Feedback based on patient evaluations: a tool for quality improvement?

doi:10.1016/S0738-3991(02)00199-4

Patient Education and Counseling

Volume 51, Issue 2, October 2003, Pages 149-153

https://doi.org/10.1016/S0738-3991(02)00199-4 Get rights and content

Abstract

Feedback regarding patient evaluations of health care is expected to be a tool for quality improvement. This study examined the response of general practitioners to such feedback in a randomised trial. Practitioners in the intervention group read and discussed the feedback report and then reported on a range of actions that can be undertaken to improve the quality of care. Their communication behaviour was not found to change. All of the practitioners were highly motivated to learn from patient views, both at baseline and after the intervention period. Compared to the control group, the practitioners in the intervention group had less favourable views of the relevance of patient feedback for their practice after the receipt of such feedback. Furthermore, these practitioners felt that a patient survey required considerable time and energy and saw little reason for change. Although patient feedback can help identify areas for improvement, specific barriers must be addressed before such feedback can be put to more widespread use.

Introduction

It has been proposed that surveys and interviews can be used with patients to elicit their views on the delivery of health care and thus as a tool for quality improvement [1]. The views of the patients can then be circulated to the health care providers and the public in order to highlight areas in need of improvement [2], [3]. Previous observational studies have shown changed GP performance after the receipt of such patient feedback [4], [5], [6], [7], [8], [9], but a large cluster randomised trial recently showed no effect on subsequent patient satisfaction [10]. The purpose of the present study was therefore to examine the responses of the practitioners in the aforementioned trial to the feedback provided.

The general hypothesis was that feedback from patients on professional performance can lead to changed health care processes and outcomes [11]. Feedback based on the views of patients was expected to be particularly effective because most health care providers are sensitive to patient dissatisfaction [12]. Feedback was expected to result in the undertaking of activities for improvement (e.g. seeking communication training), better performance and—in the end—better health care outcomes. We expected mainly changes with regard to communication as this is what patients give priority to [13]. Certain factors may either facilitate or hinder the change process, and the aim of the present study was therefore to provide greater insight into the responses of care providers to feedback from patients regarding their actions, communication behaviour and the perceived motivators of and barriers to change.

Section snippets

Method

The data for this study stems from a cluster randomised trial in which general practices were allocated to either the intervention or control group. While the patients were blind to the intervention, the GPs were obviously aware of the study condition they had been allocated to.

Results

A total of 52 GPs completed the entire study (see Table 1). GP sex, GP age and type of practice were not found to differ significantly across the two groups, but the intervention group contained more GPs from large cities than the control group (P<0.05). The eight GPs who dropped out during the study (three in the intervention group and five in the control group) did not differ from the participating 52 GPs with respect to the characteristics reported in Table 1. Due to technical problems, some

Conclusions and discussion

The results of this study suggest that GPs are highly motivated to learn from the views of their patients but find it difficult to use the feedback provided to actually improve their performance. Particularly those who received feedback saw little or no reason to change things, which may have been due to high levels of patient satisfaction and/or the fact that the patient survey took considerable time and energy in the eyes of the GP. All of the GPs found it difficult to meet the needs of all

