Background
Methods
Materials
Guarantee of anonymity
Study design
Dictionary of themes and sub-themes
Syntax analysis: measurement of speech engagement
Generation of statistics, creation of the patient journey, and prioritisation of sub-themes
Results
Characteristics of the surveys analysed
Characteristics | N = 5 868 |
---|---|
Respondent | |
Patient | 5058 (86.2%) |
Parent or relative | 536 (9.1%) |
Both | 274 (4.7%) |
Sex | |
Woman | 3694 (63%) |
Man | 2174 (37%) |
Age (yrs) | |
+ 90 | 53 (0.9%) |
80 to 89 | 269 (4.6%) |
70 to 79 | 865 (14.7%) |
60 to 69 | 1047 (17.8%) |
50 to 59 | 789 (13.4%) |
40 to 49 | 654 (11.1%) |
30 to 39 | 1391 (23.7%) |
20 to 29 | 419 (7.1%) |
10 to 19 | 182 (3.1%) |
- 10 | 199 (3.4%) |
Type of room | |
Single | 3557 (60.6%) |
Shared | 2311 (39.4%) |
Referral | |
Emergency | 811 (13.8%) |
Physician | 2664 (45.4%) |
Relative | 762 (13%) |
Other institution | 507 (8.6%) |
Other | 1124 (19.2%) |
Departments | |
Surgery | 2387 (40.7%) |
Medical | 1916 (32.7%) |
Intensive care | 31 (0.5%) |
Obstetrics/Maternity | 1398 (23.8%) |
Paediatrics | 136 (2.3%) |
Dictionary of themes
Creation and analysis of the patient journey
Prioritisation of sub-themes
Prioritisation | Description of the sub-theme | Content of the comments | Percentage of respondents and their characteristics | Actions / practices / expectations identified in the comments |
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Strengths | Quality of reception | Patients described a "warm", "smiling" and "caring" welcome | n = 10.3% All profiles | Importance of smile |
Perception of staff as being professional and competent | Perception of professionalism based on listening, follow-up, and reactivity. Better perception if there is an interaction with the surgeons and/or professors beyond care | n = 22.6% All profiles | Importance of the visit of the surgeon and/or professor | |
Listening and availability | Patients described that it was not a question of the amount of time spent with the staff but rather their ability to be “active listeners” and to identify the times when they needed to be listened to (night, day without visitors, etc.) | n = 35.5% All profiles | Work on key moments when the patient most needs attention (nights, days without visitors, etc.) | |
Kindness | This quality is expressed by the staff being in good mood (smiles, sense of humour, kind words) | n = 26.6% All profiles | Importance of smile and sense of humour | |
Priorities | Consideration of the patients | Behaviour failures: discussions in front of the patient; “rushed” visits; too many professionals during visits; no respect for privacy and intimacy | n = 8.6% Patients hospitalised in surgery departments (n = 76.5%) | Be careful regarding discussions between professionals (even in the corridors). Avoid too many professionals during visits and/or inform the patient in advance of the number of people present |
Patient support | Patients felt the wait for help was too long, that they must ask for help (lack of proactivity). Patients felt obliged to justify their request to get support | n = 7.1% Paediatric, maternity, and geriatric departments | Try not to question the request for help. Propose key moments of support: information meeting, pre-discharge briefing, etc | |
Ability to reassure the patient | Patients described feelings of anxiety that arose during hospitalisation. These feelings were caused by a lack of information and waiting times. Comments described very specific moments where the patients and/or their relatives need to be reassured (waiting times with young children, diagnostic announcements, etc.) | n = 8.3% All profiles | Work on the key moments that trigger anxiety (diagnostic announcement, management of the relatives in paediatric departments) | |
Good practice | Patience of the staff | Staff managed to not show their constraints and remained available in all situations (elderly patients, foreigners, etc.) and context (work overload, emergency, etc.) | n = 0.9% All profiles | Try not to rush the patient even if the situation is tense |
Weak signal | Lack of frankness, dishonesty on the part of the staff | Situations where respondents felt that they are “not told everything” about their health condition or the surgery they have undergone | n = 0.2% Patients hospitalised in surgery departments (n = 85.7%) | Ask more frequently if all the questions have been raised, if there are still doubts, questions |
Prioritisation | Description of the sub-theme | Content of the comments | Percentage of respondents and their characteristics | Actions / practices / expectations identified in the comments |
---|---|---|---|---|
Priorities | Satisfaction about the bedroom | Patients expressed dissatisfaction about shared bedrooms, they mentioned the size of the room, the quality of the furniture, the lack of adaptation to certain patients (disabled, obese, geriatric, etc.), the fact that they had to share a room with strangers. The patient experience was significantly better when patients were in a single room | n = 13% All profiles Higher dissatisfaction among patients hospitalised more than 4 days (successive moves, lack of knowledge of different neighbours, etc.) and among patients in paediatric/maternity departments (issues with the relatives) | Try not to move a patient several times during his hospitalisation Focus on solutions in paediatric/maternity departments given the presence of family members/relatives |
Shared room when patients had asked for a single one | Patients were surprised to find themselves in a shared room when a request for a single room had been made. Patients did not always understand why they “ended up” in a shared room | n = 7.7% All profiles | Better inform in advance the situation regarding the availability of rooms | |
