DOI QR코드

DOI QR Code

환자경험 평가와 의료 현장의 변화: 의료기관 환자경험 업무 담당자의 관점

Implementation of Patient Experience Assessment and Subsequent Changes at the Ground Level in Health Care: Patient Experience Employees' Perspective

  • 송영채 (서울대학교 의과대학 의료관리학교실) ;
  • 윤은실 (서울대학교 의학연구원 의료관리학연구소) ;
  • 한세영 (서울대학교병원 의료혁신실 CS팀) ;
  • 태지연 (서울대학교병원 의료혁신실 CS팀) ;
  • 유수경 (분당서울대학교병원 경영혁신팀) ;
  • 도영경 (서울대학교 의과대학 의료관리학교실)
  • Song, Yeong-Chae (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Yoon, Eun-Sil (Institute of Health Policy and Management, Seoul National University Medical Research Center) ;
  • Han, Se-Young (CS Team, Department of Medical Innovation, Seoul National University Hospital) ;
  • Tae, Ji-Yeon (CS Team, Department of Medical Innovation, Seoul National University Hospital) ;
  • You, Soo-Kyeong (Department of Quality Improvement & Patient Safety, Seoul National University Bundang Hospital) ;
  • Do, Young-Kyung (Department of Health Policy and Management, Seoul National University College of Medicine)
  • 투고 : 2022.04.18
  • 심사 : 2022.05.23
  • 발행 : 2022.06.30

초록

Purpose: To examine whether the Patient Experience Assessment (PEA) has led to perceptible changes at the ground level of health care, as a way of evaluating PEA as a policy intervention for quality improvement. Methods: Four focus group discussions (FGDs) were conducted, each comprising six to eight participants who were employees responsible for patient experience at their respective hospitals. The primary focus of the FGDs was on questions such as: 1) How do hospitals respond to PEA? 2) What significant changes were observed after the implementation of PEA? 3) What were the unintended consequences of implementing PEA, if any? 4) What areas of improvement have been identified for maximizing the potential of PEA? Results: Two broad themes emerged out of the FGDs: changes observed post implementation of PEA, and areas for improvement of PEA. Four significant changes were reported by participants: changes in perception and attitude regarding patient experience in hospital employees, increased active involvement by the hospital leadership, enhanced efforts to improve patient experience, and increased cooperation between such activities. Furthermore, eight areas of improvement were identified, which have been grouped in three categories: improving the process of data collection for PEA, introducing additional catalysts to facilitate further changes, and paying attention to structure- and patient-level constraints that must be addressed in parallel. Conclusion: The implementation of PEA led to perceptible changes within hospitals, which implies that it can serve as an effective catalyst for improving patient experience. A number of areas of improvement that would aid in maximizing the potential of PEA were also identified.

키워드

과제정보

This study was conducted as part of the contract research funded by the Health Insurance Review & Assessment Service (HIRA, 2020). An earlier version of the study results appeared in the final report of the contract, entitled "Mid- to Long-term Development of Patient-Centeredness Assessment" (Report No. G000ECE-2020-160).

