Authors: Davies, Elizabeth¹; Shaller, Dale²; Edgman-Levitan, Susan³; Safran, Dana G⁴; Oftedahl, Gary⁵; Sakowski, John⁶; Cleary, Paul D⁷

Source: Health Expectations, Volume 11, Number 2, June 2008 , pp. 160-176(17)

Publisher: Wiley-Blackwell

Abstract:

Objectives 

To evaluate the use of a modified Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey to support quality improvement in a collaborative focused on patient-centred care, assess subsequent changes in patient experiences, and identify factors that promoted or impeded data use. Background 

Healthcare systems are increasingly using surveys to assess patients' experiences of care but little is established about how to use these data in quality improvement. Design 

Process evaluation of a quality improvement collaborative. Setting and participants 

The CAHPS team from Harvard Medical School and the Institute for Clinical Systems Improvement organized a learning collaborative including eight medical groups in Minnesota. Intervention 

Samples of patients recently visiting each group completed a modified CAHPS® survey before, after and continuously over a 12-month project. Teams were encouraged to set goals for improvement using baseline data and supported as they made interventions with bi-monthly collaborative meetings, an online tool reporting the monthly data, a resource manual called The CAHPS® Improvement Guide, and conference calls. Main outcome measures 

Changes in patient experiences. Interviews with team leaders assessed the usefulness of the collaborative resources, lessons and barriers to using data. Results 

Seven teams set goals and six made interventions. Small improvements in patient experience were observed in some groups, but in others changes were mixed and not consistently related to the team actions. Two successful groups appeared to have strong quality improvement structures and had focussed on relatively simple interventions. Team leaders reported that frequent survey reports were a powerful stimulus to improvement, but that they needed more time and support to engage staff and clinicians in changing their behaviour. Conclusions 

Small measurable improvements in patient experience may be achieved over short projects. Sustaining more substantial change is likely to require organizational strategies, engaged leadership, cultural change, regular measurement and performance feedback and experience of interpreting and using survey data.

Keywords: patient survey data; patient's views; patient-caregiver relationships; patient-centred care; quality improvement

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1369-7625.2007.00483.x

Affiliations: 1: Senior Lecturer in Cancer Registration, King's College London School of Medicine, Thames Cancer Registry, London, UK 2: Principal, Shaller Consulting, Stillwater, MN, USA 3: Executive Director, The John D Stoeckle Center for Primary Care Innovation, Boston, MA, USA 4: Director, The Health Institute, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA, USA 5: Medical Director, Institute for Clinical Systems Improvement, Bloomington, MN, USA 6: Chief Operating Officer, Institute for Clinical Systems Improvement, Bloomington, MN, USA 7: Dean, Yale School of Public Health, Yale School of Medicine, New Haven, CT, USA

Publication date: 2008-06-01

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