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Promoting Clinical Excellence - Question 1

Patient experience is a National Health Authority quality and performance indicator to assess the quality of the healthcare services provided (AIHW, 2017). A patient experience survey tool is used to assess the healthcare facilities that are provided in the hospital setting to meet the care needs of the patient. Patient experience and satisfaction can be defined as a measure to the extent to which an individual is happy or content with the healthcare services provided (Government of Australia, 2015). The patient experience and satisfaction indicator for the quality and experience in healthcare is based upon various measures like experiences with getting their requirements heard, demonstration of respect, time spent with them for their care and improvement (Malpani et al., 2018). Patient experience is highly important and an important indicator in geriatric settings.

Patient satisfaction becomes a crucial indicator in the geriatric nursing setting as the elderly patients require both physical and psychological assistance for the management and treatment of the health condition. The patient satisfaction is measured through the self-reporting assessments. Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys are used with a standardized questionnaire and experience in the care setting based on different categories that help in the derivation of overall patient experience and satisfaction during the hospital stays (Sprague, 2014). These measurements are analyzed and then used to improve the patient experience in the clinical setting by working on the identified lacunas. This ensures that patient experience is critically considered and the quality of care provided to the patient is regularly improved.

Promoting Clinical Excellence - Question 2

Literature Review of Patient Satisfaction and Quality Assessment

Patient satisfaction and quality assessment play a crucial role in the policy-making of the hospitals and improvements of the care centres (Akasaki et al., 2018). To enhance the patient experience, collaborative efforts between the different levels of professionals in a healthcare setting is extremely important (Ikeda, 2017). A systematic review of this analysis was conducted by Lilleheie et al. (2019). The paper identifies that the elderly population is more vulnerable to the care facilities available and the quality of care provided as they possess multiple morbidity factors. Patient participation in the care facilities in a medical setting is also affected by government policies and plays a role in quality improvement (Ladin et al., 2017). The study included the patient experience and satisfaction from eighteen peer-reviewed studies and classified that the patient experience and satisfaction can be evaluated based on five themes.

These themes include complexity if the health of the patient, effective management and organization of the hospital routines, the established norm and the preference of the patients for returning home, challenges faced during the facilitation of care and communication in the care setting, and networking and team management of the hospital for the care experienced by the elderly patients. The study asserted that collaboration plays a key role in providing adequate safety and quality care in hospitals. The study also established that effective communication and regular follow-up from the patients also enhances the satisfaction and addresses the client-centred approach in care ensuring participation of the elderly patients.

The patient care quality, satisfaction, and discharge process were also studied by Bolge et al. (2018). The study was focused on an identified gap in healthcare quality and effective treatment. This included “lack of validated instruments that particularly measure quality in the hospital discharge process for the elderly”. Therefore, the study by Bolge et al. (2018) aimed to develop an assessment measure for the evaluation of patient satisfaction and quality of care for elderly patients during the discharge process. A qualitative survey was created by the researchers called the “Discharge Care Patient Experience Survey (DICARES)” that was used to derive the patient care quality and experience in the care setting. In the study, the mean age of the total of 270 participants was 77.1 years with 57.8% being male. The study resulted in the development of a comprehensive ten-item questionnaire. The reliability and the statistical significance of this questionnaire were also tested to ensure its significance for application in the healthcare setting. The researchers assert that this questionnaire can be used as an accessory tool for the improvement of the quality process in the hospitals and therefore can aid in the improvement of the patient satisfaction and overall quality of the healthcare facility.

A comprehensive cross-sectional analysis was performed by Chumbler et al. (2016) who examined the patient experience in older patients. The study also aimed to evaluate the difference in satisfaction levels among the male and female patients in the care setting. For this analysis, data from 6021 patients aged more than 65 years were collected using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. The data was collected through telephonic and personal interviews and multiple linear regression analysis were conducted to obtain results. The study concluded that the application of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey dimensions were composite and significantly associated with the overall satisfaction of the patients in the care setting.

The study reported that female patients had an overall greater satisfaction with the care facilities in the hospital. The elderly female patients reported that communication with the nurses helped in the establishment of greater satisfaction in the hospital setting for them. On the contrary, the study reported that the male patient’s communication with the doctors was extremely crucial and a determining factor for the overall satisfaction. Factors such as involvement of the patient in the decision-making process along with communication have also been identified as the essential aspects of the patient experience and satisfaction in the hospital settings (Tsakitzidis et al., 2016). The study was based on the data collected from 70 hospitals situated in the United States with more than 150000 healthcare-associated and 40,000 affiliated physicians in the setting. The researchers assert that their findings have also been in coherence with a similar study conducted by Bjertnaes et al. (2012) associated with the impact of communication in the patient satisfaction levels in the hospital setting. The study by Chumbler et al. (2016) also asserted that noise and sanitation in the hospital settings also affected the patient experience and the overall rates of satisfaction.