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Patients, as customers of the healthcare system are capable of highlighting weak areas of performance that are not usually covered by other conventional methods [6,22], or not recognised by practitioners themselves [23]. Patient feedback can be collected using questionnaires and/or by conducting interviews [24,25]. However, the full benefit of feedback can only be realised by using it to support professionals’ development.
To identify patient feedback questionnaires that assess the development of consultation skills (CSs) of practitioners.
We conducted a systematic search using seven databases from inception to January 2017 to identify self-completed patient feedback questionnaires assessing and enhancing the development of CSs of individual practitioners. Results were checked for eligibility by three authors, and disagreements were resolved by discussion. Reference lists of relevant studies and Open Grey were searched for additional studies.
Of 16,312 studies retrieved, sixteen were included, describing twelve patient feedback questionnaires that were mostly designed for physicians in primary care settings. Most questionnaires had limited data regarding their psychometric properties, except for the Doctor Interpersonal Skills Questionnaire (DISQ). Most studies conducted follow-up, capturing positive views of practitioners regarding the process (n = 14). Feedback was repeated by only three studies, demonstrating different levels of improvement in practitioners’ performance.
Identified questionnaires were mainly focused on physicians, however, to support using patient feedback, questionnaires need to be validated with other practitioners.
Several patient feedback questionnaires are available, showing potential for supporting practitioners’ development. Valid questionnaires should be used with appropriate practitioners in developing more evidence for the impact they may have on actual consultations.
Social and Consumer Informatics
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New patient engagement strategies, coupled with social and consumer technologies, are enabling novel ways for people to manage their health and interact with providers. These patient-facing technologies create opportunities for patients and families to participate actively in their care, improve communication with their care team, and allow healthcare providers to partner with their patients. This chapter provides an overview of patient engagement domains and health information technology (HIT) that most effectively engage patients throughout the care continuum. We review the key concepts of these domains, the current trends, policy-based initiatives, as well as their potential effect on healthcare outcomes. Furthermore, this chapter provides an overview of new and innovative patient engagement technologies, including patient portals, social media, telehealth, apps and wearables, and real-time patient experience feedback systems. Finally, this chapter takes a critical look at the existing needs, challenges, and opportunities for improving patient engagement through HIT; mapping out what has been accomplished, and the steps that remain to truly transform our care delivery system to be as engaging and patient-centric as possible.
Does feedback influence patient - professional communication? Empirical evidence from Italy
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One of the studies on GP-patient interaction found that systematic patient feedback helps improve interpersonal skills [23]. Another study on GP-patient interaction found that a GP group that had received feedback from patients had less favourable views of the relevance of patient feedback than the control group [24]. Our study aims to contribute to the literature on healthcare feedback by providing empirical evidence on the relationship between inpatient feedback using surveys on hospitals and the level of communication perceived by patients.
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The results of this intervention confirm that SMAs may be a potential solution among practices experiencing difficulty accommodating patients in a timely fashion.25,27,28 Our study confirms and extends prior literature demonstrating that patient satisfaction outcomes are often mixed despite concerted efforts geared toward improving the patient experience.29–32 Some studies have shown an association between patient satisfaction and clinician engagement, attentiveness, and responsiveness to patients' needs or expectations.33–37
Shared medical appointments (SMAs) are becoming popular, but little is known about their association with patient experience in primary care. We performed an exploratory analysis examining overall satisfaction and patient-centered care experiences across key domains of the patient-centered medical home among patients attending SMAs vs usual care appointments.
We undertook a cross-sectional study using a mailed questionnaire measuring levels of patient satisfaction and other indicators of patient-centered care among 921 SMA and 921 usual care patients between 2008 and 2010. Propensity scores adjusted for potential case mix differences between the groups. Multivariate logistic regression assessed propensity-matched patients' ratings of care. Generalized estimating equations accounted for physician-level clustering.
A total of 40% of SMA patients and 31% of usual care patients responded. In adjusted analyses, SMA patients were more likely to rate their overall satisfaction with care as “very good” when compared with usual care counterparts (odds ratio = 1.26; 95% CI, 1.05–1.52). In the analysis of patient-centered medical home elements, SMA patients rated their care as more accessible and more sensitive to their needs, whereas usual care patients reported greater satisfaction with physician communication and time spent during their appointment.
Overall, SMA patients appear more satisfied with their care relative to patients receiving usual care. SMAs may also improve access to care and deliver care that patients find to be sensitive to their needs. Further research should focus on enhancing patient-clinician communication within an SMA as this model of care becomes more widely adopted.
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View full text

Feedback based on patient evaluations: a tool for quality improvement?

Abstract

Introduction

Section snippets

Method

Results

Conclusions and discussion

Pat. Edu. Counsel.

Soc Sci Med

The increasing importance of patient surveys. Now that sound methods exist, patient surveys can facilitate improvement

Br. Med. J.

The public release of performance data

J. Am. Med. Assoc.

Using patient feedback for quality improvement

Qual. Manag. Health Care

Feedback from patients as a means of teaching non-technical aspects of medical care

J. Med. Edu.

Modification of residents’ behavior by preceptor feedback of patient satisfaction

J. Gen. Intern. Med.

Patient perception as a tool for evaluation and feedback in family practice resident training

J. Fam. Pract.