참고문헌

  1. Institute of Medicine Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st Century. Washington D.C, United State: National Academies Press; 2001.
  2. Arah OA, Westert GP, Hurst J, Klazinga NS. A conceptual framework for the OECD health care quality indicators project. International Journal for Quality in Health Care. 2006;18(suppl_1):5-13. https://doi.org/10.1093/intqhc/mzl024
  3. World Health Organization. The world health report: 2000: health systems: improving performance. Geneva, Switzerland: World Health Organization; 2000.
  4. Agency of Healthcare Research and Quality. What is patient experience? [Internet]. Rockville, United State: Agency of Healthcare Research and Quality. 2021 [cited 2021 November 11]. Available from: https://www.ahrq.gov/cahps/about-cahps/patient-experience/index.html.
  5. Do YK, Kim BS, Kim HB, Ahn KJ, You SK, Jung KH, et al. Mid- to long-term development of patient-centeredness assassment. Wonju, Korea: Health Insurance Review & Assessment Service; 2021.
  6. Health Insurance Review & Assessment Service. Notice on 「2021(3rd) Patient-Centeredness Assessment」 implementation plan and information session. [internet]. Wonju, Korea: Health Insurance Review & Assessment Service; 2021 [cited 2021 Feb 26]. Available from: https://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020002000100&brdScnBltNo=4&brdBltNo=8672&pageIndex=1#none.
  7. Lee SU, Kwak BH, Oh SG. Significance of qualitative evaluation and its congruence in evaluating social policy. Korea Social Policy Review. 2015;22(3);165-96. https://doi.org/10.17000/kspr.22.3.201509.165
  8. Kim NS, Oh YS, Park S, Park UJ, Jung Y, Kim DU, Choi JH. Development of evaluation model for health policy (I): analysis of the current status and priority setting of evaluation area. Sejong, Korea: Korea Institute for Health and Social Affairs; 2016.
  9. Savigny D, Adam T. Systems Thinking for health systems strengthening. Geneva, Switzerland: World Health Organization; 2009.
  10. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. British Medical Journal. 2008;337:a1655.
  11. Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, et al. A new framework for developing and evaluating complex interventions: update of medical research council guidance. British Medical Journal. 2021;374:n2061.
  12. Mannion R, Braithwaite J. Unintended consequences of performance measurement in healthcare: 20 salutary lessons from the English National Health Service. Internal Medicine Journal. 2012;42(5):569-74. https://doi.org/10.1111/j.1445-5994.2012.02766.x
  13. Mitchell P, Cribb A, Entwistle V. Made to Measure: the ethics of routine measurement for healthcare improvement. Health Care Analysis. 2021;29(1):39-58. https://doi.org/10.1007/s10728-020-00421-x
  14. Raleigh VS, Root C. Getting the measure of quality: opportunities and challenges. London, United Kingdom: The King's Fund; 2010.
  15. Berwick DM, James B. Coye MJ. Connections between quality measurement and improvement. Medical Care. 2003;41(supple_1):I30-8.
  16. Hibbard JH. What can we say about the impact of public reporting? inconsistent execution yields variable results. Annals Internal Medicine. 2008;148:160-1. https://doi.org/10.7326/0003-4819-148-2-200801150-00011
  17. Contandriopoulos D, Champagne F, Denis JL. The multiple causal pathways between performance measures' use and effects. Medical Care Research and Review. 2014 Feb;71(1):3-20. https://doi.org/10.1177/1077558713496320
  18. Marshall MN, Romano PS, Davies HTO. How do we maximize the impact of the public reporting of quality of care?. International Journal for Quality in Health Care. 2004;16(suppl_1):i57-i63 https://doi.org/10.1093/intqhc/mzh013
  19. Moore G, Audrey S, Barker M, Bond L, Bonell C, Cooper C, et al. Process evaluation in complex public health intervention studies: the need for guidance. Journal of Epidemiology and Community Health. 2014;68(2):101-2. https://doi.org/10.1136/jech-2013-202869
  20. Baldie DJ, Guthrie B, Entwistle V, Kroll T. Exploring the impact and use of patients' feedback about their care experiences in general practice settings-a realist synthesis. Family Practice. 2018;35(1):13-21. https://doi.org/10.1093/fampra/cmx067
  21. Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG. Systematic Review: The Evidence that publishing patient care performance data improves quality of care. Annals of Internal Medicine. 2008;148:111-23. https://doi.org/10.7326/0003-4819-148-2-200801150-00006
  22. Metcalfe D, Rios Diaz AJ, Olufajo OA, Massa MS, Ketelaar NA, Flottorp SA, et al. Impact of public release of performance data on the behaviour of healthcare consumers and providers. Cochrane Database of Systematic Reviews. 2018;9(9):CD004538
  23. Ritchie J. Lewis J, Nicholls CM, Ormston R. Qualitative research practice: A guide for social science students & researchers (2nd Edition). California, United States: SAGE Publications; 2013.
  24. Krueger RA, Casey MA. Focus Groups: A practical guide for applied research (4th Edition). United States: SAGE Publications; 2008.
  25. Center for Medicare & Medicaid Services. The hospital value-based purchasing (VBP) program [Internet]. Baltimore, United State: Center for Medicare & Medicaid Services; 2021 [cited 2021 November 11]. Available from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HVBP/Hospital-Value-Based-Purchasing.
  26. Casalino LP, Elster A, Eisenberg A, Lewis E, Montgomery J, Ramos D. Will pay-for-performance and quality reporting affect health care disparities?. Health Affairs. 2007;26(Suppl_2):w405-14. https://doi.org/10.1377/hlthaff.26.3.w405