理解令人难忘的负面医护服务体验：为何患者体验对医护人员很重要。

Understanding memorably negative provider care delivery experiences: Why patient experiences matter for providers.

机构信息

Stanford University School of Medicine, USA.

出版信息

Healthc (Amst). 2021 Sep;9(3):100544. doi: 10.1016/j.hjdsi.2021.100544. Epub 2021 Apr 22.

DOI:10.1016/j.hjdsi.2021.100544

PMID:33894667

Abstract

BACKGROUND

Negative experiences contribute to provider dissatisfaction and burnout. Prior research suggests that negative experiences have greater impact on individuals than positive experiences.

METHODS

Interviews were conducted with surgical and oncology care providers (107 MDs, 253 non-MDs) working in 10 geographically diverse, academic and community hospitals across the U.S. Using a thematic network approach, we identified core themes describing drivers of memorably negative experiences. We applied logistic regression with adjustments for multiple comparisons to evaluate the relationship between demographic characteristics and types of experiences.

RESULTS

We identified 13 themes from 360 experiences and from these, developed a framework describing how work culture, environment, individual factors, and patient experiences lead to memorably, negative provider experiences. Providers most frequently described negative work environment experiences (158/360) and poor communication experiences with patients and other care professionals (151/360). Across themes, one third of respondents attributed memorably negative experiences to patient experiences (119/360). Midwest providers described patient centeredness more than other providers (OR = 3.9, p < 0.001). Providers from the Northeast, MDs compared to non-MDs, and providers with 15+ years of work experience identified negative insurance-related experiences more frequently (OR = 0.2, P = 0.007; OR = 2.9, P = 0.002 OR = 4.2, P < 0.001).

CONCLUSIONS

We offer a framework for understanding negative experiences among providers. Our study suggests that across a broad set of causes, improving patient experiences could substantially improve the negative, memorable experiences of providers.

IMPLICATIONS

Addressing negative patient experiences may have the double benefit of improving patient care and reducing provider burnout.

LEVEL OF EVIDENCE

Level III.

摘要

背景

负面经历会导致提供者不满和倦怠。先前的研究表明，负面经历对个人的影响大于正面经历。

方法

对在美国 10 个地理位置不同的学术和社区医院工作的 107 名医生和 253 名非医生的外科和肿瘤护理提供者进行了访谈。使用主题网络方法，我们确定了描述导致令人难忘的负面经历的驱动因素的核心主题。我们应用逻辑回归并进行多次比较调整，以评估人口统计学特征与经历类型之间的关系。

结果

我们从 360 次经历中确定了 13 个主题，并从这些主题中开发了一个框架，描述了工作文化、环境、个人因素和患者经历如何导致令人难忘的负面提供者经历。提供者最常描述负面工作环境经历（158/360）和与患者及其他护理专业人员沟通不良的经历（151/360）。在所有主题中，三分之一的受访者将令人难忘的负面经历归因于患者经历（119/360）。中西部的提供者比其他地区的提供者更能描述以患者为中心（OR=3.9，p<0.001）。来自东北部的提供者、医生与非医生相比、以及工作经验超过 15 年的提供者更频繁地识别出与保险相关的负面经历（OR=0.2，P=0.007；OR=2.9，P=0.002；OR=4.2，P<0.001）。