The outbreak of COVID-19 resulted in widespread restrictions in hospitals, nursing homes and other care settings. These included reduction or elimination of several procedures, visitation restrictions, and sometimes challenged access to needed healthcare. These enhanced restrictions at times lead to unintended negative consequences and skepticism. As some countries begin to see significant declines in COVID-19 cases, some organizations are bringing back certain services.
Patient experience measurements re widely used as a means of assessing the quality of care from the perspective of users. Despite the recent proliferation of these measures, they are all too often poorly understood and fail to lead to service improvements. The role that measuring and understanding experiences play in ensuring that care services are person-centered is very important, including the barriers to effective use of experience information and how these can be overcome.
This interesting burning topic was presented to us by our guests from the Picker Institute and Global Services – Planetree. These are Chris Graham and Karin Jay.
Karin Jay is Senior Vice President at Global Services-Planetree where she is working to expand the network of Planetree Affiliates internationally, and provide consultation to key stakeholders on the implementation of Planetree’s relationship-centered model of care and international certification criteria. Karin has been a contributing author on several publications focused on accreditation, patient-centered care, and patients’ rights. Karin currently serves on ISQua’s Person-Centered Care Community of Practice, The Joint Commission’s Patient and Family Advisory Council, and is an active volunteer with several non-profit organizations.
Chris Graham is the CEO of Picker, a leading international charity that exists to promote and improve person-centered care. A researcher by background, Chris has particular expertise in measuring, understanding, and using people’s experiences of healthcare and has worked with partners around the world to develop approaches to patient feedback. This has included extensive work on the development of the NHS Staff and Patient Survey Programs, two of the largest programs of their kind anywhere in the world. As well as his work at Picker, Chris is a National Institute of Health Research (NIHR) faculty member, an associate member of the University of Oxford’s Health Services Research Unit, and is part of the Quality, Safety, and Outcomes of Health and Social Care Policy Research Unit.
The vision of Picker Institute is the highest quality health and social care for all, always. To influence, inspire and empower.
Why do we measure people`s experiences? Because to measure is to know and if you cannot measure it, you cannot improve it; to see through the patient’s eyes and to put patients at the heart of healthcare.
But at different levels of health systems there are different purposes of measuring patient experience. At the very top level – a national level, patient experience is basically performance assessment, resource allocation, surveillance, policy evaluation and improvement. For providers, there is a valuable role for performance tracking and management, benchmarking, service evaluation and of course improvement. Practitioners can use the data for service and QI, education and training, reward and recognition and opportunities for improvement. Patients and the public – there is a choice, transparency, and service improvements.
Surveys on patient satisfaction over 15 years show a very small shift of 2% improvement. This is a very small, almost insignificant improvement. So, what stands in the way of improvement? If we all agree, it is very important that we measure it. The problem is that people often do not react to research data and do not react to the feedback received. Research shows that clinicians often ignore survey evidence. Commonly cited barriers include: defensive reactions to bad news, concern that results will be very negative, findings not sufficiently specific, mistrust of the findings/methods, limited expertise, a narrow focus on measurement, not improvement and lack of time.
Normative & structural legitimacy together with organizational readiness to change are factors that need to be present in an organization in order for patient feedback to be used for an attempt of improvement. These are things that must be deeply rooted in culture and people for everything to work. It takes number of characteristics which are present in organizations where improvement happens. From leadership at the level of CEO and board of directors to supportive technology that engages patients and families directly in the process of care by facilitating information access. Every link in the chain is equally important on the way to the goal. Measurement is necessary when processes or outcomes need to be quantified, when things need to be compared and when performance needs to be tracked. Managing patient experience well requires that we measure those things that we can and monitor and account for those things that we can’t.
Listening to and acting on patient feedback is an important part of person-centered care. Measurement is necessary but not sufficient for improvement because we have seen that a lot of energy comes to the measurement itself with which nothing is done later. We will have no improvement due to the measurement. It is important to be aware of potential barriers to use of data at various levels. So best practice for the organization is to take a strategic approach to understanding & improving experiences as well as incorporate qualitative feedback as well as measures.
Restoring consumer confidence by partnering with patients and families after the struggle we`ve all been through with a pandemic COVID-19. There is so many articles that are saying so many patients are resisting to seek healthcare during the pandemic. Patients are worried and wonder what will happen to them if they seek medical help and see their doctor or go to the hospital. As a result of this pandemic situation, a lot has changed and people’s distrust of the health care system has grown. We’re not even aware of that much until it hits us personally. From February to May 2020, 48% of people postponed any type of medical care because of the coronavirus outbreak. It is frightening that 11% of them stated that their condition had worsened in the meantime because of not receiving proper medical treatment. People all over the world are getting very mixed messages like “Stay home, stay safe” alluding to the fact that all needs outside the household are reduced to a minimum. While on the other hand they also say “Do not delay medical care”. We need to work on building trust and confidence back with our patients. Edelman Trust Barometer research reveals 16 specific attributes that build trust, but the first and most important one is engagement.
The physical, emotional and practical dimension of consumer confidence is very important. These are questions and statements like “Am I safe?”, “Is telemedicine effective?” or having feelings of uncertainty.
Why do we want to build trust and confidence by partnering with patients & families? First and foremost, to humanize the strategy. To personalize our messaging to our patients and consumers. We want to do this as a reality check for assumptions and internal dialogues.
Who should we do it with? Reach out to those who have received care recently, to those who are delaying care. Partner with community-based organizations & community health workers. How will we do this? Of course, this is coming down to measurements again. We`re going to use existing structures and processes within our organizations. Besides that, we will facilitate virtual meetings and focus groups, engage consumers as thought partners, not just as “reactors”. Virtual partnerships would be possible with using free video/conference calling technology – Skype, Zoom, WhatsApp etc. With brief surveys in waiting rooms, Facebook polls and if patients don’t have video technology, consider small group conference calls or short one-on-one calls for input.
Engage patient/family partners on quality and safety teams, on communication teams, on ethics teams and on community outreach teams. When should we do this? NOW! This is not about a moment in time. It is an ongoing commitment.
Watch this webinar in full at the link and find out more information on the topic.
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