Practice of Cultivating Humanistic Literacy in Public Hospitals Based on Patient Experience Improvement / 中国医学伦理学

Patient experience is an important window for modern hospital management and medical service quality, and also an important point for humanistic hospital construction. Improving patient experience is of great significance for constructing harmonious doctor-patient relationship and improving patients’ satisfaction and sense of gain. Based on the perspective of patient experience improvement, this paper analyzed the core value of "patient demand first" of Mayo Clinic and the operational experience of Cleveland Medical Center Patient Experience Office, and applied them to the cultivation of humanistic hospital culture in the First Affiliated Hospital of Xi’an Jiaotong University. Based on the concept of "strengthening patient demand orientation", with the goal of "building a high-quality patient service system and significantly improving patient satisfaction", through building education platforms for medical ethics and medical humanism, exploring the medical humanism dissemination mode for medical staff, and carrying out the humanism literacy cultivation practice in the training camp for improving hospital service efficiency, the humanistic cultural atmosphere of the hospital has been further enhanced, and the patient satisfaction has been steadily improved. It provides reference for the cultivation of humanistic literacy and the construction of new culture in public hospitals in the context of high-quality development.

Facilitators and barriers of patient involvement in hospital services: integrative review / Facilitadores y barreras para la participación del paciente en los servicios hospitalarios: revisión integrativa / Facilitadores e barreiras do envolvimento do paciente nos serviços hospitalares: revisão integrativa

ABSTRACT Objective to identify the facilitating factors and barriers that influence patient involvement in hospital services. Method integrative review; search of articles published between January 2011 and December 2020, in the electronic databases PubMed, Web of Science, Cinahl, Lilacs and Scopus, using descriptors related to "patient involvement", Barriers, Facilitators, in English, Spanish and Portuguese. Data collection was performed from May to June 2021, identifying 32 publications that met the inclusion criteria. Results the analysis resulted in three categories of facilitating factors and barriers: communication, actors of involvement and organizational culture, allowing the elaboration of a theoretical model of patient involvement. This model shows that in the centrality of the process are the actors involved, that is, patients and professionals, inserted in an organizational context, being influenced by leadership, culture, environment, available resources and processes, where communication permeates as a basis for involvement. Conclusion the facilitating factors and barriers identified in this review, synthesized in a theoretical model, allow transcending theoretical knowledge for practice. The complexity to operationalize this model requires patients, professionals, health services and society join forces to make this theoretical proposition a practice incorporated by the services.

RESUMEN Objetivo incidir en los factores y barreras de la implicación del paciente en los servicios hospitalarios. Método revisión integradora; búsqueda de artículos publicados entre enero de 2011 y diciembre de 2020, en las bases de datos electrónicas PubMed, Web of Science, Cinahl, Lilacs y Scopus, utilizando descriptores relacionados con "involucramiento del paciente", Barreras, Facilitadores, en inglés, español y portugués. La recolección de datos se realizó de mayo a junio de 2021, identificándose 32 publicaciones que cumplieron con los criterios de inclusión. Resultados el análisis resultó en las tres categorías de facilitadores y barreras: comunicación, factores de involucramiento y cultura organizacional, permitiendo la elaboración de un modelo teórico de involucramiento. Este modelo muestra que en la centralidad del proceso están los actores involucrados, es decir, pacientes y profesionales, insertos en un contexto organizacional, siendo influenciados por el liderazgo, la cultura, el ambiente, los recursos disponibles y los procesos, donde la comunicación permea como base para el involucramiento. Conclusión los factores y barreras identificados en esta revisión sintetizados en un modelo teórico, permiten trascender el conocimiento teórico para la práctica. La complejidad para operacionalizar este modelo requiere que los pacientes, los profesionales, los servicios de salud y la sociedad se unan para hacer de esta propuesta teórica una práctica incorporada por los servicios.

RESUMO Objetivo identificar os fatores facilitadores e as barreiras que influenciam no envolvimento do paciente nos serviços hospitalares. Método revisão integrativa; realizada busca de artigos publicados entre janeiro de 2011 e dezembro de 2020, nas bases eletrônicas PubMed, Web of Science, Cinahl, Lilacs e Scopus, utilizando descritores relacionados a "patient involvement", Barriers, Facilitators, nos idiomas inglês, espanhol e português. Coleta de dados realizada de maio a junho de 2021, identificando-se 32 publicações que atenderam aos critérios de inclusão. Resultados a análise resultou em três categorias de fatores facilitadores e barreiras: comunicação, atores do envolvimento e cultura organizacional, permitindo a elaboração de um modelo teórico de envolvimento do paciente. Esse modelo mostra que na centralidade do processo estão os atores envolvidos, ou seja, pacientes e profissionais, inseridos em um contexto organizacional, sendo influenciados pela liderança, cultura, ambiente, recursos disponíveis e processos, onde a comunicação perpassa como base para o envolvimento. Conclusão os fatores facilitadores e as barreiras identificadas nesta revisão, sintetizados num modelo teórico, permitem transcender o conhecimento teórico para a prática. A complexidade para operacionalizar esse modelo requer que pacientes, profissionais, serviços de saúde e sociedade unam os esforços para tornar esta proposição teórica em uma prática incorporada pelos serviços.

