Burroughs T E, Davies A R, Cira J C, Dunagan W C
BJC Health System, St Louis, MO 63110.
Jt Comm J Qual Improv. 1999 Jun;25(6):271-87. doi: 10.1016/s1070-3241(16)30444-8.
Beginning in April 1995, an ongoing, comprehensive measurement system has been developed and refined at BJC Health System, a regional integrated delivery and financing system serving the St Louis metropolitan area, mid-Missouri, and Southern Illinois, to assess patient satisfaction with inpatient treatment, outpatient treatment, outpatient surgery, and emergency care. This system has provided the mechanism for identifying opportunities, setting priorities, and monitoring the impact of improvement initiatives.
Satisfaction with key components of the care process among 23,361 patients (7,083 inpatients, 8,885 patients undergoing outpatient tests/procedures, 5,356 patients undergoing outpatient surgery, and 2,037 patients receiving emergency care) at 15 BJC Health System facilities was assessed through weekly surveys administered in April 1995 through December 1996.
Structural equation models were developed to identify the key predictors of patient advocation-willingness to return for or recommend care. Across all venues of care the compassion provided to patients had the strongest relationship to patient advocation. Within each venue of care, however, a slightly different set of secondary factors emerged. The resulting models provided important information to help prioritize competing improvement opportunities in BJC Health System. In one hospital, a general medicine unit working for several years with little success to improve its patient satisfaction decided to focus on two primary factors predicting patient advocation: nursing care delivery and compassionate care. Root cause analysis was used to determine why two items-staff willingness to help with questions/concerns and clear explanation about tests and procedures-were rated low. On the basis of feedback from phone interviews with discharged patients, the care delivery process was changed to encourage patients to ask questions. Across the next two quarters, this unit experienced significant improvements in both targeted items.
The significance of compassionate care and care delivery again speaks not only to the importance of the technical quality of clinical care but also to the customer-focused way in which this care was provided. After the primary predictors of patient advocation were identified, management was able to strategically focus improvement initiatives to maximize their impact. Across the organization, improvement teams scanned their data to find key factors where performance was lacking. Once these key opportunities were identified, the teams developed potential solutions and launched initiatives to improve their performance.
Results suggest that some core issues are of extreme importance to patients regardless of whether they are receiving care in an inpatient, outpatient, or emergency setting. The compassion with which care is provided appears to be the most important factor in influencing patient intentions to recommend/return, regardless of the setting in which care is provided.
自1995年4月起，BJC医疗系统（一个服务于圣路易斯大都市地区、密苏里州中部和伊利诺伊州南部的区域综合医疗服务与融资系统）开发并完善了一套持续运行的综合测量系统，以评估患者对住院治疗、门诊治疗、门诊手术和急诊护理的满意度。该系统为识别机会、确定优先事项以及监测改进措施的影响提供了机制。
通过1995年4月至1996年12月每周进行的调查，评估了BJC医疗系统15家机构中23361名患者（7083名住院患者、8885名接受门诊检查/治疗的患者、5356名接受门诊手术的患者以及2037名接受急诊护理的患者）对护理过程关键组成部分的满意度。
构建了结构方程模型以确定患者推荐意愿（即愿意再次接受治疗或推荐该医疗机构）的关键预测因素。在所有护理场所中，给予患者的关怀与患者推荐意愿的关系最为紧密。然而，在每个护理场所中，出现了一组略有不同的次要因素。所得模型提供了重要信息，有助于在BJC医疗系统中对相互竞争的改进机会进行优先排序。在一家医院，一个多年来致力于提高患者满意度但成效甚微的普通内科病房决定专注于预测患者推荐意愿的两个主要因素：护理服务提供和关怀护理。通过根本原因分析来确定为什么两个项目——工作人员帮助解答问题/关注事项的意愿以及对检查和程序的清晰解释——得分较低。根据对出院患者电话访谈的反馈，改变了护理服务流程以鼓励患者提问。在接下来的两个季度中，该病房在这两个目标项目上都取得了显著改善。
关怀护理和护理服务的重要性再次表明，不仅临床护理的技术质量很重要，而且提供护理的以客户为中心的方式也很重要。在确定了患者推荐意愿的主要预测因素后，管理层能够从战略上聚焦改进措施以使其影响最大化。在整个组织中，改进团队审视他们的数据以找出表现欠佳的关键因素。一旦确定了这些关键机会，团队就会制定潜在解决方案并启动改进绩效的措施。
结果表明，一些核心问题对患者极为重要，无论他们是在住院、门诊还是急诊环境中接受治疗。无论护理提供的环境如何，提供护理时的关怀似乎是影响患者推荐/再次接受治疗意愿的最重要因素。
