The Study On Outpatient Experience Of Human Caring In Outpatient Department

BackgroundWith the government putting forward "improving the patients’ experience, paying attention to giving them human caring", more and more researches of the patient experience or medical human caring have arisen. The outpatient clinic is the window and very important part of the hospital. The medical care quality of the outpatient clinic directly affects the honor and status of the hospital. There are about 2,542 million outpatients going to the outpatient clinic in our country every year. And the outpatient procedures are very complex. Nowadays, the main reason of doctor-patient dispute is that the hospital and the medical workers lack of human caring. And the related researches are not good enough. So it is necessary to study the outpatient experience of human caring.ObjectiveTo explore the outpatient experience of human caring in outpatient clinic, develop a scale to measure it and investigate some outpatients and analyze the characteristics and influencing factors of the outpatient human caring experience by the scale.MethodsIn the first part, 21 outpatients in hospital I from hospital have been semi-structure interviewed to describe their experience of human caring in outpatient clinic. And the initial outpatient experience of human caring scale has been developed by analyzing the results of the literature research and phenomenology research.In the second part, the scale has been modified and its construct validity has been tested by consulting 16 experts from China and investigating the 272 outpatients inhospital I.In the third stage, 890 outpatients from some Chinese hospitals have been investigated by filling out the outpatient experience of human caring scale with the print or electronic questionnaires to explore the characteristics and influencing factors of the outpatient human caring experience.ResultsResults of the first part: Some items for reference have been extracted by literature research. Through the semi-structure interview, ten themes about outpatient experience of human caring extracted were passionate and patient, careful and considerate, respecting others, encouraging and comforting, apologizing courteously,using humorous words, considering truthfully, serious and responsible, environment filled of caring; five themes about lacking of human caring experience extracted were:communicating impatiently, seeing patients roughly, delayed service, facilities without enough details. Then the initial outpatient experience of human caring scale(OPEHC-Scale) has been developed including 9 dimensions based on the outpatient processes and 78 items.Results of the second part: In the first consulting round, the recovery rate showed the experts’ enthusiasm was 80%; the coefficient of reliability(Cr) ascertained the authority of the evaluation was 0.92; the means and full mark ratios responded the concentration of the evaluation were 2.88~4.94 and 6.25%~93.75%; the coefficients of variation(CV) and the Kendall’s W determined the concordance of the evaluation were 5.06%~52.15% and 0.21~0.24; and there were 11 experts putting forward 50 advice. In the second round, the recovery rate was 93.75%; the Cr was 0.93; the means were 3.93~4.93; the full mark ratios were 26.67%~93.33%; the CV were5.25%~23.61%, the Kendall’s W were 0.14~0.31; there were 8 experts putting forward 24 advice; and the Content Validity Index of Item-level(I-CVI) establishedthe content validity of the scale were 0.73~1.00, and the Average Content Validity Index of Scale-level(S-CVI/Ave) was 0.93. In the pre-survey, the factor loadings of items less than 0.450 have been deleted based on the item analysis and factor analysis.So the factor loadings of the final items determined the concurrent validity of the scale have been 0.453~0.867. The Cronbach’s alpha coefficient responded the reliability of the scale has been 0.966, and the Cronbach’s alpha coefficient of 10 dimensions have been 0.635~ 0.914. Then the final outpatient experience of human caring scale(OPEHC-Scale) has been built up including 10 dimensions and 47 items.Results of the third part: Based on the analysis of the state, the mean of the items of the outpatient human caring experience scale have been 3.37~3.88(67.47%~77.63%);the ratio of the dimensions have been 68.25%~76.44%; the mean of the total score has been 173.05±30.05(73.87%). The outpatient experience of human caring has been different because of the different survey time, way of filling, age, residence, way of payment, nearest medical treatment time, role of being hospital, the times of seeing the doctor in this hospital, severity of illness, department, aims of going to the hospital, familiar degree with the process, hospital, and the differences have been statistically significant(P < 0.05).ConclusionFirstly, the related researches have been an origin of the items pool of the outpatient experience of human caring scale(OPEHC-Scale) and provided the methods to develop the scale. Secondly, the phenomenology research has showed that the outpatients had abundant experience of human caring, but also experienced something lacking of caring. And the results have been a basis of improving the human caring service and also constructing the items pool of the scale. Thirdly, the scale with the dimension of the outpatient processes has been recognized by the experts and has good reliability and validity after modifying by analyzing the Delphi consultation andpre-survey data. It has made the experience of human caring from an abstract concept to a measurable concept. Fourthly, after survey some outpatients, their experience of human caring has been bad and affected by many factors. So the medical staffs should improve their human caring ability and serve the patients with the targeted human caring measures. Also, the hospital management should remove obstacles of implementing human caring.