Patient experiences: a systematic review of quality improvement interventions in a hospital setting

Figures & data

Figure 1 Flowchart literature search.

Table 1 Study characteristics

Author/Year	Setting	Design and size	PE assessment method(s) and PE topic(s) to be improved
Ahrens and Wirges^Citation39(2013)	Neuro-medical surgery, US	Pre–post design n=60 pre vs 61 post	Survey (H-CAHPS) Medication side-effects
Bellamkonda et al^Citation32(2016)	Emergency department, US	Pre–post design n=193 pre vs 45 post	Survey (Point-of-service cards) Provider compassion
Bookout et al^Citation28(2016)	Cardiac telemetry, US	Pre-post design n=N/R	Survey (H-CAHPS) Pain management
Davies et al^Citation37(2007)	N/A, UK	Pre–post design n=N/R	Survey (Modified CAHPS) Overall patient experiences
Indovina et al^Citation23(2015)	General internal medicine, US	RCT n=35 pre vs 30 post	Survey (H-CAHPS) Provider specific experiences
Jayasinha^Citation33(2016)	Pediatrics, US	Pre–post design n=94 pre vs N/R post	Survey (self-developed) Cycle time
Jiang et al^Citation38(2016)	Otolaryngology surgery, US	Pre–post design n=17 pre vs 10 post	Survey (S-CAHPS) Enough time, involvement and respect
Kamiya et al^Citation24(2017)	N/A, TZ	RCT n=1,101 pre vs 1,070 post	Survey (self-developed) Communication, confidence and trust
Kane et al^Citation30(2015)	Emergency department, US	Pre–post design n=N/R	Survey (Press Ganey survey) Crowding
Khan et al^Citation34(2014)	Neurosurgery, UK	Pre–post design n=150 pre vs 150 post	Survey (self-developed) Communication
Maqbool et al^Citation35(2016)	Orthopedics, plastics, CA	Pre–post design n=42 pre vs 20–25 post	Survey (self-developed) Stress levels related to waiting
Nieboer et al^Citation26(2014)	N/A, NL	Longitudinal study n=140 pre vs 177 post	Survey (Mind the GAP scale) Transitional care delivery
Norgaard et al^Citation40(2012)	Orthopedics, DK	Pre–post design n=1,279 pre vs 1,854 post	Survey (ISRF) Communication
Norton et al^Citation31 (2014)	N/A, UK	Pre–post design n=749 pre vs 783 post	Survey (self-developed), interviews Sleep disturbance
Pratt et al, 2011^Citation21(2011)	Pediatric intensive care, UK	Qualitative study n=4 families pre vs 8 parents post	Informal interviews Admission to healthcare
Reeves et al^Citation25(2013)	N/A, UK	RCT n=987 pre vs 648 post	Survey (NHS Adult inpatient questionnaire) Nursing care
Roberts^Citation41(2013)	Physiotherapy, UK	Pre–post design n=100 pre vs 349 post	Survey (CSP’s patient feedback questionnaire) Overall patient experience
Ugarte^Citation22 (2015)	N/A, UK	Qualitative study n=76 pre vs 106 post	Narrative stories, survey (FFT), interviews Waiting time
Van Houdt et al^Citation27(2013)	Radical prostatectomy pathway, BE	Pre–post design n=46 pre vs 46 post	Survey (self-developed) Coordination between caregivers
Waldhausen et al^Citation29(2009)	Surgery, US	Pre–post design n=N/R	Survey (Picker Questionnaire) Waiting and value added time
Wilson et al^Citation42(2017)	Medical oncology, surgery, US	Pre–post design n=N/R pre vs 27 post Interviews n=30 pre vs 30 post	Survey (H-CAHPS), interviews Hospital environment noise at night

Abbreviations: BE, Belgium; CA, Canada; CSP, the chartered society of physiotherapy; DK, Denmark; FFT, family and friends test; H-CAHPS, hospital consumer assessment of healthcare providers and systems; ISRF, interpersonal skills rating form; NHS, national health service; N/A, not applicable; NL, the Netherlands; PE, patient experiences; S-CAHPS, consumer assessment of healthcare providers and systems surgical care survey; TZ, Tanzania; UK, United Kingdom; US, United States.

