Fradgley Elizabeth A, Paul Christine L, Bryant Jamie, Collins Nicolas, Ackland Stephen P, Bellamy Douglas, Levi Christopher R
Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia.
Eval Health Prof. 2016 Dec;39(4):475-495. doi: 10.1177/0163278716659524. Epub 2016 Aug 1.
Identification of patients' and health professionals' quality improvement preferences is an essential first step in collaborative improvement models. This includes experience-based codesign (EBCD), where service change is strategically introduced following stakeholder consultation. This study compared the number and types of improvement initiatives selected by outpatients and health professionals. Using electronic surveys designed to inform EBCD studies, 541 outpatients (71.1% consent) and 124 professionals (47.1% response) selected up to 23 general initiatives. On average, outpatients selected 2.4 (median = 1, interquartile range = 1-3) initiatives and professionals selected 10.7 (median = 10; interquartile range = 6-15) initiatives. Outpatients demonstrated a strong preference for improvements to clinic organization, such as appointment scheduling and clinic contact. Outpatients selected relatively fewer initiatives potentially reducing the complexity of service change and resources required to address preferences. Comparatively, professionals indicated a greater degree of change is needed and selected initiatives related to communication with patients and other professionals, including coordinating multidisciplinary care. Improvements to information provision were commonly selected by both groups and offered a strategic opportunity to address patients' and professionals' preferences. By quantifying the ways in which preferences differed, this study emphasizes the need for collaborative approaches to health service change and may be used to initiate an informed discussion on patients' and professionals' quality improvement preferences in tertiary care.
识别患者和卫生专业人员对质量改进的偏好是协作改进模型中至关重要的第一步。这包括基于经验的协同设计(EBCD),即在利益相关者协商后有策略地引入服务变革。本研究比较了门诊患者和卫生专业人员选择的改进举措的数量和类型。通过旨在为EBCD研究提供信息的电子调查,541名门诊患者(同意率71.1%)和124名专业人员(回复率47.1%)选择了多达23项一般举措。门诊患者平均选择2.4项举措(中位数 = 1,四分位间距 = 1 - 3),专业人员平均选择10.7项举措(中位数 = 10;四分位间距 = 6 - 15)。门诊患者强烈倾向于改进诊所组织,如预约安排和诊所联系。门诊患者选择的可能降低服务变革复杂性和满足偏好所需资源的举措相对较少。相比之下,专业人员表示需要更大程度的变革,并选择了与患者及其他专业人员沟通相关的举措,包括协调多学科护理。两组通常都选择了改进信息提供方面的举措,这为满足患者和专业人员的偏好提供了一个战略机会。通过量化偏好差异的方式,本研究强调了卫生服务变革采用协作方法的必要性,并可用于发起关于三级医疗中患者和专业人员质量改进偏好的明智讨论。