needed in order to satisfy the differing agendas of managers, staff and patients. It propounds the need for closer collaborative practice between health care professionals, for it finds that they value the ability to communicate as an essential element of their jobs. It reflects that, without such collaboration, it will be difficult for nurses to take a lead position on changes shaping community care.