Study on patient experiences of residents contracted with family doctor services in a city / 中华医院管理杂志

Objective:To evaluate and analyze the patient experience of residents contracted with primary medical institutions, for providing a basis for improving quality of contracted family doctor services.Methods:Using the Chinese version of the primary care assessment tools(PCAT), a household survey was conducted on 1 400 contracted residents in 9 community health service centers and 9 township health centers in a city from May to June 2020, and their medical experience in primary medical institutions was statistically analyzed. At the same time, interviews were conducted with institutional managers and family doctors. Descriptive statistics and one-way ANOVA were used for data analysis.Results:1 333 valid questionnaires were collected, and the effective recovery rate was 95.2%.The total PCAT scoring was 25.17. Seven dimensions of first contact, continuous, coordination, comprehensiveness, patient and family centered, community-oriented and cultural competence scored in average 3.57, 3.68, 3.54, 3.40, 3.72, 3.67 and 3.59 respectively.372 people(47.1%) had not been referred by the contracted institution before going to the superior hospital or specialized hospital. There were significant differences in the scores of four core dimensions in different types of institutions, age, education level, occupation and income( P<0.001). Conclusions:Given the initial progress of contracted family doctor services in the city, there is still room for improvement. It is suggested to further improve the comprehensiveness, coordinationand accessibility of services, and promote the high-quality development of contracted family doctor services.

Impact of health literacy on patient experience of outpatients in China and its mechanism / 北京大学学报(医学版)

OBJECTIVE@#To understand the relationship between health literacy and patient experience of outpatients in China, and to explore its mechanism.@*METHODS@#The conceptual framework was developed based on Andersen's behavioral model of health services use and health literacy skills framework. An online cross-sectional survey was conducted with snowball sampling method, while the health literacy was measured by self-designed patient health literacy scale, and the patient experience was measured by the Chinese patient experience questionnaire for ambulatory care developed by Peking Union Medical College. And a structural equation model was built to explore the relationship between them and test the mechanism of health literacy influencing patient experience.@*RESULTS@#A total of 2 773 subjects were investigated. The average score of health literacy was (90.72±12.90) points, accounting for 78.89% of the full score, and the dimension of seeking social support had the lowest score. The average score of overall rating of patient experience was (3.71±0.74) points, and the scores of each dimension of patient experience were between 3.56 and 3.80. The model fit indices of structural equation model for overall rating of patient experience among the outpatients were χ2/df=9.29 (χ2=4 107.27, df=442), root mean square error of approximation (RMSEA)=0.055 (< 0.06), comparative fit index (CFI)=0.926 (>0.90), Tucker-Lewis index (TLI)=0.918 (>0.90), standardized root mean square residual (SRMR)=0.061 (< 0.08), the model was acceptable. The variance in patient experience explained by the model was 0.108. The structural equation model analysis results showed that the overall rating of outpatient experience was directly affected by health literacy (β=0.263, P < 0.001), also indirectly affected by health literacy (β=0.012, P < 0.001). In other words, the overall rating increased by 0.275 units for each standard deviation increase of health literacy. Self-evaluated health status mediated the relationship between health literacy and the overall rating of outpatient experience. In terms of diffe-rent dimensions of patient experience, the standardized path coefficient of the total effect of health literacy on patient experience was as follows: Information guidance 0.337, humanistic care 0.319, communication with doctors 0.294, service efficiency 0.240, and hospital environment 0.173.@*CONCLUSION@#The patients with higher level of health literacy were more likely to have a better outpatient experience in China, and the information guidance experience and humanistic care experience were most affected by health literacy. And the communication and information utilization ability had the greatest influence on patient experience.

Reproducibilidad y validez del Picker Patient Experience (versión con 26 ítems) en participantes de investigaciones en Medellín, Colombia, en 2018 / Reproducibility and validity of the Picker Patient Experience (26-item version) in research participants in Medellin, Colombia, in 2018 / Reprodutibilidade e validade da Picker Patient Experience (versão com 26 itens) em participantes da pesquisa em Medellín, Colômbia, em 2018

