Evaluation Study Of Medical Services Quality Based On Patients’experience

[Purpose]1、This topic is to build a theoretical framework and conceptual model of patient experience in line with China’s national conditions through the introduction of foreign philosophy and practices of improving medical service quality by patient experience.2、This study will explore the establishment of key indicators on the quality of medical service system based on patient experience, to further develop the measurement tools of medical service quality based on patient experience, and thus overcome the traditional shortcomings of patient satisfaction evaluation, to explore new methods and tools of evaluating medical services quality scientifically from the patient’s perspective.3、Carrying out applied research on the established theory of patients experience of medical service quality, key indicators system and developed evaluating scale of medical services quality of patient experience. Getting real, appropriate, high-quality, stable and accurate measurement results by conducting site surveys of patient experience to evaluate medical quality from the patient’s perspective, to achieve comparability and traceability of the medical services quality. Meanwhile, exploring and analyzing the relevant factors affecting the medical services quality of patient experience to provide strategies for the continuous improvement of medical services quality.[Methods]This paper carries out theoretical and empirical research by collecting relevant research findings on patient experience, patient satisfaction and medical services quality management at home and abroad through a comprehensive literature search and analysis system to form a theoretical framework of medical services quality based on patients experience. Using AHP (The Analytic Hierarchy Process, referred to as the AHP method),determined the weights of each index key indicators based on medical services quality of patients’experience. Using customer experience theory, total quality management theory, SERVQUAL theory and other classical theories and the Delphi method, expert advice and other methods to build the system of key indicators of medical services quality based on patient experience m our country.Using the DeVellis.R.F’s Scaling Theory to develop the evaluation scale of medical services quality based on patient experience with the three-level index system as the item pool and to conduct reliability and validity testing. Develop the quantitative scoring approach, using SPSS19.0statistical software to develop scale analysis process.Using the method of random stratified cluster sampling to conduct the field application research of scale, and to identify, analyze and evaluate the survey results. Using EpiData3.1, SPSS19.0and EXCEL2000, established a database. Categorical variables were compared using configuration information that the quantitative data with x±s, using single-factor analysis of variance to compare the scale entry.Multiple linear regression,analysis of variance, t-test, correlation analysis and other comprehensive analysis of factors was used to analyze the factors of medical services quality of patients’experience.To find the problems of medical services quality existing in hospitals,explore the targeted improvement measures of medical quality and evaluate improvement effect.[Results]1、The theoretical framework and conceptual model of medical services quality based on patient experience in our country is built.This paper defines the relevant concepts of the experience, patient experience, traditional medical quality, modern medical quality, patient satisfaction survey and patient experience surveys. It compares and analyzes the patient experience surveys and traditional patient satisfaction surveys and presents the theoretical concept of patient experiencing medical quality. Studies show that the connotation of medical services quality based on patient experience in the present stage of our country should be patient-centered by improving patients’treatment feeling as a starting point and for the purpose of continuously improving medical services. Focusing on the reflect of patient’s true feelings, strengthening patient’s perceived value, seeking the quality improvement opportunities, ultimately improving patient satisfaction and promoting harmony between doctors and patients. Six issues which are more concern with medical service quality patient experience are if the service facility is the complete, the service is reliable, the service is convenient and efficient, the treatment is safe and reliable, the patient is to be respected, and the service is continuous and so on. A theoretical framework and conceptual model of medical service quality that patient experiences is formed with Tangible, Reliability, Responsiveness, Assurance, Empathy and Continuity as the main content.2、The key indicators system of medical services quality based on patient experience is innovatively established.The construction of the medical service index system based on patient experience follows principles of scientifically oriented, overall consistency, relatively independent, operability and pertinence. We have conducted two rounds of expert consultation.163experts participate in this consulting. The positive coefficients of the experts were96.3%and92.0%respectively. The coordination coefficient in the first round is0.24～0.37, and the consultation coordination in the second round is0.28-0.46. The coordination coefficients of the two rounds are statistically significant after being tested (P<0.05). The criterion, familiarity degree and of the experts’authority degree are, the index of tangibles are successively0.93,0.84,0.86, the index of reliability are successively0.92,0.83,0.83, the index of responsiveness are successively0.91,0.83,0.87, the index of assurance are successively0.92,0.84,0.86, the index of empathy are successively0.93,0.83,0.85, and the index of continuity are successively0.91,0.82,0.86.The first-level indicator which consists of6dimensions with tangible, reliability, responsiveness, assurance, empathy and continuity is determined combining with the safe, effective, convenient and affordable medical service goals proposed by the new health reform, with the consulting questionnaire is designed with the methods of brainstorming and literature analysis and expert consultation with Delphi method. Every dimension further extends to form33second-level indicators and108third-level indicators. The first round expert consulting table of patient experience indicator system is dispatched to163experts in the health administrative departments, hospitals and health management experts. The second round expert consulting table of patient experience indicator system is formed after removing duplicate and unrelated projects, which has28second-level indicators and83third-level indicators. The28second-level indicators such as Hospital security facilities、 Hospital barrier-free facilities、Informed consent or decisions、Service efficiency、Patient safety、Privacy protection、Service for transferring to another department/hospital and83third-level indicators such as Security surveillance and monitoring、Physicians’ability to fully inform patients about their conditions and the treatment methods、Quick and accurate auxiliary imaging