Professor of Health Services Research, Health Services Research Unit, University of Aberdeen, UK.
Senior Researcher, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
J Health Serv Res Policy. 2020 Jul;25(3):151-161. doi: 10.1177/1355819619888675. Epub 2020 Feb 14.
Improving patient experience is widely regarded as a key component of health care quality. However, while a considerable amount of data are collected about patient experience, there are concerns this information is not always used to improve care. This study explored whether and how frontline staff use patient experience data for service improvement.
We conducted a year-long ethnographic case study evaluation, including 299 hours of observations and 95 interviews, of how frontline staff in six medical wards at different hospital sites in the United Kingdom used patient experience data for improvement.
In every site, staff undertook quality improvement projects using a range of data sources. Teams of health care practitioners and ancillary staff engaged collectively in a process of sense-making using formal and informal sources of patient experience data. While survey data were popular, 'soft' intelligence - such as patients' stories, informal comments and observations - also informed staff's improvement plans, without always being recognized as data. Teams with staff from different professional backgrounds and grades tended to make more progress than less diverse teams, being able to draw on a wider net of practical, organizational and social resources, support and skills, which we describe as team-based capital.
Organizational recognition, or rejection, of specific forms of patient experience intelligence as 'data' affects whether staff feel the data are actionable. Teams combining a diverse range of staff generated higher levels of 'team-based capital' for quality improvement than those adopting a single disciplinary approach. This may be a key mechanism for achieving person-centred improvement in health care.
提高患者体验被广泛认为是医疗质量的关键组成部分。然而，尽管已经收集了相当数量的患者体验数据，但人们担心这些信息并不总是被用于改善护理。本研究探讨了一线工作人员是否以及如何将患者体验数据用于服务改进。
我们对英国六个不同医院地点的六个医疗病房的一线工作人员如何使用患者体验数据进行改进进行了为期一年的人种学案例研究评估，包括 299 小时的观察和 95 次访谈。
在每个地点，工作人员都使用各种数据源开展质量改进项目。医疗保健从业者和辅助人员团队集体参与了一个使用正式和非正式的患者体验数据来源进行意义建构的过程。虽然调查数据很受欢迎，但“软性”情报——例如患者的故事、非正式的评论和观察——也为工作人员的改进计划提供了信息，而这些情报并不总是被视为数据。具有不同专业背景和职级的工作人员的团队往往比人员构成较单一的团队取得更大的进展，因为他们能够利用更广泛的实用、组织和社会资源、支持和技能网络，我们将其描述为基于团队的资本。
组织对特定形式的患者体验情报作为“数据”的认可或拒绝，会影响工作人员对数据是否可操作的看法。与采用单一学科方法的团队相比，结合了多种员工的团队产生了更高水平的“基于团队的资本”，以实现医疗保健的以患者为中心的改进。这可能是实现以人为本的医疗保健改进的关键机制。
