Beyond HCAHPS: Analysis of patients’ comments provides an expanded view of their hospital experiences

An important concern for health care professionals is that standardized patient surveys may not fully capture all the topics that are important to patients. As a result, health care professionals may not have a complete picture of what their patients experience. The purpose of this research is to utilize a state-of-the-art Natural Language Processing technique to make sense of patients’ solicited, unstructured comments to gain a deeper and broader understanding of their experiences in the hospital. We analyzed a large dataset of inpatient survey responses (48,592 patients generating 65,998 comments) by a patient experience survey vendor for an eleven-hospital health care system in a large Midwest US city. Comments were first analyzed by Top2Vec algorithm in Python and more than 650 groupings of comments were then reduced into 20 sub-domains within 4 topic domains to better understand patient feedback on their hospital experience. We find distinct domains in the textual data that are not completely captured by survey domains. Furthermore, these domains match components of a hierarchical model of health service quality: interpersonal, technical, environmental, and administrative quality. Our findings broaden and deepen understanding of domains on standardized surveys. That is, completely new issues that are not measured in structured surveys are found in patient comments, and even when patient comments can be assigned to specific domains (e.g., nurse communication, discharge, etc.) found in standardized surveys, novel sub-topics provide a more nuanced understanding of patients’ hospital experiences. Novel sub-topics found in patient comments include clinicians’ diagnostic skill, compassionate care, team coordination, transfer processes, roommates, and others. Health care organizations should utilize state-of-the-art methods to mine insights from patient comments, and ensure they have processes, resources, and capabilities needed to translate insights into action. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

The impact of patient shadowing on service design: Insights from a family medicine clinic

A central tenet of patient-centered care is to truly and deeply understand how patients experience health care. One particular qualitative method, patient shadowing, holds the promise of seeing things through the patient’s eyes in real time. The purpose of this research is to utilize patient shadowing to capture the realities of patient experiences in an outpatient family medicine clinic and to report opportunities for improvement to clinic leadership. A total of twenty (20) patients were shadowed at a family medicine outpatient clinic over the course of eight (8) different days, providing a variety of circumstances including staffing levels, shift changes, patient volume, and other factors. Patient shadowing revealed many interesting observations, capturing many best practices in delivering patient experiences as well as a short list of recommendations that could improve patients’ and staff experiences. Areas for improvement include helping patients better understand the entire process, wayfinding from the exam room to check-out, and creating a checklist for patient follow-up items. Patient shadowing presents many benefits to health care organizations and employees, including enhanced communication and teamwork, a greater connection with patient experiences and hardships, and the opportunity to redesign processes to optimize efficiency and service quality. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this len

Evaluation and measurement of patient experience

Despite the increasing presence of a variety of measures of patient health care experiences in research and policy, there remains a lack of consensus regarding measurement. The objectives of this paper were to: (1) explore and describe what is known about measures and measurement of patient experience and (2) describe evaluation approaches/methods used to assess patient experience. Patient-experience does not simply reflect clinical outcomes or adherence–driven outcomes; rather it seeks to represent a unique encompassing dimension that is challenging to measure. Several challenges exist when measuring patient experience, in part, because it is a complex, ambiguous concept that lacks a common or ubiquitous definition and also because there are multiple cross-cutting terms (e.g., satisfaction, engagement, perceptions, and preferences) in health care that make conceptual distinction (and therefore measurement) difficult. However, there are many measurement and evaluation approaches that can be used to obtain meaningful insights that can generate actionable strategies and plans. Measuring patient experience can be accomplished using mixed methods, quantitative, or qualitative approaches. The strength of the mixed methods design lies not only in obtaining the “full picture,” but in triangulating (i.e., cross-validating) qualitative and quantitative data to see if and where findings converge, and what can be learned about patient experience from each method. Similar to deciding which measures to use, and which approaches to utilize in measurement, the timing of measurement must also fit the need at hand, and make both practical and purposeful sense and be interpreted in light of the timeframe context. Eliciting feedback from patients and engaging them in their care and health care delivery affords an opportunity to highlight and address aspects of the care experience that need improvement, and to monitor performance with regard to meeting patient experience goals in the delivery of care. The use of core patient-reported measures of patient experience as part of systematic measurement and performance monitoring in health care settings would markedly improve measurement of the ‘total’ patient experience and would heighten our understanding of the patient experience within and across settings. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

