Factors affecting the use of patient survey data for quality improvement in the Veterans Health Administration

<p>Abstract</p> <p>Background</p> <p>Little is known about how to use patient feedback to improve experiences of health care. The Veterans Health Administration (VA) conducts regular patient surveys that have indicated improved care experiences over the past decade. The goal of this study was to assess factors that were barriers to, or promoters of, efforts to improve care experiences in VA facilities.</p> <p>Methods</p> <p>We conducted case studies at two VA facilities, one with stable high scores on inpatient reports of emotional support between 2002 and 2006, and one with stable low scores over the same period. A semi-structured interview was used to gather information from staff who worked with patient survey data at the study facilities. Data were analyzed using a previously developed qualitative framework describing organizational, professional and data-related barriers and promoters to data use.</p> <p>Results</p> <p>Respondents reported more promoters than barriers to using survey data, and particularly support for improvement efforts. Themes included developing patient-centered cultures, quality improvement structures such as regular data review, and training staff in patient-centered behaviors. The influence of incentives, the role of nursing leadership, and triangulating survey data with other data on patients' views also emerged as important. It was easier to collect data on current organization and practice than those in the past and this made it difficult to deduce which factors might influence differing facility performance.</p> <p>Conclusions</p> <p>Interviews with VA staff provided promising examples of how systematic processes for using survey data can be implemented as part of wider quality improvement efforts. However, prospective studies are needed to identify the most effective strategies for using patient feedback to improve specific aspects of patient-centered care.</p

Using patients' experiences to identify priorities for quality improvement in breast cancer care: patient narratives, surveys or both?

Background: Patients’ experiences have become central to assessing the performance of healthcare systemsworldwide and are increasingly being used to inform quality improvement processes. This paper explores therelative value of surveys and detailed patient narratives in identifying priorities for improving breast cancer services as part of a quality improvement process.Methods: One dataset was collected using a narrative interview approach, (n = 13) and the other using a postalsurvey (n = 82). Datasets were analyzed separately and then compared to determine whether similar priorities forimproving patient experiences were identified.Results: There were both similarities and differences in the improvement priorities arising from each approach. Daysurgery was specifically identified as a priority in the narrative dataset but included in the survey recommendationsonly as part of a broader priority around improving inpatient experience. Both datasets identified appointmentsystems, patients spending enough time with staff, information about treatment and side effects and more information at the end of treatment as priorities. The specific priorities identified by the narrative interviews commonly related to ‘relational’ aspects of patient experience. Those identified by the survey typically related to more ‘functional’aspects and were not always sufficiently detailed to identify specific improvement actions.Conclusions: Our analysis suggests that whilst local survey data may act as a screening tool to identify potentialproblems within the breast cancer service, they do not always provide sufficient detail of what to do to improvethat service. These findings may have wider applicability in other services. We recommend using an initialpreliminary survey, with better use of survey open comments, followed by an in-depth qualitative analysis to help deliver improvements to relational and functional aspects of patient experience