Background
Methods
Study design
Target population
Data collection
Data analysis
Ethical consideration
Results
Focus group discussions
Group | Code | Age range | Gender | Self-reported chronic illness* | Reason for admission | Hospital of admission | Specialty of admission* | Type of admission#
| Length of stay (days) range |
---|---|---|---|---|---|---|---|---|---|
1 | F01 | 60 or above | Female | Cancer; Diseases of thyroid gland | Surgery | QEH | GYN | Planned | 1-10 |
F02 | 40-59 | Male | Cancer | Lung infection | PYN | MED | Planned | 30 or above | |
F03 | 40-59 | Female | No | Blood transfusion | UCH | GYN | Planned | 1-10 | |
F04 | 18-39 | Male | Disease of the heart or circulatory system | Spinal cord infection | QEH | ORT | Emergency | 30 or above | |
F05 | 40-59 | Male | Diabetes | Hyperglycemia | OLM | MED | Others | 11-20 | |
F06 | 18-39 | Male | No | Surgery | NDH | ORT | Planned | 1-10 | |
F07 | 40-59 | Female | HT; DM; Stomach and intestinal disease | Hypertension | TMH | MED | Emergency | 1-10 | |
F08 | 18-39 | Male | Cancer | Chemotherapy | PYN | ONC | Planned | 11-20 | |
F09 | 18-39 | Male | Disease of ENT; Kidney disease | Stomachache | TKO | SUR | Emergency | 1-10 | |
2 | F10 | 60 or above | Female | Cancer | Surgery | OLM | GYN | Planned | 11-20 |
F11 | 60 or above | Male | Disease of the heart or circulatory system; HT | Chest pain | TKO | MED | Emergency | 1-10 | |
F12 | 60 or above | Male | Respiration disease; Eye disease | Short of Breath | KH | MED | Transfer | 1-10 | |
F13 | 60 or above | Female | No | Fracture | TPH | ORT | Transfer | 21-30 | |
F14 | 60 or above | Female | HT; Kidney disease | Health Problem | QEH | MED | Emergency | 1-10 | |
F15 | 60 or above | Female | HT; DM; Hypercholesterolemia | Fall | TMH | Others | Emergency | 21-30 | |
F16 | 60 or above | Male | Cancer; Diabetes | Body Checking | UCH | SUR | Planned | 1-10 | |
F17 | 60 or above | Female | Eye disease; Disease of ENT | Fall | TPH | ORT | Transfer | 21-30 | |
3 | F18 | 60 or above | Female | Respiration disease; skin disease | Surgery | -- | SUR | Planned | 1-10 |
F19 | 40-59 | Female | Stomach and intestinal disease; DM; disease of the heart or circulatory system | Working Injury | TKO | ORT | Emergency | 1-10 | |
F20 | 40-59 | Male | Stock; HT; DM; Kidney disease | Hydronephrosis | QMH | Others | Referral | 1-10 | |
F21 | 40-59 | Female | No | Surgery | PYN | GYN | Planned | 11-20 | |
F22 | 40-59 | Male | Kidney disease; Liver disease | Cirrhosis | QMH | SUR | Planned | 1-10 | |
F23 | 60 or above | Male | Eye disease; HT; Hypercholesterolemia; Endocrine and metabolic disease | Surgery | TWH | OPH | Planned | 1-10 | |
F24 | 60 or above | Male | Diabetes | Chemotherapy | PYN | ONC | Planned | 1-10 | |
F25 | 40-59 | Male | No | Dermatitis | RH | MED | Planned | 1-10 |
Theme | Subtheme |
---|---|
1. Prompt access
| |
a) Availability of staff | |
b) Clinical staff response time | |
c) Emergency admission procedure | |
- Waiting for consultation | |
- Waiting in A&E to be admitted to a bed | |
d) Planning admission procedure | |
- Waiting list before admission to hospital | |
- Change and choice of admission date | |
- Waiting in hospital to be admitted to a bed | |
2. Information Provision
| |
a) Information on condition, treatment & procedure | |
b) Information on medicines | |
c) Information on post-d discharge care | |
3. Care &
Involvement in Decision Making
| |
a) Answers to questions | |
b) Confidence and trust | |
c) Involvement in decision making | |
d) Opportunity to talk to doctors / nurses | |
e) Willingness to listen | |
4. Physical &
Emotional Needs
| |
a) Pain control | |
b) Staff’s care and attitude towards patient’s need | |
c) Staff’s care of patient’s worries and fears | |
5. Coordination of Care
| |
a) Coordination in the hospital | |
b) Arrangement for discharge and follow-up | |
c) Delay of discharge | |
6. Respect &
Privacy
| |
a) Respect & privacy when being examined or treated | |
b) Respect & privacy when discussion of condition or treatment | |
7. Environment & Facilities
| |
a) Food | |
b) Cleanliness of physical setting | |
c) Comfort in hospital ward | |
- Light setting | |
- Bed setting | |
- Temperature | |
- Space | |
- Clothes & other daily commodities | |
- Others | |
d) Noise bothering | |
e) Safety & Security | |
8. Handling Patient Feedback
| |
a) Availability of feedback mechanism | |
b) Transparency of feedback mechanism | |
c) Patient’s attitudes toward feedback | |
9. Overall Care of Health-care Professionals &
Quality of Care
|
Theme 1: prompt access
“She [the nurse] is always busy and in a hurry to settle down all patient care at the same time…I am really afraid she does not focus and is always thinking about what to do next during an injection.” (F25)
“The nurse and health-care assistant help me immediately when I press the call button.” (F08)“They [the nurse] sometimes reply ‘I am not available at the moment, I will be back after finishing this stuff.’” (F15)
“He [the doctor] told me that I was required to be admitted to hospital for my urgent medical condition…but then I needed to wait for 2 hours, not sure whether there was enough manpower…why did I have to wait for so long if my medical condition was urgent or serious?” (F07)