Table 2 CASP quality assessment of included papers

First author	1	2	3	4	5	6	7	8	9	10
Ahrens^Citation39	Yes	Yes	Yes	Yes	Yes	Can’t tell	Yes	No	Yes	Valuable
Bellamkonda^Citation32	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	No	Unclear
Bookout^Citation28	Yes	Yes	Yes	Can’t tell	Yes	Can’t tell	Can’t tell	No	No	Valuable
Davies^Citation37	Yes	Yes	Yes	Yes	Yes	Can’t tell	Yes	No	Yes	Valuable
Indovina^Citation23	Yes	Yes	Yes	Yes	Yes	Can’t tell	Yes	No	Yes	Valuable
Jayasinha^Citation33	Yes	Yes	Yes	Yes	Yes	Can’t tell	Can’t tell	No	No	Unclear
Jiang^Citation38	Yes	Yes	Yes	Yes	Yes	Can’t tell	Yes	Yes	Yes	Valuable
Kamiya^Citation24	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Valuable
Kane^Citation30	Yes	Yes	Yes	Can’t tell	Yes	Can’t tell	Can’t tell	No	Yes	Valuable
Khan^Citation34	Yes	Yes	Yes	Yes	Yes	Yes	Can’t tell	No	No	Valuable
Maqbool^Citation35	Yes	Yes	Yes	Yes	Yes	Can’t tell	Yes	No	No	Valuable
Nieboer^Citation26	Yes	Yes	Yes	Yes	Yes	Can’t tell	Yes	No	Yes	Valuable
Norgaard^Citation40	Yes	Yes	Yes	Yes	Yes	Can’t tell	Yes	No	Yes	Valuable
Norton^Citation31	Yes	Yes	Yes	Can’t tell	Yes	Can’t tell	Yes	Yes	Yes	Valuable
Pratt^Citation21	Yes	Yes	Yes	Can’t tell	Yes	Can’t tell	Can’t tell	Yes	No	Unclear
Reeves^Citation25	Yes	Yes	Yes	Yes	Yes	Can’t tell	Yes	Yes	No	Valuable
Roberts^Citation41	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Valuable
Ugarte^Citation22	Yes	Yes	Yes	Can’t tell	Yes	Can’t tell	Yes	Can’t tell	Yes	Valuable
Van Houdt^Citation27	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Valuable
Waldhausen^Citation29	Yes	Yes	Yes	Can’t tell	Yes	Can’t tell	Can’t tell	Yes	Yes	Valuable
Wilson^Citation42	Yes	Yes	Yes	Yes	Yes	Can’t tell	Yes	No	Yes	Valuable

Notes: 1) Was there a clear statement of the aims of the research? 2) Is a qualitative/quantitative methodology appropriate? 3) Was the research design appropriate to address the aims of the search? 4) Was the recruitment strategy appropriate to the aims of the research? 5) Was the data collected in a way that addressed the research issue? 6) Has the relationship between researcher and participants been adequately considered? 7) Have ethical issues been taken into consideration? 8) Was the data analysis sufficiently rigorous? 9) Is there a clear statement of findings? 10) How valuable is the research?