Resumen Objetivo: Evaluar la reproducibilidad y validez del Picker Patient Experience versión con 26 ítems, en participantes de investigaciones de una institución de alta complejidad de Medellín, Colombia, en 2018. Metodología: Evaluación psicométrica en 241 sujetos, mediante fiabilidad con el alfa de Cronbach, consistencia interna con correlaciones de Spearman, validez de apariencia, contenido y predictiva con análisis factorial. Resultados: Más del 90% de los participantes calificó positivamente la claridad de la información, relación con personal asistencial y la atención. El alfa de Cronbach fue 0,70 (intervalo de confianza -IC- 95%=0,64-0,76); las correlaciones en la consistencia interna fueron mayores que 0,30 en la mitad de los ítems; en la validez de contenido, el porcentaje de éxito fue mayor al 90%; la validez predictiva fue moderada, con una proporción de la varianza explicada del 55%. En una escala de cero (peor resultado) a cien (mejor), el 50% de los valores centrales del Picker Patient Experience osciló entre 80,8 y 92,3, con rango entre 62 y 98, lo que demuestra la excelente percepción de calidad en el grupo de estudio, sin diferencias estadísticas según la edad, el número de hijos, la escolaridad, el estrato socioeconómico de la vivienda, el estado civil, ni la ocupación. Solo se halló asociación estadística con el sexo, siendo menor la mediana del puntaje en las mujeres (Me=85; rango intercuartil -RI-=81-92) en comparación con los hombres (Me=87; RI=83-94). Conclusión: Se dispone de una escala reproducible, válida y útil para la percepción de calidad en investigaciones con 26 ítems, correspondiente a una modificación de la versión en español del Picker Patient Experience versión con 33 ítems. Esto es de gran relevancia, al considerar que la calidad asistencial requiere la inclusión de la perspectiva del paciente con constructos psicométricamente robustos.

Abstract Objective: To evaluate the reproducibility and validity of the 26-item Picker Patient Experience, in research participants of a high complexity institution in Medellin, Colombia, in 2018. Methodology: Psychometric evaluation in 241 subjects, through reliability with Cronbach's alpha, internal consistency with Spearman correlations, appearance, content and predictive validity with factor analysis. Results: Over 90% of participants positively rated the clarity of the information, relationship with care staff and care. Cronbach's alpha was 0.70 (confidence interval - CI - 95% = 0.64-0.76); the correlations in internal consistency were greater than 0.30 in half of the items; in the content validity, the success rate was greater than 90%; predictive validity was moderate, with a proportion of variance explained of 55%. On a scale of zero (worst result) to one hundred (best), 50% of the central values of the Picker Patient Experience ranged between 80.8 and 92.3, with a range between 62 and 98, demonstrating the excellent perception of quality in the study group, with no statistical differences according to age, number of children, schooling, socioeconomic status of housing, marital status, or occupation. The only statistical association was found with sex, the median score being lower in women (Me = 85; interquartile range —IR— = 81-92) compared to men (Me = 87; IR = 83-94). Conclusion: There is a reproducible, valid and useful scale for the perception of quality in research with 26 items, corresponding to a modification of the Spanish version of the 33-item Picker Patient Experience. This is of great relevance, considering that the quality of care requires the inclusion of the patient's perspective with psychometrically robust constructs.

Resumo Objetivo: Avaliar a reprodutibilidade e a validade do Picker Patient Experience versão com 26 itens, em participantes de pesquisas de uma instituição altamente complexa em Medellín, na Colômbia, em 2018. Metodologia: Avaliação psicométrica em 241 sujeitos, através da confiabilidade com o alfa de Cronbach, consistência interna com correlações de Spearman, validade de aparência, conteúdo e preditiva com análise fatorial. Resultados: Mais de 90% dos participantes qualificaram positivamente a clareza das informações, o relacionamento com a equipe de assistência e o atendimento. O alfa de Cronbach foi de 0,70 (intervalo de confiança —ic— 95 % = 0,64-0,76); as correlações na consistência interna foram superiores a 0,30 na metade dos itens; na validade do conteúdo, a percentagem de sucesso foi superior a 90 %; a validade preditiva foi moderada, com proporção da variância explicada de 55 %. Em uma escala de zero (pior resultado) a cem (o melhor), 50 % dos valores centrais da Paciente Picker Experience oscilou entre 80,8 e 92,3, com um intervalo entre 62 e 98, demonstrando a excelente percepção de qualidade no grupo de estudo, sem diferenças estatísticas segundo a idade, o número de filhos, a escolaridade, a condição socioeconômica da moradia, o estado civil nem a ocupação. Somente foi achada associação estatística com o sexo, sendo mais baixa a mediana dos pontos nas mulheres (Me = 85; intervalo interquartil —RI— = 81-92) em comparação aos homens (Me = 87; ri = 83-94). Conclusão: Existe uma escala reproduzível, válida e útil para a percepção de qualidade em pesquisas com 26 itens, correspondendo a uma modificação da versão em espanhol da versão Picker Patient Experience com 33 itens. Isso é de grande relevância, considerando que a qualidade da assistência requer a inclusão da perspectiva do paciente em constructos psicometricamente robustos.