Hughes et al. (2019) provided a systematic analysis to accumulate various interventions to improve the experience of the elderly patients in the emergency department of the hospitals measured through the patient experience instruments. The study identified 21 involving older adults with the total number of 3132 individuals in consideration. The patient experience in the geriatric setting was found to be affected by the discharge planning, assessment units, referral for community services, communication, and focused area coordination. The study identified that a heterogeneous combination of tools to assess the patient experience and satisfaction were used in the studies.

The interventions that were found to be associated with the patient experience in high correlation included the role of the doctors and healthcare providers, the content of the communication and effectiveness of patient education, addressing the barriers to communication, wait times associated with the healthcare facilities application, addressing of the physical needs of the emergency care setting of the patients, and provision of care to the general elderly needs and care transitions for overall health care experience in the hospital setting. The study used a GRADE approach to evaluate the findings provided through various questionnaires collected in the studies. This analysis also aligns with a study by Shakerinia (2018) that asserts the importance of the significant interventions in the elderly care to ensure the overall improvement of the care services that are provided to enhance the patient satisfaction.

Promoting Clinical Excellence - Question 3

PDSA quality cycles stand for “Plan, Do, Study, and Act” (Leis & Shojania, 2017). The PDSA cycles serve to provide a model for the improvement on a small scale. The cycles are applied to access the change by applying it and observing the results, and then acting on the acquired learning of this process (Christoff, 2018). The PDSA cycles are mostly applied in action-based learning projects (Laverentz & Kumm, 2017). The PDSA cycle that can be applied for this study is as follows:

PDSA Cycle 1

Plan: The primary goal is to improve the quality of care and patient satisfaction in the geriatric clinical setting. This can be done by the development of strong communication and collaborative approach for the process of decision making in the clinical setting. The healthcare professionals will be briefed about the importance of communication and collaboration in the healthcare setting to improve their application and patient satisfaction 

Do: All the elderly patients in the hospital will be identified and will be allotted a primary care nurse to address the patient needs and establish strong communication with the patient. This nurse will be responsible for the collaboration with other healthcare team embers to ensure patient satisfaction. 

Study: The evaluation of this strategy will be done and the impact in improvement will be studied for patient satisfaction 

Act: The feedback from the patients and their carers will take to make amendments and make changes for further improvements in the strategy. 

PDSA Cycle 2

Plan: Based on the feedback, if lack of patient satisfaction will be observed due to 24X7 unavailability of the nurse, then further improvements would be required in establishing the required patient satisfaction levels in the clinical setting as the primary nurse allocated cannot ensure the availability round the clock and in absence of the care nurse, the patient needs would not be addressed adequately and this needs to be fixed.

Do: A rotational shift for the nurses will be established so that the availability of the personal carers with the elderly patient to ensure patient satisfaction. 

Study: The application of the amended strategy will be studied with an analytical approach. The results of patient satisfaction will be noted and evaluated and analysed. Further suggestions for the improvements will ask. 

Act: The feedbacks will be reported with an assessment of the improvements and the lacunas for further improvements in the strategy.

PDSA Cycle 3

Plan: Based on the feedback, if in case, improvements will be required in establishing strong communication links with the patient and demonstration of competency while addressing their needs for the enhancement of overall experience of the patients then, next PDSA will be run. The healthcare professionals will be trained for the competency and importance of cultural safety in the care facility. 

Do: A training session for the healthcare professionals for competency and communication skills will be organized. The skills of healthcare professionals will be improved and assessed to ensure maximum patient satisfaction. 

Study: The impact of the training sessions will be assessed through the assessment of the healthcare professionals and via patient feedback. 

Act: The results obtained will be evaluated and analysed. A significant improvement in patient satisfaction is expected to be observed through the demonstration of strong communication skills and competency by the carers. The formal guidelines and policy for this strategy to improve patient satisfaction will be established 

Promoting Clinical Excellence - Question 4

The process of assessment and quality improvement requires identification of the loopholes in the overall quality program, perform the suitable investigations that can help in the development of improvement strategies and focusing on the proactive approaches during the quality development program (DeVore et al., 2017). The indicator chosen in this study is “patient experience and satisfaction” The quality assessment of this indicator can be done by performing surveys and gaining the information from the patients. It is important to ensure that the patients get the highest quality care in the hospital through combinatorial efforts of the healthcare professionals (Martin et al., 2017). The Australian Charter of healthcare rights asserts that quality care is a fundamental right of the patient (Martin, 2018).

