Capturing the experience of the hospital-stay journey from admission to discharge using diaries completed by patients in their own words: a qualitative study

Abstract

ObjectiveTo capture and better understand patients’ experience during their healthcare journey from hospital admission to discharge, and to identify patient suggestions for improvement.DesignProspective, exploratory, qualitative study. Patients were asked to complete an unstructured written diary expressed in their own words, recording negative and positive experiences or anything else they considered noteworthy.Participants and settingPatients undergoing vascular surgery in a metropolitan hospital.Primary outcome measuresComplete diary transcripts underwent a general inductive thematic analysis, and opportunities to improve the experience of care were identified and collated.ResultsWe recruited 113 patients in order to collect 80 completed diaries from 78 participants (a participant response rate of 69%), recording patients’ experiences of their hospital-stay journey. Participating patients were a median (range) age of 69 (21–99) years and diaries contained a median (range) of 197 (26–1672) words each. Study participants with a tertiary education wrote more in their diaries than those without—a median (range) of 353.5 (48–1672) vs 163 (26–1599) words, respectively (Mann-Whitney U test, p=0.001). Three primary and eight secondary themes emerged from analysis of diary transcripts—primary themes being: (1) communication as central to care; (2) importance of feeling cared for and (3) environmental factors shaping experiences. In the great majority, participants reported positive experiences on the hospital ward. However, a set of 12 patient suggestions for improvement were identified, the majority of which could be addressed with little cost but result in substantial improvements in patient experience. Half of the 12 suggestions for improvement fell into primary theme 1, concerning opportunities to improve communication between healthcare providers and patients.ConclusionsUnstructured diaries completed in a patient’s own words appear to be an effective and simple approach to capture the hospital-stay experience from the patient’s own perspective, and to identify opportunities for improvement.

Introducing physician associates to hospital patients: Development and feasibility testing of a patient experience‐based intervention

“…These responses are congruent with findings from the literature indicating that patients receive insufficient personal information from their doctors during hospital ward rounds 46 . The psychological benefits of patient information in the hospital context are also recognized in terms of helping patients know what to expect, thereby reducing uncertainty and anxiety 20,21 …”

“…Some studies have shown a positive association between hospital patients’ ability to identify clinicians involved in their care, and patient‐clinician communication and patient experience and satisfaction 17‐19 . Explanatory theories suggest reduced psychological stress experienced by the hospitalized patients 20,21 . Evidence is inconclusive that interventions such as facecards, and use of whiteboards can improve clinician identification and understanding of roles among inpatients 22,23 .…”

Exploring the hospital patient journey: What does the patient experience?

“…Understanding what organizations can do to improve patient experience is critical [40]. However, the literature is still exploring the best methods to capture the patient's experience [17, 23, 30]. This study deals with the lived experience of orthopaedic patients by capturing the different points of view of patients and professionals on individual hospital patient journeys.…”

“…Shadowing highlights what the patient experiences in the different contexts and when going through one service and on to another, which professionals do not see since this falls outside the scope of their direct responsibility. Moreover, unlike using diaries completed by patients [23], this methodology allows the patient to be observed in the moment and in the spaces in which the relationship with the professionals takes place. However, this necessarily determines a subjective interpretation of what the researcher observes with respect to what the patient affirms.…”

“…during the transfer to the operating theatre or in the post-operative period, immediately after surgery). Furthermore, the authors show how study participants with a tertiary education wrote more in their diaries than those without [23]. This could potentially eliminate important aspects of the experience lived by vulnerable people.…”