Theme 2: information provision
“They [hospital staff] clearly explained to me that diabetes required a plan to guide my diet…how to choose the food and drinks…and that I cannot eat too much…I should eat a small amount each time and eat more frequently. They clearly explained to me and also gave me a booklet to follow the diet plan so that my family also had information to help my recovery.” (F05)
Theme 3: care and involvement in decision making
“The doctor told me that I might need surgery…the doctor should ask me whether I prefer to keep my whole breast or part of my breast…but he didn’t ask or discuss it with me…about my feelings…I think the practice should be changed…it needs to involve patient opinion.” (F10)“The doctor told me to wait for the consultant to discuss the plan in detail…then a while later…he came back and said, ‘The consultant doesn’t have time, you had best go home first’…I am really confused.” (F20)
Theme 4: physical and emotional needs
“The nurse was so good…when I was in pain at night, and she helped me immediately by giving a pain-killing injection upon my request.” (F17)“I was weak…I felt cold when I was sent to the surgery room…they [the nurses] covered me with more blankets…it was very important for the patient.” (F09)
Theme 5: coordination of care
“One doctor tells me I am to have screening today, but another doctor tells me no screening is required today when I am preparing to go to screening room…I don’t know how the health-care staff communicate and coordinate.” (F07)“On the day of discharge, the doctor arranged a number of follow-up appointments for me. When I got back home, I received a reminder calling me for a colon examination in October…then a CT scan in December…I felt the doctor cared for me.” (F20)
“I feel that the discharge procedure takes too long…I can leave in the morning but have to wait until 4 pm.” (F09)
Theme 6: respect and privacy
“Normally, the hospital staff would not draw the curtains because it blocked the nursing station’s view for monitoring other patients.” (F10, F24)
“Actually…I could hear all their conversations when the doctor was talking to the patient just next to me.” (F04)
Theme 7: environment and facilities
“The taste of food is not important…but at least the amount of food should be enough for patients (F24)…the broccoli is too hard and we don’t have teeth to chew. It is not only my problem but also a common problem for elderly.” (F17)“I had an experience in the neurological ward when one of the patients shouted the whole night and I could not sleep well. I accept it if it happens in the day time but not at night…I think the hospital should do something to improve it…the environment is important for patients receiving treatment and recovery.” (F15)
Theme 8: handling patient feedback
“Many medical blunders were reported in the newspaper recently, the hospital authority agrees to do further investigation, but what happens then?…The investigation should be transparent with a proper mechanism…otherwise, the hospital staff would not improve.” (F19)“Sometimes, I am afraid after making complaint…Because I am not sure how the staff will treat me…it is important to have a fair mechanism to handle complaints and also ensure the quality of care for a patient who complains.”(F07)
Theme 9: overall care of health-care professionals and quality of care
“I feel that the overall impression towards service and health-care staff is important…actually, the hospital service is good…” (F09)“The nurses, the health-care assistants, all of them are good, and their service manner is good too.” (F25)
Findings of the card-sorting exercise
Category | Care aspect |
---|---|
Most Important
| |
1.Short waiting time for admission and for a bed | |
2. Clear explanations / information of your condition, treatment & medications | |
3. Pain/discomfort relief | |
4. Opportunity to talk to doctors | |
5. Prompt help from hospital staff when you need it | |
6. Cleanliness of hospital | |
Quite Important
| |
1. Clear information and support received on discharge and follow-up | |
2. Getting clear answers to your questions | |
3. Being treated with dignity and respect | |
4. Being involved in decisions about your care | |
Least Important
| |
1. Clear information about admission and ward routines | |
2. Information about what to expect before being admitted to hospital | |
3. Privacy when being examined and treated | |
4. Good food | |
5. Channel for making feedbacks |
In-depth individual interviews
Code | Age range | Gender | Cluster of discharged hospital | Type of admission* |
---|---|---|---|---|
F8005 | 40-59 | Male | New Territories East | Planned |
F9005 | 40-59 | Male | Hong Kong West | Emergency |
F9012 | 18-39 | Female | Kowloon Central | Emergency |
F3014 | 40-59 | Female | Kowloon East | Emergency |
F9025 | 40-59 | Male | New Territories West | Emergency |
F9003 | 40-59 | Female | Hong Kong East | Planned |
F8003 | 18-39 | Female | Kowloon West | Emergency |
Theme 1: prompt access—emergency admission procedure
Q1. Following your arrival at the hospital, how long did you wait before you were examined by a doctor?Q2. Following examination by a doctor, how long did you wait before you were admitted to a bed in the ward?
