"Nothing Is More Powerful than Words:" How Patient Experience Narratives Enable Improvement.

IF 1.2 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES
Quality Management in Health Care Pub Date : 2024-07-01 Epub Date: 2024-06-26 DOI:10.1097/QMH.0000000000000477
Rachel Grob, Yuna S H Lee, Dale Shaller, Emily Warne, Sasmira Matta, Mark Schlesinger, Ingrid M Nembhard
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引用次数: 0

Abstract

Background and objectives: Patient experience narratives (narratives) are an increasingly important element of both measurement approaches and improvement efforts in healthcare. Prior studies show that narratives are considered by both clinicians and staff to be an appealing, meaningful, and credible form of evidence on performance. They also suggest that making concrete use of narratives within organizational settings to improve care can be complex and challenging. Our qualitative study was designed to explore how middle managers working in a health system's outpatient clinics value and use written narratives in their day-to-day work.

Methods: We conducted qualitative interviews with 20 middle managers working in 8 outpatient clinics. Interviews were fully transcribed, loaded into MAX-QDA software, and coded using thematic analysis techniques. Code reports were extracted and reanalyzed for subthemes related to the objectives of this paper.

Results: Middle managers across sites described valuing narratives as a tool to: enable better patient experience assessment by augmenting data from patient experience scores; deepen understanding of and relationships with patients; provide insight about operational issues; identify areas for needed improvement and potential solutions; and facilitate strategic work. They reported using narratives for a range of activities related to their roles as supervisors, such as focusing attention on positive practices and needed improvements, promoting deeper group learning, motivating change, reinforcing sense of purpose for staff, recognizing staff strengths and training needs, and inspiring transformational thinking. Finally, interviewees reported numerous specific quality improvement projects (both short- and longer-term) that were informed by narratives-for example, by identifying an issue to be addressed or by suggesting a workable solution. Together, these interviews suggest a collective "narrative about narratives" woven by these organizational actors-a story which illustrates how narratives are highly relevant for how middle managers derive meaning from their work, put organizational values such as responsive service provision into practice, and enact their roles as supervisors.

Conclusions: Our results add to the nascent literature a detailed description of how narratives can be used both as a tool for middle managers in their leadership and supervisory roles, and as a blueprint for improvement work within outpatient settings. They also illuminate why patient experience scores may improve when narrative data are collected and used. Finally, our results suggest that for middle managers, perhaps "nothing is more powerful than words" because narratives function as both an insight provider and a compelling tool that adds direction and meaning to workplace endeavors.

"没有什么比语言更有力量:"患者体验叙述如何促进改进。
背景和目标:患者体验叙述(叙述)在医疗保健的测量方法和改进工作中都是一个日益重要的元素。先前的研究表明,临床医生和员工都认为叙述是一种有吸引力、有意义且可信的绩效证据形式。这些研究还表明,在组织环境中具体使用叙事来改善医疗服务可能是复杂而具有挑战性的。我们的定性研究旨在探讨医疗系统门诊部的中层管理人员在日常工作中如何重视和使用书面叙述:我们对 8 家门诊部的 20 名中层管理人员进行了定性访谈。访谈内容全部誊写完毕,载入 MAX-QDA 软件,并使用主题分析技术进行编码。提取编码报告并重新分析与本文目标相关的次主题:结果:各医疗机构的中层管理人员都认为叙述是一种重要的工具,它可以:通过增加患者体验评分的数据来更好地评估患者体验;加深对患者的了解和与患者的关系;提供有关运营问题的见解;确定需要改进的领域和潜在的解决方案;以及促进战略工作。他们报告说,他们在一系列与主管角色相关的活动中使用了叙述,如关注积极的做法和需要改进的地方、促进更深入的小组学习、激励变革、加强员工的使命感、认可员工的优势和培训需求,以及激发变革思维。最后,受访者报告了许多具体的质量改进项目(包括短期和长期项目),这些项目都从叙事中获得了信息--例如,通过确定需要解决的问题或提出可行的解决方案。总之,这些访谈表明,这些组织行为者共同编织了一个 "关于叙事的叙事"--这个故事说明,叙事与中层管理人员如何从其工作中获得意义、如何将组织价值观(如提供响应性服务)付诸实践以及如何扮演其主管角色高度相关:我们的研究结果为新生文献增添了新的内容,详细描述了叙事如何既能作为中层管理者发挥领导和监督作用的工具,又能作为门诊环境改进工作的蓝图。它们还阐明了为什么在收集和使用叙事数据时,患者体验评分会有所改善。最后,我们的研究结果表明,对于中层管理人员来说,也许 "没有什么比文字更有力量",因为叙事既是洞察力的提供者,也是引人注目的工具,它为工作场所的努力增添了方向和意义。
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来源期刊
Quality Management in Health Care
Quality Management in Health Care HEALTH CARE SCIENCES & SERVICES-
CiteScore
1.90
自引率
8.30%
发文量
108
期刊介绍: Quality Management in Health Care (QMHC) is a peer-reviewed journal that provides a forum for our readers to explore the theoretical, technical, and strategic elements of health care quality management. The journal''s primary focus is on organizational structure and processes as these affect the quality of care and patient outcomes. In particular, it: -Builds knowledge about the application of statistical tools, control charts, benchmarking, and other devices used in the ongoing monitoring and evaluation of care and of patient outcomes; -Encourages research in and evaluation of the results of various organizational strategies designed to bring about quantifiable improvements in patient outcomes; -Fosters the application of quality management science to patient care processes and clinical decision-making; -Fosters cooperation and communication among health care providers, payers and regulators in their efforts to improve the quality of patient outcomes; -Explores links among the various clinical, technical, administrative, and managerial disciplines involved in patient care, as well as the role and responsibilities of organizational governance in ongoing quality management.
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