Barriers and facilitators of a near real-time feedback approach for measuring patient experiences of hospital care

Käsbauer, Susanne; Cooper, Robyn; Kelly, Laura; King, Jenny

doi:10.1016/j.hlpt.2016.09.003

Cited by 17 publications

(38 citation statements)

References 15 publications

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“…Outputs include a toolkit, which included the validated patient survey instrument, publications in peer-reviewed and professional journals and three conference presentations. 46,53 Synthesis of findings for research question 1: can near real-time feedback be used to measure relational aspects of care?…”

Section: Methods For the Evaluationmentioning

confidence: 99%

“…A report outlining the barriers and facilitators has been published in the Health Policy and Technology journal. 53 Three case studies are included to provide an overview of challenges experienced as part of the NRTF approach, lessons learnt and impacts generated from the methodology. The short form of the survey instrument to measure relational aspects of care is also available as part of the toolkit.…”

Section: Other Changesmentioning

confidence: 99%

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An evaluation of a near real-time survey for improving patients’ experiences of the relational aspects of care: a mixed-methods evaluation

Graham

Käsbauer

Cooper

et al. 2018

Health Serv Deliv Res

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Background The Francis Report (of 2013) provided many recommendations to improve compassionate care in NHS organisations, including more widespread use of real-time feedback (RTF) to collect patient experience data. This research directly addressed these recommendations and aimed to provide an evidence-based toolkit to support NHS quality improvements. Objectives To develop and validate a survey of compassionate care for use in near real time on elderly care wards and accident and emergency (A&E) departments. This research also evaluated the effectiveness of the RTF approach for improving relational aspects of care and provides suggestions for how the approach can be used by other hospitals to strengthen compassionate care. Design The research utilised a mixed-methods design, using quantitative, qualitative and participatory research approaches to collect patients’ experiences of relational care and the views of NHS staff in an effort to evaluate the processes and impacts of near real-time feedback (NRTF) data collection. Data sources included a NRTF patient experience survey, weekly volunteer diaries, staff interviews and surveys, workshops and meetings with case study sites. Setting The research was carried out across six case study sites across England, in wards that predominantly serve elderly patients and in A&E departments. Participants The 3928 participants in the patient experience survey were inpatients on elderly care wards, or persons who had sought medical care in A&E. Frontline staff, service leads, senior management and volunteers also took part in surveys (n = 274) and interviews (n = 82) designed to understand the staff perspectives and opinions of collecting patient experience data. Interventions A patient experience survey was implemented using a tablet computer-based methodology, facilitated by trained volunteers. Responses were used alongside feedback from staff to evaluate the use of a NRTF approach as a method for improving patient experiences of relational aspects of care. Main outcome measures The patient experience survey measured relational aspects of care. Another outcome measure was improvements to care as planned, implemented and reported by staff. Results A small but statistically significant improvement (p = 0.044) in relational aspects of care over the course of the study was noted overall. Staff implemented a variety of improvements to enhance communication with patients. Limitations Maintaining volunteer and staff engagement throughout the study was difficult. Few surveys were completed per ward or department each week. This made examining trends in patient experiences over time challenging. Conclusions Near real-time feedback offers an effective approach for monitoring and improving relational aspects of care. Future work Staff frequently expressed a view that volunteers’ interactions with patients while administering the survey were themselves beneficial to patients. Future research should examine the impact of volunteer interactions with patients on their experiences of relational aspects of care. Study registration The project is registered on the Clinical Research Network portfolio under the primary trial identification number 18449. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Section: Methods For the Evaluationmentioning

confidence: 99%

Section: Other Changesmentioning

confidence: 99%

An evaluation of a near real-time survey for improving patients’ experiences of the relational aspects of care: a mixed-methods evaluation

Graham

Käsbauer

Cooper

et al. 2018

Health Serv Deliv Res

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“…Of the 13 studies included in the final review (Table 1), 5 were based in general practice [10,21-24] and the rest were based in an acute care hospital setting [9,25-31]. Of all the studies, 5 were from the United Kingdom [21,22,24,25,28], 7 from the United States [9,10,26,27,29-31], and 1 from Canada [23]. All but one [28] studies were based on adult populations.…”

Section: Resultsmentioning

confidence: 99%

“…However, the experience was reported by adults (parents or relatives) for the study [28] conducted in the neonatal ward. Five studies were qualitative studies on patients’ or staff views [21,24] and on barriers to and facilitators [25,27,28] of RTF. The remainder of the studies used a quantitative approach with varied outcome measures, of which the recurring measures were response rates of RTF [9,10,22,23,27,29] and association with patient demographics, that is, age, gender, ethnicity, and literacy [9,22,23,31].…”

Section: Resultsmentioning

confidence: 99%

Evaluating Digital Maturity and Patient Acceptability of Real-Time Patient Experience Feedback Systems: Systematic Review

