Improving the usefulness and use of patient experience feedback

Patient experience is recognised as a pillar of healthcare quality equal to safety and effectiveness (1)(2). In the UK National Health Service (NHS), this paradigm has supported robust feedback collection, leading to a repository of nationally-collected patient experience data (3)(4). However, such data has not been effectively used to drive local quality improvements (4)(5)(6). This work addresses the question, how can the usefulness and use of patient experience feedback be improved? In order to contribute a clear body of knowledge in response, this work ascertains the root causes of limited data use; tests how novel analytic techniques can enhance data utility; and explores how experience data can be used in conjunction with other data to improve organisational responsiveness to patient feedback. First, this work systematically appraises the evidence relied upon to design patient surveys. This confirms a deficit of patient input into the evidence base, and subsequently insufficient information about how patients’ priorities differ. Population segmentation techniques are then employed to identify patient groups and their varying concerns, and present feedback in a disaggregated way that facilitates targeted improvement. Furthermore, interviews with NHS staff elucidate what adaptations they feel are necessary in order to embed national patient survey results within their local improvement strategies. This work then leverages existing data to generate a new patient experience composite score that challenges current national benchmarking metrics. The composite score is used to cluster acute NHS organisations, revealing organisational patterns in patient experience. Furthermore, multi-linear regression analysis delineates which organisational factors predict positive patient experience, intimating the importance of cultural variables. A translational research case study then captures the process towards achieving the organisational culture necessary to act on patient experience data. Individually, these findings convey a series of policy recommendations, while cumulatively they showcase the possibilities for a more patient-centric health service.Open Acces

Developing approaches to the collection and use of evidence of patient experience below the level of national surveys

National approaches to collecting patient feedback provide trust level information which although can provide a benchmark for trusts often doesn’t provide information about specific services or patients experiences of pathways of care. This more granular level of data could be more informative for local service development and improvement. This research explored the feasibility and usefulness of such approaches. A conceptual model and standard questionnaire of patient experience was developed that might work across a range of services and pathways of care. Seven trusts were recruited as collaborating sites in which the model and survey instrument was tested. These were from different geographical locations and settings. The impact of the pilot and survey results on the improvement and development of services was evaluated. The service- line approach to capturing patient feedback was generally more feasible and considered of value for service improvement. The collection of patients’ experiences across pathways of care was more challenging in terms of the development of the survey and interpretation of results. However, many sites identified specific actionable areas for improvement. This study has shown that it is possible to develop and apply a standardised survey in a range of services and provides evidence that a consistent unified approach to monitoring patient experiences is feasible. However several methodological problems are acknowledged such as the availability of resources and capacity for improvements to services and care. Evidence is now particularly needed to establish how best to produce positive impact from patient feedback

Assessing the safety of home oximetry for COVID-19: A multisite retrospective observational study

Objectives To determine the safety and effectiveness of home oximetry monitoring pathways for patients with COVID-19 in the English National Health Service. Design Retrospective, multisite, observational study of home oximetry monitoring for patients with suspected or proven COVID-19. Setting This study analysed patient data from four COVID-19 home oximetry pilot sites in England across primary and secondary care settings. Participants A total of 1338 participants were enrolled in a home oximetry programme across four pilot sites. Participants were excluded if primary care data and oxygen saturations at rest at enrolment were not available. Data from 908 participants were included in the analysis. Interventions Home oximetry monitoring was provided to participants with a known or suspected diagnosis of COVID-19. Participants were enrolled following attendance to emergency departments, hospital admission or referral through primary care services. Results Of 908 patients enrolled into four different COVID-19 home oximetry programmes in England, 771 (84.9%) had oxygen saturations at rest of 95% or more, and 320 (35.2%) were under 65 years of age and without comorbidities. 52 (5.7%) presented to hospital and 28 (3.1%) died following enrolment, of which 14 (50%) had COVID-19 as a named cause of death. All-cause mortality was significantly higher in patients enrolled after admission to hospital (OR 8.70 (2.53-29.89)), compared with those enrolled in primary care. Patients enrolled after hospital discharge (OR 0.31 (0.15-0.68)) or emergency department presentation (OR 0.42 (0.20-0.89)) were significantly less likely to present to hospital than those enrolled in primary care. Conclusions This study finds that home oximetry monitoring can be a safe pathway for patients with COVID-19; and indicates increases in risk to vulnerable groups and patients with oxygen saturation

The role of digital innovation in improving healthcare quality in extreme adversity: an interpretative phenomenological analysis study

# Background High quality is a necessary feature of healthcare delivery. Healthcare quality challenges are particularly present in conditions of extreme adversity, such as conflict settings or sustained humanitarian crises. Digital health technologies have recently emerged as an innovation to deliver care around the world in a variety of settings. However, there is little insight into how digital health technologies can be used to improve the quality of care where extreme adversity introduces unique challenges. This study aimed to identify how digital health technologies may be most impactful in improving the quality of care and evaluate opportunities for accelerated and meaningful digital innovation in adverse settings. # Methods A phenomenological approach (Interpretative Phenomenological Approach $$IPA$$), using semi-structured interviews, was adopted. Six individuals were interviewed in person based on their expertise in global health, international care delivery, and the application of digital health technologies to improve the quality of care in extreme adversity settings. The interviews were informed by a semi-structured topic guide with open-ended questions. The transcripts were compiled verbatim and were systematically examined by two authors, using the framework analysis method to extract themes and subthemes. # Results The participants identified several areas in which digital health technologies could be most impactful, which include engagement in care, continuity of care, workforce operations, and data collection. Opportunities for accelerated digital innovation include improving terminology, identity, ownership, and interoperability, identifying priority areas for digital innovation, developing tailored solutions, coordination and standardisation, and sustainability and resilience. # Conclusions These results suggest that there are conditions that favour or challenge the application of digital health technologies, even in specific areas in which they could be useful. A better understanding of the drivers and barriers to digitally driven quality improvement in settings of extreme adversity could inform international policies and optimisation strategies for the future

What Has Been the Impact of Covid-19 on Safety Culture? A Case Study from a Large Metropolitan Healthcare Trust

Covid-19 has placed an unprecedented demand on healthcare systems worldwide. A positive safety culture is associated with improved patient safety and, in turn, with patient outcomes. To date, no study has evaluated the impact of Covid-19 on safety culture. The Safety Attitudes Questionnaire (SAQ) was used to investigate safety culture at a large UK healthcare trust during Covid-19. Findings were compared with baseline data from 2017. Incident reporting from the year preceding the pandemic was also examined. SAQ scores of doctors and “other clinical staff”, were relatively higher than the nursing group. During Covid-19, on univariate regression analysis, female gender, age 40–49 years, non-White ethnicity, and nursing job role were all associated with lower SAQ scores. Training and support for redeployment were associated with higher SAQ scores. On multivariate analysis, non-disclosed gender (−0.13), non-disclosed ethnicity (−0.11), nursing role (−0.15), and support (0.29) persisted to a level of significance. A significant decrease (p < 0.003) was seen in error reporting after the onset of the Covid-19 pandemic. This is the first study to investigate SAQ during Covid-19. Differences in SAQ scores were observed during Covid-19 between professional groups when compared to baseline. Reductions in incident reporting were also seen. These changes may reflect perception of risk, changes in volume or nature of work. High-quality support for redeployed staff may be associated with improved safety perception during future pandemics

Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic: A multinational cross-sectional study

10.1371/journal.pone.0238666PLOS ONE16