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Yazdani A, Shamloo M, Khaki M, Nahvijou A. Use of sentiment analysis for capturing hospitalized cancer patients' experience from free-text comments in the Persian language. BMC Med Inform Decis Mak 2023; 23:275. [PMID: 38031102 PMCID: PMC10685532 DOI: 10.1186/s12911-023-02358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
PURPOSE Today, the Internet provides access to many patients' experiences, which is crucial in assessing the quality of healthcare services. This paper introduces a model for detecting cancer patients' opinions about healthcare services in the Persian language, both positive and negative. METHOD To achieve the objectives of this study, a combination of sentiment analysis (SA) and topic modeling approaches was employed. All pertinent comments made by cancer patients were collected from the patient feedback form of the Tehran University of Medical Science (TUMS) Cancer Institute (CI) in Iran, from March to October 2021. Conventional evaluation metrics such as accuracy, precision, recall, and F-measure were utilized to assess the performance of the proposed model. RESULT The experimental findings revealed that the proposed SA model achieved accuracies of 89.3%, 92.6%, and 90.8% in detecting patients' sentiments towards general services, healthcare services, and life expectancy, respectively. Based on the topic modeling results, the topic "Metastasis" exhibited lower sentiment scores compared to other topics. Additionally, cancer patients expressed dissatisfaction with the current appointment booking service, while topics such as "Good experience," "Affable staff", and "Chemotherapy" garnered higher sentiment scores. CONCLUSION The combined use of SA and topic modeling offers valuable insights into healthcare services. Policymakers can utilize the knowledge obtained from these topics and associated sentiments to enhance patient satisfaction with cancer institution services.
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Affiliation(s)
- Azita Yazdani
- Health Information Management Department, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Shamloo
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Khaki
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.
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Preston S, Harvey-Lloyd J. 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] [What about the content of this article? (0)] [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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Spinnewijn L, Bolte AC, Braat DDM, Scheele F, Aarts JWM. Structurally collecting patient feedback on trainee skills: A pilot study in Obstetrics and Gynaecology. Patient Educ Couns 2022; 105:1276-1282. [PMID: 34483004 DOI: 10.1016/j.pec.2021.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This pilot study tested a tool that collects patient feedback on trainees' skills in shared decision-making (SDM) and general consultation. It also examined trainees' views on SDM and patient feedback, exploring potential skills improvement through reflexive practice. METHODS Patients were asked to rate trainees after consultation in a six-itemed questionnaire. The questionnaire included 'CollaboRATE' (a validated tool to test SDM), the 'Net Promoter Score' and two open-ended questions. Questionnaire results were described quantitatively and tested for differences. Results were presented to trainees at three intervals. Trainees were interviewed afterwards. Interview transcripts were thematically analysed. RESULTS Eleven trainees in Obstetrics and Gynaecology participated. Out of 1651 sent questionnaires 399 were returned (response rate 24%). Questionnaire results showed no differences when comparing trainees or group scores over time. Interview results were thematically analysed using the reflexivity framework. Trainees were able to reflect on their SDM skills. They valued receiving patient feedback, yet were able to formulate few learning points from it. CONCLUSION Although skills improvement was not evident, patient feedback still has potential benefits. PRACTICE IMPLICATIONS Patient feedback should be combined with facilitated reflections at timely intervals to reinforce behaviour change. Supervisors play an important role in facilitating reflections with trainees.
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Affiliation(s)
- Laura Spinnewijn
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, The Netherlands; VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, The Netherlands.
| | - Annemieke C Bolte
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, The Netherlands
| | - Didi D M Braat
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, The Netherlands
| | - Fedde Scheele
- VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, The Netherlands; Amsterdam University Medical Centers, School of Medical Sciences, Amsterdam, The Netherlands
| | - Johanna W M Aarts
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, The Netherlands; Amsterdam University Medical Centers, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
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Bernacki K, Keister A, Sapiro N, Joo JS, Mattle L. Impact of COVID-19 on patient and healthcare professional attitudes, beliefs, and behaviors toward the healthcare system and on the dynamics of the healthcare pathway. BMC Health Serv Res 2021; 21:1309. [PMID: 34872537 PMCID: PMC8646017 DOI: 10.1186/s12913-021-07237-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND COVID-19 has dramatically changed how healthcare is delivered and experienced. METHODS One-on-one interviews and a virtual ethnographic roundtable were conducted among 45 patients, caregivers, and healthcare professionals (HCPs) in 4 therapeutic areas from the United States and Japan: overactive bladder, vasomotor symptoms, prostate cancer, and metastatic urothelial carcinoma. The goal was to identify the impact of COVID-19 on patient/caregiver and HCP attitudes, interactions, beliefs, and behaviors toward the healthcare system and care pathway. RESULTS Four foundational themes were identified: 1) COVID-19 risk is relative; 2) isolation is collateral damage; 3) telehealth is a parallel universe; and 4) COVID-19 is destabilizing the foundations of healthcare. Numerous insights, influenced by diverse cultural, social, and psychological factors, were identified within each theme. CONCLUSIONS The impacts of COVID-19 were noticeable at multiple points of care during the "universal" care pathway, including at initial screening, referral to specialists, diagnosis, treatment initiation/surgery, and during ongoing care. Greater appreciation of the short- and long-term impacts of COVID-19 and resulting gaps in care may act as a catalyst for positive change in future patient care.
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Affiliation(s)
- Katarzyna Bernacki
- Astellas Pharma Inc. Patient Centricity, 1 Astellas Way, Northbrook, IL, 60062, USA.
| | - Angie Keister
- Astellas Pharma Inc. Patient Centricity, 1 Astellas Way, Northbrook, IL, 60062, USA
| | | | - Jin Su Joo
- Throughline Strategy, Toronto, ON, Canada
| | - Lisa Mattle
- Astellas Pharma Inc. Patient Centricity, 1 Astellas Way, Northbrook, IL, 60062, USA.