The relationships between HCAHPS communication and discharge satisfaction items and hospital readmissions

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has become a key metric used by organizations and patients to evaluate patient experience. Readmissions also continue to be a metric used to evaluate performance because of the added cost to both healthcare systems and patients. Both measures are also seen in programs such as Value Based Purchasing that have an effect on hospital reimbursements. Previous studies have demonstrated a relationship between patient perceptions and quality of care, and have found patients to be reliable evaluators of their care. While good communication and positive provider relationships have been related to higher satisfaction and higher rates of treatment compliance, past research has been limited to evaluating the relationship between readmissions and satisfaction at an organizational level. This retrospective, cross-sectional study will examine the relationship between communication and discharge HCAHPS questions and readmissions at 30 days, specifically at the patient level. Of the eight HCAHPS questions analyzed, higher scores on questions regarding “nurses listening” and “doctors explaining information” were linked to a decreased risk of readmission, while higher scores regarding “help after discharge” were linked to an increased risk for readmission. These results show the importance that a patient’s severity of illness and hospital procedures have on explaining HCAHPS results. This study’s seemingly paradoxical findings suggest the need to recognize potential trade-offs when reviewing HCAHPS results and using them to drive patient experience initiatives

SDG commentary : service ecosystems with the planet - weaving the environmental SDGs with human services

Purpose: Humanity and all life depend on the natural environment of Planet Earth, and that environment is in acute crisis across land, sea and air. One of a set of commentaries on how service can address the UN’s sustainable development goals (SDGs), the authors focus on environmental goals SDG 13 (climate action), SDG 14 (life below water) and SDG 15 (life on land). This paper aims to propose a conceptual framework that incorporates the natural environment into transformative services. Design/methodology/approach: The authors trace the evolution of service thinking about the natural environment, from a stewardship perspective of the environment as a set of resources to be managed, through an acknowledgement of nonhuman organisms as actors that can participate in service exchange, towards an emergent concept of ecosystems as integrating human social actors and other biological actors who engage fully in value co-creation. Findings: The authors derive a framework integrating human and other life forms as co-creating actors, drawing on shared natural resources to achieve mutualism, where each actor can have a net benefit from the relationship. Future research questions are posited that may help services research address SDGs 13–15. Originality/value: The framework integrates ideas from environmental ecosystem literature to inform the nature of ecosystems. By integrating environmental actors and ecological insights into the understanding of service ecosystems, service scholars are well placed to make unique contributions to the global challenge of creating a sustainable future

How do you feel today? Managing patient emotions during health care experiences to enhance well-being

Health care customers (patients) experience heightened emotions due to high stakes from risks to life, health, and well-being. Understanding and managing emotions during service experiences is an important area of inquiry because emotions influence customer perceptions, future intentions and behaviors. Yet despite its significance, research focusing on the impact of emotions on customer experiences remains fragmented, lacking a theoretically based conceptual framework. The authors attempt to fill this gap by addressing two important research questions contextualized in health care: (1) How can health care organizations better understand patient and family emotions during health care experiences? and (2) How should health care organizations use this understanding to design and better manage patient experiences to enhance patient well-being? The authors propose a new theoretically based framework on emotional responses following triggering events to enhance outcomes. Recommendations designed to enhance health care customer well-being are provided, as are directions to guide future work

Perfect ratings with negative comments: Learning from contradictory patient survey responses

