Understanding the determinants of patient experience quality in UK hospitals

F. Ponsignon, J. Hall, M. Williams

6th November 2012

Centre for Innovation and Service Research (ISR)

Contents

1 2

Research context and rationale Research objective and question

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4 5

Methods
Preliminary results Next steps

1. Context and rationale

Need for a holistic approach from the patient perspective

Need to understand service experience quality from the patient perspective: the voice of the patient Patient experience quality: how patients perceive their interactions with health services

The holism requirement: before, during, after the diagnostic and treatment
Designing for and managing the customer experience: an important trend in other sectors

2. Objectives and research questions

Work with clinicians and policy-makers

Dual requirement of building a robust theory and of informing healthcare practice Empirical development and validation of a measurement scale of patient experience quality

Enhance the experience through design

Provision of practical tools to evaluate and improve the quality of the patient experience

Impact delivery of health services

RQ1: What are the determinants of experience quality?

RQ2: Which determinants lead to positive and negative experience evaluations?

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3. Research Methods

Capture the VoP from published stories

Empirical material: 800 stories of cancer patients

Proxy for hospital and no confounding effects

Large dataset + open-ended question + high patient involvement = data richness and holistic perspective

The pros outweigh the cons

Key aspects of experience emerge as perceived by the patient (non-obstructive and independent)
Recaller bias and interviewer bias minimised

Representative of the patient population (potential biases)

Accuracy and objectivity of patient accounts
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Code 200 patient stories independently

1. Positive or Negative 2. Interaction type 3. Discrete determinant (e.g. rude; ignored

Coding, sorting, and classifying

Compare decisions and resolve disagreements

Reliability requirement

Classification Sample Sort and classify (1-125)

Sort and classify (125-165)

Verification Sample

2 samples to build and test the model

Achieve interjudge reliability of 80% minimum

New Categories?

3. A useful framework to think about experience

Direct Interactions

Surrogate Interactions

Independent processing

Source: Visualizing service operations, Scott Sampson, Journal of Service Research, 2012

4. Findings: quality drivers by frequency of mention

Determinants of positive experiences (N = 144)

Coded Item Direct Interactions Caring Explaination Kind Helpful Friendly Professionalism Attentive Informative (patients) Accessibility of Staff Accommodate Request At ease - comfortable Consideration Diagnosis (speed) Diagnosis and Treatment Speed N 112 11 11 10 6 5 5 3 3 2 2 2 2 2 2 % 78% 8% 8% 7% 4% 3% 3% 2% 2% 1% 1% 1% 1% 1% 1% Treatment Outcome 7 5% Independent Processing Internal communication Communication outside hospital 5 2 1 3% 1% 1% Coded Item Surrogate Interactions Cleanliness Food Quality Car Parking (cost) Appointment System Camaraderie Decor Food Quantity N 19 5 3 2 1 1 1 1 % 13% 3% 2% 1% 1% 1% 1% 1%

Determinants of negative experiences (N = 127)

Coded Item Direct Interactions Ignored Rude Staff Wrong Diagnosis Lack of explaination Staff (lack of) Delivery of Diagnosis Lack of listening Uncompassionate Availability of staff Arrogance Comm. with relatives Lack of comm. Noisy Night Staff Staff Training Uncaring Unhelpful Unreliable N 70 5 5 5 4 4 3 3 3 2 2 2 2 2 2 2 2 2 % 55% 4% 4% 4% 3% 3% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2%
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Coded Item Surrogate Food quality Car Parking (Busy) Cleanliness Wait for treatment Ward Layout Car Parking (Costs)

N 33 5 4 4 3 2 1

% 26% 4% 3% 3% 2% 2% 1%

Independent Internal Comm External Comm Appointment Admin

22 8 6 4

17% 6% 5% 3%

2%

4. Findings: emerging themes

Holistic conceptualisation: reputation, proximity, car park, post-treatment contact The satisfaction mirror Importance of accommodating special requests

Importance of communication facilities (TV, WiFi)

Role of fellow patients

5. Next steps and implications

1.
A long journey

Continue with the coding, sorting, classifying

2. 3.

Validate the measurement scale

Pilot the experience fitness test in hospitals: a tool for evaluating experience quality and identifying redesign opportunities Link with the NHS Institute for Innovation and Improvement

Pathway to impact

Engage all key stakeholders

Inform the design of the feedback system

Text mining (i.e. partially automate the analysis)
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