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New L, Goodridge D, Kappel J, Lawson J, Dobson R, Penz E, Groot G, Gjevre J. Improving hospital safety for patients with chronic kidney disease: a mixed methods study. BMC Nephrol 2021; 22:318. [PMID: 34556044 PMCID: PMC8461959 DOI: 10.1186/s12882-021-02499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People living with chronic kidney disease (CKD) require complex medical management and may be frequently hospitalized. Patient safety incidents during hospitalization can result in serious complications which may negatively affect health outcomes. There has been limited examination of how these patients perceive their own safety. OBJECTIVES This study compared the safety perceptions of patients hospitalized with CKD using two approaches: (a) the Patient Measure of Safety (PMOS) questionnaire and (b) qualitative interviews. The study objectives were to: (1) assess concordance between qualitative and quantitative data on safety perceptions and (2) better understand safety as perceived by study participants. METHODS A cross-sectional convergent mixed methods design was used. Integration at the reporting level occurred by weaving together patient narratives and survey domains through the use of a joint display. Interview data were merged with results of the PMOS on a case-by-case basis for analysis to assess for concordance or discordance between these approaches to safety data collection. RESULTS Of the 30 inpatients with CKD, almost one quarter (23.3 %) of participants reported low levels of perceived safety in hospitals. Four major themes emerged from the interviews: receiving safe care; expecting to be taken care of; expecting to be cared for; and reporting safety concerns. Suboptimal communication, delays in care and concerns about technical aspects of care were common to both forms of data collection. Concordance was noted between qualitative and quantitative data with respect to communication/teamwork, respect and dignity, staff roles, and ward type/lay-out. While interviews allowed for participants to share specific concerns related to safety about quality of interpersonal interactions, use of the questionnaire alone did not capture this concern. CONCLUSIONS Safety issues are a concern for in-patients with CKD. Both quantitative and qualitative approaches provided important and complementary insights into these issues. Narratives were mostly concordant with questionnaire scores. Findings from this mixed methods study suggest that communication, interpersonal interactions, and delays in care were more concerning for participants than technical aspects of care. Eliciting the concerns of people with CKD in a systematic fashion, either through interviews or a survey, ensures that hospital safety improvement efforts focus on issues important to patients.
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Affiliation(s)
- Lucia New
- Health Sciences Program, College of Medicine, University of Saskatchewan, Saskatoon, SK Canada
| | - Donna Goodridge
- Department of Medicine, College of Medicine, University of Saskatchewan, 103 Hospital Drive, SK S7N OW8 Saskatoon, Canada
| | - Joanne Kappel
- Department of Medicine, Saskatchewan Health Authority, Saskatoon, Saskatchewan Canada
| | - Joshua Lawson
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan Canada
| | - Roy Dobson
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK Canada
| | - Erika Penz
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan Canada
| | - Gary Groot
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan Canada
| | - John Gjevre
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan Canada
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Björklund K, Stenfors T, Nilsson GH, Alinaghizadeh H, Leanderson C. Let's ask the patient - composition and validation of a questionnaire for patients' feedback to medical students. BMC Med Educ 2021; 21:269. [PMID: 33971866 PMCID: PMC8111976 DOI: 10.1186/s12909-021-02683-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 04/22/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND Adequate communication and maintaining a patient-centered approach throughout patient encounters are important skills for medical students to develop. Feedback is often provided by clinical teachers. Patients are seldom asked to provide feedback to students that systematically addresses knowledge and skills regarding communication and patient-centeredness during an encounter. One way for patients to provide feedback to students is through a questionnaire; there is, however, a lack of such validated feedback questionnaires. This study aimed to compose and validate a feedback questionnaire for patients' feedback to medical students regarding students' ability to communicate and apply patient-centeredness in clinical practice. METHOD This study comprises (a) composition of the questionnaire and (b) validation of the questionnaire. The composition included (1) literature review, (2) selection and composition of items and construction of an item pool, (3) test of items' content, and (4) test of the applicability of the questionnaire. The items originated from the Calgary-Cambridge Guide (Kurtz S, Silverman J, Benson J and Draper J, Acad Med 78:802-809, 2003), the 'Swedish National Patient Survey' (National Patient Survey, Primary Health Care, 2020), patient evaluation form by Braend et al. (Tidsskr Nor Laegeforen 126:2122-5, 2006), and additional developed items. The items were further developed after feedback from 65 patients, 22 students, eight clinical supervisors, and six clinical teachers. The validation process included 246 patients who provided feedback to 80 students. Qualitative content analysis and psychometric methods were used and exploratory factor analysis assessed internal validity. Cronbach's alpha was used to test the reliability of the items. RESULTS The process resulted in the 19-item 'Patient Feedback in Clinical Practice' (PFCP) questionnaire. Construct validity revealed two dimensions: consultational approach and transfer of information. Internal consistency was high. Thematic analysis resulted in three themes: ability to capture the personal agenda of the consultation, alignment with the consultation, and constructs and characteristics. Students reported that the PFCP questionnaire provided useful feedback that could facilitate their learning in clinical practice. CONCLUSIONS The results of this study indicate that the questionnaire is a valid, reliable, and internally consistent instrument for patients' feedback to medical students. The participants found the questionnaire to be useful for the provision of feedback in clinical practice. However, further studies are required regarding the PFCP questionnaire applicability as a feedback tool in workplace learning.
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Affiliation(s)
- Karin Björklund
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar H Nilsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | | | - Charlotte Leanderson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
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Tatsuta K, Miyazaki S, Ogiku M, Harada T, Yoshiro N. Defining treatment strategy for uncomplicated appendicitis based on patient satisfaction feedback: A cross-sectional study. Asian J Surg 2021; 45:167-171. [PMID: 33966963 DOI: 10.1016/j.asjsur.2021.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/03/2020] [Accepted: 04/15/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Two surgical strategies are available for appendicitis: emergency laparoscopic appendectomy and interval laparoscopic appendectomy. However, timing of surgical intervention remains debatable. This study aimed to compare the surgical outcomes of emergency laparoscopic appendectomy and interval laparoscopic appendectomy and conduct a questionnaire survey to investigate the use of emergency laparoscopic appendectomy and patient satisfaction with regard to treatment. METHODS We included 162 patients who underwent laparoscopic appendectomy at our hospital. Outcomes were assessed by operation time, blood loss, postoperative fasting time, length of hospital stay, and complication rate. Patient satisfaction was measured by questionnaire addressing degree of satisfaction, presurgery anxiety, and length of hospital stay. RESULTS Of 162 patients, 74 (46%) and 88 (54%) received emergency and interval laparoscopic appendectomy, respectively. No significant difference was observed in the operation time, blood loss, length of hospital stay, or complication rate. Among 66 patients who responded to the questionnaire (28 emergency, 38 interval), a significant difference was observed only in the degree of satisfaction regarding the timing of the surgical intervention (p = 0.04). CONCLUSION Surgical outcomes of emergency and interval appendectomy were equivalent; however, patient satisfaction favored emergency appendectomy, suggesting it is a preferable approach for the treatment of uncomplicated appendicitis.
