British Library EThOS: International healthcare accreditation : an analysis of clinical quality and patient experience in the UAE
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International healthcare accreditation : an analysis of clinical quality and patient experience in the UAE
Devkaran, Subashnie
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Awarding Body:
Heriot-Watt University
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Heriot-Watt University
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A mixed method research design was used to ‘does accreditation have an impact on hospital quality, clinical measures and patient experience?’ The thesis contains three study components: 1) A case study determining the predictors o 2) a cross-sectional study examining the relationship of hospital accreditation and patient experience and 3) A four year time series analysis of the impact of accreditation on hospital quality using 27 quality measures. A case study analysis of patient experience, using a piloted, validated and reliable survey tool, was conducted in Al Noor Hospital. The survey was administered via face-to-face interviews to 391 patients. Patient demographic variables, stay characteristics and patient experience constructs were tested against five patient experience outcome measures using regression analysis. The predictors of positive patient experience were the patient demographics (age, nationality, and health status), hospital stay characteristics (length of stay and hospital treatment outcome) and patient experience constructs (care from nurses, care from doctors, cleanliness, pain management and quality of food). Recommendations were made on how hospital managers can improve patient experience using these modifiable factors. The cross-sectional study found that accredited hospitals had significantly higher inpatient experience scores than non-accredited hospitals. The hospital level variables, other than patient volume, had no correlations with patient experience. The interrupted time series analysis demonstrated that although accreditation improved the quality performance of the hospital with a residual benefit of 20 percentage points above the baseline level, this improvement was not sustained over the 3-year accreditation cycle. The accreditation life cycle theory was developed as an explanatory framework for the pattern of performance during the accreditation cycle. This theory was consequently supported by empirical evidence. Recommendations were made for improvement of the accreditation process. The Life Cycle Model and time series analysis were proposed as strategic tools for healthcare managers to recognise and prevent the negative trends of the accreditation life cycle in order to sustain improvements gained from accreditation. The findings of the three research components were triangulated to form a theory on the impact of accreditation on clinical quality measures and patient experience. This thesis is important from a research perspective, as healthcare accreditation, although commonly used to improve quality, is still under researched and under theorised. This is the first investigation of accreditation to use interrupted time series analysis, the first analysis on patient experience and hospital accreditation and also the first study on patient experience in the Middle East. Thus it adds to the evidence base of accreditation and patient experience but also has policy and management implications.
Supervisor:
O'Farrell, Patrick
Not available
Qualification Name:
Thesis (Ph.D.)
Qualification Level:
uk.bl.ethos.650571&
Not availableImprove Clinical Trial Outcomes by Boosting Patient Experience
Life Sciences July 14, 2016
Improve Clinical Trial Outcomes by Boosting Patient Experience
Shifting from &Subjects& to &Customers&
We are in the Experience Era. Consumers are drawn to organizations that consistently deliver high-quality and engaging experiences. As a result, organizations across industries and around the globe are changing the way they interact with customers. Those that do it well see higher customer satisfaction, loyalty and financial return.&
Customer experience is the paramount source of corporate differentiation in today&s economy:
89% of senior marketing executives expect to compete primarily on the basis of customer experience this year.1&
From 2007 to 2014, customer experience leaders& cumulative returns were 49% greater than the S&P 500 Index, while laggards underper-formed the index by 162%.2
Customer experience leaders have an average Net Promoter Score rating that is 24 points higher than laggards.3
The Life Sciences industry in general, and the clinical trials space in particular, can benefit by identifying and implementing changes that enhance patient experience. While long-term studies to measure the impact of patient-centricity in clinical trials have not yet been completed, there is significant momentum in the industry towards a patient-centric approach. Anticipated benefits include faster enrollment, higher levels of patient engagement and retention, increased compliance, and improved patient loyalty. Given that the average cost to recruit and retain one enrolled subject is $7,600 and the loss in revenue due to a delay in clinical trials is estimated to be $40 million per month, even modest improvements due to a patient-centric approach should translate into significant savings.4
89% OF SENIOR MARKETING EXECUTIVES EXPECT TO COMPETE PRIMARILY ON THE BASIS OF CUSTOMER EXPERIENCE THIS YEAR.1&
1. &Gartner Surveys Confirm Customer Experience is the New Battlefield.& October 2013. &
2. &The 2015 Customer Experience ROI Study.& Watermark Consulting, 2015.&
3. &ROI of Customer Experience 2015.& Temkin Group, October 2015.
4. Tufts (2011, April 26), Mintz, C. (2010), Beasley, D. (2006).&
In response, companies are testing new models and techniques for patient-centricity to identify approaches that add value and positively impact trial outcomes. Examples include targeted recruitment strategies, patient-influenced protocol design, and return of individual trial results directly to patients. The industry is still on the early part of the learning curve and trying to build the &critical mass& needed to drive toward widespread adoption.
