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Kerry Kuluski, Michelle L A Nelson, C Shawn Tracy, Carole Ann Alloway, Charles Shorrock, Sara Shearkhani, Ross E G Upshur
We are grateful for the thoughtful discussion and ideas put forth in this issue on the measurement of healthcare experiences. Our colleagues, who span multiple jurisdictions across Canada and internationally, agree that we need to do a better job at engaging patients and families in their care and measuring their experiences across health services and sectors. In this response paper, we reflect on three core content areas that were identified across the eight papers in this issue: the role of context and engagement-capable environments; approaches to improve the measurement of experience and acting on results; and challenges that must be attended to in our quest to make our healthcare systems work better...
October 2017: HealthcarePapers
Rose McCloskey, Pamela Jarrett, Linda Yetman
Improving performance measurement within the Canadian healthcare system is proving to be challenging despite advances in evidence-informed care and best practices for healthcare delivery. Perhaps what is most challenging is the need to meet requirements to measure what most Canadians hold dear - being seen as a person during a healthcare encounter. Measures of healthcare delivery have typically been developed to capture patient satisfaction during isolated healthcare encounters. Such measures simply do not get to the essence of what matters to patients and their families...
October 2017: HealthcarePapers
Sabina Nuti, Sabina De Rosis, Manila Bonciani, Anna Maria Murante
Patient experience should be the starting point to achieve a high quality of care. Coherently, healthcare performance evaluation systems, driving the change in line with the main strategic goals, should be designed considering the patient perspective. Instead, they are traditionally defined according to the healthcare service provider's point of view. Consequently, they reproduce a "silo-vision" characterized by a clear separation of responsibilities limited to a specific setting of care or to a single organization...
October 2017: HealthcarePapers
Jennifer Quaglietta, Karyn Popovich
The measurement of the patient experience is a global movement that has caught the attention of healthcare reformers. The use of patient experience data to ameliorate healthcare practice is promising, although standardization in what, where, how and whose experience is measured does not yet exist. To truly further the patient experience agenda, there needs to be adoption at the system, regional and local level to help promote, inspire and lead to sustainable change. Caregiver insight into the patient experience should be leveraged to learn what is important to patients and extract more useful data, as they are often present during transitions in care that span across the continuum...
October 2017: HealthcarePapers
Malcolm B Doupe
I have reviewed with pleasure the article by Kuluski et al. (2017) who posit that measures of patient experience are required to more effectively guide healthcare reform. While I am generally in support of the original paper, I argue in this commentary that: (1) measuring patient engagement experience should not be done in isolation from broader change management processes; (2) care must be taken to ensure that measures of patient experience are developed with rigor and do not further complicate the already vast performance metrics literature and, (3) any revised set of performance metrics requires ongoing evaluation, to help ensure its optimal value...
October 2017: HealthcarePapers
Carole A Estabrooks
Kuluski et al.'s (2017) argument for including a more advanced form of health system performance management centred on "the experience of care," raises the major challenge of creating and sustaining engagement-capable environments. Here I briefly address frameworks that may be useful in meeting this challenge - Complex Adaptive Systems, Innovation Diffusion, Whole System Change. I also offer a personal perspective drawn from a successful citizen engagement experience, concluding with a perspective on the numerous challenges we have or are in the process of overcoming compared to the challenges of engagement-capable environments...
October 2017: HealthcarePapers
Anne Wojtak
Among the recommendations raised in the lead paper (Kuluski et al. 2017) for optimizing the utility of patient experience data are several important questions about the nature of person-centred care, the engagement of patients and caregivers in evaluating care and the need to address barriers to measurement. This commentary focuses on the concept that common approaches to measuring patient experience are reactive by design. To truly enhance our patients' experience, we must first connect with patients to understand what they want from their care experience...
October 2017: HealthcarePapers
Jon Glasby
In response to the lead article by Kuluski et al. (2017), this commentary draws on UK debates around the quality of healthcare and on the author's personal experience training as a social worker. Judging whether a service has "worked" has to involve understanding what a good outcome would be for the person receiving it. While carers provide important insights here, the "user" may have a different view, and reconciling different perspectives can be challenging. Although individual services may have fulfilled their part of the process, it is important to look at the person's overall experience (although this is difficult to achieve in practice)...
October 2017: HealthcarePapers
Sabrina T Wong, Sharon Johnston, Fred Burge, Kim McGrail, William Hogg
Performance measurement must be meaningful to those being asked to contribute data and to the clinicians who are collecting the information. It must be actionable if performance measurement and reporting is to influence health system transformation. To date, measuring patient experiences in all parts of the healthcare system in Canada lags behind other countries. More attention needs to be paid to capturing patients with complex intersecting health and social problems that result from inequitable distribution of wealth and/or underlying structural inequities related to systemic issues such as racism and discrimination, colonialism and patriarchy...
October 2017: HealthcarePapers
Kerry Kuluski, Michelle L A Nelson, C Shawn Tracy, Carole Ann Alloway, Charles Shorrock, Sara Shearkhani, Ross E G Upshur
People's experiences can provide critical guidance on how to better meet their quality of life and care needs and deploy resources more appropriately. To maximize the utility of experience data and to advance the current debate, we present four recommendations: (1) measuring experiences outside the healthcare system can provide insight into what needs to change within the healthcare system; (2) focusing on patient experience is necessary but insufficient, (family) caregiver insights and experiences require attention and can provide insight into the needs of the patient; (3) moving from "one time/single sector" measurement of experience to iterative, ongoing measurement across sectors better reflects the true lived experience of patients (especially those with complex care needs) and their caregivers; and (4) embedding measurement within engagement-capable environments that adequately resource patients, caregivers, and providers to work together is required to move from collection to meaningful change...