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Affiliation(s)
- Kyota Tatsuta
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Nakaku, Shizuoka, 432-8580, Japan.
| | - Shinichiro Miyazaki
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Nakaku, Shizuoka, 432-8580, Japan
| | - Masahito Ogiku
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Nakaku, Shizuoka, 432-8580, Japan
| | - Takashi Harada
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Nakaku, Shizuoka, 432-8580, Japan
| | - Nishiwaki Yoshiro
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Nakaku, Shizuoka, 432-8580, Japan
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Barr J, Ogden K, Robertson I, Martin J. Exploring how differently patients and clinical tutors see the same consultation: building evidence for inclusion of real patient feedback in medical education. BMC Med Educ 2021; 21:246. [PMID: 33926426 PMCID: PMC8082899 DOI: 10.1186/s12909-021-02654-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 04/07/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND Undergraduate medical education recognises that patient feedback is potentially valuable for student learning and development as a component of multi-source feedback. However greater exploration of how patient feedback perspectives differ to clinical educators is required for curriculum development and improving student feedback literacy. This study aimed to determine how two sources of feedback, patients and clinical tutors, compare on the same patient-centred, interpersonal criteria. METHODS A patient feedback instrument designed for the undergraduate medical education setting was used to compare patients' feedback with clinical tutors' feedback following a student-patient consultation in the learning context. Assessments from 222 learning consultations involving 40 medical students were collected. Descriptive statistics for tutors and patients for each question were calculated and correlations between patient and tutor were explored using Spearman's rank-order correlation. Mixed effects ordered logistic regression was used to compare each question with an overall rating for tutor and patients in addition to comparing patient with tutor ratings. RESULTS Clinical tutor and patient assessments had a weak but significant positive correlation in all areas except questions related to respect and concern. When making judgements compared with overall assessment, patients' ratings of respect, concern, communication and being understood in the consultation have a greater effect. After eliminating the effect of generally higher ratings by patients compared with tutors using comparative ordered logistic regression, patients rated students relatively less competent in areas of personal interaction. CONCLUSION This study provides insight about patient feedback, which is required to continue improving the use and acceptability of this multisource feedback to students as a valuable component of their social learning environment. We have revealed the different perspective-specific judgement that patients bring to feedback. This finding contributes to building respect for patient feedback through greater understanding of the elements of consultations for which patients can discriminate performance.
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Affiliation(s)
- Jennifer Barr
- Tasmanian School of Medicine, University of Tasmania, Hobart, Australia.
| | - Kathryn Ogden
- Tasmanian School of Medicine, University of Tasmania, Hobart, Australia
| | | | - Jenepher Martin
- Eastern Health Clinical School, Monash University, Melbourne, Australia
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Baines R, Underwood F, O'Keeffe K, Saunders J, Jones RB. Implementing online patient feedback in a 'special measures' acute hospital: A case study using Normalisation Process Theory. Digit Health 2021; 7:20552076211005962. [PMID: 33868704 PMCID: PMC8020246 DOI: 10.1177/20552076211005962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/06/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Online patient feedback is becoming increasingly prevalent on an
international scale. However, limited research has explored how healthcare
organisations implement such feedback. This research sought to explore how
an acute hospital, recently placed into ‘special measures’ by a regulatory
body implemented online feedback to support its improvement journey. Methods Semi-structured interviews were conducted with eleven key stakeholders
involved in the implementation and/or use of online patient feedback. Data
was analysed using deductive thematic analysis with Normalisation Process
Theory used as the analytical framework. Research findings are translated
into the Engage, Support and Promote (ESP) model, a model of rapid feedback
adoption. Results Participants viewed the implementation of online feedback as an opportunity
to learn, change and improve. Factors found to facilitate implementation
were often linked to engagement, support and promotion. Although less
frequently described, barriers to implementation included staff anxieties
about time pressures, moderation processes and responding responsibilities.
Such anxieties were often addressed by activities including the provision of
evidence based responder training. Overall, staff were overwhelmingly
positive about the value of online feedback with 24 impacts identified at an
individual and organisational level, including the ability to boost staff
morale, resilience and pride. Conclusions The rapid implementation of online patient feedback can be achieved in a
‘special measures’ organisation. However, the difficulties of implementing
such feedback should not be underestimated. In order to embed online
feedback, staff members need to be engaged and feel supported, with
opportunities to provide, respond and invite patient feedback frequently
promoted to both patients and staff members.
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Affiliation(s)
- Rebecca Baines
- Centre for Health Technology, University of Plymouth, Plymouth, UK
| | - Frazer Underwood
- South West Clinical School in Cornwall, University of Plymouth and Royal Cornwall Hospital NHS Trust.,Royal Cornwall Hospital NHS Trust, Truro, UK.,Centre for Innovations in Health and Social Care: A JBI Centre of Excellence, University of Plymouth, UK
| | - Kim O'Keeffe
- South West Clinical School in Cornwall, University of Plymouth and Royal Cornwall Hospital NHS Trust.,Royal Cornwall Hospital NHS Trust, Truro, UK
| | | | - Ray B Jones
- Centre for Health Technology, University of Plymouth, Plymouth, UK
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Cox R, Khalid S, Brierly G, Forsyth A, McNamara R, Heppell V, Granne I. Implementing a community model of early pregnancy care. BMC Health Serv Res 2020; 20:664. [PMID: 32680503 PMCID: PMC7367246 DOI: 10.1186/s12913-020-05524-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 07/08/2020] [Indexed: 11/25/2022] Open
Abstract
Background In the UK Early Pregnancy Assessment Units (EPAUs) are usually situated alongside hospital maternity and gynaecology services. In June 2018, the Oxford EPAU relocated from the John Radcliffe Hospital to a community clinic. This is to our knowledge, the UK’s first community-based EPAU. This change was inspired by our patient feedback describing the co-location of the EPAU with maternity services as distressing. Methods Following the introduction of the community EPAU we developed a database to capture information on the patients seen in the clinic. This is a retrospective observational study of a single cohort of patients attending the clinic over an 8 month period. Data was collected from 1st July 2018 to 28th February 2019. This data included clinical, safety and patient experience outcomes. Results Two thousand nine hundred and twenty patient episodes were recorded, 1,932 were new patients. Mean waiting time to be seen in clinic was 1.3 days. When miscarriage was confirmed 48.6% chose conservative management, 19.9% chose medical management, and 31.5% chose surgical management. The mean rate of ambulance transfers to hospital was 3.1 per month. Of all patients seen in EPAU 32 had unplanned admissions, which accounted for 2.7% of all patients seen in EPAU. Patient feedback questionnaires have been consistently positive. Conclusion The development of a community EPAU has improved services to allow care closer to home in an environment separate from maternity care. Our data shows that a community EPAU can deliver timely, good quality patient care, is safe, and a service valued by patients. Further research is indicated to evaluate the cost-effectiveness of community EPAUs and the long term safety and effectiveness of care.
