Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Patients’ experiences in Australian hospitals: a systematic review of evidence

Reema Harrison A F , Merrilyn Walton A , Elizabeth Manias A C , Steven Mears D and Jennifer Plumb E

A School of Public Health, University of Sydney, NSW 2006, Australia. Email: merrilyn.walton@sydney.edu.au

B The University of Melbourne, Parkville, Vic. 3010, Australia. Email: emanias@unimelb.edu.au

C Deakin University, 75 Pigdons Road, Waurn Ponds, Vic. 3216, Australia.

D Hunter New England Medical Library, New Lambton, NSW 2350, Australia. Email: steve.mears@hnehealth.nsw.gov.au

E Australian Commission on Safety and Quality in Health Care, 200 Elizabeth Street, Sydney, NSW 2000, Australia. Email: jennifer.plumb@safetyandquality.gov.au

F Corresponding author. Email: reema.harrison@sydney.edu.au

Australian Health Review - http://dx.doi.org/10.1071/AH16053
Submitted: 23 February 2016  Accepted: 29 June 2016   Published online: 19 August 2016

Abstract

Objective Patients are uniquely positioned to provide insightful comments about their care. Currently, a lack of comparable patient experience data prevents the emergence of a detailed picture of patients’ experiences in Australian hospitals. The present study addresses this gap by identifying factors reported in primary research as relating to positive and negative experiences of patients in Australian hospitals.

Methods Evidence from Australian qualitative studies of patients of all ages reporting their experiences in any hospital or day procedure centre was synthesised. A range of text words, synonyms and subject headings was developed and used to undertake a systematic search of seven electronic databases from January 1995 to July 2015 and the grey literature. Two reviewers independently screened the titles, abstracts or executive summaries and applied the inclusion criteria. Data were synthesised in a meta-narrative.

Results Thirty-nine publications were included: 33 articles from database searches and six from the grey literature. Quality improvement researchers produced the dominant narrative and the nursing perspective was strong. Six themes emerged: ‘Reciprocal communication and information sharing’, ‘Interpersonal skills and professionalism’, ‘The care environment’, ‘Emotional support’, ‘Discharge planning and process’ and ‘Correct treatment and physical outcomes’.

Conclusion Tangible opportunities to enhance the patient experience are apparent. Small changes to the way that the health system operates and is resourced and the way that health professionals engage with patients could substantially improve care. Examples include inviting patients and carers to contribute to decision making and discussions about their treatment options and care preferences.

What is known about the topic? Patient experience is identified as a key component of an optimal health system, along with improving the health of populations and reducing the per capita costs of care. The use of patient experience data has been associated with improved clinical effectiveness and patient safety.

What does this paper add? Patient experience data are currently not routinely captured and difficulties exist as to where this information is available. These data are gathered using a variety of different methods that prohibit the development of a national picture. As a step towards overcoming this barrier, the present study identifies the common elements of healthcare experience reported by patients in Australia as being positive or negative.

What are the implications for practitioners? Ensuring that patients and carers are active partners in their care is at the centre of a positive patient experience. Health professionals should provide patients with opportunities to make decisions about their care and ask questions, and to provide clear information before, during and after hospitalisation to enhance patients’ experiences in Australian hospitals.


References

[1]  Australian Commission on Safety and Quality in Health Care. Australian safety and quality framework for health care. 2010. Available at: http://www.safetyandquality.gov.au/wp-content/uploads/2012/01/32296-Australian-SandQ-Framework1.pdf [verified 16 April 2014].

[2]  Agency for Healthcare Research Quality. The CAHPS program. 2011. Available at: https://www.cahps.ahrq.gov/about-cahps/cahps-program/index.html [verified 18 July 2013].

[3]  Department of Health. Creating a patient-led NHS: delivering the NHS improvement plan. London: Department of Health; 2005.

[4]  Department of Health. Equity and excellence: liberating the NHS. London: The Stationery Office; 2010.

