After Bristol: putting patients at the centre (original) (raw)
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Using Patient-Reported Information to Improve Clinical Practice
Health Services Research, 2015
Objective. To assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. Data Sources/Study Setting. Existing literature (gray and peer-reviewed) on measuring patient experience and patient-reported outcomes, identified from Medline and Cochrane databases; evaluations of pay-for-performance programs in the United States, Europe, and the Commonwealth countries. Study Design/Data Collection. We analyzed (1) studies of pay-for-performance, to identify those including metrics for patient experience, and (2) studies of patient experience and of patient-reported outcomes to identify evidence of influence on clinical practice, whether through public reporting or private reporting to clinicians. Principal Findings. First, we identify four forms of "patient-reported information" (PRI), each with distinctive roles shaping clinical practice: (1) patient-reported outcomes measuring self-assessed physical and mental well-being, (2) surveys of patient experience with clinicians and staff, (3) narrative accounts describing encounters with clinicians in patients' own words, and (4) complaints/grievances signaling patients' distress when treatment or outcomes fall short of expectations. Because these forms vary in crucial ways, each must be distinctively measured, deployed, and linked with financial incentives. Second, although the literature linking incentives to patients experience is limited, implementing pay-for-performance systems appears to threaten certain patient-valued aspects of health care. But incentives can be made compatible with the outcomes patients value if: (a) a sufficient portion of incentives is tied to patient-reported outcomes and experiences, (b) incentivized forms of PRI are complemented by other forms of patient feedback, and (c) health care organizations assist clinicians to interpret and respond to PRI. Finally, we identify roles for the public and private sectors in financing PRI and orchestrating an appropriate balance among its four forms. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Soliciting Patient Complaints to Improve Performance
The Joint Commission Journal on Quality and Safety, 2003
uality in health care has been described as having two main components-the technical quality of care and the quality of service. 1 Service in health care is defined as "the characteristics that shape the experience of care beyond technical competence." 1(p 661) Most patients do not feel competent to assess the technical quality of their care and judge the quality of their health care by the quality of service they receive. 1 From the patient's perspective, highquality service would include good communication, physical comfort, support, an opportunity to participate in decision making, and individualized and cooordinated care delivery. 2,3 Consistent delivery of high-quality service across all these dimensions is challenging in a large tertiary care teaching hospital. Problems in service quality must be identified and remedied to improve the quality of health care in the United States. 1,2 Improvement in service quality can improve patient outcomes. Improved physician-patient communication reduced blood pressure and improved functional and heath status in patients with chronic illnesses, 4 and it improved functional status in patients with acute myocardial infarction. 5 Increased support from health care providers decreased pain and increased quality of life in patients with cancer 6 and reduced postoperative pain in surgical patients. 7 Increased participation in care reduced pain in patients with osteoarthritis 6 and improved functional status in patients with ulcers. 8 Improved service quality can increase patient and employee satisfaction 1,5 and decrease the probability of litigation from patients who have grievances. 9,10 Background: A study was conducted in 2000 to describe service quality problems in a large tertiary care teaching hospital and evaluate the effect of a predischarge program for active complaint surveillance and resolution on patient satisfaction. Methods: The pre-post intervention study with temporal controls was conducted at a tertiary care teaching hospital in St Louis. Eighty-four percent (1,023 of 1,218) of patients admitted to a general medical unit between October 2, 2000, and December 22, 2000, were interviewed by a patient advocate to identify and address patient complaints about service quality. Patient satisfaction was measured, using a validated instrument administered by telephone interview 7-10 days after discharge. Results: The advocate completed 1,233 patient interviews and received 695 complaints about service quality. Half of the complaints concerned local unit care, most frequently delays in response to patient requests. Patients also complained about food, delays in admission and discharge, and inadequate communication about procedures. Concurrently, the hospital's formal reporting system received 12 complaints. Patient satisfaction scores were unchanged during the intervention. Discussion: Active surveillance using predischarge patient interviews by a patient advocate identified many local and systemwide service quality problems in a large tertiary care teaching hospital that needed to be addressed to improve the quality of patient care. However, patient satisfaction scores were unchanged.
Physicians in health care management: 2. Managing performance: who, what, how and when?
Canadian Medical Association Journal
Physicians are becoming more involved in performance management as hospitals restructure to increase effectiveness. Although physicians are not hospital employees, they are subject to performance appraisals because the hospitals are accountable to patients and the community for the quality of hospital services. The performance of a health care professional may be appraised by the appropriate departmental manager, by other professionals in a team or program or by peers, based on prior agreement on expectations. Appraisal approaches vary.
Frontiers of Performance in the NHS
2004
As the government announces the next steps in the reform and modernisation of the NHS, this report highlights in some detail the key factors that determine overall patient perceptions. This research is particularly relevant and timely -one of the challenges facing the new Healthcare Commission is how much weight to give to patient perceptions, as opposed to financial or clinical measures of success, in whatever system replaces CHI's star ratings.
Involving patients and users of services in quality improvement: what are the benefits?
Journal of Clinical Effectiveness, 1996
The current interest in involving all members of the health care team in the evaluation and improvement of care has grown to include patients and recipients of care. Although much is written about how important it is to involve patients there is less information available about how this might be achieved. Even the term ‘involvement’ is itself open to various interpretations and this may result in involving patients in quality improvement remaining in the realms of rhetoric rather than reality. In this article we outline the benefits obtained from the active collaboration of patients with health care professionals in making decisions about their care. We examine ways in which patients’ views about the quality of the care that they receive can be heard and suggest that clinical guidelines might be one way of bridging the knowledge gap between health care professionals and patients so that joint decision‐making becomes more effective.
The Journal of the Royal College of General Practitioners, 1989
This chapter describes how there are three major stakeholders in a patient’s hospitalization: the patient, the healthcare providers, and the hospital. Satisfaction with the care and hospital experience is important to the patient because evidence suggests satisfied patients are more likely to adhere to self-care instructions and have better clinical outcomes. Hospitals have aimed to provide care and service that is highly satisfying to patients because it is the right thing to do and because reputation affects volume and revenues which in turn impacts the fiscal bottom line. Unfortunately, not all patients enjoy equal levels of satisfaction in the health care system. To succeed amongst today’s competition; healthcare organizations must be patient-centered and win the loyalty of their patients by providing an outstanding patient experience, then retaining these patients, increasing the number of patients through positive word of mouth and continually delivering greater value.
Working for Patients? The Right Approach?
Social Policy & Administration, 1989
This paper is a slightly revised version of a Memorandum requested by the House o f Commons Social Services Select Committee to assist the Committee in its analysis o f the White Paper Working for Patients (Cm555). It was submitted to the Committee on 28 February 1989. The paper follows up the authors'earlier study of the reform of the NHS (Barr, Glennerster and Le Grand, 19%8), prepared aL the request of the Select Committee prior to thepublication of the White Paper. The success or failure of the White Paper depends crucially on the precise details of the way in which its proposals are implemented. The Working Papers, althoughproviding some more information as to how the White Paper$proposals will be implemented, do not in the main address the issues that concern us here. Given the inescapable tension between cost and quality, quality control will be absolutely critical i f t h e incentives to economize on the use o f resources are not on occasion to lead to unacceptable reductions in qualibreductions which might well apply dfferentially by socioeconomic group.