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Affiliation(s)
- Rebecca Cox
- Nuffield Department of Primary Care Health Science, Oxford, UK.
| | - Somia Khalid
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gemma Brierly
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Annie Forsyth
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruth McNamara
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Ingrid Granne
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Wong E, Mavondo F, Fisher J. Patient feedback to improve quality of patient-centred care in public hospitals: a systematic review of the evidence. BMC Health Serv Res 2020; 20:530. [PMID: 32527314 DOI: 10.1186/s12913-020-05383-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/01/2020] [Indexed: 11/22/2022] Open
Abstract
Background To review systematically the published literature relating to interventions informed by patient feedback for improvement to quality of care in hospital settings. Methods A systematic search was performed in the CINAHL, EMBASE, PsyInfo, MEDLINE, Cochrane Libraries, SCOPUS and Web of Science databases for English-language publications from January 2008 till October 2018 using a combination of MeSH-terms and keywords related to patient feedback, quality of health care, patient-centred care, program evaluation and public hospitals. The quality appraisal of the studies was conducted with the MMAT and the review protocol was published on PROSPERO. Narrative synthesis was used for evaluation of the effectiveness of the interventions on patient-centred quality of care. Results Twenty papers reporting 20 studies met the inclusion criteria, of these, there was one cluster RCT, three before and after studies, four cross-sectional studies and 12 organisational case studies. In the quality appraisal, 11 studies were rated low, five medium and only two of high methodological quality. Two studies could not be appraised because insufficient information was provided. The papers reported on interventions to improve communication with patients, professional practices in continuity of care and care transitions, responsiveness to patients, patient education, the physical hospital environment, use of patient feedback by staff and on quality improvement projects. However, quantitative outcomes were only provided for interventions in the areas of communication, professional practices in continuity of care and care transitions and responsiveness to patients. Multi-component interventions which targeted both individual and organisational levels were more effective than single interventions. Outcome measures reported in the studies were patient experiences across various diverse dimensions including, communication, responsiveness, coordination of and access to care, or patient satisfaction with waiting times, physical environment and staff courtesy. Conclusion Overall, it was found that there is limited evidence on the effectiveness of interventions, because few have been tested in well-designed trials, very few papers described the theoretical basis on which the intervention had been developed. Further research is needed to understand the choice and mechanism of action of the interventions used to improve patient experience.
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Degaga TS, Weston S, Tego TT, Abate DT, Aseffa A, Wayessa A, Price RN, Hailu A, Thriemer K. Disseminating clinical study results to trial participants in Ethiopia: insights and lessons learned. Malar J 2020; 19:205. [PMID: 32513176 PMCID: PMC7282093 DOI: 10.1186/s12936-020-03279-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/29/2020] [Indexed: 01/13/2023] Open
Abstract
International regulatory authorities and funders require that research be disseminated promptly and appropriately to all involved stakeholders. However, following completion of clinical trials participants often either do not receive any feedback or materials provided are not appropriate for the context. The investigators of a multicentre anti-malarial clinical trial (the IMPROV study) conducted a dissemination meeting at one of the study sites in Ethiopia; trial participants and medical staff were provided feedback on the study results. This report summarizes the dissemination strategies adopted by the investigators, including a plain language visual aid and simple communication techniques. Lessons learned are reported with a discussion on the operational challenges to dissemination of clinical trials in resource limited settings.
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Affiliation(s)
- Tamiru S. Degaga
- grid.442844.a0000 0000 9126 7261College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Sophie Weston
- grid.271089.50000 0000 8523 7955Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT Australia
| | | | - Dagimawie T. Abate
- grid.442844.a0000 0000 9126 7261College of Medicine & Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Ashenafi Aseffa
- grid.452387.fEthiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Adugna Wayessa
- grid.452387.fEthiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ric N. Price
- grid.271089.50000 0000 8523 7955Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT Australia ,grid.10223.320000 0004 1937 0490Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand ,grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Asrat Hailu
- grid.7123.70000 0001 1250 5688College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kamala Thriemer
- grid.271089.50000 0000 8523 7955Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT Australia
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Ong BN, Hodgson D, Small N, Nahar P, Sanders C. Implementing a digital patient feedback system: an analysis using normalisation process theory. BMC Health Serv Res 2020; 20:387. [PMID: 32381075 PMCID: PMC7203816 DOI: 10.1186/s12913-020-05234-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 04/16/2020] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Patient feedback in the English NHS is now widespread and digital methods are increasingly used. Adoption of digital methods depends on socio-technical and contextual factors, alongside human agency and lived experience. Moreover, the introduction of these methods may be perceived as disruptive of organisational and clinical routines. The focus of this paper is on the implementation of a particular digital feedback intervention that was co-designed with health professionals and patients (the DEPEND study). METHODS The digital feedback intervention was conceptualised as a complex intervention and thus the study focused on the contexts within which it operated, and how the different participants made sense of the intervention and engaged with it (or not). Four health care sites were studied: an acute setting, a mental health setting, and two general practices. Qualitative data was collected through interviews and focus groups with professionals, patients and carers. In total 51 staff, 24 patients and 8 carers were included. Forty-two observations of the use of the digital feedback system were carried out in the four settings. Data analysis was based on modified grounded theory and Normalisation Process Theory (NPT) formed the conceptual framework. RESULTS Digital feedback made sense to health care staff as it was seen as attractive, fast to complete and easier to analyse. Patients had a range of views depending on their familiarity with the digital world. Patients mentioned barriers such as kiosk not being visible, privacy, lack of digital know-how, technical hitches with the touchscreen. Collective action in maintaining participation again differed between sites because of workload pressure, perceptions of roles and responsibilities; and in the mental health site major organisational change was taking place. For mental health service users, their relationship with staff and their own health status determined their digital use. CONCLUSION The potential of digital feedback was recognised but implementation should take local contexts, different patient groups and organisational leadership into account. Patient involvement in change and adaptation of the intervention was important in enhancing the embedding of digital methods in routine feedback. NPT allowed for a in-depth understanding of actions and interactions of both staff and patients.