[5]  Ward J, Armitage G. Can patients report patient safety incidents in a hospital setting? A systematic review. BMJ Qual Saf 2012; 21 685–99.
Can patients report patient safety incidents in a hospital setting? A systematic review.CrossRef | 22562875PubMed | open url image1

[6]  Godlee F. Partnering with patients. BMJ 2013; 346 f3153
Partnering with patients.CrossRef | open url image1

[7]  Aiken LH, Sermeus W, Van den Heede K, Sloane DM, Busse R, McKee M, Bruyneel L, Rafferty AM, Griffiths P, Moreno-Cabas MT, Tishelman C, Scott A, Brzostek T, Kinnunen J, Schwednimann R, Heinen M, Zikos D, Sjetne IS, Smith HL, Kutney-Lee A. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ 2012; 344 e1717
Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.CrossRef | 22434089PubMed | open url image1

[8]  Department of Health. NHS patient experience framework. London: Department of Health; 2012.

[9]  Bureau of Health. NSW patient survey program. 2014. Available at: http://www.bhi.nsw.gov.au/nsw_patient_survey_program [verified 22 May 2014].

[10]  Victoria Patient Satisfaction Monitor. Victorian Healthcare Experience Survey. Available at: https://www2.health.vic.gov.au/hospitals-and-health-services/quality-safety-service/patient-experience-survey [verified 22 May 2014].

[11]  Luxford K. The forgotten tenet: client focus and quality improvement in health care. Build Qual Health Care 2010; 4 10–12. open url image1

[12]  Edwards KJ, Duff J, Walker K. What really matters? A multi-view perspective of one patient’s hospital experience. Contemp Nurse 2014; 49 122–36.
What really matters? A multi-view perspective of one patient’s hospital experience.CrossRef | 25549753PubMed | open url image1

[13]  Devkaran S. Patient experience is not patient satisfaction: understanding the fundamental differences. 2015. Available at: http://www.isqua.org/docs/default-source/education-/isqua-webinar_november-2014_subashnie-devkaran.pdf?sfvrsn=0 [verified 23 July 2015].

[14]  Sitzia J, Wood N. Patient satisfaction: a review of issues and concepts. Soc Sci Med 1997; 45 1829–43.
Patient satisfaction: a review of issues and concepts.CrossRef | 1:STN:280:DyaK1c7gvV2gsQ%3D%3D&md5=b5ec25829e7a069783ee72cb926f29ddCAS | 9447632PubMed | open url image1

[15]  Berwick DM. Disseminating innovations in health care. JAMA 2003; 289 1969–75.
Disseminating innovations in health care.CrossRef | 12697800PubMed | open url image1

[16]  Australian Commission on Safety and Quality in HealthCare (ACSQHC). Review of patient experience and satisfaction surveys conducted within public and private hospitals in Australia. Sydney: ACSQHC; 2012.

[17]  Consumer Health Forum of Australia. Real people real data project: capturing, analysing and using consumers’ health experience narratives to drive better health outcomes. 2013. Available at: https://www.chf.org.au/pdfs/rep/rep-1142-Literature-Review-Using-Consumer-Narrative-to-Inform-Better-Health-Outcomes.pdf [verified 24 January 2016].

[18]  Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The quality in Australian health care study. Med J Aust 1995; 163 458–71.
| 1:STN:280:DyaK28%2FosV2qsQ%3D%3D&md5=40be5e8b3cec9b0a857f74051971e66fCAS | 7476634PubMed | open url image1

[19]  Health Foundation. Measuring patient experience: evidence scan. London: Health Foundation; 2013.

[20]  Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O, Peacock R. Storylines of research in diffusion of innovation: a meta-narrative approach to systematic review. Soc Sci Med 2005; 61 417–30.
Storylines of research in diffusion of innovation: a meta-narrative approach to systematic review.CrossRef | 15893056PubMed | open url image1

[21]  CASP UK. CASP checklists. 2006. Available at: http://www.casp-uk.net/#!casp-tools-checklists/c18f8 [verified 26 June 2015].

[22]  Bradley S, Mott S. Adopting a patient-centred approach: an investigation into the introduction of bedside handover to three rural hospitals. J Clin Nurs 2014; 23 1927–36.
Adopting a patient-centred approach: an investigation into the introduction of bedside handover to three rural hospitals.CrossRef | 24164249PubMed | open url image1

[23]  Brough C. Language services in Victoria’s health system: perspectives of culturally and linguistically diverse consumers. Melbourne: Centre for Culture Ethnicity and Health; 2006.