Table 3 Interventions and results

First author	PE topic: Outcome measure(s)	Main QI method and intervention (theoretical model, tool)	Number of statistically significant pre/post comparisons; significant results in words
Ahrens^Citation39	Medication side-effects: understanding the description of medication	Patient education: information brochure/website; Staff education: communication skills; Clinician reminders: repeated communications through work- and e-mail	N/R
Bellamkonda^Citation32	Provider compassion: receiving compassionate care	Organization change: survey cards and sending a follow-up letter; Staff education: communication skills of shared decision-making; Patient education: giving information by staff (Lean, Kano)	1/1; Improvement in perceived concern and sensitivity
Bookout^Citation28	Pain management: experienced pain management; overall patient experience	Organization change: implementation of a patient and family advisory council and comfort carts	N/R
Davies^Citation37	Overall patient experiences: kept informed of a clinic wait; taken to exam room within 15 minutes; schedule appointment when needed; treated with courtesy and respect by staff; received follow-up of test results; doctor is informed and up-to-date; rating of doctor’s knowledge of medical history; patients see their personal doctor; understandable explanation by doctor; understanding/satisfaction with FU-plan	Organization change: redesigning processes and better information; Staff education: communication skills; Audit and feedback: patient and staff evaluations and focus groups (The CAHPS improvement guide)	1/15; More patients were taken to the exam room within 15 minutes
Indovina^Citation23	Provider specific experiences: overall hospital rating; courtesy/respect; clear communication; listening	Staff education: communication skills; Audit and feedback: real time patient feedback	1/4; The overall hospital rating was higher in the intervention group than in the control group
Jayasinha^Citation33	Cycle-time: overall cycle time; friendliness of staff, nurses, and front desk	Organization change: relocation of staff and revise unnecessary processes (Lean Six Sigma)	N/R
Jiang^Citation38	Overall patient experience; did the provider spend enough time with you; did the provider encourage you to ask questions; did the provider show respect for what you had to say	Organization change: new procedure of scheduling post-operative appointments; Clinician reminders: a list of standardized questions in each clinic room? (Lean, A3)	4/6; 2 weeks post-intervention: improvement of provider spend time with the patient; encourage to ask questions; show respect for what the patient had to say 2 months post-intervention: provider showed more respect for what the patient had to say
Kamiya^Citation24	Communication: enough time to discuss; reason for treatment; listen; get answers; confidence and trust; reason of test; how to take medication; purpose of medication; side-effect	Organization change: redesigning workspaces and reorganize processes and procedures; Staff education: training of the 5S (Lean, 5S)	1/10; Improvement in understandable explanation by health worker about test results
Kane^Citation30	Crowding: likelihood to recommend (percentile); waiting time to see doctor (percentile); informed about delays (percentile)	Staff education: rapid process improvement workshop; Organization change: 5S workshop and value stream mapping; Audit and feedback: data sharing with visibility walls (Lean, 5S)	N/R
Khan^Citation34	Communication: mean experience with surgeons/junior doctors/nurses/hospital service	Organization change: optimizing staff collaboration Staff education: communication skills (Plan Do Study Act)	2/4; Improved experience with junior doctors and nurses
Maqbool^Citation35	Waiting experience: Stressful waiting process	Organization change: floor signage and navigation guide (Plan Do Study Act)	1/1; Reduction in patient stress levels
Nieboer^Citation26	Transitional care delivery: staff knows how to talk and listen to teenagers; treats as an individual and understands needs; staff understands realities of being a teenager; providers work well together; interested in me as a person, not just the illness; make own decisions about healthcare options; opportunities to be seen in the clinic alone; provides info to other involved professionals; decide who is in consultation/examination room; helps prepare for move to adult services; helps plan for future; providers arrange joint appointments hours; helps improve independence with action plan; does not waste my time at the clinic; staff to talk about sensitive or difficult issues; staff member coordinating my transitional care	Patient education: group education; Promotion of self- management: the completion of an individual transition plan; Organization change: optimizing caregiver consultation; Policy Change; joint policies to align procedures and treatment; Clinician reminders: formats and instruments for intervention (Breakthrough Series improvement and implementation strategy)	2/16; Improved provision of opportunities for adolescents to visit the clinic alone and to decide who should be present during consultations
Norgaard^Citation40	Communication: doctor/nurse/nursing assistant prepared for interview; understandable language doctor/nurse/nursing assistant; opportunity explain problem to doctor/nurse/nursing assistant; doctor/nurse/nursing assistant explain examination/treatment; doctor/nurse/nursing assistant explain future plans; satisfied with information from doctor/nurse/nursing assistant; coherent information from doctors/nurse/nursing assistant; overall information received coherent; experience kindness and obligingness; doctors/nurse/nursing assistant enough time; involved in care and treatment	Staff education: communication skills	15/19; Improved preparation for interview of nurses/nursing assistants; understandable language of doctor/nurse/nursing assistant; opportunity to explain problems to nurse/nursing assistant; explanation of examination/treatment and future plans by nurse/nursing assistant; satisfaction with information from doctor/nurse/nursing assistant; coherent information from doctors/nurse/nursing assistant; coherent received overall information; experience of kindness and obligingness; time with doctors/nurse/nursing assistant/time and involvement in care and treatment
Norton^Citation31	Sleep disturbance: patient rating of sleep	Audit and feedback: ward-specific patient feedback Staff education: ward-specific action plan; Organization change: window blinds instalment and reduce noise; Clinician reminders: text notifications by posters and telephone	1/1; Improved ratings of sleep
Pratt^Citation21	Admission to healthcare: experiences of parents about the use of a structured checklist to ensure a successful admission	Clinician reminders: new admission checklist; Organization change: a pre- admission key-member of staff	N/A
Reeves^Citation25	Nursing care: basic feedback or control vs feedback plus	Audit and feedback: ward-specific patient feedback; Staff education: ward-specific action plan	1/1; Nursing care is improved more for Feedback Plus than Basic Feedback or Control
Roberts^Citation41	Overall patient experience of physiotherapy care: 37 items of patient experiences from initial contact to discharge	Audit and feedback: ward-specific patient feedback; Staff education: ward-specific action plan; Clinician reminders: item on the agenda of a departmental meeting	8/37; Improved choices of appointment times; addressment by the name of choice; change to say what was on the mind; listening to the patient; choice of options for treatment; information of possible achievements; satisfaction with care; involvement in deciding about treatment plan
Ugarte^Citation22	Waiting time: overall patient experience of waiting time; time spend in the clinic	Organization change: new appointment scheduling profile (Plan Do Study Act)	N/R, N/A
Van Houdt^Citation27	Coordination between caregivers: specialist/GP familiar with recent medical history; GP aware of results of surgery; GP aware of recommended treatment; GP had information to make treatment decision; received info you wanted about condition/treatment; contradictory info in hospital; contradictory info from caregivers at home; contradictory info between caregivers; you knew who to ask if anxious or worried; you knew who to contact if you experienced problems; received a clear/understandable response to questions; you knew what the next step in your care would be; home care staff worked well together; home care staff made good agreements; caregivers aware of special conditions/needs	Organization change: Implementation of a care pathway (30-step-scenario)	0/16
Waldhausen^Citation29	Waiting and value added time: overall patient experience of value-added time with provider	Staff education: rapid process improvement workshop; Organization change: standardization of exam rooms and revise unnecessary processes (Lean, 5S)	1/1; Improved overall patient experience
Wilson^Citation42	Hospital environment noise at night	Staff education: purposeful rounding to inform patients and the use of a flashlight; Clinician reminders: visual aids for staff (Kotter’s model of change)	N/R