Analysis on the experience of inpatients at tertiary hospitals in Shanxi province / 中华医院管理杂志

Objective@#To evaluate the medical services of tertiary hospitals in Shanxi province from the perspective of patients and provide references for improving the quality of medical services.@*Methods@#From April to December 2018, 1 358 patients at 8 tertiary hospitals in Shanxi province were selected for the survey of medical service quality evaluation scale based on patient experience, while the status quo of patient experience in tertiary hospitals in Shanxi province was evaluated, and the multivariate mixed linear model was constructed based on the three-level model of hospital-department-patient to analyze the relevant factors of patient experience. If the quantitative data conform to the normal distribution, it was expressed as ±s. Otherwise, it was expressed as M(QR).@*Results@#The patient experience score was 626±126, which was in the middle level. Whether the hospital was directly affiliated to the teaching hospital, and patient factors(marriage, occupation, education, medical insurance, number of hospital stays, etc.)were the main factors that affect the patient experience score(P<0.05).@*Conclusions@#Through the investigation, the influence characteristics of patients′ medical experience were discussed to improve the medical service and the overall service level.

El análisis de la calidad asistencial desde la perspectiva de la satisfacción y la experiencia del paciente: una mirada enfermera / An analysis of assistance quality from the perspective of patience satisfaction and experience: A nursing view

Este artículo pretende describir dos grandes aspectos: la satisfacción y la experiencia del paciente, y cómo medirlos y analizarlos en los campos de la gestión sanitaria, la gestión clínica y los servicios sanitarios. Dichos elementos están inmersos en el abordaje en seguridad del paciente y permiten que la enfermería se relacione con temas como la calidad de los cuidados, la satisfacción del usuario, su experiencia dentro del sistema, los cambios y la implementación de mejoras así como sus formas de medición y análisis dentro del vasto campo de la gestión clínica y sanitaria. Aunque se trata de un tema ampliamente explorado y complejo, susceptible de ser abordado por métodos cuantitativos y cualitativos, en el que la encrucijada entre calidad total, calidad percibida, satisfacción y experiencia parece conformar la hoja de ruta, el artículo aporta conceptos de reciente aparición como Healthcare Improvement Science (mejora de la ciencia de la salud), centrado en la mejora de la calidad del cuidado de la salud y la reducción de daños a los usuarios de los servicios y sus familias; Magnet Hospital (hospital magnético), que relaciona la satisfacción de los profesionales con la calidad de los cuidados, y Patient Experience Officer (director de la experiencia del paciente), nuevo perfil laboral creado en Estados Unidos, centrado en la mejora continua de la calidad a partir de la experiencia del paciente. Todos estos conceptos han sido desarrollados por instituciones e investigadores reconocidos en la materia. En conclusión, en este artículo se resumen algunas de las cuestiones clave que se deben tener en cuenta a la hora de analizar la experiencia del paciente, que es un elemento importante para la mejora y el mantenimiento de la calidad en la atención sanitaria.

This article aims to describe two major aspects: patient satisfaction and experience and the way these are measured and analyzed within health management, clinical management, and health services. These elements are immersed within processes of patient safety and assume a motive for nursing of interweaving issues such as quality of care, user satisfaction, user experience within the system, change and the implementation of improvements, as well as ways of measuring and analyzing these issues within the vast field of clinical and health management. This is a widely explored and complex topic where total quality, perceived quality, satisfaction, and experience appear to make up a crossroad that needs to be taken into account and whose engagement is susceptible to qualitative and quantitative measurements. This article, however, contributes new concepts like Healthcare Impro-vement Science, centered on the improving the quality of health care and reducing harm to users of services and their families, Magnet Hospital, where the satisfaction of employed professionals is related with quality of care, and Patient Experience Officer, a new job profile created in the United States focused on the continuous improvement of patient experience quality. All these concepts were developed by recognized institutions and researchers in the field. In conclusion, this article summarizes some of the key issues that must be taken into account when analyzing the patient's experience, which is an important element for the improvement and maintenance of quality in health care.

Emergency department patient experience: Same location, same provider, different scores by different survey methods / 世界急诊医学杂志（英文）

BACKGROUND@#Recent findings on emergency department (ED) patient experience surveys and concerns for the low response rates challenge the quality and reliability of the survey reports. We assessed the consistency of an ED patient experience survey report and identified the effects of patient demographics on ED patient experiences.@*METHODS@#We conducted a prospective, cross-sectional study at a university-based ED from July to December 2017. We obtained ED patient experience scores from an institutional version (IS) survey and the Press Ganey Associates-distributed survey (PGA). We compared top box scores from the two reports using frequency analysis and performed multivariable logistic regressions to identify associations between IS patient demographics and scores.@*RESULTS@#We obtained 289 PGA and 234 IS responses. The IS reported significant, higher top box scores in doctor-specific patient questions compared to PGA (all four P-values < 0.01). Female, Christian and White patients were more likely to give top box scores (OR 3.07, OR 2.22 and OR 2.41, P-value < 0.05, respectively).@*CONCLUSION@#We found significant differences in ED patient experience scores between the IS and PGA surveys. We recommend that healthcare providers consider patient demographic variables when interpreting ED experience score reports. Multiple survey techniques and distribution methods may be adopted to best capture ED patient experiences.