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Affiliation(s)
- Bie Nio Ong
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Damian Hodgson
- Sheffield University Management School, University of Sheffield, Sheffield, UK
| | - Nicola Small
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Papreen Nahar
- Brighton and Sussex Medical School, Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Caroline Sanders
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK.
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Baines R, Zahra D, Bryce M, de Bere SR, Roberts M, Archer J. Is Collecting Patient Feedback "a Futile Exercise" in the Context of Recertification? Acad Psychiatry 2019; 43:570-576. [PMID: 31309453 DOI: 10.1007/s40596-019-01088-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/19/2019] [Accepted: 06/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Patient feedback is considered integral to maintaining excellence, patient safety, and professional development. However, the collection of and reflection on patient feedback may pose unique challenges for psychiatrists. This research uniquely explores the value, relevance, and acceptability of patient feedback in the context of recertification. METHODS The authors conducted statistical and inductive thematic analyses of psychiatrist responses (n = 1761) to a national census survey of all doctors (n = 26,171) licensed to practice in the UK. Activity theory was also used to develop a theoretical understanding of the issues identified. RESULTS Psychiatrists rate patient feedback as more useful than some other specialties. However, despite asking a comparable number of patients, psychiatrists receive a significantly lower response rate than most other specialties. Inductive thematic analysis identified six key themes: (1) job role, setting, and environment; (2) reporting issues; (3) administrative barriers; (4) limitations of existing patient feedback tools; (5) attitudes towards patient feedback; and (6) suggested solutions. CONCLUSIONS The value, relevance, and acceptability of patient feedback are undermined by systemic tensions between division of labor, community understanding, tool complexity, and restrictive rule application. This is not to suggest that patient feedback is "a futile exercise." Rather, existing feedback processes should be refined. In particular, the value and acceptability of patient feedback tools should be explored both from a patient and professional perspective. If issues identified remain unresolved, patient feedback is at risk of becoming a "futile exercise" that is denied the opportunity to enhance patient safety, quality of care, and professional development.
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Abstract
Patient feedback about healthcare experiences has gained increasing attention as an essential and meaningful source of information for identifying gaps and developing effective action plans for improving the quality of care. As experiences differ across patient groups, flexible and responsive feedback systems are essential. The population of older adults is growing rapidly; it constitutes an increasing proportion of the NHS client base. This group wants to have a say in their care and their views are critical in any performance assessment of a modern healthcare system. Nevertheless, collecting feedback data from older adults presents unique challenges, due to chronic conditions and comorbidities involving vision, hearing, speech and cognitive processing. In addition, nurses often find it difficult to act on feedback data in order to make quality improvements. This difficulty is associated with poor leadership, absence of explicit targets and an action plan, and the nature of clinical change required. This article offers insight into the development of a local innovation centred on enhancing the feedback system in a medical rehabilitation ward for older adults. A model for improvement in the form of the Plan, Do, Study, Act (PDSA) cycle provided a structured learning approach to facilitate the planning, testing, analysing and refining of the feedback system.
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Affiliation(s)
| | - Bernie Reid
- Lecturer in Nursing, Ulster University, Magee Campus, Derry
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Bodegård H, Helgesson G, Juth N, Olsson D, Lynøe N. Challenges to patient centredness - a comparison of patient and doctor experiences from primary care. BMC Fam Pract 2019; 20:83. [PMID: 31202259 PMCID: PMC6570949 DOI: 10.1186/s12875-019-0959-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/30/2019] [Indexed: 12/02/2022]
Abstract
Background We designed this observational study to investigate the level of patients’ and doctors’ ratings of patient-centred aspects of the primary care consultation. Methods Questionnaire study with patients and doctors. Consecutive patients in a primary care setting and 16 doctors responding post visit. Results are presented as proportions with 95% confidence intervals. Results 411 questionnaires, 223 from patients and 188 from doctors, covered 251 consultations. Both patients and doctors gave the highest possible estimations on the aspects of patient-centred communication and satisfaction less frequently when the patient had other reasons for visit than purely somatic. Unlike the doctors’ estimations, the frequency of highest possible estimations in patient responses dropped if the patients had two to six reasons for visit rather than one. Among the six patient-centred aspects, both patients and doctors gave the highest possible estimation least frequently on the aspect of shared decision-making. Conclusion The results suggest that the nature of the reason, as well as the number of reasons for visit, interferes with the doctors’ level of patient-centred communication. Our results furthermore confirm the findings of previous studies that doctors insufficiently involve patients in their care. Electronic supplementary material The online version of this article (10.1186/s12875-019-0959-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helene Bodegård
- Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.
| | - Gert Helgesson
- Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Niklas Juth
- Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Daniel Olsson
- Unit of Medical Statistics, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Niels Lynøe
- Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
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Al-Jabr H, Twigg MJ, Scott S, Desborough JA. Patient feedback questionnaires to enhance consultation skills of healthcare professionals: A systematic review. Patient Educ Couns 2018; 101:1538-1548. [PMID: 29598964 DOI: 10.1016/j.pec.2018.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/26/2018] [Accepted: 03/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To identify patient feedback questionnaires that assess the development of consultation skills (CSs) of practitioners. METHODS We conducted a systematic search using seven databases from inception to January 2017 to identify self-completed patient feedback questionnaires assessing and enhancing the development of CSs of individual practitioners. Results were checked for eligibility by three authors, and disagreements were resolved by discussion. Reference lists of relevant studies and Open Grey were searched for additional studies. RESULTS Of 16,312 studies retrieved, sixteen were included, describing twelve patient feedback questionnaires that were mostly designed for physicians in primary care settings. Most questionnaires had limited data regarding their psychometric properties, except for the Doctor Interpersonal Skills Questionnaire (DISQ). Most studies conducted follow-up, capturing positive views of practitioners regarding the process (n = 14). Feedback was repeated by only three studies, demonstrating different levels of improvement in practitioners' performance. CONCLUSION Identified questionnaires were mainly focused on physicians, however, to support using patient feedback, questionnaires need to be validated with other practitioners. PRACTICE IMPLICATIONS Several patient feedback questionnaires are available, showing potential for supporting practitioners' development. Valid questionnaires should be used with appropriate practitioners in developing more evidence for the impact they may have on actual consultations.