[24]  De S, Tong A, Isaacs D, Craig JC. Parental perspectives on evaluation and management of fever in young infants: an interview study. Arch Dis Child 2014; 99 717–23.
Parental perspectives on evaluation and management of fever in young infants: an interview study.CrossRef | 24849214PubMed | open url image1

[25]  De Jesus G, Abbotts S, Collins B, Burvill A. Same day surgery: results of a patient satisfaction survey. J Qual Clin Pract 1996; 16 165–73.
| 1:STN:280:DyaK2s%2Fkt1Klsg%3D%3D&md5=0be86adb188648b6d9c31d1e79651ce0CAS | 8887860PubMed | open url image1

[26]  Ford K. ‘I didn’t really like it, but it sounded exciting’: admission to hospital for surgery from the perspectives of children. J Child Health Care 2011; 15 250–60.
‘I didn’t really like it, but it sounded exciting’: admission to hospital for surgery from the perspectives of children.CrossRef | 22089702PubMed | open url image1

[27]  Garrett PW, Dickson HG, Whelan AK, Roberto F. What do non-English-speaking patients value in acute care? Cultural competency from the patient’s perspective: a qualitative study. Ethn Health 2008; 13 479–96.
What do non-English-speaking patients value in acute care? Cultural competency from the patient’s perspective: a qualitative study.CrossRef | 18850371PubMed | open url image1

[28]  Henderson A, Van Eps MA, Pearson K, James C, Henderson P, Osborne Y. Maintenance of patients’ dignity during hospitalization: comparison of staff-patient observations and patient feedback through interviews. Int J Nurs Pract 2009; 15 227–30.
Maintenance of patients’ dignity during hospitalization: comparison of staff-patient observations and patient feedback through interviews.CrossRef | 19703037PubMed | open url image1

[29]  Henderson A, Caplan G, Daniel A. Patient satisfaction: the Australian patient perspective. Aust Health Rev 2004; 27 73–83.
Patient satisfaction: the Australian patient perspective.CrossRef | 15362299PubMed | open url image1

[30]  Iedema R, Sorensen R, Manias E, Tuckett A, Piper D, Mallock N, Williams A, Jorm C. Patients’ and family members’ experiences of open disclosure following adverse events. Int J Qual Health Care 2008; 20 421–32.
Patients’ and family members’ experiences of open disclosure following adverse events.CrossRef | 18801752PubMed | open url image1

[31]  Iedema RA, Mallock NA, Sorensen RJ, Manias E, Tuckett AG, Williams AF, Perrott B, Brownhill S, Piper D, Hor S, Hegney D, Scheeres H, Jorm C. The National Open Disclosure Pilot: evaluation of a policy implementation initiative. Med J Aust 2008; 188 397
| 18393742PubMed | open url image1

[32]  Iedema R, Merrick E, Piper D, Walsh J. Emergency department co-design Stage 1 evaluation: report to Health Services Performance Improvement Branch, NSW Health. Sydney: Centre for Health Communication, University of Technology Sydney; 2008.

[33]  Iedema R, Allen S, Britton K, Piper D, Baker A, Grbich C, Allan A, Jones L, Tuckett A, Williams A, Manias E, Gallagher TH. Patients’ and family members’ views on how clinicians enact and how they should enact incident disclosure: the ‘100 patient stories’ qualitative study. BMJ 2011; 343 d4423
Patients’ and family members’ views on how clinicians enact and how they should enact incident disclosure: the ‘100 patient stories’ qualitative study.CrossRef | 21788260PubMed | open url image1

[34]  Johnson A, Gaughwin B, Moore N, Crane R. Long-stay views from the hospital bed: patient perspectives of organisation of care and impact of hospitalisation. Aust Health Rev 2005; 29 235–40.
Long-stay views from the hospital bed: patient perspectives of organisation of care and impact of hospitalisation.CrossRef | 15865575PubMed | open url image1