Analysis of patient experience at public hospitals in China / 中华医院管理杂志

Objective To get an understanding of the patient experience in public hospitals nationwide, and to evaluate the implementation of the Action Plan to Improve Health Care. Methods Supported by the mobile technology, from September 6, 2017 to December 15, 2018, the authors conducted an online survey that measured the satisfaction of both inpatients and outpatients at secondary and tertiary hospitals across the country. 15 questions from six dimensions including registration experience, patient-doctor communication, nurse-patient communication, the healthcare signage system, responsiveness of care providers and privacy protection were prepared for outpatients, while 20 questions from nine aspects such as nurse-patient communication, patient-doctor communication, pain management, medication communication, admission and discharge information, responsiveness of care-givers, food service, friendliness to patient family, and the healthcare signage system were directed at inpatients. Descriptive statistical analysis was used to describe the basic features of the data. Results 9.18 million valid responses from outpatients and another 5.38 million from inpatients were obtained. The overall satisfaction rate with outpatient services had reached a score of 90.45 points where nurse-patient communication stands out as the top-rated dimension and privacy protection gets the lowest rating. On the other hand, the inpatient satisfaction stands at a score of 93.01 with friendliness to patient family receiving the top score and patient-doctor communication the lowest. Conclusions Despite the positive feedback Chinese patients give on the outpatient care they receive, we should make efforts to improve the outpatient care environment, the wayfinding system, privacy protection, and responsiveness of care-givers.

A experiência do paciente na coprodução de cuidados: percepções acerca da qualidade no serviço hospitalar / Experiencia del paciente en la coproducción de cuidados: percepciones acerca de la calidad en el servicio hospitalario / Patient experience in coproduction of care: perceptions about quality in the hospital service

Trata-se de estudo qualitativo, do tipo exploratório-descritivo, acerca da experiência do paciente atendido em serviço hospitalar, na perspectiva da coprodução de cuidados em saúde. Pauta-se na sistematização de Donabedian, a qual enfatiza o engajamento do paciente na avaliação da qualidade em saúde, com base na tríade estrutura, processo e resultado. O objetivo geral consistiu em analisar a experiência do paciente durante a internação hospitalar em unidades clínicas e cirúrgicas, com foco na coprodução de cuidados orientados para a qualidade. O cenário de estudo foi um hospital universitário público do sul do país. Participaram 10 profissionais da equipe de saúde, 22 pacientes e 8 familiares adultos procedentes de 12 unidades de internação clínicas e cirúrgicas do hospital. Para a coleta de dados, procedeu-se à triangulação de múltiplas fontes: análise documental, observação e entrevistas. Os dados primários da observação de 30 encontros de serviço durante a prestação dos cuidados em duas unidades e da realização de 24 entrevistas com pacientes-famílias, conduzidas com base na Técnica de Incidente Crítico, foram submetidos à análise temática. A pesquisa atendeu aos preceitos éticos para seu desenvolvimento. A análise resultou em quatro categorias empíricas, cujo eixo transversal foi o papel dos pacientes-famílias como coprodutores do cuidado seguro, sendo elas: i) um recorte da qualidade e segurança assistencial no campo estudado; ii) protocolos de segurança segundo a experiência do paciente iii) caminhos percorridos e a percorrer no cuidado centrado no paciente e; iv) atributos de satisfação de segurança na experiência do paciente. Constatou-se que há alinhamento entre as percepções dos pacientes, as definições institucionais e os protocolos básicos do Programa Nacional de Segurança do Paciente. No entanto, viu-se que os pacientes percebem que esses protocolos nem sempre são seguidos pelos profissionais. A coprodução para um cuidado seguro foi percebida em relação aos protocolos de cirurgia segura e de prevenção de lesões decorrentes de queda. Na identificação do paciente, higienização de mãos e processo de medicação, verificou-se que a coprodução depende do comportamento proativo de pacientes-famílias. Por um lado, foi possível constatar oportunidades para coprodução no cuidado centrado no paciente, mediante o comportamento de profissionais em instigar, envolver e esclarecer pacientes-famílias. Por outro, verificou-se que os encontros de serviço se centraram no motivo da internação e em intervenções técnicas. Ao passo que o comportamento dos profissionais foi valorizado pelos pacientes-famílias, quando houve maior interação e pela percepção de padrões assistenciais de qualidade, o seu oposto emergiu como falta de subsídios para acompanhar o tratamento, ou falta de cuidados em alguns momentos demandados. Emergiram atributos de satisfação de segurança sobre estrutura, processo e resultados assistenciais. Considera-se que a experiência do paciente sustenta a tese que o processo de atendimento hospitalar, quando orientado pelos pressupostos da segurança do paciente, conduz ao cuidado centrado no paciente e, a experiência do paciente como coprodutor de serviços de saúde, oportuniza identificar atributos de satisfação em relação à segurança do cuidado.