Since patient satisfaction and experience is associated with various factors, it is important to identify the core responsible factors through the published and primary analysis that can help in the development of a suitable strategy. The data collected from the patients regarding the care experience and satisfaction must be rigorously analysed to identify the existing lacunas and work on them to improve the quality and the experience (DeVore et al., 2017). The feedback must be collected at different stages to ensure that the patient needs are essentially catered to and the maximum satisfaction is provided through care services. Assessment of the applied interventions for quality improvement must also be done regularly to ensure the efficacy of the strategies and development based on feedback (Martin et al., 2017).

References for Promoting Clinical Excellence

AIHW (2017). OECD health-care quality indicators for Australia 2015. Canberra: AIHW. Retrieved from: https://www.aihw.gov.au/reports/international-comparisons/oecd-health-care-quality-indicators-2015/contents/table-of-contents

Akasaki, Y., Ikeda, Y., Sasaki, T., Kuwahata, S., Sasaki, Y., & Ohishi, M. (2018). A13127 Questionnaire Survey from the viewpoint of concordance in patient and physician satisfaction concerning hypertensive treatment in elderly patients (patients voice study). Journal of Hypertension, 36, 324.

Bjertnaes, O. A., Sjetne, I. S., Iversen, H. H. (2012). Overall patient satisfaction with hospitals: Effects of patient-reported experiences and fulfillment of expectations. BMJ Quality & Safety, 21(1), 39-46

Boge, R. M., Haugen, A. S., Nilsen, R. M., & Harthug, S. (2018). Elderly patients’(≥ 65 years) experiences associated with discharge; Development, validity and reliability of the Discharge Care Experiences Survey. PloS One, 13(11).

Christoff, P. (2018). Running PDSA cycles. Current Problems in Pediatric and Adolescent Health Care, 48(8), 198-201.

Chumbler, N. R., Otani, K., Desai, S. P., Herrmann, P. A., & Kurz, R. S. (2016). Hospitalized older adults’ patient satisfaction: Inpatient care experiences. Sage Open, 6(2), 2158244016645639.

DeVore, J., Clontz, A., Ren, D., Cairns, L., & Beach, M. (2017). Improving patient satisfaction with better pain management in hospitalized patients. The Journal for Nurse Practitioners, 13(1), 23-27.

Government of Australia (2015). Assessment of patient satisfaction: Consumer Assessment of Healthcare Providers and Systems. 

Hughes, J. M., Freiermuth, C. E., Shepherd‐Banigan, M., Ragsdale, L., Eucker, S. A., Goldstein, K., ... & Tabriz, A. A. (2019). Emergency department interventions for older adults: a systematic review. Journal of the American Geriatrics Society, 67(7), 1516-1525.

Ikeda, Y. (2017). Switching insufficient hypotensive monotherapy to arb/ccb combination tablet in elderly patients increases both patient and physician satisfaction rates and contributes better patient-physician concordance (patients voice study). Hypertension, 70(1), 385-385.

Ladin, K., Lin, N., Hahn, E., Zhang, G., Koch-Weser, S., & Weiner, D. E. (2017). Engagement in decision-making and patient satisfaction: A qualitative study of older patients' perceptions of dialysis initiation and modality decisions. Nephrology Dialysis Transplantation, 32(8), 1394-1401.

Laverentz, D. M., & Kumm, S. (2017). Concept evaluation using the PDSA cycle for continuous quality improvement. Nursing Education Perspectives, 38(5), 288-290.

Leis, J. A., & Shojania, K. G. (2017). A primer on PDSA: executing plan–do–study–act cycles in practice, not just in name. BMJ Quality &Safety, 26(7), 572-577.

Lilleheie, I., Debesay, J., Bye, A., & Bergland, A. (2019). Experiences of elderly patients regarding participation in their hospital discharge: A qualitative metasummary. BMJ Open, 9(11).

Malpani, R., Hilibrand, A. S., & Grauer, J. N. (2018). Evolution and use of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys and their application for spinal surgery patients. Contemporary Spine Surgery, 19(5), 1-6.

Martin, B. (2018). An experience with open disclosure. Australian Nursing and Midwifery Journal, 25(11), 34-34.

Martin, N. M., Odeh, K., Boujelbane, L., Rijhwani, M. V., Olet, S., Noor, A., ... & Battiola, R. (2017). positive impact on patient satisfaction and caregiver identification using team facecards: A quality improvement study. Journal of Patient-Centered Research and Reviews, 4(4), 263.

Shakerinia, I. (2018). Relationship between nursing students' communication skills with Perceived quality of care by elderly patients. Quarterly Journal of Geriatric Nursing, 2(4), 22-34.

Sprague, L. (2014). Consumer Assessment of Healthcare Providers and Systems (CAHPS) Surveys: Assessing patient experience. 

Tsakitzidis, G., Timmermans, O., Callewaert, N., Verhoeven, V., Lopez-Hartmann, M., Truijen, S., ... & Van Royen, P. (2016). Outcome indicators on interprofessional collaboration interventions for elderly. International Journal of Integrated care, 16(2).

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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