CHAPTER 2:LITERATURE REVIEW
2.5 Patient Experience
2.5.1 Global Perspective of Patient Experience Themes
According to the Beryl Institute patient experience is defined as follows:
“The sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care”(Beryl Institute,2015:14).
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Patient experience is also explained as "the influence of various health events on patients and the extent to which patients needs are met"(Health Foundation Inspiring Movement, 2013:5). The entire path that the patient follows from the entrance of the clinic all the way through to the exit and everything in between should be included in the experience of care (Institute of Medicine (IOM),2001:32). For the purpose of the study, the definition of patient experience as offered by the Beryl Institute is applicable to the study. According to the National Institute for Health and Clinical Excellence (2010:12) the experience of care does not exist in isolation, but, is in fact influenced by a number of factors or domains based on the services rendered, healthcare professionals and the patient as an individual. These factors have also been included in the conceptual framework for the study.
Measuring patient experience benefits the process of service delivery improvement, supports better clinical outcomes and reduces costs (De Silva,2013:18). Furthermore, patient experience is associated with improved adherence to medication especially in the case of chronic conditions.
Another benefit of patient experience is reported as the reduction in employee turnover.
Developing a comprehensive strategy for measuring patient experience entails what factors/domains should be measured and how (De Silva,2013:25). Therefore the study adds new knowledge by highlighting the domains of patient experience that are relevant to patients within the context of healthcare in SA.
Research conducted by the WHO (2010:14) outlined the following areas for addressing experience of care:
• "providing a suitable environment for people and health professionals";
• "care co-ordination";
• "care teams that have a multi-disciplinary approach";
• "patient education, family involvement, self-management and counselling";
• "standards and incentives for high quality, safe services";
• "developing new models of care"; and
• "developing the right leaders to support a positive patient experience".
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There is a gap that exists within the public health sector in SA with reference to developing new models of care as supported by WHO (2010:16). This gap presents opportunities for research into developing models of care that support a positive patient experience. This study, in particular seeks to develop a conceptual model to improve patient experience as a strategy to engage Public Health Service reform in SA.
The Picker Institute in Europe (Boyd,2007:210) reported the following top elements as priority to the experience of care:
1." The doctors know enough about my medical history and treatment";
Patients want doctors that are informed and knowledgeable about the diagnosis and management thereof. This requires that doctors take the initiative to further develop and equip themselves with new knowledge.
2. "The doctors can answer questions about my condition and treatment in a way that I can understand";
The art of communication is once again emphasised as patients need doctors that are not only knowledgeable but can also communicate this knowledge so that the sharing of knowledge can take place.
3. "I have confidence and trust in the hospital staff that treats me";
Patients require health staff that are appropriately skilled and are able to treat them with patient safety as a priority.
4. "The doctors wash or clean their hands in between touching patients;
Hygiene is very important to patients. Therefore hygiene and infection prevention protocols have to be adhered to.
5. "The nurses know enough about my medical history and treatment";
It is clear that patients expect not only the doctors to be knowledgeable but also place a demand on the nursing staff to hold similar knowledge.
6. "Before my operation or procedure, I get a clear explanation of what will happen";
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Patients can be anxious about procedures and require emotional support. When health staff provide an explanation for the patient it helps the patient to prepare for what is going to happen and they are less likely to become fearful during the procedure.
7. "The risks and benefits of my operation or procedure are explained to me in a way that I can understand";
It is insufficient for a patient to be informed that a procedure is needed without the information regarding the procedure. This is needed to help gain a patient's commitment towards the procedure.
8. "The nurses wash or clean their hands between touching patients";
The emphasis on hygiene protocol indicates that patients need to be reassured that the health worker is not going to transmit any infections in the process of the consultation.
9. "The rooms and ward are clean";
Cleanliness in a facility that provides medical care should at its very core support cleanliness as a primary objective.
10. "The doctors and nurses are open with me about my treatment or condition".
With the advancements in technology patients have been clearly given the means of accessing information about medical conditions. It is pointless to assume that patients are incapable of processing information that relates to their treatment or condition. On, the contrary, health staff should actually make an effort to provide patients with information in order to support the patient's education and understanding thereof.
An earlier international study by Grol (1999:503) reported that the five priorities for a good patient experience in a United Kingdom general practice are as follows:
1. "A doctor should be able to provide a quick service in case of emergencies;
2. during the consultation a doctor should have enough time to listen, talk and explain to me;
3. A doctor should guarantee the confidentiality of information about all his/her patients;
4. A doctor should make me feel free to tell him or her my problems; and
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5. A doctor should tell me all I want to know about my illness".
The patient experience themes that have been identified in Table 2.3 are included in the development of the Conceptual Framework for the research instrument.
Table 2. 2 : Themes for Patient Experience
Theme Explanation
Knowing the patient as an individual Every patient is unique and needs to be consulted accordingly
Essential requirements of care "Health is not merely the absence of disease" according to the WHO (2016).
Therefore the importance of viewing the whole patient in respect of the emotional, mental and social aspects.
Tailoring healthcare services for each
patient Treatment plans and protocols need to be
organised according to the patient's needs.
Continuity of care and relationships The patient needs to be referred to other relevant professionals to support a multi- disciplinary approach.
Enabling patients to actively participate
in their care The patient needs to have a voice in the decision making process of treatment management.
Source: National Institute for Health and Clinical Excellence (2010:14)
The themes support patient experience and are relevant to the study. A recent survey (Figure 2.3) conducted by the DoH based the dimensions of patient experience as follows:
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Figure 2. 3: Dimensions of Patient Satisfaction according to the DoH Source: NDoH (2015:36)
However, the DoH has not provided a comprehensive overview of how patient experience should be evaluated. Therefore the study is relevant as it addresses the shortcomings of how patient experience has been evaluated in the past. The need for other domains is evident based on the literary support provided in the preceding sections.