[35]  Lobb EA, Halkett GKB, Nowak AK. Patient and caregiver perceptions of communication of prognosis in high grade glioma. J Neurooncol 2011; 104 315–22.
Patient and caregiver perceptions of communication of prognosis in high grade glioma.CrossRef | 1:STN:280:DC%2BC3MjktVensg%3D%3D&md5=2c949ada1b18e5393a1c8d8582e0b1abCAS | 21153859PubMed | open url image1

[36]  Manias E, Beanland C, Riley R, Baker L. Self-administration of medication in hospital: patients’ perspectives. J Adv Nurs 2004; 46 194–203.
Self-administration of medication in hospital: patients’ perspectives.CrossRef | 15056333PubMed | open url image1

[37]  Markovic M, Bandyopadhyay M, Manderson L, Allotey P, Murray S, Vu T. Day surgery in Australia qualitative research report. J Sociol 2004; 40 74–84.
Day surgery in Australia qualitative research report.CrossRef | open url image1

[38]  Marshall A, Kitson A, Zeitz K. Patients’ views of patient-centred care: a phenomenological case study in one surgical unit. J Adv Nurs 2012; 68 2664–73.
Patients’ views of patient-centred care: a phenomenological case study in one surgical unit.CrossRef | 22416890PubMed | open url image1

[39]  Montgomery K, Little M. Enriching patient-centered care in serious illness: a focus on patients’ experiences of agency. Milbank Q 2011; 89 381–98.
Enriching patient-centered care in serious illness: a focus on patients’ experiences of agency.CrossRef | 21933273PubMed | open url image1

[40]  O’Callaghan AM, McAllister L, Wilson L. Experiences of care reported by adults with traumatic brain injury. Int J Speech-Language Pathol 2010; 12 107–23.
Experiences of care reported by adults with traumatic brain injury.CrossRef | open url image1

[41]  Olver IN, Eliott JA, Long L, McKinnon M, Rumsby G. The impact of receiving treatment for cancer at a large metropolitan teaching hospital as recorded by patients using unstructured journals. J Cancer Ed 2012; 27 625–30.
The impact of receiving treatment for cancer at a large metropolitan teaching hospital as recorded by patients using unstructured journals.CrossRef | open url image1

[42]  Peiris CL, Taylor NF, Shields N. Patients value patient–therapist interactions more than the amount or content of therapy during inpatient rehabilitation: a qualitative study. J Physiother 2012; 58 261–8.
Patients value patient–therapist interactions more than the amount or content of therapy during inpatient rehabilitation: a qualitative study.CrossRef | 23177229PubMed | open url image1

[43]  Penney W, Wellard SJ. Hearing what older consumers say about participation in their care. Int J Nurs Pract 2007; 13 61–8.
Hearing what older consumers say about participation in their care.CrossRef | 17244246PubMed | open url image1

[44]  Piper D, Iedema R, Merrick E, Perrott B. Experience-based co-design program 2 Stage 1 evaluation report: final report to Health Services Performance Improvement Branch, NSW Health. Sydney: Centre for Health Communication, University of Technology Sydney; 2010.

[45]  Piper D, Iedema R, Bower K. Rural patients’ experiences of the open disclosure of adverse events. Aust J Rural Health 2014; 22 197–203.
Rural patients’ experiences of the open disclosure of adverse events.CrossRef | 25123624PubMed | open url image1

[46]  Roden J. The involvement of parents and nurses in the care of acutely-ill children in a non-specialist paediatric setting. J Child Health Care 2005; 9 222–40.
The involvement of parents and nurses in the care of acutely-ill children in a non-specialist paediatric setting.CrossRef | 16076897PubMed | open url image1

[47]  Schembri S. Through the patient’s eyes: strategic insight derived from patient narratives. Proceedings of the ANZAM Conference Tasmania 4–6 December 2013, Hobart, Australia. Hobart: Australia and New Zealand Academy of Management.