This research explores why patients give perfect domain scores yet provide negative comments on surveys. In order to explore this phenomenon, vendor-supplied in-patient survey data from eleven different hospitals of a major U.S. health care system were utilized. The dataset included survey scores and comments from 56,900 patients, collected from January 2015 through October 2016. Of the total number of responses, 30,485 (54%) contained at least one comment. For our analysis, we use a two-step approach: a quantitative analysis on the domain scores augmented by a qualitative text analysis of patients’ comments. To focus the research, we start by building a hospital recommendation model using logistic regression that predicts a patient’s likelihood to recommend the hospital; we use this to further evaluate the top four most predictive domains. In these domains (personal issues, nurses, hospital room, and physicians), a significant percentage of patients who rated their experience with a perfect domain score left a comment categorized as not positive, thus giving rise to stark contrasts between survey scores and comments provided by patients. Within each domain, natural language analysis of patient comments shows that, despite providing perfect survey scores, patients have much to say to health care organizations about their experiences in the hospital. A summary of comments also shows that respondents provide negative comments on issues that are outside the survey domains. Results confirm that harvesting and analyzing comments from these patients is important, because much can be learned from their narratives. Implications for health care professionals and organizations are discussed

Cocreating transformative value propositions with customers experiencing vulnerability during humanitarian crises

Publisher Copyright: © 2022, Academy of Marketing Science.To understand the cocreation and impact of transformative value propositions (TVPs), which are designed to address vulnerabilities that customers experience because of humanitarian crises, this study applies a typology of service innovation archetypes as a domain theory to examine different ways to cocreate TVPs. The authors identify different types of customers who experience vulnerability, using a social determinants of health (SDOH) framework. Exemplary TVPs reveal how service organizations can alleviate customer vulnerabilities, in the short and long terms, and highlight a distinction between TVPs that require incremental changes to existing resource deployment versus those that require novel capabilities. This article contributes to transformative service research by establishing a value-centric model that relates the cocreation of TVPs to customers experiencing vulnerability. In turn, researchers and managers can identify the output-based, process-based, experiential, and systemic changes needed to cocreate TVPs.Peer reviewe

Perfect ratings with negative comments: Learning from contradictory patient survey responses

This research explores why patients give perfect domain scores yet provide negative comments on surveys. In order to explore this phenomenon, vendor-supplied in-patient survey data from eleven different hospitals of a major U.S. health care system were utilized. The dataset included survey scores and comments from 56,900 patients, collected from January 2015 through October 2016. Of the total number of responses, 30,485 (54%) contained at least one comment. For our analysis, we use a two-step approach: a quantitative analysis on the domain scores augmented by a qualitative text analysis of patients’ comments. To focus the research, we start by building a hospital recommendation model using logistic regression that predicts a patient’s likelihood to recommend the hospital; we use this to further evaluate the top four most predictive domains. In these domains (personal issues, nurses, hospital room, and physicians), a significant percentage of patients who rated their experience with a perfect domain score left a comment categorized as not positive, thus giving rise to stark contrasts between survey scores and comments provided by patients. Within each domain, natural language analysis of patient comments shows that, despite providing perfect survey scores, patients have much to say to health care organizations about their experiences in the hospital. A summary of comments also shows that respondents provide negative comments on issues that are outside the survey domains. Results confirm that harvesting and analyzing comments from these patients is important, because much can be learned from their narratives. Implications for health care professionals and organizations are discussed

The impact of patient shadowing on service design: Insights from a family medicine clinic

A central tenet of patient-centered care is to truly and deeply understand how patients experience health care. One particular qualitative method, patient shadowing, holds the promise of seeing things through the patient’s eyes in real time. The purpose of this research is to utilize patient shadowing to capture the realities of patient experiences in an outpatient family medicine clinic and to report opportunities for improvement to clinic leadership. A total of twenty (20) patients were shadowed at a family medicine outpatient clinic over the course of eight (8) different days, providing a variety of circumstances including staffing levels, shift changes, patient volume, and other factors. Patient shadowing revealed many interesting observations, capturing many best practices in delivering patient experiences as well as a short list of recommendations that could improve patients’ and staff experiences. Areas for improvement include helping patients better understand the entire process, wayfinding from the exam room to check-out, and creating a checklist for patient follow-up items. Patient shadowing presents many benefits to health care organizations and employees, including enhanced communication and teamwork, a greater connection with patient experiences and hardships, and the opportunity to redesign processes to optimize efficiency and service quality. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this len