Background:
Many industries and corporations have adopted user‐centered design methods to drive meaningful improvement in commercial products and customer experience. Healthcare has been slow to follow, relying on superficial quantitative surveys, such as HCAHPS for hospitals, to understand patient experience and satisfaction. As a result, improvement teams often lack guidance for how to meaningfully incorporate patient‐centered perspectives when prioritizing quality targets.
Purpose:
We sought to utilize empathy‐driven design methods to understand the experience of patients as they received care in 8 clinical areas across our large quaternary academic hospital, and then use these results to inform improvement initiatives.
Description:
In spring 2013, our team of hospitalist physicians, nurses, and process improvement specialists created a customer‐focused interview tool based on the Picker Institute’s 8 Domains of Patient and Family Centered Care (PFCC). The tool relies on initial open ended questions in each domain followed by tailored questions to gain depth around positive or negative care experiences. From May‐July 2013, an RN patient‐experience expert and a process improvement manager used the tool to conduct interviews of 71 patients who were actively receiving care in 8 clinical delivery areas at our hospital. The clinical delivery areas included the emergency department, inpatient units, and affiliated ambulatory clinics. Clinicians in each area identified patients who were clinically stable enough for an extended interview, and interviewers asked permission of patients before beginning. The average interview time was 15 minutes. 1 patient refused the interview citing time constraints. At the conclusion of each interview, patients were asked to prioritize the PFCC domain that most impacted their current care. The most frequently elevated domain (34% of patients) was “Information, Communication, and Education,” but domain priority varied among the clinical areas. Qualitative interview transcript analysis highlighted six organizing themes that also varied in prevalence across the clinical areas: (1) Clarity of care plan and options, (2) Perception of staff competence, (3) Perception of respectful treatment, (4) Physical comfort, (5) Perception of care coordination, and (6) Wait time and navigation. We distributed the complete interview transcripts and summary thematic data to frontline clinical leadership teams in each area, all of whom were participating in a year‐long systems improvement program within our organization. Teams reported that these data were more actionable than existing patient satisfaction sources and promoted the integration of the patient perspective into the prioritization of improvement targets. All 8 teams launched specific quality improvement projects in July‐November 2013, and in all 8 cases the selected projects tied directly to at least one of the top 3 patient‐prioritized domains in that particular clinical area. In 4 cases, the projects tied directly to more than one patient‐prioritized domain.
Conclusions:
Qualitative patient interviews, pursued using user‐centered design methods while patients are actively receiving care, can elicit rich information about patients’ experiences and perspectives on opportunities for systems improvement. This approach can provide actionable insights for front‐line clinical improvement teams who otherwise may struggle to incorporate standard patient satisfaction survey results into improvement work.