Khanbhai¹,

Flott²,

Darzi³

et al. 2019

J Med Internet Res

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Background One of the essential elements of a strategic approach to improving patients’ experience is to measure and report on patients’ experiences in real time. Real-time feedback (RTF) is increasingly being collected using digital technology; however, there are several factors that may influence the success of the digital system. Objective The aim of this review was to evaluate the digital maturity and patient acceptability of real-time patient experience feedback systems. Methods We systematically searched the following databases to identify papers that used digital systems to collect RTF: The Cochrane Library, Global Health, Health Management Information Consortium, Medical Literature Analysis and Retrieval System Online, EMBASE, PsycINFO, Web of Science, and CINAHL. In addition, Google Scholar and gray literature were utilized. Studies were assessed on their digital maturity using a Digital Maturity Framework on the basis of the following 4 domains: capacity/resource, usage, interoperability, and impact. A total score of 4 indicated the highest level of digital maturity. Results RTF was collected primarily using touchscreens, tablets, and Web-based platforms. Implementation of digital systems showed acceptable response rates and generally positive views from patients and staff. Patient demographics according to RTF responses varied. An overrepresentation existed in females with a white predominance and in patients aged ≥65 years. Of 13 eligible studies, none had digital systems that were deemed to be of the highest level of maturity. Three studies received a score of 3, 2, and 1, respectively. Four studies scored 0 points. While 7 studies demonstrated capacity/resource, 8 demonstrated impact. None of the studies demonstrated interoperability in their digital systems. Conclusions Patients and staff alike are willing to engage in RTF delivered using digital technology, thereby disrupting previous paper-based feedback. However, a lack of emphasis on digital maturity may lead to ineffective RTF, thwarting improvement efforts. Therefore, given the potential benefits of RTF, health care services should ensure that their digital systems deliver across the digital maturity continuum.

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“…A detailed evaluation of the barriers and facilitators to the implementation of RAC-Q is outlined elsewhere. 20 While many barriers to collecting real-time data can relate to technology resources and staff engagement, reducing the number of questionnaire items to be administered is one way to reduce burden of questionnaire completion. Fewer questionnaire items are particularly welcome given that older people and A&E attendees can present unique challenges when completing lengthy questionnaires.…”

Section: Introductionmentioning

confidence: 99%

The Relational Aspects of Care Questionnaire: item reduction and scoring using inpatient and accident and emergency data in England

Kelly

Sizmur

Käsbauer

et al. 2018

PROM

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PurposeThe Relational Aspects of Care Questionnaire (RAC-Q) is an electronic instrument which has been developed to assess staff’s interactions with patients when delivering relational care to inpatients and those accessing accident and emergency (A&E) services. The aim of this study was to reduce the number of questionnaire items and explore scoring methods for “not applicable” response options.Patients and methodsParticipants (n=3928) were inpatients or A&E attendees across six participating hospital trusts in England during 2015–2016. The instrument, consisting of 20 questionnaire items, was administered by trained hospital volunteers over a period of 10 months. Items were subjected to exploratory factor analysis to confirm unidimensionality, and the number of items was reduced using a range of a priori psychometric criteria. Two alternative approaches to scoring were undertaken, one treated “not applicable” responses as missing data, while the second adopted a problem score approach where “not applicable” was considered “no problem with care.”ResultsTwo short-form RAC-Qs with alternative scoring options were identified. The first (the RAC-Q-12) contained 12 items, while the second scoring option (the RAC-Q-14) contained 14 items. Scores from both short forms correlated highly with the full 20-item parent form score (RAC-Q-12, r=0.93 and RAC-Q-14, f=0.92), displayed high internal consistency (Cronbach’s α: RAC-Q-12=0.92 and RAC-Q-14=0.89) and had high levels of agreement (intraclass correlation coefficient [ICC]=0.97 for both scales).ConclusionThe RAC-Q is designed to offer near-real-time feedback on staff’s interactions with patients when delivering relational care. The new short-form RAC-Qs and their respective method of scoring are reflective of scores derived using the full 20-item parent form. The new short-form RAC-Qs may be incorporated into inpatient surveys to enable the comparison of ward or hospital performance. Using either the RAC-Q-12 or the RAC-Q-14 offers a method to reduce missing data and response fatigue.

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Barriers and facilitators of a near real-time feedback approach for measuring patient experiences of hospital care

Cited by 17 publications

References 15 publications

An evaluation of a near real-time survey for improving patients’ experiences of the relational aspects of care: a mixed-methods evaluation

An evaluation of a near real-time survey for improving patients’ experiences of the relational aspects of care: a mixed-methods evaluation

Evaluating Digital Maturity and Patient Acceptability of Real-Time Patient Experience Feedback Systems: Systematic Review

The Relational Aspects of Care Questionnaire: item reduction and scoring using inpatient and accident and emergency data in England

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