Article

Factors affecting the use of patient survey data for quality improvement in the Veterans Health Administration

Thames Cancer Registry, King's College London, 42 Weston Street, London SE1 3QD, UK.
BMC Health Services Research (Impact Factor: 1.66). 12/2011; 11(1):334. DOI: 10.1186/1472-6963-11-334
Source: PubMed

ABSTRACT Little is known about how to use patient feedback to improve experiences of health care. The Veterans Health Administration (VA) conducts regular patient surveys that have indicated improved care experiences over the past decade. The goal of this study was to assess factors that were barriers to, or promoters of, efforts to improve care experiences in VA facilities.
We conducted case studies at two VA facilities, one with stable high scores on inpatient reports of emotional support between 2002 and 2006, and one with stable low scores over the same period. A semi-structured interview was used to gather information from staff who worked with patient survey data at the study facilities. Data were analyzed using a previously developed qualitative framework describing organizational, professional and data-related barriers and promoters to data use.
Respondents reported more promoters than barriers to using survey data, and particularly support for improvement efforts. Themes included developing patient-centered cultures, quality improvement structures such as regular data review, and training staff in patient-centered behaviors. The influence of incentives, the role of nursing leadership, and triangulating survey data with other data on patients' views also emerged as important. It was easier to collect data on current organization and practice than those in the past and this made it difficult to deduce which factors might influence differing facility performance.
Interviews with VA staff provided promising examples of how systematic processes for using survey data can be implemented as part of wider quality improvement efforts. However, prospective studies are needed to identify the most effective strategies for using patient feedback to improve specific aspects of patient-centered care.

