Enhance Patient Experience Research Articles

QA4 IS THE AIM OF THE HEALTH CARE SYSTEM TO MAXIMISE QALYS? AN INVESTIGATION OF ‘WHAT ELSE MATTERS’ IN THE NHS

Background: It is often assumed that the objective of health care is to maximise health using available resources. This is the principle underpinning NICE’s use of cost effectiveness analysis based on incremental cost per QALY gained. Yet research on local NHS decision making shows that cost per QALY is far from the only consideration. Similarly, many key national health policy initiatives appear to be driven primarily not by QALY gain, but by ‘process‐of‐care’ and other considerations. The apparent disjunction between the goals being pursued by different agencies within the health care system has potentially important implications for efficiency. Objective: While the criteria used by NICE are well understood, the principles underpinning policy evaluation by the Department of Health (DH) have not previously been subject to any systematic enquiry. Since 2008, the DH has been required to undertake and publish Impact Assessments (IAs) identifying the costs and benefits expected from all new policy implementation. The aim of this study is to identify the benefits considered by the DH as relevant to its decision making, and to highlight implications for decision making across the NHS. Methods: We analyse all IAs carried out by the DH in 2008 and 2009. The stated benefits of each policy were extracted and a combination of methods used to categorise these. Other DH documents were consulted for information on the means by which these benefits are valued. Results: 51 IAs were analysed, 8 of which mentioned QALY gains as a benefit. 18 benefits other than QALY gains were identified. Apart from improving health outcomes, commonly referred to types of benefit included: reducing costs, improving quality of care, and enhancing patient experience and empowerment. Many of the policies reviewed were implemented on the basis of benefits unrelated to health outcome. The methods being used to apply a monetary valuation to QALY gains (in IA cost‐benefit calculations) are not consistent across IAs or with NICE’s stated threshold range. Conclusions: The DH, local NHS commissioners of health care and NICE each appear to approach resource allocation decisions in different ways, based upon different considerations and underlying principles. Given that all these decisions affect the allocation of a fixed health care budget, there is a case for establishing a uniform framework for option appraisal and priority setting.

Addressing the Need for Improved Patient and Nurse Education on Subcutaneous Immunoglobulin: Enhancing Patient Experiences and Nurse Support

RATIONALE: Nursing school curriculums currently do not provide training for subcutaneous immunoglobulin (SCIG) infusion therapy, and educational materials by SCIG manufacturers for nurses and patients with primary immunodeficiency (PI) are not sufficient. This has lead to suboptimal patient experiences, which may contribute to reduced adherence to therapy and increased side effects. To address this unmet need, a panel of nurses was convened to develop a comprehensive self- administration educational tool for both patients and nurses who are unfamiliar with SCIG therapy.

Erlotinib: Introducing a collaborative approach to enhance patient experience

Erlotinib: Introducing a collaborative approach to enhance patient experience

Looking Ahead: The Use of Prospective Analysis to Improve the Quality and Safety of Care

Patient safety and quality are paramount at Lakeridge Health, in Durham, Ontario. The use of prospective analysis has provided us with the opportunity to understand systemic issues in a hospital organization and, as such, to implement sustainable changes that are meaningful to staff and will ensure an enhanced patient experience. To complement Accreditation Canada required organizational practices and a commitment to continuous quality improvement, Lakeridge Health has recognized how an inter-professional approach, staff engagement and use of quality tools support the focus on quality and safety. The implementation of best practices (both clinical and administrative processes) has been possible as a direct result of using this approach. This article outlines three case studies representing different applications of the prospective analysis methodology: ensuring safety with endoscopy processes, minimizing risk in narcotic administration and enhancing infection control practices. In each case, the methodology of prospective analysis was used to ensure the implementation of sustainable change that spans all sites in a multi-sited health facility. This article also includes lessons learned in an effort to understand and implement this quality methodology in healthcare.

What are the experiences of patients waking from fast-track

Nationally, the majority of cardiac surgery centres practise some type of rapid recovery or fast-track (FT) system in which low-risk cardiac surgical patients are extubated quickly following surgery to relieve the pressure on scarce critical care resources and improve patient outcome. In order to facilitate early extubation, FT patients often receive less sedative and analgesic medication than their conventionally-recovered counterparts while in the intensive care environment. Research was undertaken into the initial waking experiences of these patients as the intensive care unit (ICU) is well recognized to be a stressful place. This phenomenological study highlights that nurses play a vital role during the immediate post-operative period that goes beyond the more widely-recognized technical aspects of their role. The results of this study could be used by nurses to enhance patient experiences and potentially lead to improved physical and psychological outcomes for FT cardiac surgical patients in the future.

Patient-Centred Measures in Dental Practice: 3. Patient Satisfaction

This, the final paper in this three-part series, looks at how patients evaluate the dental care they receive and how this translates into either satisfaction, dissatisfaction or something in between. It explains how it might be possible to manage patient expectations so that patients are more likely to be satisfied with all aspects of the care provided and describes a framework for dentists and staff to use when trying to enhance patient experience in everyday dental practice. By better understanding the concept of 'patient satisfaction' dentists can develop strategies that take into account the way patients evaluate the quality of their own dental care.

Smooth workflow enhances patient experience

Smooth workflow enhances patient experience

A pilot project to design, implement and evaluate an electronic integrated care pathway

The project focused on the design, implementation and evaluation of an electronic integrated care pathway (eICP), within a Mother and Baby Unit. Health care professionals and service users (stakeholders) were involved in the process in order to promote patient centred, co-constructed care. Questionnaire and discussion groups were used for data collection regarding the initial eICP development. Of 15 participants who took part in the design and development of the eICP, seven were able to take part in the evaluation process on the Unit. Results show that 100% (n = 7) of the participants were in agreement with the eICP and the format that was produced and implemented for trial on the Unit. Increased ownership of records, greater multi disciplinary involvement and enhanced patient experience were also reported. Recommendations for clinical practice include resource management, ownership of the research group, holism maintenance and the acquisition of computer skills.