Good practice | Atmosphere | This sub-theme was very dependent on the staff’s behaviours towards the patients (smile, politeness, etc.) and on the perception of the behaviours between professionals (greeting, respect for each other, no depreciation, etc.) | n = 1.2% Patients hospitalised in surgery departments (n = 84.6%) | Pay particular attention towards having a respectful attitude between professionals |
Weak signals | Orientation | Difficulty in finding their way around the hospital | n = 0.7% Mentioned by patients hospitalised in one of the institutions of the HCL | Improvements needed: signs from public transport; indications to find the admission building; bigger signs (to increase visibility) and better placed. Patients asked to include them in the process of rethinking the signposting |
Smells | Patients pointed out that the water and the products used to clean the floor smell particularly “bad” | n = 1% Mentioned by patients hospitalised in one of the institutions of the HCL | Change the cleaning products | |
Personal hygiene products | Lack of hygiene products (soap, shampoo, toothpaste) | n = 0.3% All profiles | Better inform/remind patients before hospitalisation of products needed. Offer emergency products | |
Telephone | The telephone service was criticised by patients and their relatives for being too expensive and not working properly | n = 0.6% Elderly patients and their relatives | When elderly patients: increase vigilance on the phone service quality |
Prioritisation | Description of the sub-theme | Content of the comments | Percentage of respondents and their characteristics | Actions / practices / expectations identified in the comments |
---|---|---|---|---|
Priorities | Perception of the quality of the surgery | Patients mentioned difficulties in assessing the quality of the procedure they had undergone. To assess it, they mentioned other elements (absence of pain, complications; relational behaviours among the staff; reputation of the institution and of the surgeons). The perception of quality no longer depended solely on the level of competence but relied above all on the information given. When there was a lack of information/communication felt by the patient, they thought there was a problem during the surgery | n = 8.2% Surgery and obstetric departments | Particular attention needed concerning communication before (to reassure, defuse anxieties, etc.), during (explanations from the anaesthetist, etc.), and after the surgery (details of the surgery, follow-up, etc.) |
Pain management | Two very significant negative subjects: a lack of responsiveness to pain and a pain that was not “taken seriously”, for which the patient had to “prove” his or her pain | n = 7.5% All profiles | Try not to question the pain expressed by the patient | |
Good practice | Care during surgery preparation | Surgery preparation: information/ explanations, relational behaviours, heated operating table, etc | n = 1.6% Surgery department | Each member of the staff should introduce him/herself (first name) |
Prioritisation | Description of the sub-theme | Content of the comments | Percentage of respondents and their characteristics | Actions / practices / expectations identified in the comments |
---|---|---|---|---|
Priority | Communication and access to information | Patients regretted a lack of information, information that was not “spontaneous” and for which the patient must “dig deeper” (make several requests), information that was not very precise or too precise, staff who did not adapt to the patient, badly chosen “information moments” | n = 6.8% All profiles. Higher dissatisfaction among women in maternity departments | Proactivity in giving information Try to adapt the information to the patient Ask the patient if the moment is convenient |
Weak signals | Coordination and communication between teams | Lack of communication between teams: the patient must inform the various people involved and repeat information. They also mentioned errors and missing information in their files | n = 1.5% All profiles | Ensure greater use of the patient record (or use a summary sheet with the most relevant information) Ensure identity surveillance |
Contradictory opinions | Patients described opinions that differed according to the professionals encountered. Two subjects stood out: organisation regarding hospital discharge and the specific subject of breastfeeding | n = 0.8% All profiles. Higher dissatisfaction among women in maternity departments | Be careful to harmonise information, especially during staff turnover | |
Birth registration service | Non-efficient process for declaring stillbirths | n = 0.2% Women in maternity departments | Try to facilitate/support the process for declaring children born without life |
Usefulness of the non-prioritised sub-themes from the patient journey
Discussion
Conclusions
Key points for decision makers
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Although measurement of patient experience using surveys has greatly been developed in the recent years, the effective use of the data obtained to improve practice and quality of care remains debated.
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In an institutional strategy to improve patient experience, a thematic and syntactic analysis of comments from patient experience national surveys allows to identify a great variety of specific themes and sub-themes. This enables to identify and categorise different levels of actions according to different timeframes (quick operational actions and long-term improvements) that involve different members of staff (e.g., nurses, physicians, administrative teams).
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Translating qualitative data obtained from patient comments into quantitative indicators allows to create a patient journey of which each step can be analysed and prioritised to implement field-oriented actions to improve quality of care and help staff improve their practice.