To accelerate efforts, companies should build a patient-centricity program on a central foundation of providing a world-class patient experience. This requires a shift away from the traditional classification of trial participants as &subjects& who serve as a means for data collection towards one that considers participants as &customers.& Sponsors can achieve competitive advantage in areas such as recruitment and retention by providing customer-centric experiences similar to leading organizations in other industries. Furthermore, an enhanced patient experience, with higher levels of engagement and motivation, will support the current trend toward greater use of patient-reported outcomes.&
THE EXPERIENCE TOOLSET: PERSONAS AND JOURNEY MAPS
Providing a high-quality patient experience requires understanding and navigating a complex landscape composed of multiple partners and stakeholder groups. For global trials in particular & with varying regulations, compliance procedures and cultural norms & delivering a consistently high-level patient experience can pose numerous challenges.
With primary responsibility for the conduct of the trial, the sponsor is best-positioned to spearhead efforts to build a patient-centric approach. This requires a deep understanding of the patient and the trial journey. Personas and journey maps are two powerful tools used in the customer experience discipline that can be applied to patient-centricity efforts. Adopting these methods will help trial sponsors and partners better align around a patient-centric strategy.&
IN A RECENT STUDY OF 400+ CLINICAL TRIAL PROFESSIONALS, 75% SAID &PUTTING THE PATIENT AT THE HEART OF THE CLINICAL TRIAL& IS A TOP PRIORITY. YET, ALARMINGLY, ONLY 21% SAID IT WAS A COMPANY-WIDE PRIORITY, AND 17% REPORTED, &NO ONE IS SPEARHEADING THE EFFORT.&5
5. &Patient-centric clinical trials becoming a higher priority for biopharmaceutical, CRO management.& CenterWatch, January 2015
Creating patient-centric experiences requires a well-articulated understanding of the patient population, and the meaningful differences within it. Personas are representative portraits that serve to categorize and describe a customer base. For clinical trial organizations, patient personas would typically capture a combination of:
Demographic factors (such as age, ethnicity and gender)
Health-related factors (including disease state/therapeutic area, medical history and familiarity with clinical trials)
Psychographic factors (for example motivations for participating in trials, trial expectations, dependence on caregiver, communication style and channel preference)
Personas may also be created for stakeholders such as caregivers and family members who experience the clinical trial process through their relationship with the patient.
BUILT ON A FOUNDATION OF QUANTITATIVE AND QUALITATIVE RESEARCH AND BROUGHT TO LIFE THROUGH COMPELLING NARRATIVES AND VISUALS, WELL-CRAFTED PERSONAS PROVIDE ORGANIZATIONS WITH DEEP PATIENT UNDERSTANDING AND A LIVING ROADMAP FOR ALL ASPECTS OF DESIGNING THE PATIENT&S EXPERIENCE. READ MORE IN OUR PERSONA DEVELOPMENT OVERVIEW6&PUBLISHED BY SPARKS GROVE, THE EXPERIENCE DESIGN DIVISION OF NORTH HIGHLAND.&
6. /personas-an-experience-design-tool/
Journey Maps
Journey mapping tells the story of a representative patient&s experience and provides insight into needs, motivations and expectations using ethnographic research techniques and data analytics.
To more fully understand and articulate the patient&s journey, experience it. Have key teams and company leaders role-play as participants in a trial to build empathy and understanding around the actual experience as it is delivered. Document the experience, compare it against expectations, identify gaps and prioritize improvement opportunities. Highlight the key interactions that add value or have the most impact on patient engagement (the &moments that matter&) to align teams on improvement efforts. During this process, adopt the patient&s perspective and language as much as possible. This will go a long way to reinforce a patient-centric vs. company-centric mindset.
Many customer journeys suffer due to handoffs from one department, channel, entity or owner to the next. Closely examine these handoffs for potential gaps or &failure points& and identify solutions. For clinical trials, focus on ensuring a consistent patient experience is delivered across interactions with the Study Coordinator, Physician/Investigator, Lab Personnel and the rest of the clinical team. Remember to include technology interactions that will be required of the patient and design solutions that address the high degree of variability in patients& ability to use technology and master new tools.&
FROM FAILURE POINTS TO OPTIMIZED &MOMENTS THAT MATTER&
By understanding patient needs, motivations and expectations at each phase of the trial lifecycle, sponsors can enhance the patient experience and improve on important outcomes such as speed and quality. Since every trial and circumstance is unique, documenting individual patient journeys can be useful to make real-time assessments and adjustments, while aggregating such data can highlight pain points and areas requiring particular focus.