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Affiliation(s)
- Hiyam Al-Jabr
- School of Pharmacy, University of East Anglia, Norwich, UK.
| | | | - Sion Scott
- School of Pharmacy, University of East Anglia, Norwich, UK
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Baines R, Regan de Bere S, Stevens S, Read J, Marshall M, Lalani M, Bryce M, Archer J. The impact of patient feedback on the medical performance of qualified doctors: a systematic review. BMC Med Educ 2018; 18:173. [PMID: 30064413 PMCID: PMC6069829 DOI: 10.1186/s12909-018-1277-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/11/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND Patient feedback is considered integral to quality improvement and professional development. However, while popular across the educational continuum, evidence to support its efficacy in facilitating positive behaviour change in a postgraduate setting remains unclear. This review therefore aims to explore the evidence that supports, or refutes, the impact of patient feedback on the medical performance of qualified doctors. METHODS Electronic databases PubMed, EMBASE, Medline and PsycINFO were systematically searched for studies assessing the impact of patient feedback on medical performance published in the English language between 2006-2016. Impact was defined as a measured change in behaviour using Barr's (2000) adaptation of Kirkpatrick's four level evaluation model. Papers were quality appraised, thematically analysed and synthesised using a narrative approach. RESULTS From 1,269 initial studies, 20 articles were included (qualitative (n=8); observational (n=6); systematic review (n=3); mixed methodology (n=1); randomised control trial (n=1); and longitudinal (n=1) design). One article identified change at an organisational level (Kirkpatrick level 4); six reported a measured change in behaviour (Kirkpatrick level 3b); 12 identified self-reported change or intention to change (Kirkpatrick level 3a), and one identified knowledge or skill acquisition (Kirkpatrick level 2). No study identified a change at the highest level, an improvement in the health and wellbeing of patients. The main factors found to influence the impact of patient feedback were: specificity; perceived credibility; congruence with physician self-perceptions and performance expectations; presence of facilitation and reflection; and inclusion of narrative comments. The quality of feedback facilitation and local professional cultures also appeared integral to positive behaviour change. CONCLUSION Patient feedback can have an impact on medical performance. However, actionable change is influenced by several contextual factors and cannot simply be guaranteed. Patient feedback is likely to be more influential if it is specific, collected through credible methods and contains narrative information. Data obtained should be fed back in a way that facilitates reflective discussion and encourages the formulation of actionable behaviour change. A supportive cultural understanding of patient feedback and its intended purpose is also essential for its effective use.
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Affiliation(s)
- Rebecca Baines
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - Sam Regan de Bere
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - Sebastian Stevens
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - Jamie Read
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - Martin Marshall
- Improvement Science London, University College London, London, UK
| | - Mirza Lalani
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - Julian Archer
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK.
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Mirzoev T, Kane S. Key strategies to improve systems for managing patient complaints within health facilities - what can we learn from the existing literature? Glob Health Action 2018; 11:1458938. [PMID: 29658393 PMCID: PMC5912438 DOI: 10.1080/16549716.2018.1458938] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Information from patient complaints - a widely accepted measure of patient satisfaction with services - can inform improvements in service quality, and contribute towards overall health systems performance. While analyses of data from patient complaints received much emphasis, there is limited published literature on key interventions to improve complaint management systems. OBJECTIVES The objectives are two-fold: first, to synthesise existing evidence and provide practical options to inform future policy and practice and, second, to identify key outstanding gaps in the existing literature to inform agenda for future research. METHODS We report results of review of the existing literature. Peer-reviewed published literature was searched in OVID Medline, OVID Global Health and PubMed. In addition, relevant citations from the reviewed articles were followed up, and we also report grey literature from the UK and the Netherlands. RESULTS Effective interventions can improve collection of complaints (e.g. establishing easy-to-use channels and raising patients' awareness of these), analysis of complaint data (e.g. creating structures and spaces for analysis and learning from complaints data), and subsequent action (e.g. timely feedback to complainants and integrating learning from complaints into service quality improvement). No one single measure can be sufficient, and any intervention to improve patient complaint management system must include different components, which need to be feasible, effective, scalable, and sustainable within local context. CONCLUSIONS Effective interventions to strengthen patient complaints systems need to be: comprehensive, integrated within existing systems, context-specific and cognizant of the information asymmetry and the unequal power relations between the key actors. Four gaps in the published literature represent an agenda for future research: limited understanding of contexts of effective interventions, absence of system-wide approaches, lack of evidence from low- and middle-income countries and absence of focused empirical assessments of behaviour of staff who manage patient complaints.
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Affiliation(s)
- Tolib Mirzoev
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Jones R, Young K, Munro J, Miller H, Brelsford S, Aronsson J, Goodman B, Peters J. Including the online feedback site, Patient Opinion, in the nursing curriculum: Exploratory study. Nurse Educ Today 2017; 57:40-46. [PMID: 28728037 DOI: 10.1016/j.nedt.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 05/27/2017] [Accepted: 07/02/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Globally, universities aim to involve people who use health services to enrich the nursing curriculum for students, but there can be barriers to this involvement. Many also want students to contribute to local communities. Online communication can help connect students to service users to achieve these aims. The online British patient feedback site, Patient Opinion, gathers comments from service users about services and encourages service responses to the comments. OBJECTIVES To explore the feasibility and acceptability of five ways of including Patient Opinion in the undergraduate nursing curriculum. DESIGN Five case studies using mixed data collection methods. SETTINGS British University with nursing students across two campuses, accustomed to using webinars, video presentations and social media. PARTICIPANTS Students from different years participated in the five approaches of making use of Patient Opinion in the curriculum; 18 students took part in an online forum to discuss Patient Opinion in the curriculum. METHODS We trialled timetabled webinars, video-linked lectures, optional enhanced access for self-study, optional audit of service user comments for two local hospitals, and optional Twitter and Tweetchat. Students discussed the aims and approaches in an online forum. RESULTS Of the five approaches trialled, webinars seemed effective in ensuring that all nursing students engaged with the topic. Video-linked lectures provided an alternative when timetabling did not allow webinars, but were less interactive. The three optional approaches (Tweetchats, audit exercise, self-directed study) provided opportunities for some students to enhance their learning but students needed guidance. Sending a summary of student reviews of patients' feedback to local hospitals illustrated how students might be agents of change in local health services. CONCLUSIONS Experience from these case studies suggests that webinars followed by use of Patient Opinion preparing for placements may be a sustainable way of embedding feedback sites in the nursing curriculum.