Abbreviations: N/R, not reported; N/A, not applicable.

Figure 2 QI initiative.

Ahrens SL, Wirges AM. Using evidence to improve satisfaction with medication side-effects education on a Neuro-medical surgical unit. J Neurosci Nurs. 2013;45(5):281–287. doi:10.1097/JNN.0b013e31829d8ca524025467

 PubMed Web of Science ®Google Scholar

Bellamkonda VR, Kumar R, Scanlan-Hanson LN, et al. Pilot study of kano “attractive quality” techniques to identify change in emergency department patient experience. Ann Emerg Med. 2016;68(5):553–561. doi:10.1016/j.annemergmed.2016.02.00527125817

 PubMed Web of Science ®Google Scholar

Bookout ML, Staffileno BA, Budzinsky CM. Partnering with a patient and family advisory council to improve patient care experiences with pain management. J Nurs Adm. 2016;46(4):181–186. doi:10.1097/NNA.000000000000032826963442

 PubMed Web of Science ®Google Scholar

Davies E, Shaller D, Edgman‐Levitan S. Evaluating the Use of a Modified CAHPS® Survey to Support Improvements in Patient‐Centred Care: Lessons from a Quality Improvement Collaborative. Health Expect. 2008;11(2):160–176. doi:10.1111/j.1369-7625.2007.00483.x.

 Google Scholar

Indovina K, Keniston A, Reid M, et al. Real-time patient experience surveys of hospitalized medical patients. J Hosp Med. 2016;11(4):251–256. doi:10.1002/jhm.253326777721

 PubMed Web of Science ®Google Scholar

Jayasinha Y. Decreasing turnaround time and increasing patient satisfaction in a safety net hospital-based pediatrics clinic using lean six sigma methodologies. Qual Manag Health Care. 2016;25(1):38–43. doi:10.1097/QMH.000000000000008326783866

 PubMed Web of Science ®Google Scholar

Jiang N, Malkin BD. Use of lean and CAHPS surgical care survey to improve patients’ experiences with surgical care. Otolaryngol Head Neck Surg. 2016;155(5):743–747. doi:10.1177/019459981665705127329420

