Abstract
BackgroundPatient and staff experiences provide important insights into care quality, but health systems have difficulty using these data to improve care. Little attention has been paid to understanding how patient experience feedback can act as a prompt to reflection in practice in the clinical setting.ObjectiveWe aimed to identify the ways in which different types of patient experience feedback act as a trigger or prompt for engagement in reflection in clinical practice in acute hospital settings and identify important considerations for enhancing the value of patient experience data for reflective learning.MethodsWe conducted an ethnographic study in eight acute care units in three NHS hospital trusts in England, including 140 hours of observations and 45 semi‐structured interviews with nursing, medical and managerial staff working in acute medical units and intensive care units. The data were analysed thematically.FindingsWe distinguished between formal patient experience data sources: data purposively collected and collated to capture the patient experience of care, generally at organizational level, including surveys, complaints and comments; and informal sources of feedback on the patient experience recognized by staff alongside the formal data. We also identified patient narratives as an ‘in between’ source of data. The impact of different types of patient feedback in triggering reflection primarily depended on the extent to which the feedback was experienced as personally relevant, meaningful and emotionally salient.DiscussionPatient experience feedback is multi‐faceted, but our study suggests that all types of feedback could be harnessed more effectively to prompt reflection.
Highlights
Patient and staff experiences provide important insights into care quality, but health systems have difficulty using these data to improve care
Evidence suggests that organizations struggle to manage the data they collect and to make improvements based on patient experience feedback, and that clinicians often fail to change their practice based on patient experience feedback[1,2]
We aimed to identify the ways in which different types of patient experience feedback act as a trigger or prompt for engagement in reflection in clinical practice in acute hospital settings and identify important considerations for enhancing the value of patient experience data for reflective learning in clinical practice
Summary
Patient and staff experiences provide important insights into care quality, but health systems have difficulty using these data to improve care. It can be an individual or group activity.[10] It may happen ‘in action’ when an event gives immediate cause for thought or can be a deliberative process looking back ‘on action’ to generate new perspectives and intentions for change.[11] The idea that reflection will lead to learning and improvement is based on the work of Dewey from the 1930s12 and continued with models such as Schön and Gibbs designed to support reflective practice.[13,14,15,16] Whether reflection prompts learning and change has been questioned, some studies have identified changes in behaviour as a direct result of reflection taking place within clinical practice settings.[17,18,19,20] Reflective practice is mandated for most health professionals, with documented evidence of reflecting on patient and colleague feedback required for continuing professional development and revalidation. Objective: We aimed to identify the ways in which different types of patient experience feedback act as a trigger or prompt for engagement in reflection in clinical practice in acute hospital settings and identify important considerations for enhancing the value of patient experience data for reflective learning. Discussion: Patient experience feedback is multi-faceted, but our study suggests that all types of feedback could be harnessed more effectively to prompt reflection
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