[48]  Sharp R, Grech C, Fielder A, Mikocka-Walus A, Cummings M, Esterman A. The patient experience of a peripherally inserted central catheter (PICC): a qualitative descriptive study. Contemp Nurse 2014; 48 26–35.
The patient experience of a peripherally inserted central catheter (PICC): a qualitative descriptive study.CrossRef | 25410192PubMed | open url image1

[49]  Stevens J, van de Mortel T, Leighton D. Generating theory from the client’s experience of same day laparoscopic sterilisation. Aust J Holistic Nurs 2001; 8 23–30.
| 1:STN:280:DC%2BD387ms1Ckug%3D%3D&md5=98e4e3e0a37965461352617e75088d20CAS | open url image1

[50]  Health VIC. Consumer participation and culturally and linguistically diverse communities. Melbourne: Centre for Culture Ethnicity and Health; 2005.

[51]  Health WA. Patient stories bank. 2015. Available at: http://ww2.health.wa.gov.au/Corporate/Articles/N_R/Patient-stories/Patient-stories-bank [verified 23 July 2015].

[52]  Watson J, Hodson K, Johnson R, Kemp K. The maternity experiences of indigenous women admitted to an acute care setting. Aust J Rural Health 2002; 10 154–60.
The maternity experiences of indigenous women admitted to an acute care setting.CrossRef | 12081508PubMed | open url image1

[53]  Williams AM, Irurita VF. Therapeutic and non-therapeutic interpersonal interactions: the patient’s perspective. J Clin Nurs 2004; 13 806–15.
Therapeutic and non-therapeutic interpersonal interactions: the patient’s perspective.CrossRef | 15361154PubMed | open url image1

[54]  Williams A. Patients with comorbidities: perceptions of acute care services. J Adv Nurs 2004; 46 13–22.
Patients with comorbidities: perceptions of acute care services.CrossRef | 15030438PubMed | open url image1

[55]  Williams AM, Irurita VF. Enhancing the therapeutic potential of hospital environments by increasing the personal control and emotional comfort of hospitalized patients. Appl Nurs Res 2005; 18 22–8.
Enhancing the therapeutic potential of hospital environments by increasing the personal control and emotional comfort of hospitalized patients.CrossRef | 15812732PubMed | open url image1

[56]  Williams AM, Irurita VF. Emotional comfort: the patient’s perspective of a therapeutic context. Int J Nurs Stud 2006; 43 405–15.
Emotional comfort: the patient’s perspective of a therapeutic context.CrossRef | 16102768PubMed | open url image1

[57]  Williams AM, Dawson S, Kristjanson LJ. Exploring the relationship between personal control and the hospital environment. J Clin Nurs 2008; 17 1601–9.
Exploring the relationship between personal control and the hospital environment.CrossRef | 18482122PubMed | open url image1

[58]  Zeitz K, Kitson A, Gibb H, Bagley E, Chester M, Davy C, Frankham J, Guthrie S, Roney F, Shanks A. Working together to improve the care of older people: a new framework for collaboration. J Adv Nurs 2011; 67 43–55.
Working together to improve the care of older people: a new framework for collaboration.CrossRef | 20946115PubMed | open url image1

[59]  Zugai J, Stein-Parbury J, Roche M. Effective nursing care of adolescents with anorexia nervosa: a consumer perspective. J Clin Nurs 2013; 22 2020–9.
Effective nursing care of adolescents with anorexia nervosa: a consumer perspective.CrossRef | 23398386PubMed | open url image1

[60]  Bench S, Day T. The user experience of critical care discharge: a meta-synthesis of qualitative research. Int J Nurs Stud 2010; 47 487–99.
The user experience of critical care discharge: a meta-synthesis of qualitative research.CrossRef | 20004396PubMed | open url image1

[61]  Bridges J, Flatley M, Meyer J. Older people’s and relatives’ experiences in acute care settings: systematic review and synthesis of qualitative studies. Int J Nurs Stud 2010; 47 89–107.
Older people’s and relatives’ experiences in acute care settings: systematic review and synthesis of qualitative studies.CrossRef | 19854441PubMed | open url image1

[62]  Gordon J, Sheppard LA, Anaf S. The patient experience in the emergency department: a systematic synthesis of qualitative research. Int Emerg Nurs 2010; 18 80–8.
The patient experience in the emergency department: a systematic synthesis of qualitative research.CrossRef | 20382369PubMed | open url image1