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    • "Qualitative research suggests that NHS staff recognise the national surveys’ methodological robustness [9,10] but that there are a number of barriers to the surveys’ impact. Conducting trust-level surveys means that members of staff do not recognise the results as their own, often claiming “that doesn’t happen on my ward” [9,11-13]. Currently, the survey results are communicated to senior hospital managers; they are not communicated directly to those who are towards the bottom of hospitals’ hierarchies, even though they are the staff members who are disproportionately responsible for making day-to-day decisions about the way care is delivered [14]. The extent to which managers in many NHS trusts successfully “cascade” results to clinical staff is acknowledged to be inadequate [9]. "
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    ABSTRACT: England's extensive NHS patient survey programme has not fulfilled government promises of widespread improvements in patients' experiences, and media reports of poor nursing care in NHS hospitals are increasingly common. Impediments to the surveys' impact on the quality of nursing care may include: the fact that they are not ward-specific, so nurses claim "that doesn't happen on my ward"; nurses' scepticism about the relevance of patient feedback to their practice; and lack of prompt communication of results. The surveys' impact could be increased by: conducting ward-specific surveys; returning results to ward staff more quickly; including patients' written comments in reports; and offering nurses an opportunity to discuss the feedback. Very few randomised trials have been conducted to test the effectiveness of patient feedback on quality improvement and there have been few, if any, published trials of ward-specific patient surveys. Over two years, postal surveys of recent inpatients were conducted at four-monthly intervals in 18 wards in two NHS Trusts in England. Wards were randomly allocated to Basic Feedback (ward-specific printed patient survey results including patients' written comments sent to nurses by letter); Feedback Plus (in addition to printed results, ward meetings to discuss results and plan improvements) or Control (no active feedback of survey results). Patient survey responses to questions about nursing care were used to compute wards' average Nursing Care Scores at each interval. Nurses' reactions to the patient feedback were recorded. Conducting ward-level surveys and delivering ward-specific results was feasible. Ward meetings were effective for engaging nurses and challenging scepticism and patients' written comments stimulated interest. 4,236 (47%) patients returned questionnaires. Nursing Care Scores improved more for Feedback Plus than Basic Feedback or Control (difference between Control and Feedback Plus = 8.28 +/- 7.2 (p = 0.02)). This study provides preliminary evidence that facilitated patient feedback can improve patients' experiences such that a full trial is justified. These findings suggest that merely informing nurses of patient survey results in writing does not stimulate improvements, even if results are disaggregated by ward, but the addition of ward meetings had an important and significant impact.
    BMC Health Services Research 07/2013; 13(1):259. DOI:10.1186/1472-6963-13-259 · 1.66 Impact Factor
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    • "The fact that some are now covered by the English national survey, [22-24] suggests that the survey medium is not inevitably constricting but can be developed for quality improvement purposes. Examples of more structured programmes for the feedback of survey data and the development of improvement priorities have been developed in some US organizations [25]. "
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    ABSTRACT: Patients' experiences have become central to assessing the performance of healthcare systems worldwide and are increasingly being used to inform quality improvement processes. This paper explores the relative value of surveys and detailed patient narratives in identifying priorities for improving breast cancer services as part of a quality improvement process. One dataset was collected using a narrative interview approach, (n = 13) and the other using a postal survey (n = 82). Datasets were analyzed separately and then compared to determine whether similar priorities for improving patient experiences were identified. There were both similarities and differences in the improvement priorities arising from each approach. Day surgery was specifically identified as a priority in the narrative dataset but included in the survey recommendations only as part of a broader priority around improving inpatient experience. Both datasets identified appointment systems, patients spending enough time with staff, information about treatment and side effects and more information at the end of treatment as priorities. The specific priorities identified by the narrative interviews commonly related to 'relational' aspects of patient experience. Those identified by the survey typically related to more 'functional' aspects and were not always sufficiently detailed to identify specific improvement actions. Our analysis suggests that whilst local survey data may act as a screening tool to identify potential problems within the breast cancer service, they do not always provide sufficient detail of what to do to improve that service. These findings may have wider applicability in other services. We recommend using an initial preliminary survey, with better use of survey open comments, followed by an in-depth qualitative analysis to help deliver improvements to relational and functional aspects of patient experience.
    BMC Health Services Research 08/2012; 12:271. DOI:10.1186/1472-6963-12-271 · 1.66 Impact Factor
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    ABSTRACT: BACKGROUND Advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs) are cost-effective substitutes for physicians, with similar outcomes in primary care and surgery. However, little is understood about APP roles in inpatient medicine.OBJECTIVE Describe APPs role in inpatient medicine.DESIGNObservational cross-sectional cohort study.SETTINGOne hundred twenty-four Veterans Health Administration (VHA) hospitals.PARTICIPANTSChiefs of medicine (COMs) and nurse managers.MEASUREMENTSSurveys included inpatient medicine scope of practice for APPs and perceived healthcare quality. We conducted bivariate unadjusted and multivariable adjusted analyses.RESULTSOne hundred eighteen COMs (95.2%) and 198 nurse managers (75.0%) completed surveys. Of 118 medicine services, 56 (47.5%) employed APPs; 27 (48.2%) used NPs only, 15 (26.8%) PAs only, and 14 (25.0%) used both. Full-time equivalents for NPs was 0.5 to 7 (mean = 2.22) and PAs was 1 to 9 (mean = 2.23). Daily caseload was similar at 4 to 10 patients (mean = 6.5 patients). There were few significant differences between tasks. The presence of APPs was not associated with patient or nurse manager satisfaction. Presence of NPs was associated with greater overall inpatient and discharge coordination ratings by COMs and nurse managers, respectively; the presence of PAs was associated with lower overall inpatient coordination ratings by nurse managers.CONCLUSIONSNPs and PAs work on half of VHA inpatient medicine services with broad, yet similar, scopes of practice. There were few differences between their roles and perceptions of care. Given their very different background, regulation, and reimbursement, this has implications for inpatient medicine services that plan to hire NPs or PAs. Journal of Hospital Medicine 2014. © 2014 Society of Hospital Medicine
    Journal of Hospital Medicine 10/2014; 9(10). DOI:10.1002/jhm.2231 · 2.08 Impact Factor
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