Patient-centeredness is a primary aim of quality improvement (QI) but optimal strategies to achieve that goal remain elusive. Benign prostatic hyperplasia (BPH) is one of the commonest urologic diagnoses and significantly affects quality of life.
Patient ethnography is an emerging qualitative method of observation and dynamic interviews to understand the context through which the patient experiences care. We implemented patient ethnography to support our QI infrastructure and improve patient-centeredness in BPH.
Little is known about how to measure whether processes of care are patient-centered. We did not know whether the care processes our patients experienced provided value from their perspective.
We sought to discover previously unrecognized components of care that patients perceived to be of low value. Our primary goal was to develop QI initiatives that targeted low-value themes identified in the ethnography. Our secondary goal was a rapid rollout of three targeted initiatives.
We used a 4-step patient ethnography: (1) created detailed process maps to define phases of care, (2) interviewed patients, (3) synthesized transcript data in focus groups using the Crawford Slip method, and (4) targeted undesirable components of care for QI. Semi-structured interviews with seven representative patients identified low-value themes. Focus groups, comprised of primary care physicians, case coordinators, nurses, and urologists, evaluated the interview transcripts and generated improvement opportunities prioritized based on feasibility, patient value, scalability, and innovation. We used affinity mapping and priority matrix techniques to prioritize QI opportunities.
We identified five low-value themes from the patient interviews and developed corresponding QI opportunities. These included issues surrounding the referral and consultation process as well as postoperative care, especially home urinary catheter maintenance. Six months after completing the ethnography three of five targeted improvement opportunities had been implemented.
Healthcare (Amsterdam, Netherlands). 2014 Nov 12 [Epub]
A L Kaplan, M P Klein, H J Tan, N P Setlur, N Agarwal, K Steinberg, C S Saigal
Department of Urology, David Geffen School of Medicine at the University of California, UCLA 10833 Le Conte Avenue, Box 951738, Los Angeles, CA 90095-1738, USA. Institute for Innovations in Health, UCLA Health System, USA. , Department of Urology, David Geffen School of Medicine at the University of California, UCLA 10833 Le Conte Avenue, Box 951738, Los Angeles, CA 90095-1738, USA. , Performance Excellence, UCLA Health System, USA. , Performance Excellence, UCLA Health System, USA. , Institute for Innovations in Health, UCLA Health System, USA. , Department of Urology, David Geffen School of Medicine at the University of California, UCLA 10833 Le Conte Avenue, Box 951738, Los Angeles, CA 90095-1738, USA.