Understanding negative feedback from South Asian patients: an experimental vignette study

Burt, Jenni; Abel, Gary; Elmore, Natasha; Lloyd, Cathy E.; Benson, John; Sarson, Lara; Carluccio, Anna; Campbell, John; Elliott, Marc N.; Roland, Martín

doi:10.1136/bmjopen-2016-011256

Cited by 19 publications

(21 citation statements)

References 25 publications

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“…The differences that we observed were in the opposite direction to those in the national GP Patient Survey, Reproduced from Burt et al 190 under the terms of the Creative Commons Attribution license (CC BY 4.0), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/). DOI: 10.3310/pgfar05090 PROGRAMME GRANTS FOR APPLIED RESEARCH 2017 VOL.…”

Section: Discussionmentioning

confidence: 89%

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Burt

Campbell

Abel

et al. 2017

Programme Grants Appl Res

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BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Discussionmentioning

confidence: 89%

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Burt

Campbell

Abel

et al. 2017

Programme Grants Appl Res

Self Cite

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“…On the other hand, collecting data from pediatric is conducive to reflecting poor DPR in mobile consultation, because users in the pediatric department are usually the guardians of patients rather than patients themselves. And guardians who have strong feelings for their loved children are more likely to have conflicts with doctors [47]. The "dissatisfied" consultation records represent users' dissatisfactory experience.…”

Section: Data Collectionmentioning

confidence: 99%

The Antecedents of Poor Doctor-Patient Relationship in Mobile Consultation: A Perspective from Computer-Mediated Communication

Yan

Tan

Jia

et al. 2020

IJERPH

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This study aims to understand the underlying reasons for poor doctor-patient relationships (DPR). While extant studies on antecedents of poor DPR mainly focus on the offline context and often adopt the patients' perspective, this work focuses on the mobile context and take both doctors' and mobile consultation users' perspectives into consideration. To fulfill this purpose, we first construct a theoretical framework based on the Computer-Mediated Communication (CMC) literature. Then we coded 592 doctor-user communication records to validate and elaborate the proposed theoretical model. This work reveals that characteristics of mobile technologies pose potential challenges on both doctors' and patients' information providing, informative interpreting, and relationship maintaining behaviors, resulting in 10 and 6 types of inappropriate behaviors of doctors and users, respectively, that trigger poor DPR in the mobile context. The findings enrich the research on online DPR and provide insights for improving DPR in the mobile context. Extant research on mobile healthcare service is emerging, but studies that aim at uncovering the underlying reasons for poor DPRs in the mobile context are still lacking. The majority of previous research tends to focus on the positive experience brought about by mobile healthcare services, such as user satisfaction [10] and the adoption or continuous usage of mobile technology [3,11]. However, the experience of dissatisfied participants is largely ignored. The negative experience is also worth noting because understanding the complaints guide practitioners to improve service quality [8]. Although a few studies have paid attention to the dissatisfying experience of mobile healthcare services, they tend to interpret the experience only from the perspective of users [8,12]. While these studies are insightful, a single perspective from users is not adequate, because they missed the perception of doctors which is considered quite different from that of users [13,14].These two literature gaps (namely lacking studies on dissatisfying experience of mobile healthcare services and lacking dual perspectives from both users and doctors) might partly be attributed to the mainstream research method in the healthcare field. Most studies rely on questionnaires and interviews to collect subjective ratings about mobile healthcare services, such as Akter et al. (2013) [15], Deng et al. (2015) [16], and Wu et al. (2018) [17]. The collected responses are usually inaccurate since respondents are rating events that happened at an earlier time. Besides, it is difficult to match responses from doctors and patients via questionnaires.This work aims to uncover the underlying reasons for poor DPR from dual perspectives of both doctors and users in mobile medical consultation service. To achieve our goals, we first reviewed the literature on Computer-Mediated Communication (hereafter, CMC) in search of theoretical accounts for the poor DPR in the mobile context. The CMC literature focuses on the influence of the fe...

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“…The relationship between providers and people with diabetes (regardless of socio‐economic status, ethnicity or culture) is a key component of satisfaction and influences self‐management of diabetes . An early study employing video observations has offered useful insights into person‐centred diabetes care and patient satisfaction.…”

Section: Resultsmentioning

confidence: 99%

“…Stereotypes and generalizations can be addressed by using person-first language and may reduce the stigma experienced by having diabetes, however, the opposite has also been posited; as Collier argues, trying to hide a word in a sentence might emphasis stigma [13]. The relationship between providers and people with diabetes (regardless of socio-economic status, ethnicity or culture) is a key component of satisfaction and influences self-management of diabetes [12,14]. An early study employing video observations [16] has offered useful insights into person-centred diabetes care and patient satisfaction.…”

Section: Negative Termsmentioning

confidence: 99%

Language matters: a UK perspective

et al. 2018

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Understanding negative feedback from South Asian patients: an experimental vignette study

Cited by 19 publications

References 25 publications

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

The Antecedents of Poor Doctor-Patient Relationship in Mobile Consultation: A Perspective from Computer-Mediated Communication

Language matters: a UK perspective

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