CHAPTER 2:LITERATURE REVIEW
2.5 Patient Experience
2.5.3 The Role of Patient Experience
2.5.3.1 Patient Experience Measures for Quality Improvement
In a study by Manary, Staelin, Kosel, Schulman, and Glickman (2015:12) and a Beryl Institute (2014:11) report, most managers supported the role of patient experience in addressing QI. This is a considerable turnaround as the general perspective offered by managers did not link patient experience in this regard. The Beryl Institute "found that improving the patient experience was the top priority by over 70% of the managers" (Beryl Institute,2014:14). However, there still remains uncertainty on the methods that are most appropriate to apply the data towards QI.
Measurement of patient experience is important and relevant in the current healthcare environment to achieve the following:
• "identify gaps in service;
• to gain insights into issues that are causing negative effects on patient care; and
• To innovate and/or redesign processes in order to better deliver care with patients".
(Lehrman, Silvera and Wolf,2014:9; Luxford et al.,2012:18).
Patients have exclusive knowledge about important aspects of care, and measuring patient experiences can be used for quality improvement (Wolf,2015:15; Bjertnaes, Sjetne and Iversen, 2012:39).
According to Ahmed, Burt and Roland (2014:15) the change towards using patient experience in developing policies to support QI is gaining momentum throughout the world. The benefits of incorporating patient experience into policies are as follows:
• "understanding current problems in care delivery;
• informing continuous improvement and redesign of services;
• helping professionals reflect on their own and their team’s practice;
• monitoring the impact of any changes;
49
• facilitating benchmarking between services/organisations;
• comparing organisations for performance assessment purposes;
• informing referring clinicians about the quality of services;
• informing commissioners and patients about the quality of services;
• informing patients about care pathways;
• helping patients choose high quality providers; and
• Enabling public accountability" Ahmed et al. (2014:15).
England, USA Australia, Canada, New Zealand and other European countries have moved towards the use of patient experience (Robert and Cornwall,2013:67; Lombarts, Rupp, Vallejo, Sun˜ol and Klazinga,2009:28). The results of patient experience surveys have far-reaching consequences, as these are often used as a management tool and as a basis for political decision- making. Measures of patient experience are important information and should be a priority for health care managers. However, there are significant challenges with regard to analyzing and interpreting data, thus practitioners must be cautious when using the information in quality assessment and in decision-making processes (Sandager, Freil, Knudsen and Lehmann,2016:17).
"The use of patient experience information can be an important strategy to use in driving system transformation" (Browne et al.,2010:921) which supports patient experience in QI.
2.5.3.2 Patient Experience and Clinical Outcomes
Luxford and Sutton (2014:16) explain "that organizations cannot address clinical outcomes or the quality and safety efforts that shape them in isolation". The key to improving clinical outcomes as part of the overall patient experience strategy is to identify the key dimensions or domains of patient experience that are most relevant to the patient experience phenomenon.
Achieving excellent clinical outcomes cannot be prioritized in lieu of the quality and safety of health service delivery. Therefore the patient experience objectives should be developed so that all service delivery in the health sector is provided such that there is negligible compromise of safety or quality. Once the domains of patient experience have been identified, health leadership can develop appropriate health policies and regulations that incorporate these domains into the provision of service delivery in order to effect the required change.
50
Browne et al. (2010:922) explain "that health care providers cannot achieve positive health outcomes without commitment and action from patients". Research by Luxford and Sutton (2014:19) demonstrated a positive association between patient experience data and the clinical outcomes of patients; while another positive association with reduced hospital admission stays, improved patient safety and compliance to treatment protocols are noted (Doyle, Lennox, and Bell,2013:4).
2.5.3.3 Patient Experience and Financial Outcomes
Patient experience is also recognised for its role in financial outcomes. The benefits that result from this association can be found in the reduction of health care costs, increased efficiency and effectiveness at the health facility (Stanowski, Simpson and White,2015:268; Zhao,Haley, Spaulding, and Balogh,2012:309). This is also supported by Boulding Glickman Schulman, Staelin and Manary (2011:12) and Trzeciak, Gaughan, Bosire and Mazzarelli (2016:6), who show that patient experience was positively associated with the performance of the health organisation, patient retention, reduced provider malpractice risk, and increased health staff satisfaction. In an earlier study conducted by Nelson, Zahorik, Rose, Batalden and Siemanksi (1992:12) "patients’ perceptions of quality explained nearly 30 percent of the variation in hospital financial performance". In a country such as SA there is an emphasis to reduce financial wastage and improve the financial viability. The high burden of disease has placed a significant constraint on the availability of resources and has the potential to undermine the financial sustainability of the system in SA.
2.5.3.4 Patient Experience and Consumer Loyalty
According to Wolf (2015:3) the inability to elicit a positive patient experience has implications for patient loyalty. In fact, Arab et al. determined that:
“The patient's experience has a strong impact on the outcome variables like willingness to return to the same hospital and reuse its services or recommend them to others.”
In a country such as SA where the prevalence of communicable diseases is high, a positive patient experience is needed for patients to develop an unwavering commitment to the health facility, services and staff.
51
2.5.3.5 Patient Experience and Community Reputation
Healthcare organizations are a prominent presence in communities and the experiences that result thereof are more likely to be communicated within the community (Stanowski et al., 2015:269). The reputation of an organisation will influence the patient's decision to seek healthcare from that specific organisation. Simply put, if the facility has a good reputation then there is a greater probability that individuals will choose to frequent that particular facility. There is limited research that addresses the link between patient experience and community reputation which provides a new area for further research.
2.5.3.6 Patient Experience and Safety Outcomes
Stein, Day, Karia, Hutzler and Bosco (2015:21) noted an association between patient safety outcomes and patient experience measures. Kvist, Voutilainen, Mantynen and Vehviläinen- Julkunen (2014:11) also associated patient experience scores with job satisfaction among nurses.
The link between job satisfaction and patient safety is evidenced by improved effectiveness of the health worker when the motivation levels are high. Safety outcomes are important especially when one considers the rising costs of malpractice lawsuit cases that can be levelled against the public health sector. With an already alarming incidence of patients who are dissatisfied with the quality and safety of healthcare delivery the need to improve safety outcomes has increased.
2.5.3.7 Patient Experience and Employee Outcomes
According to Browne et al. (2010:923) a positive patient experience contributes to employee satisfaction (Figure 2.4) thereby reducing turnover. When the health professional provides reputable service it provides a sense of fulfilment that they are doing a good piece of work. The employee is better motivated and is able to function well within the work environment thus also reducing employee turnover. This type of scenario will lead to improved levels of satisfaction and motivate them to be better employees. This highlights the need for health facility managers to ensure the operational functioning. The benefits for improving patient experience with regard to the impact on employee satisfaction and turnover is clear whilst the case for good business is evidenced in previous studies according to Brown et al (2010:923). Whilst the literature supporting the link between patient experience and employee satisfaction is limited in this regard, the evidence for improving the employee level of satisfaction through patient experience should not be minimized. It is well known that health professionals have been experiencing low
52
levels of job satisfaction which has in turn influenced the quality and effectiveness of service delivery (Dieleman and Hammejer, 2010:6). Therefore as reflected in Figure 2.4 there is a need for employees to experience need satisfaction so that they can be perform better within the work environment and in so doing there should be justifiable rewards that reinforce the need satisfaction.
Figure 2. 4: Basic Motivational Model
Source: Cronje, du Toit, Marais and Motlatla, 2012:223
The area of job satisfaction presents a potential area for further research.