October 2017: HealthcarePapers
Jason M Sutherland
Patients' experiences with healthcare providers can be tumultuous and stressful. Focusing on what matters, the experience of care is important to improving patients' quality of life. In this issue's lead article, Kuluski and colleagues (2017) propose moving beyond setting-based patient experience measures. In doing so, the authors emphasize the importance of caregivers and the communities in which patients live in improving patients' and caregivers' care experiences. To achieve these aims, however, the authors demand a higher level of reflexivity from provinces' healthcare funders and providers...
October 2017: HealthcarePapers
Michael Gardam, Leah Gitterman, Liz Rykert, Elisa Vicencio, Erika Bailey
It is a pleasure to respond to the commentaries and we thank the authors for the thought, time and effort they so obviously put into their writing. We are excited that documenting our experience has resulted in such a wide range of opinion.
2017: HealthcarePapers
Suzie Bailey, Helen Bevan
Based on our own experiences leading healthcare improvement in the English National Health Service (NHS), we identify seven themes that connect with the story of front-line ownership (FLO): Create investors not buyers of change - "buy-in" is too late in the change process; We need to combine both technical and cultural aspects of change - go slow to go fast and make sure that we pay attention to the human dimensions of change; Build strong ties AND weak ties - reach out to your usual suspects AND find your unusual suspects and unlikely allies; If we want innovation, we need to create psychological safety - the conditions of trust and support that make people feel safe to try new things that might fail; Build energy for change for the long haul, right from the start of your change efforts - go beyond the typical "intellectual" energy and build "social" and "spiritual" energy that create strong foundations for change; Challenge "the myth of the disinterested" - everyone is passionate about something; The leader as coach and team member - be the leadership role model that enables change...
2017: HealthcarePapers
Maura Davies
The approach to front-line ownership proposed by Gardam et al. (2017) consists of many elements integral to most approaches to quality improvement. The mix of these elements may need to be modified in circumstances that have the most impact on patient safety, where a higher level of standardization may be essential and a more directive approach may be needed. The inclusion of patients as partners in quality improvement means that staff do not exclusively own the solutions and power must be shared with others whose views may be quite different...
2017: HealthcarePapers
Paul Plsek
Front-line ownership (FLO) is an approach to change that is consistent with what we know about complex adaptive systems (CAS), such as a healthcare organization. Traditional change approaches can fail because they are based in the "organization as a machine" metaphor of traditional, scientific management. Both metaphors have their application. It depends on how closely the work naturally resembles a predictable machine. Often, the drive for detailed standardization is a misguided effort to make a human CAS behave more like a machine, so that our traditional approaches to change will work...
2017: HealthcarePapers
Brian Robson
In their paper, Gardam et al. (2017) set out a series of case studies exemplifying their conceptual construct of front-line ownership (FLO). While the construct of FLO has face validity, in this commentary I urge further consideration of the "conditions" under which FLO will flourish which go beyond the principles set out by the authors. I also challenge the positioning of "standardization" and offer reflections that position "standardization to allow mass customization" to achieve person-centred goals...
2017: HealthcarePapers
Leslee J Thompson, Louise Clement
Collaboration is a powerful force of social change. History has shown us time and time again that when people come together with a shared passion for making things better, high impact change can happen. Minds are opened. Voices are heard. Lives are saved. Our experience at Health Standards Organization (HSO) and Accreditation Canada shows that when people feel involved, empowered and engaged in a meaningful way to bring about improvement, then the chances that it will be sustained over time increase as well...
2017: HealthcarePapers
Linda Hughes, Katarina R Busija, Esha Ray Chaudhuri, Ioana Cristina Popescu
As patient partners, we are pleased by the success of the front-line ownership (FLO) approach in advancing safe care in a variety of initiatives and settings. The FLO underlying principles and approach deeply resonate with us as illustrated in the following quotes from the paper: "Nothing about me without me," "Most passionate change agents are not in roles that typically get invited to participate," "Inviting anybody who is interested in the problem at hand," "FLO creates a way to break down hierarchies, increase positive dialogue between diverse players in organizations, and encourage people who may not have felt empowered previously to come forward and problem-solve...
2017: HealthcarePapers
Michael Gardam, Leah Gitterman, Liz Rykert, Elisa Vicencio
Front-line ownership (FLO) is a complexity science-based approach to leading change initiatives that is built upon a foundation of Positive Deviance and the use of Liberating Structures to engage others. In this paper, we outline the use of FLO in four successful patient safety or quality improvement projects in four countries. While the underlying principles guiding the use of FLO were the same for each of these projects, project goals, the types of roles involved and how the projects evolved, spread and were sustained, varied considerably between settings...
2017: HealthcarePapers
Chris Power
Over the next 30 years in Canada, it is estimated that there could be roughly 400,000 average annual cases of patient safety incidents, costing approximately $6,800 per patient and generating an additional $2.75 billion in healthcare treatment costs per year. What will it take to "crack the code" on creating safe environments and practice in healthcare?
2017: HealthcarePapers
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