Riebling Nancy B, Norouzzadeh Shaghayegh, Reeder George, Mouradian Christina, Hillier Alison, Cowan Ryan, Doerfler Martin
Clinical Transformation, Northwell Health, Lake Success, New York, USA.
Partners in Clinical Care, LLP, Islip, New York, USA.
BMJ Open Qual. 2019 Mar 9;8(1):e000458. doi: 10.1136/bmjoq-2018-000458. eCollection 2019.
Current patient satisfaction assessment results are delayed and obtained from select patient surveys. As a result, these assessments may not represent the experience of the entire patient population. This study developed a method to measure and evaluate all patients' experiences while they are within the care episode and link it to processes within the organisation.
Using the Six Sigma methodology, sites assembled diverse teams to categorise and analyse negative experience comments from patients to understand the drivers of dissatisfaction. These customer expectations lead to the development of the four components in the Patient Experience Bundle (PEB): communication, environment, basic needs/comfort and logistics. Individual process elements were ranked to create a numerical relationship between service and the needs expressed by the voice of the customer. Sites created surveys incorporating questions that focused on the bundle elements and measured daily bundle compliance. Graphical analysis and hypothesis testing enabled sites to determine key drivers of patient dissatisfaction within the bundle elements. Improvement strategies were developed and implemented to address the key drivers of patient dissatisfaction.
After implementing process improvements focused on issues identified by the PEB, bundle compliance improved from an average of 51% to an average of 82.5% and Press Ganey Likelihood to Recommend (PG LTR) scores improved from an average of 64.73% to an average 74.64%. The data demonstrated that the trends in improving PEB are followed by meaningful changes in PG LTR scores.
This work is built on the identification of common elements of care that impact patient satisfaction and detailed mathematical analysis of the relationship between factors. Using the bundle concept, these improvement efforts maintain highly reliable processes to drive outcomes and provide real-time feedback on patient experience.
目前患者满意度评估结果延迟，且是从部分患者调查中获得的。因此，这些评估可能无法代表全体患者的体验。本研究开发了一种方法，用于在患者接受护理期间衡量和评估所有患者的体验，并将其与医疗机构内部流程相联系。
各机构运用六西格玛方法组建多元化团队，对患者的负面体验评论进行分类和分析，以了解不满的驱动因素。这些客户期望促成了患者体验包（PEB）四个组成部分的形成：沟通、环境、基本需求/舒适度和后勤保障。对各个流程要素进行排序，以建立服务与客户声音所表达需求之间的数值关系。各机构设计了包含聚焦于体验包要素问题的调查问卷，并每日测量体验包合规情况。通过图形分析和假设检验，各机构能够确定体验包要素中导致患者不满的关键驱动因素。制定并实施了改进策略，以解决导致患者不满的关键驱动因素。
在针对PEB所确定问题实施流程改进后，体验包合规率从平均51%提高到了平均82.5%，Press Ganey推荐可能性（PG LTR）得分从平均64.73%提高到了平均74.64%。数据表明PEB改善趋势之后随之而来的是PG LTR得分的显著变化。
这项工作建立在对影响患者满意度的护理共同要素的识别以及对各因素之间关系的详细数学分析基础之上。利用体验包概念，这些改进措施维持了高度可靠的流程以推动成果，并提供有关患者体验的实时反馈。