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Affiliation(s)
- Ray Jones
- School of Nursing and Midwifery, Plymouth University, Drake Circus, Plymouth PL4 8AA, United Kingdom.
| | - Kim Young
- School of Nursing and Midwifery, Plymouth University, Drake Circus, Plymouth PL4 8AA, United Kingdom
| | - James Munro
- Patient Opinion, 53 Mowbray Street, Sheffield S3 8EN, United Kingdom
| | - Heather Miller
- School of Nursing and Midwifery, Plymouth University, Drake Circus, Plymouth PL4 8AA, United Kingdom
| | - Stephanie Brelsford
- School of Nursing and Midwifery, Plymouth University, Drake Circus, Plymouth PL4 8AA, United Kingdom
| | - Jennie Aronsson
- School of Nursing and Midwifery, Plymouth University, Drake Circus, Plymouth PL4 8AA, United Kingdom
| | - Benny Goodman
- School of Nursing and Midwifery, Plymouth University, Drake Circus, Plymouth PL4 8AA, United Kingdom
| | - Jane Peters
- School of Nursing and Midwifery, Plymouth University, Drake Circus, Plymouth PL4 8AA, United Kingdom
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Abstract
OBJECTIVE To examine the key themes of positive and negative feedback in patients' online feedback on NHS (National Health Service) services in England and to understand the specific issues within these themes and how they drive positive and negative evaluation. DESIGN Computer-assisted quantitative and qualitative studies of 228 113 comments (28 971 142 words) of online feedback posted to the NHS Choices website. Comments containing the most frequent positive and negative evaluative words are qualitatively examined to determine the key drivers of positive and negative feedback. PARTICIPANTS Contributors posting comments about the NHS between March 2013 and September 2015. RESULTS Overall, NHS services were evaluated positively approximately three times more often than negatively. The four key areas of focus were: treatment, communication, interpersonal skills and system/organisation. Treatment exhibited the highest proportion of positive evaluative comments (87%), followed by communication (77%), interpersonal skills (44%) and, finally, system/organisation (41%). Qualitative analysis revealed that reference to staff interpersonal skills featured prominently, even in comments relating to treatment and system/organisational issues. Positive feedback was elicited in cases of staff being caring, compassionate and knowing patients'' names, while rudeness, apathy and not listening were frequent drivers of negative feedback. CONCLUSIONS Although technical competence constitutes an undoubtedly fundamental aspect of healthcare provision, staff members were much more likely to be evaluated both positively and negatively according to their interpersonal skills. Therefore, the findings reported in this study highlight the salience of such 'soft' skills to patients and emphasise the need for these to be focused upon and developed in staff training programmes, as well as ensuring that decisions around NHS funding do not result in demotivated and rushed staff. The findings also reveal a significant overlap between the four key themes in the ways that care is evaluated by patients.
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Affiliation(s)
- Gavin Brookes
- School of English, University of Nottingham, Nottingham, UK
| | - Paul Baker
- Department of Linguistics and English Language, Lancaster University, Lancaster, UK
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Sheard L, Marsh C, O'Hara J, Armitage G, Wright J, Lawton R. The Patient Feedback Response Framework - Understanding why UK hospital staff find it difficult to make improvements based on patient feedback: A qualitative study. Soc Sci Med 2017; 178:19-27. [PMID: 28189820 PMCID: PMC5360173 DOI: 10.1016/j.socscimed.2017.02.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/31/2017] [Accepted: 02/02/2017] [Indexed: 12/05/2022]
Abstract
Patients are increasingly being asked for feedback about their healthcare experiences. However, healthcare staff often find it difficult to act on this feedback in order to make improvements to services. This paper draws upon notions of legitimacy and readiness to develop a conceptual framework (Patient Feedback Response Framework - PFRF) which outlines why staff may find it problematic to respond to patient feedback. A large qualitative study was conducted with 17 ward based teams between 2013 and 2014, across three hospital Trusts in the North of England. This was a process evaluation of a wider study where ward staff were encouraged to make action plans based on patient feedback. We focus on three methods here: i) examination of taped discussion between ward staff during action planning meetings ii) facilitators notes of these meetings iii) telephone interviews with staff focusing on whether action plans had been achieved six months later. Analysis employed an abductive approach. Through the development of the PFRF, we found that making changes based on patient feedback is a complex multi-tiered process and not something that ward staff can simply 'do'. First, staff must exhibit normative legitimacy - the belief that listening to patients is a worthwhile exercise. Second, structural legitimacy has to be in place - ward teams need adequate autonomy, ownership and resource to enact change. Some ward teams are able to make improvements within their immediate control and environment. Third, for those staff who require interdepartmental co-operation or high level assistance to achieve change, organisational readiness must exist at the level of the hospital otherwise improvement will rarely be enacted. Case studies drawn from our empirical data demonstrate the above. It is only when appropriate levels of individual and organisational capacity to change exist, that patient feedback is likely to be acted upon to improve services.
