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Patient experiences: a systematic review of quality improvement interventions in a hospital setting

Authors Bastemeijer CM, Boosman H, van Ewijk H, Verweij LM, Voogt L, Hazelzet JA

Received 20 January 2019

Accepted for publication 9 April 2019

Published 21 May 2019 Volume 2019:10 Pages 157—169

DOI https://doi.org/10.2147/PROM.S201737

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Robert Howland


Carla M Bastemeijer,1 Hileen Boosman,2 Hans van Ewijk,3 Lisanne M Verweij,4 Lennard Voogt,5 Jan A Hazelzet4

1MMT, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands; 2Department of Quality & Patient Safety, Leiden University Medical Center, Leiden, the Netherlands; 3Department of Normative Professionalization, University of Humanistic Studies, Utrecht, the Netherlands; 4Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands; 5Department of Physical Therapy Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands

Purpose: In the era of value-based healthcare, one strives for the most optimal outcomes and experiences from the perspective of the patient. So, patient experiences have become a key quality indicator for healthcare. While these are supposed to drive quality improvement (QI), their use and effectiveness for this purpose has been questioned. The aim of this systematic review was to provide insight into QI interventions used in a hospital setting and their effects on improving patient experiences, and possible barriers and promoters for QI work.
Methods: Prisma guidelines were used to design this review. International academic literature was searched in Embase, Medline OvidSP, Web of Science, Cochrane Central, PubMed Publisher, Scopus, PsycInfo, and Google Scholar. In total, 3,289 studies were retrieved and independently screened by the first two authors for eligibility and methodological quality. Data was extracted on the study purpose, setting, design, targeted patient experience domains, QI strategies, results of QI, barriers, and promotors for QI.
Results: Twenty-one pre–post intervention studies were included for review. The methodological quality of the included studies was assessed using a Critical Appraisal Skills Program (CASP) Tool. QI strategies used were staff education, patient education, audit and feedback, clinician reminders, organizational change, and policy change. Twenty studies reported improvement in patient experience, 14 studies of the 21 included studies reported statistical significance. Most studies (n=17) reported data-related barriers (eg, questionnaire quality), professional, and/or organizational barriers (eg, skepticism among staff), and 14 studies mentioned specific promoters (eg, engaging staff and patients) for QI.
Conclusions: Several patient experience domains are targeted for QI using diverse strategies and methodological approaches. Most studies reported at least one improvement and also barriers and promoters that may influence QI work. Future research should address these barriers and promoters in order to enhance methodological quality and improve patient experiences.

Keywords: PREM, value based healthcare, outcomes, quality indicators


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