Theme 2: information provision—information on condition, treatment, and procedure
Q1. Was the given contact information useful to you?
Theme 3: care and involvement in decision making—involvement in decision making
Q1. Were you involved in decisions about your care, treatment, or procedure?Q2. Would you like to be involved in decisions about your care, treatment, or procedure?
Theme 4: physical and emotional needs—staff’s care and attitude toward patients’ needs
Theme 6: respect and privacy—respect and privacy when being examined or treated
Theme 7: environment and facilities—others
Theme 8: handling patient feedback—patients’ attitudes toward feedback
Q1: From the date of discharge until now, have you expressed your opinions or complaints regarding the care you received in the hospital?
Theme 9: overall care of health-care professionals and quality of care
Q1. How would you rate the care you received from doctors?Q2. How would you rate the care you received from nurses?Q3. How would you rate the care you received from health-care assistants?
Theme | Subtheme | Item modification |
---|---|---|
1. Prompt Access
| Emergency admission procedure |
“Following arrival at the hospital, how long did you wait before being admitted to a bed in a ward?”
|
Replaced by two following items:
| ||
“Following your arrival at the hospital, how long did you wait before you were examined by a doctor?
“
| ||
“Following examination by a doctor, how long did you wait before you were admitted to a bed in the ward?”
| ||
2. Information Provision
| Information on condition, treatment & procedure |
“Were you told about what to expect or feel after you had the treatment, operation, or procedure?”
|
Revised to the following item:
| ||
“Were you told about the details of your treatment, operation, or procedure and what you should feel after you had the treatment, operation, or procedure?”
| ||
3. Care &
Involvement in Decision Making
| Involvement in decision making |
“Were you involved as much as you wanted to be in decisions about your care, treatment, or procedure?”
|
Replaced by the two following items:
| ||
“Were you involved in decisions about your care, treatment, or procedure?”
| ||
“Would you like to be involved in decisions about your care, treatment, or procedure?”
| ||
4. Physical &
Emotional Needs
| Staff’s care and attitude towards patient’s need |
“Did you get enough help that you needed from the staff (e.g. eating meals)?”
|
Revised to the following item:
| ||
“Did you get enough help that you needed from the staff (e.g. eating meals, going to the toilet, and moving from/to bed)?”
| ||
5. Coordination of Care
| No revision required | |
6.Respect &
Privacy
| Respect & privacy when being examined or treated |
“Were you given enough privacy when being examined or treated in the A&E Department?”
|
Item removed
| ||
7. Environment &
Facilities
| Others |
“As far as you know, did doctors/nurses wash or clean their hands in between touching patients?”
|
Item removed
| ||
8. Handling Patient Feedback
| Patient’s attitudes towards feedback |
“Did you want to complain about the care you received in hospital?”
|
Replaced by two following items:
| ||
“Did you want to express your opinions about the recent care you received in the hospital?”
| ||
“Did you want to complain about the recent care you received in hospital?”
| ||
Added 1 new item:
| ||
“From the date of discharge until now, have you expressed your opinions or complaints regarding the care you received in the hospital?”
| ||
9. Overall Care of Health-care Professionals &
Quality of Care
|
Added 3 new items as follows:
| |
“How would you rate the care you received from doctors?”
| ||
“How would you rate the care you received from nurses?”
| ||
“How would you rate the care you received from healthcare assistants?”
|