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Affiliation(s)
- Laura Sheard
- Bradford Institute for Health Research, United Kingdom.
| | - Claire Marsh
- Bradford Institute for Health Research, United Kingdom
| | - Jane O'Hara
- Bradford Institute for Health Research and University of Leeds, United Kingdom
| | | | - John Wright
- Bradford Institute for Health Research, United Kingdom
| | - Rebecca Lawton
- Bradford Institute for Health Research and University of Leeds, United Kingdom
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Hughes A, Landers D, Arkenau HT, Shah S, Stephens R, Mahal A, Simmons M, Lemech C, Royle J. Development and Evaluation of a New Technological Way of Engaging Patients and Enhancing Understanding of Drug Tolerability in Early Clinical Development: PROACT. Adv Ther 2016; 33:1012-24. [PMID: 27167621 PMCID: PMC4920852 DOI: 10.1007/s12325-016-0335-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION During early clinical testing of a new medication, it is critical to understand and characterise patient tolerability. However, in early clinical studies, it is difficult for patients to contribute directly to the sponsors' understanding of a new compound. Patient reported opinions about clinical tolerability (PROACT) provides a new, simple and innovative way in which patients can collaborate using an application downloaded to a mobile computer or smartphone. METHODS PROACT was designed with special consideration given to patient confidentiality, patient engagement and data security. A pilot study was conducted to investigate patient uptake of PROACT and to characterize clinical trial information it captured. Patients recruited to Phase I oncology trials at a UK center were eligible to participate but were required to have a tablet computer or smartphone. Patients used PROACT to upload audio/video messages that became available instantly to their clinical team, who were able to reply to the patient within PROACT. The patient's message was also analyzed, personally-identifiable information removed and anonymized information then made available to the sponsor in an analytics module for decision-making. In parallel, a patient focus group was engaged to provide feedback on communication needs during early clinical trials and the PROACT concept. RESULTS Of the 16 patients informed of PROACT, 8 had a smart device and consented to take part. Use of PROACT varied and all messages volunteered were relevant and informative for drug development. Topics disclosed included tolerability impacts, study design, and drug formulation. Alignment with the clinical study data provided a richer understanding of tolerability and treatment consequences. This information was available to be shared among the clinical team and the sponsor, to improve patient support and experience. Patient forum feedback endorsed the concept and provided further information to enhance the application. CONCLUSION Overall, PROACT achieved proof of concept in this small pilot study and delivered a secure end-to-end system that protected patient privacy and provided preliminary insight into patient experiences beyond the usual clinical trial data set. The use of mobile devices to interact actively with participants in clinical trials may be a new way of engaging and empowering patients. Further validation of this technology in larger patient cohorts is ongoing. FUNDING AstraZeneca.
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Affiliation(s)
- Andrew Hughes
- Manchester Cancer Research Centre, University of Manchester, Manchester, UK
| | | | | | | | | | | | | | - Charlotte Lemech
- Sarah Cannon Research Institute, London, UK
- University College London, London, UK
| | - Jennifer Royle
- AstraZeneca, Cambridge, UK.
- Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK.
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24
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van Oenen FJ, Schipper S, Van R, Schoevers R, Visch I, Peen J, Dekker J. Feedback-informed treatment in emergency psychiatry; a randomised controlled trial. BMC Psychiatry 2016; 16:110. [PMID: 27095106 PMCID: PMC4837581 DOI: 10.1186/s12888-016-0811-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immediate patient feedback has been shown to improve outcomes for patients in mild distress but it is unclear whether psychiatric patients in severe distress benefit equally from feedback. This study investigates the efficacy of an immediate feedback instrument in the treatment of patients with acute and severe psychosocial or psychiatric problems referred in the middle of a crisis. METHODS A naturalistic mixed diagnosis sample of patients (N = 370) at a Psychiatric Emergency Centre was randomised to a Treatment-as-Usual (TAU) or a Feedback (FB) condition. In the FB condition, feedback on patient progress was provided on a session-by-session basis to both therapists and patients. Outcomes of the two treatment conditions were compared using repeated measures MANCOVA, Last Observation Carried Forward and multilevel analysis. RESULTS After 3 months, symptom improvement in FB (ES 0.60) did not significantly differ from TAU (ES 0.71) (p = 0.505). After 6 weeks, FB patients (ES 0.31) actually improved less than TAU patients (0.56) (p = 0.019). CONCLUSIONS Patients with psychiatric problems and severe distress seeking emergency psychiatric help did not benefit from direct feedback. TRIAL REGISTRATION Dutch Trial Register, NTR3168 , date of registration 1-9-2009.
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Affiliation(s)
- Flip Jan van Oenen
- Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands. .,, Baarsjesweg 224, 1058 AA, Amsterdam, The Netherlands.
| | - Suzy Schipper
- Arkin, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Rien Van
- Arkin, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Robert Schoevers
- Universitair Medisch Centrum Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Irene Visch
- Arkin, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Jaap Peen
- Arkin, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Jack Dekker
- Arkin, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands ,Klinische Psychologie Vrije Universiteit van Amsterdam, de Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
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25
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Murante AM, Vainieri M, Rojas D, Nuti S. Does feedback influence patient - professional communication? Empirical evidence from Italy. Health Policy 2014; 116:273-80. [PMID: 24630781 DOI: 10.1016/j.healthpol.2014.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 01/31/2014] [Accepted: 02/01/2014] [Indexed: 11/28/2022]
Abstract
Healthcare providers often look for feedback from patient surveys. Does health-professional awareness of patient survey results improve communication between patients and providers? To test this hypothesis, we analyzed the data of two surveys on organizational-climate and patient experience in Italy. The two surveys were conducted in 26 hospitals in the Tuscany region and involved 8942 employees and 5341 patients, respectively. Statistical analysis showed that the patient experience index significantly improved by 0.35 points (scale: 0-100) when the professionals' knowledge of the patient survey results increased by 1%. These findings suggest that the control systems should focus more on the dissemination phase of patient survey results among health professionals in order to improve the quality of services.
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Affiliation(s)
- Anna Maria Murante
- Scuola Superiore Sant'Anna, Istituto di Management, Laboratorio Management e Sanità, Piazza Martiri della Libertà 24, 56127 Pisa, Italy.
| | - Milena Vainieri
- Scuola Superiore Sant'Anna, Istituto di Management, Laboratorio Management e Sanità, Piazza Martiri della Libertà 24, 56127 Pisa, Italy
| | - Diana Rojas
- Scuola Superiore Sant'Anna, Istituto di Management, Laboratorio Management e Sanità, Piazza Martiri della Libertà 24, 56127 Pisa, Italy
| | - Sabina Nuti
- Scuola Superiore Sant'Anna, Istituto di Management, Laboratorio Management e Sanità, Piazza Martiri della Libertà 24, 56127 Pisa, Italy
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