[63]  Munn Z, Jordan Z. The patient experience of high technology medical imaging: a systematic review of the qualitative evidence. Radiography 2011; 17 323–31.
The patient experience of high technology medical imaging: a systematic review of the qualitative evidence.CrossRef | open url image1

[64]  Nairn S, Whotton E, Marshal C, Roberts M, Swann G. The patient experience in emergency departments: a review of the literature. Accid Emerg Nurs 2004; 12 159–65.
The patient experience in emergency departments: a review of the literature.CrossRef | 15234713PubMed | open url image1

[65]  Ridd M, Shaw A, Lewis G, Salisbury C. The patient–doctor relationship: a synthesis of the qualitative literature on patients’ perspectives. Br J Gen Pract 2009; 59 e116–33.
The patient–doctor relationship: a synthesis of the qualitative literature on patients’ perspectives.CrossRef | 19341547PubMed | open url image1

[66]  Waibel S, Henao D, Aller MB, Vargas I, Vázquez ML. What do we know about patients’ perceptions of continuity of care? A meta-synthesis of qualitative studies. Int J Qual Health Care 2012; 24 39–48.
What do we know about patients’ perceptions of continuity of care? A meta-synthesis of qualitative studies.CrossRef | 22146566PubMed | open url image1

[67]  Barry MJ, Edgman-Levitan S. Shared decision making: the pinnacle of patient-centered care. N Engl J Med 2012; 366 780–1.
Shared decision making: the pinnacle of patient-centered care.CrossRef | 1:CAS:528:DC%2BC38XjsV2qurw%3D&md5=b5dec140a24def478f7806336edc8b9aCAS | 22375967PubMed | open url image1

[68]  Bolster D, Manias E. Person-centred interactions between nurses and patients during medication activities in an acute hospital setting: qualitative observation and interview study. Int J Nurs Stud 2010; 47 154–65.
Person-centred interactions between nurses and patients during medication activities in an acute hospital setting: qualitative observation and interview study.CrossRef | 19577752PubMed | open url image1

[69]  Manias E. Communication relating to family members’ involvement and understandings about patients’ medication management in hospital. Health Expect 2015; 18 850–66.
Communication relating to family members’ involvement and understandings about patients’ medication management in hospital.CrossRef | 23405906PubMed | open url image1

[70]  Manias E, Rixon S, Williams A, Liew D, Braaf S. Barriers and enablers affecting patient engagement in managing medications within specialty hospital settings. Health Expect 2015; 18 2787–98.
Barriers and enablers affecting patient engagement in managing medications within specialty hospital settings.CrossRef | 25186633PubMed | open url image1

[71]  Chaboyer W, McMurray A, Wallis M. Bedside nursing handover: a case study. Int J Nurs Pract 2010; 16 27–34.
Bedside nursing handover: a case study.CrossRef | 20158545PubMed | open url image1

[72]  Durand M, Moulton B, Cockle E, Mann M, Elwyn G. Can shared decision-making reduce medical malpractice litigation? A systematic review. BMC Health Serv Res 2015; 15 167
Can shared decision-making reduce medical malpractice litigation? A systematic review.CrossRef | 25927953PubMed | open url image1

[73]  Southwick FS, Cranley NM, Hallisy JA. A patient-initiated voluntary online survey of adverse medical events: the perspective of 696 injured patients and families. BMJ Qual Saf 2015; 24 620–9.
A patient-initiated voluntary online survey of adverse medical events: the perspective of 696 injured patients and families.CrossRef | 26092166PubMed | open url image1

[74]  Cleary PD. Satisfaction may not suffice! A commentary on ‘A patient’s perspective’. Int J Technol Assess Health Care 1998; 14 35–7.
Satisfaction may not suffice! A commentary on ‘A patient’s perspective’.CrossRef | 1:STN:280:DyaK1c3lsFelsg%3D%3D&md5=1970a4b7c788434bc36db40be0e2cff2CAS | 9599093PubMed | open url image1



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