This is a qualitative, exploratory-descriptive study about the experience of patients treated in hospitals with a view to health care co-production. It is based on Donabedian model, which emphasizes patient's engagement in the evaluation of health quality, with focus on the triad: structure, process and outcome. The general objective was to analyze patient's experience during hospital stay in medical and surgical units, focusing on co-production of quality-oriented care. The study scenario was a public university hospital in the south of Brazil. A total of 10 professionals from the health team, 22 patients and 8 adult family members from 12 medical and surgical hospital units participated in the study. For data collection a triangulation of multiple sources ­ documentary analysis, observation and interviews ­ was done. The primary data came from the observation of 30 service encounters during health care in two units, and the accomplishment of 24 interviews with patient-families which were conducted based on the Critical Incident Technique. For the analysis of data and information, descriptive statistics and thematic analysis were used. The research met the ethical precepts for its development. The analysis resulted in four empirical categories, whose transversal axis was the role of patient-families as co-producers of safe care, being: i) a cutoff in quality and safety of care in the field studied; ii) safety protocols according to patient's experience; iii) paths covered and to be covered in patient-centered care; and iv) attributes of safety satisfaction in patient's experience. It was found that there is an alignment among patients' perceptions, institutional definitions, and basic protocols of the National Patient Safety Program. However, it has been seen that patients realize that those protocols are not always followed by the professionals. The co-production to a safe care was perceived in relation to the protocols of safe surgery and prevention of injuries due to fall. In the identification of the patient, hand hygiene, and medication process it was verified that the co-production depends on the proactive behavior of patient-families. On the one hand, it was possible to verify opportunities for co-production in patient-centered care, through the behavior of professionals in instigating, involving and clarifying patient-families. On the other hand, it was found that the service meetings focused on the reason of hospitalization and in technical interventions. While the behavior of the professionals was valued by patient-families when there was more interaction and perception of quality care standards, its opposite emerged as a lack of subsidies to follow the treatment, or lack of care in some moments. Attributes of safety satisfaction on structure, process, and outcomes emerged. It is considered that patient's experience supports the thesis that hospital care process, when guided by the assumptions of patient safety, leads to patient-centered care, and patient's experience as a co-producer of health services, allows the identification of satisfaction attributes regarding the safety of care.

Se trata de un estudio cualitativo, de tipo exploratorio-descriptivo, a cerca de la experiencia del paciente atendido en servicio hospitalar, en la perspectiva de la coproducción de los cuidados en salud. Se guía en la sistematización de Donabedian, la cual enfatiza el compromiso del paciente en la evaluación de la calidad en salud, con base en la tríada estructura, proceso y resultado. El objetivo general consistió en analizar la experiencia del paciente durante la internación hospitalar en unidades clínicas y quirúrgicas, con foco en la coproducción de cuidados orientados para la calidad. El escenario de estudio fue un hospital universitario público del sur del país. Participaron 10 profesionales del equipo de salud, 22 pacientes y 8 familiares adultos procedentes de 12 unidades de internación clínica y quirúrgica del hospital. Para la colecta de datos, se procedió a la triangulación de múltiples fuentes: análisis documental, observación y entrevistas. Los datos primarios fueron oriundos de la observación de 30 encuentros de servicio durante la prestación de los cuidados en 2 unidades y la realización de 24 entrevistas con pacientes-familiares, conducidas con base en la Técnica de Incidente Crítico. Para el análisis de los datos e informaciones, se utilizó estadística descriptiva y análisis temática. La pesquisa atendió los preceptos éticos para su desarrollo. El análisis resultó en cuatro categorías empíricas, cuyo eje transversal fue el papel de los pacientes-familias como coproductores del cuidado seguro, siendo ellas: i) un recorte de la calidad y seguridad asistencial en el campo estudiado; ii) protocolos de seguridad según la experiencia del paciente, iii) caminos recorridos y por recorrer en el cuidado centrado en el paciente y; iv) atributos de satisfacción de seguridad en la experiencia del paciente. Se constató que hay alineamiento entre las percepciones de los pacientes, las definiciones institucionales y los protocolos básicos del Programa Nacional de Seguridad del Paciente. Sin embargo, se vio que los pacientes perciben que esos protocolos ni siempre son seguidos por los profesionales. La coproducción para un cuidado seguro fue percibida en relación a los protocolos de cirugía segura y de prevención de lesiones provenientes de caída. En la identificación del paciente, higiene de las manos y proceso de medicación, se verificó que la coproducción depende del comportamiento colaborador de pacientes-familias. Por un lado, fue posible constatar oportunidades para coproducción en el cuidado centrado en el paciente, mediante el comportamiento de profesionales en instigar, involucrar e informar pacientes-familias. Por otro, se verificó que los encuentros de servicio se centraron en el motivo de la internación y en intervenciones técnicas. Al mismo tiempo que el comportamiento de los profesionales fue valorado por los pacientes-familias, cuando hubo mayor interacción y por la percepción de padrones asistenciales de calidad, lo opuesto emergió como falta de subsidios para acompañar el tratamiento, o falta de cuidados demandados en algunos momentos. Emergieron atributos de satisfacción de seguridad sobre la estructura, proceso y resultados asistenciales. Se considera que la experiencia del paciente sostiene la tesis de que el proceso de atención hospitalar, cuando orientado por lo que él presupone al respecto de seguridad, conduce al cuidado centrado en el paciente y, la experiencia del paciente como coproductor de servicios de salud, nos da la oportunidad de identificar atributos de satisfacción en relación a la seguridad de aquél que está siendo cuidado.