The hypothetical and highly simplified patient journey map in Figure 1 helps illustrate how key interaction points can be visually captured. Adding additional layers of data (such as specific clinical and non-clinical touch points, internal/external influencers, etc.) will reveal insights and opportunities to strengthen the patient experience.
Discovery / Recruitment
The initial phase of a patient&s trial journey is characterized by emotional adjustment to a diagnosis along with information gathering. Newly aware of a diagnosis, patients seek to understand all options, from lifestyle changes and FDA-approved treatments to clinical trials. Learning about a trial from a physician or sponsor advertisement is often the first step & ideally this is positively reinforced by interactions with a patient advocacy group or another trusted party.
In this phase, provide information and resources that help patients quickly assess eligibility, understand the protocol, ask questions and begin a dialogue. Patient education is critical & forty percent of adults report they do not understand the idea of a clinical trial.7&In addition, set clear expectations with each patient. Experience is a perception & one that is grounded in expectation. When establishing and communicating expectations, address patients& needs for emotional support as well as for clear information on trial details.&
7. &Patient-centric clinical trials becoming a higher priority for biopharmaceutical, CRO management.& CenterWatch, January 2015
Sponsors can overcome this awareness barrier using innovative outreach tools to educate patients and by simplifying the screening process. For example, some companies have developed websites designed specifically for patients enrolled in a clinical trial or considering a trial. These sites include features such as educational resources (disease-specific or general info on clinical trials), links to find out more about active trials, tools to document a patient&s individual journey, or forums to provide feedback.
Conversely, be sure to develop a good understanding of patient motivations for participating in clinical trials. The persona development process along with third party resources such as the Center for Information and Study on Clinical Research Participation (CISCRP) can be very useful in this regard. Interestingly, a survey conducted by CISCRP8&revealed that patients more frequently mention altruistic benefits (advancing science and treatment, helping improve or save lives) for participating in a clinical trial than they do direct personal benefits, such as treating or curing their own condition. Other reasons cited include monetary compensation, free medication, and doctor recommendations.
8. &2013 Perceptions & Insights Study.& Center for information and Study on Clinical Research Participation
Enrollment / Participation
Understandably, patients may struggle with information overload, confusion and uncertainty leading up to a decision to enroll in a clinical trial. Even after enrollment, ongoing uncertainty can lead to a patient dropping out of the trial. Counter this by putting the patient at ease and building confidence, starting with the first interaction at a clinical trial site. Convey understanding of the patient&s situation and help patients understand how the trial will be conducted and what will be expected of them. Further, demonstrate credibility through informative and easy-to-understand content. For example, the current trend toward simpler and shorter informed consent documents is very positive for patients.
When a trial requires several site visits and/or procedures, consider offering patient support programs that help with the logistics and cost of travel. This can make a real difference for certain patients & allowing more individuals to participate and boosting enrollment rates. Also, consider using technology that alerts patients of upcoming visits to help ensure trial completion.
Trial Completion / Follow-Up
Trial completion provides an opportunity to recognize patient accomplishment and provide clear communication about what comes next. Where feasible, share data with the patient and ask for feedback. Find ways to incorporate proven customer experience measures such as Net Promoter Score and Customer Effort Score, and link results back to continuous improvement plans and incentives. This approach should be supplemented by more open-ended dialogues with patients to understand the trial experience and gather deeper insight into improvement opportunities.&
FIND WAYS TO INCORPORATE PROVEN CUSTOMER EXPERIENCE MEASURES SUCH AS NET PROMOTER SCORE AND CUSTOMER EFFORT SCORE, AND LINK RESULTS BACK TO CONTINUOUS IMPROVEMENT PLANS AND INCENTIVES.
CUSTOMER EXPERIENCE MEASURES
Net Promoter Score&is an index ranging from -100 to 100 that measures the willingness of customers to recommend a company&s products or services to others. It is used as a proxy for gauging the customer&s overall satisfaction with a company&s product or service and the customer&s loyalty to the brand.
Customer Effort Score&measures customer service satisfaction with one single question (typically, &the company made it easy for me to accomplish my task&). The underlying thought is that service organizations create loyal customers primarily by reducing customer effort.&
IN SUMMARY
Achieving patient-centricity requires shifting mindsets along with processes. It means abandoning the old &patient as subject& model in favor of a new approach based on proven customer-experience techniques. Sponsors can strengthen capabilities to deliver a positive patient experience by using powerful tools such as journey maps and patient personas. As they continue to build insights around the critical interactions that impact patient experience, sponsors will refine policies, procedures and practices around clinical trials and convert failure points to optimized &moments that matter.& Ultimately, organizations that boost customer experience will improve clinical trial outcomes and drive greater patient satisfaction and loyalty.
For more information, please contact:
Bob Pietrobono
+1 215-207-0787
Alan Susser
+1 215-207-0796
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