 PubMed Web of Science ®Google Scholar

Kamiya Y, Ishijma H, Hagiwara A, Takahashi S, Ngonyani HAM, Samky E. Evaluating the impact of continuous quality improvement methods at hospitals in Tanzania: A cluster-randomized trial. Int J Qual Health Care. 2017;29(1):32–39. doi:10.1093/intqhc/mzw12827920249

 PubMed Web of Science ®Google Scholar

Kane M, Chui K, Rimicci J, et al. Lean manufacturing improves emergency department throughput and patient satisfaction. J Nurs Adm. 2015;45(9):429–434. doi:10.1097/NNA.000000000000022826252725

 PubMed Web of Science ®Google Scholar

Khan A, Naushad Chaudhry M, Khalid S, Nandi D. Improvement of Patient Satisfaction with the Neurosurgery Service at a Large Tertiary Care, London-Based Hospital. BMJ Qual Improv Rep 2014;3(1). doi:10.1136/bmjquality.u203956.w1881.

 Google Scholar

Maqbool T, Raju S, In E. Importance of Patient-Centred Signage and Navigation Guide in an Orthopaedic and Plastics Clinic. BMJ Qual Impron Rep.2016;5(1). doi:10.1136/bmjquality.u209473.w3887.

 Google Scholar

Nieboer AP, Cramm JM, Sonneveld HM, Roebroeck ME, van Staa A, Strating MM. Reducing bottlenecks: professionals‘ and adolescents‘ experiences with transitional care delivery. BMC Health Serv Res. 2014;14:47. doi:10.1186/1472-6963-14-4724485282

 PubMed Web of Science ®Google Scholar

Nørgaard B, Kofoed PE, Ohm Kyvik K, Ammentorp J. Communication skills training for health care professionals improves the adult orthopaedic patient‘s experience of quality of care. Scand J Caring Sci. 2012;26(4):698–704. doi:10.1111/j.1471-6712.2012.00982.x22420418

 PubMed Web of Science ®Google Scholar

Norton C, Flood D, Brittin A, Miles J. Improving sleep for patients in acute hospitals. Nurs Stand. 2015;29(28):35–42. doi:10.7748/ns.29.28.35.e8947

 Google Scholar

Pratt K, Baird G, Gringras P. Ensuring successful admission to hospital for young people with learning difficulties, autism and challenging behaviour: a continuous quality improvement and change management programme. Child Care Health Dev. 2012;38(6):789–797. doi:10.1111/j.1365-2214.2011.01335.x22017703

 PubMed Web of Science ®Google Scholar

Reeves R, West E, Barron D. Facilitated patient experience feedback can improve nursing care: a pilot study for a phase III cluster randomised controlled trial. BMC Health Serv Res. 2013;13:259. doi:10.1186/1472-6963-13-43823826970

 PubMed Web of Science ®Google Scholar

Roberts L. Improving quality, service delivery and patient experience in a musculoskeletal service. Man Ther. 2013;18(1):77–82. doi:10.1016/j.math.2012.04.01022609270

 PubMed Web of Science ®Google Scholar

Ugarte M. Waiting time reduction in intravitreal clinics by optimization of appointment scheduling: balancing demand and supply. BMJ Open Qual. 2015;4:u208924–w3618.

 Google Scholar

Van Houdt S, Heyrman J, Vanhaecht K, Sermeus W, De Lepeleire J. Care pathways to improve care co-ordination and quality between primary and hospital care for patients with radical prostatectomy: a quality improvement project. Qual Prim Care. 2013;21(3):149–155.23968264

 PubMedGoogle Scholar

Waldhausen JH, Avansino JR, Libby A, Sawin RS. Application of lean methods improves surgical clinic experience. J Pediatr Surg. 2010;45(7):1420–1425. doi:10.1016/j.jpedsurg.2009.10.04920638518

 PubMed Web of Science ®Google Scholar

Wilson C, Whiteman K, Stephens K, Swanson-Biearman B, LaBarba J. Improving the patient‘s experience with a multimodal quiet-at-night initiative. J Nurs Care Qual. 2017;32(2):134–140. doi:10.1097/NCQ.000000000000021927479519

 PubMed Web of Science ®Google Scholar