Relationship between Perceived Health Status andPatient Satisfaction in Outpatient Settings - Korean National Health and Nutrition Examination Survey 2015 / 의료커뮤니케이션

BACKGROUND: It is important to investigate patient satisfaction to improve the quality of healthcare. Among the many factors that affect patient satisfaction, perceived health status has been considered as one of the major factors. Therefore, we investigated patient satisfaction through patient experience in outpatient settings according to perceived health status.METHODS: This cross-sectional study using questionnaires of patient experience and perceived health status from the Korean National Health and Nutrition Examination Survey 2015 included 4267 people aged over 19 years who met the inclusion criteria. Perceived health status was classified into three: good, fair, and poor. Questions about patient experience consisted of four items: doctor spending enough time with patients, doctor providing easy-to-understand explanation, doctor giving opportunity to ask questions or raise concerns, and doctor involving patient in decisions about care or treatment. Patient experience was classified into two: satisfied and non-satisfied. A multivariate regression model was used to analyze the data.RESULTS: In the good perceived health status group, level of satisfaction was 79.2%, 88.5%, 83.3% and 87.2%, respectively for the four items targeting patient experience. In the poor group, level of satisfaction was 76%, 84.9%, 79.5%, and 83.1%, respectively for the four items. In multivariate logistic regression analyses, the odds ratios of good perceived health status group were 1.775 (1.347–2.338), 1.946 (1.356–2.793), 1.652 (1.218–2.240), and 1.665 (1.193–2.323) compared with the poor group.CONCLUSION: Perceived health status is associated with patient satisfaction. In particular, the better the perceived health status, the better the patient satisfaction through patient experience.

Construction and consideration of hospital services continuous improvement based on patients ' experience / 中国基层医药

Patients' experience is the feeling of patients in the process of medical perception. This paper expounded the new concept based on the experience of patients with medical services,then reviewed the specific practices of improve services,which including three - dimensional registration service,process intensification,service public commitment, patients choose doctors in medico - technical departments, hospital president in outpatient. Finally,the article proposed that patients' experience should be based on patients' evaluation,have " love" heart, exceed customers' expectation and build patients' experience culture.

Comparative study of hospital information disclosure between China and the United States / 中华医院管理杂志

Objective To compare the contents of hospital information disclosure in China and the United States, and provide reference to improve hospital information disclosure in China. Methods Systematic collection was made for hospital information disclosure data from government documentation, statistical yearbooks, and hospital website portals like Hospital Compare of the United States and China. By means of inductive method and comparative analysis, hospital's medical services that were openly and freely accessible to the public of the two countries were studied in terms of structural indexes, medical quality indexes and patient experience assessment. Results The disclosed structure indexes of the US were abundant and distinctive. Its disclosed medical service quality indexes include such four diseases as myocardial infarction, cardiac failure, pneumonia and childhood asthma, as well as classification indexes under surgery infection prevention, comprising ten core process indexes and nine outcome indexes. In addition, the US also discloses patient experience survey results of ten aspects. Given the rich hospital information structure openly accessible in China, there lacks medical service quality information for disclosure. The only information directly comparable was the ranking of hospitals and specialties, instead of patient experience results. Conclusions China can learn from the experiences of American hospital information disclosure, establish an easy-to-understand and comparable index system; enrich the disclosure content, and build an authoritative and unified disclosure platform.

Third-party Evaluation Program for Primary Care Facilities: Situation in Other Countries and Suggestions for Our Country / 日本プライマリ・ケア連合学会誌

In Japan, improving the quality of primary care is an urgent issue; however, there is currently no specialized third-party evaluation program for primary care facilities. In this article, prior to the development of Japan's third-party evaluation program for primary care, we examined the systems and standards for the evaluation of primary care facilities in other countries. Based on the comparison of standards for the evaluation of primary care facilities by third-party evaluation agencies in four countries with Japanese hospital evaluation standards, the standards for collecting and utilizing quality data need to be strengthened from the viewpoint of patients, and areas, such as preventive medicine and home care, need to be covered when developing evaluation standards for primary care facilities in Japan. Moreover, building the structure of the standards with primary care as the main framework will strengthen the function of primary care facilities through continuous quality improvement.

