Kelsey Flott

A patient-centered framework for evaluating digital maturity of health services: a systematic review

Background Digital maturity is the extent to which digital technologies are used as enablers to deliver a high-quality health service. Extensive literature exists about how to assess the components of digital maturity, but it has not been used to design a comprehensive framework for evaluation. Consequently, the measurement systems that do exist are limited to evaluating digital programs within one service or care setting, meaning that digital maturity evaluation is not accounting for the needs of patients across their care pathways. Objective The objective of our study was to identify the best methods and metrics for evaluating digital maturity and to create a novel, evidence-based tool for evaluating digital maturity across patient care pathways. Methods We systematically reviewed the literature to find the best methods and metrics for evaluating digital maturity. We searched the PubMed database for all papers relevant to digital maturity evaluation. Papers were selected if they provided insight into how to appraise digital systems within the health service and if they indicated the factors that constitute or facilitate digital maturity. Papers were analyzed to identify methodology for evaluating digital maturity and indicators of digitally mature systems. We then used the resulting information about methodology to design an evaluation framework. Following that, the indicators of digital maturity were extracted and grouped into increasing levels of maturity and operationalized as metrics within the evaluation framework. Results We identified 28 papers as relevant to evaluating digital maturity, from which we derived 5 themes. The first theme concerned general evaluation methodology for constructing the framework (7 papers). The following 4 themes were the increasing levels of digital maturity: resources and ability (6 papers), usage (7 papers), interoperability (3 papers), and impact (5 papers). The framework includes metrics for each of these levels at each stage of the typical patient care pathway. Conclusions The framework uses a patient-centric model that departs from traditional service-specific measurements and allows for novel insights into how digital programs benefit patients across the health system. Trial Registration N/A

Improving the Usefulness and Use of Patient Survey Programs: National Health Service Interview Study

Background A growing body of evidence suggests a concerning lag between collection of patient experience data and its application in service improvement. This study aims to identify what health care staff perceive to be the barriers and facilitators to using patient-reported feedback and showcase successful examples of doing so. Objective This study aimed to apply a systems perspective to suggest policy improvements that could support efforts to use data on the frontlines. Methods Qualitative interviews were conducted in eight National Health Service provider locations in the United Kingdom, which were selected based on National Inpatient Survey scores. Eighteen patient-experience leads were interviewed about using patient-reported feedback with relevant staff. Interviews were transcribed and underwent thematic analysis. Staff-identified barriers and facilitators to using patient experience feedback were obtained. Results The most frequently cited barriers to using patient reported feedback pertained to interpreting results, understanding survey methodology, presentation of data in both national Care Quality Commission and contractor reports, inability to link data to other sources, and organizational structure. In terms of a wish list for improved practice, staff desired more intuitive survey methodologies, the ability to link patient experience data to other sources, and more examples of best practice in patient experience improvement. Three organizations also provided examples of how they successfully used feedback to improve care. Conclusions Staff feedback provides a roadmap for policy makers to reconsider how data is collected and whether or not the national regulations on surveys and patient experience data are meeting the quality improvement needs of local organizations.

Strategies and challenges for monitoring patient experience at the local level

Patient experience is widely regarded as a key element of healthcare quality. In England, this recognition is formalised in the National Health Service’s (NHS) defined view of quality (Darzi, 2008), and a broad range of national and local activities are undertaken to gather patients’ views. This includes patients’ anecdotal feedback from the growing popularity of outlets like Patient Opinion, as well as quantitative experience data from the National Patient Survey Programme which reaches hundreds of thousands of patients across acute, mental health, emergency sectors. This focus on patient feedback is testament to how much importance the NHS places on patients’ views. But whilst patient experience information is widely used, it has not always resulted in the improvements to patient care that were the initial motive for establishing the measures, and some commentators have argued that there is a critical gap in the connection between patient experience data and actual quality improvement locally (Coulter et al., 2014). Results from a study conducted by Picker Institute Europe and the University of Oxford provide new insight into the way patient experience collections are organised and used by health and social care providers (Fitzpatrick et al., 2015). Drawing on evidence from a range of case studies, the research shows that local activities around measuring patient experience are substantial, but that there is nevertheless considerable potential to improve the co-ordination of these activities and to help translate them into improved services.

Care pathway and organisational features driving patient experience: statistical analysis of large NHS datasets

Objective The aim of this study was to identify the care pathway and organisational factors that predict patient experience. Design Statistical analysis of large National Health Service (NHS) datasets. Setting andparticipants England; acute NHS organisational-level data. Primary and secondary outcome measures The relationship of care pathway and organisational variables to organisation-level patient experience. Results A framework of 18 care pathway and organisational variables were created based on the existing literature. 11 of these correlated to patient experience in univariate analyses. Multicollinearity tests resulted in 1 of the 11 variables holding a correlation to another variable larger than r=0.70. A significant multilinear regression equation, including the final 10 variables, was found (F(10,108)=6.214, p<0.00), with an R 2 of 0.365. Two variables were significant in predicting better in patient experience: Amount of support to clinical staff (beta=0.2, p=0.02) and the proportion of staff who would recommend the trust as a place to work or receive treatment (beta=0.26, p=0.01). Two variables were significant in predicting a negative impact on the patient’s rating of their experience: Number of patients spending over 4 hours from decision to admit to admission (beta=−1.99, p=0.03) and the percentage of estates and hotel services contracted out (beta=−0.23, p=0.01). Conclusions These results indicate that augmenting clinical support and investing in the mechanisms that facilitate positive staff experience is essential to delivering appropriate, informative and patient-centric care. Reducing wait times and the extent of external contracting within hospitals is also likely to improve patient ratings of experience. Understanding the relationship between patient experience and objective, measurable organisational features promote a more patient-centric interpretation of quality and compel a better use of patient experience feedback to drive improvement.

The Tokyo Declaration on patient safety

A new partnership between health workers and patients to promote safer care.

A patient-centric approach to improving experience in urological cancer care

Rationale: Patient experience data are often reported at the provider level rather than the patient level, meaning that providers receive an aggregate score of all patient experience scores across their service. This inflates positivity and makes it difficult for providers to use patient experience scores to tailor improvements for patients within specific sites, wards or pathways. Patients have different priorities for their urological cancer care experience, and improvement programmes should take these differences into account. A more granular understanding of different patterns of patient experience will allow health care providers to focus their improvement strategies differently based on the needs of the patient groups that utilise their services. Objective: This study examines what groups exist within the urological cancer patient population, and what are their respective priorities for patient experience improvement. Methods: Using urological cancers as a case study, this paper uses data from the UK National Cancer Patient Experience Survey to segment the patient population based on their scores for 14 domains of experience. TwoStep cluster analyses were carried out on two groups of survey respondents: those who had an operation and those who did not. These analyses identified previously unknown clusters within the two populations. Profiles were created for each cluster based on a series of demographic variables, and a regression analysis was conducted to assess the significance of each demographic variable in determining cluster membership. Results: The TwoStep analysis yielded three clusters for both the operations and non-operations groups based on how patients experienced care: Positive, Middling and Negative. Gender, age, cancer type and income significantly influenced cluster membership: women, younger and more deprived patients were more prevalent in the Negative experience cluster. Conclusion: This more nuanced understanding of the patient population and the variation in their priorities for patient experience improvement is the first step to more patient-centric improvement. It will allow services to make more meaningful and individualised changes based on the voices of patients. This is a proof of concept that can be applied broadly in health care to more effectively deliver on the patient-centred agenda.