and laboratory examinations、No nosocomial infection happened during hospital visit or stay、Hospital has channels and department for taking care of complaints, and the feedbacks are provided after complaints are addressed、Providing dietary guidance for discharged patients are finally formed after taking the second round expert consultation, and the key indicator system of medical service based on patient experience is established. The index weight of the key indicator system at all levels is determined by conducting expert consultation again with the key indicator system of medical services quality that patients experience3、The evaluation scale PEES-50of the medical services quality based on patients experience is developed.With the established three-level index in the key indicator system of medical services quality that patients experience as the item pool and in the principle of describing tightly around problems that patients can feel by themselves and trying to avoid using evaluative language from the doctors perspective. The three-level index is transformed by the scale item. The transformed language changes the Likert five classes scoring "poor/general/good/very good/excellent" always used previously in the patient satisfaction survey. Patients only talk about whether a medical behavior that they feel is there or not instead of requiring evaluating directly the medical behavior is good or not in the past. Therefore, the testing version of the scale is formed by transforming83three-level indicators to109items of the original scale.Scale Amendment divides into3stages. In the first stage,86items are ultimately remained after completing100questionnaires and eliminating the duplicate and lower positive rate projects. In the second stage,54items are ultimately remained by field investigating136discharged patients and eliminating insensitive items with more subjective judgments of patients and low positive rate. In the third stage,50items are definitely remained by field investigating780discharged patients and mainly eliminating items with low positive rate. The evaluation scale (PEES-50) of medical services quality that patient experiences is finally formed through three rounds of amendment and optimizing the scale length.The Scale retest reliability is0.92. The split-half reliability Spearman-Brown split-half reliability is0.834. The Guttman split-half reliability is0.817. The Cronbach α coefficient is0.855.40experts are selected to appraise and score. The results verify that content validity is higher. The construct validity is evaluated with confirmatory factor analysis, and the KMO value is0.789. The chi-square value is977.856by Bartlett’s Test of Sphericity, P <0.05, validity is good.4、The application research is conducted with the established theory, key indicator and scale.Site investigation is conducted in20hospitals of7cities in the way of on-site interviews, questionnaires, etc.3265copies of the questionnaire are dispatched and3187copies are recovered in which3066copies are valid and121copies are invalid. The recovering rate is97.61%and the effective rate is96.20%.3066valid questionnaires are comparatively analyzed using the score calculating program made by SPSS19.0. Analysis divides into two levels of the second-level hospital and the third-level hospital. Each level is analyzed comparatively from various dimensions. The overall score of the third-level hospitals’questionnaire is687.27among which the highest score of the third-level hospital G1is715.30and the lowest score of the third-level hospital B1is631.14. The overall score of the second-level hospitals’questionnaire is670.45among which the highest score of the second-level hospital H3is700.01and the lowest score of the second-level hospital D5is606.70. The ranking of each hospital’s score is discussed by experts in the health field. They all agree that it is in accordance with the actual condition of hospital operation now and patient experience, which suggests that the improving space of medical services quality is large from the patients’perspective.Factors analyzed using univariate and multivariate linear regression analysis shows that the hospital level x1, payment method x2, job x3affect the patient experience. The regression equation is as follows with multivariate analysis.y=637.760+17.729*x1-12.853*x2-12.600*x3The evaluation scale of medical services quality based on patient experience is evaluated with SWOT analysis, and the stakeholders among government, hospitals and patients are also analyzed.[Conclusions]1、The conceptual model of medical services quality is the medical service transforming from "provider-oriented" to "service object-oriented" which contains the quality connotation of6dimensions such as tangible, reliability, responsiveness assurance, empathy and continuity. It provides theoretical guidance for perfecting the service strategy of patient-oriented, improving patients’treatment experience and continuously improving medical services quality.2、The key indicator system of medical services quality based on patient experience is the important basis of making scientifically the evaluating tool of medical services quality that patient experience. In terms of indicators screening, patients treatment details are more concerned and highlights patients’true feelings, which is more meaningful for establishing the patient-oriented working mechanism and service model with the connotation of safety objectives, service culture, service processes, service environment and cost control. It is the innovative practice of modern medical services quality in the economic era.3、The evaluation scale of medical services quality based on patient experience solves the problem of comparability and retrospectives of medical services quality, and provides evaluating tools for health administration departments and hospital administrators. It is good to guiding the health institutions to systematically analyze the medical services quality problem and influencing factors that patient encountered in the treatment. Concerning patients’feel, focusing on details of services, improving clinical results, reducing medical errors and improving the doctor-patient relationship provide important basis for the medical services quality that continually improved. The evaluation scale is very important to improve and complete our evaluation tools and strategies of the medical services quality.[Innovations and Deficiencies]1、Explains the connotation of medical services quality that patient experience, clarifies differences and connections of patient experience survey and satisfaction survey, builds the conceptual model of medical services quality that patient experience.2、Builds the key indicator system of medical services quality based on patient experience firstly in China, develops the evaluating scale (PEES-50) of medical services quality that patient experience, achieves the comparability and retrospective of medical services quality.3、Because of the object of our issue is Henan medical institutions and our country is in the social transformation period, medical services quality based on patient experience also is changed. Therefore, the evaluation scale of medical services quality based on patient experience and evaluating tools need to be perfected in Popularization and application.