Patients' Experience of Participation in Hospital Care / 간호행정학회지

PURPOSE: The aim of this study was to explore patients' experience of participation in their hospital care. METHODS: Face-to-face interviews using a semi-structured interview guide were conducted with a total of 21 patients in a tertiary hospital in Seoul, South Korea. Collected data were analyzed using a qualitative content analysis. RESULTS: Two categories of patients' experience of participation in hospital care emerged: 1) Reactive participatory activity, 2) active participatory activity. Major participatory activities included ‘complying with medical instructions’, ‘listening’, ‘responding’ and ‘questioning’. Healthcare professionals' attentive attitudes and explanation, and availability of care equipment were facilitating factors affecting patient participation in their care, whereas limited accessibility to and poor communication with healthcare professionals, inconvenient patient room, and patient factors were barriers to their participation. CONCLUSION: The findings in this study reveal that patients tend to participate in their care in a reactive way and that healthcare professionals have a significant role in facilitating patients' participation. Furthermore, the care environment and patient factors need to be considered to promote patient participation in hospital care.

Development of a hospital performance scale based on patient experience / 中华医院管理杂志

The paper described the development stages of a hospital performance evaluation scale based on patient experience.An empirical application on 7 856 patients of 26 hospitals in four provinces in the country identified the challenges encountered in the course of its application.These include limits of patients experience,variations on the experience reports incurred by different services experienced by patients,and setting of the patient-inpatient ratio among others.Solutions proposed based on these studies aim at creating a patient experience scale tailored to Chinese patients.

Assessment of Dental Service Provided by Undergraduate Dental Students in Faculty of Dentistry, University of Malaya

@#Patient satisfaction can be used as one of the indicator for measuring quality of dental care provided. The objective of this study was to assess patient experiences with dental service provided by undergraduate dental students in Faculty of Dentistry, University of Malaya. A cross sectional study was done by distributing a self-answered questionnaire to patients treated by undergraduate dental students. Patient level of satisfaction was assessed by using five point Likert-like scale (strongly disagree, disagree, neutral, agree and strongly agree), with a list of items divided into three domains, consist of interpersonal skills, dental treatment and services. The response rate was 71.3%. The mean satisfaction scores were 83.09%, 78.62 and 74.16 for interpersonal skills, dental treatment and services domains respectively and the overall mean satisfaction score was highly satisfactory (78.62%). The percentage of satisfied patients was 82.4%, 66.2% and 55.4% for interpersonal skills, dental treatment and services domains respectively. There was significant association between satisfaction score with age (p-value=<0.001), treatment received by examination and diagnosis (p-value=0.027), denture treatment (p-value=0.032), others treatment (p-value=0.043) and ‘year of study’ of the students (p-value=0.001). Patients were satisfied with their overall experiences while receiving dental care provided by undergraduate dental students. They were highly satisfied with the students’ interpersonal skills, dental treatment received and services provided at the undergraduate dental clinics.

Quality Assessment of community pharmacy services provided in the United Arab Emirates: patient experience and satisfaction.

Whilst a limited number of studies have been conducted in nearby Arab countries to evaluate patients’ experiences and satisfaction with community pharmacy services provided, in the UAE, this area remains unexamined. Therefore, this study assessed patients’ experiences and satisfaction with community pharmacy services in the UAE, which can be used as an indicator to improve services. An online questionnaire was distributed through social media platforms to customers accessing community pharmacies and who are living in the UAE. The study showed that patient satisfaction regarding the two areas, which includes items on communication quality and other aspects of service delivery quality, was more than the average of Likert scale (cut point=3). However, items on satisfaction with consultation quality were a little less than the mentioned cut point. The worst experience, the one with the lowest level of satisfaction, was associated with non-Arabic or non-English speakers and participants over 60 years. The community pharmacy services provided in the UAE are seen to be traditional or product-focused with minimal or negligible pharmaceutical care provided. Therefore, unique structure strategies and health system reforms need to be introduced to follow the trend of extending community pharmacists’ roles and to meet the growing needs of patients.

Quality assessment in primary care-focusing on patient experience / 日本プライマリ・ケア連合学会誌

Quality assessment in primary care is increasingly important, and quality indicators of primary care principles and primary care physicians' tasks are available for policy making and quality improvement in other countries. Patient centeredness is an especially important concept for evaluation of primary care principles, so patient experience surveys using quality assessment tools have been conducted in Europe and the US. On the other hand, similar effective approaches are lacking in Japan. Previous studies have indicated that important primary care principles in Japan are accessibility, comprehensiveness, coordination, longitudinal continuity, interpersonal continuity, community oriented care, and family oriented care. Quality assessment and assurance from multiple aspects should be promoted in the future to improve the quality of primary care in Japan.

Patient experience based key indicators for quality of care / 中华医院管理杂志

Objective To establish patient-experience based key indicators for quality of care.Methods Literature review,collection of proven surveys on patient experience and satisfaction,study of China's conditions,with demonstrations by experts team.Results A framework was built for patientexperience based key indicators on quality of care.Level-1 indicators within the framework are tangibility,reliability,responsiveness,assurance,care and continuity.There are 28 level-2 indicators and 83level-3 indicators.Conclusion Such key indicators are highly practical as the basis for developing the scale of patient experience.