Answers to multiple choice questions and brief comments on patient satisfaction surveys don't tell providers the whole story. Qualitative reports, in the form of detailed patient stories, can better capture information of value to providers, researchers say.
One of the benefits of being a journalist is that I get to tell other people's stories. Heart-breaking stories, informative stories, far-fetched stories, and funny stories. I find developing a rapport with the people I interview before start asking questions is usually a good idea. So I ask people about what they are passionate about, such as hobbies, families, or social causes. If they sense I am interested in them, they usually become amenable to answering more probing questions.
My method is not based on science, but it usually works.
Some healthcare researchers also believe that eliciting patients' stories or personal narratives is more useful toward gaining an understanding of patient satisfaction than the traditional Q&A format now used in most surveys.
Mark J. Schlesinger |
And they believe there is a scientific way in which these stories can be gleaned. In a New England Journal of Medicine article published this month, the authors propose that patient narratives can provide rich, relevant information about the areas in which clinicians need to improve.
"What we are trying to get at… is that in order to really make sense of people's experiences you need to get them to tell the full story of what their encounters were like," says Mark J. Schlesinger, professor of health policy, Yale University School of Public Health. "We need to start thinking about how we rigorously ask people about their stories instead of just having them leave comments"
Narratives Tell a Fuller Story
"The incorporation of narrative feedback into public reporting can highlight aspects of quality that are missing from conventional surveys," the article says. "In addition, elicitation of narrative feedback can encourage participation in patient experience surveys by allowing consumers to report what matters most to them."
Schlesinger and his colleagues have been studying the best ways to construct surveys for more than three years. Although their research focuses on physician visits, he says it applies to other healthcare settings as well.
"Qualitative reports from patients about healthcare represent an essential missing link both for consumers seeking to understand the experience[s] of other patients and for physicians seeking to learn from patients to improve quality," the article says. "
Framing the Questions Right
Using data collected from the current surveys makes it difficult to ferret out what is really going on with patients. Schlesinger and his fellow researchers explored the most effective ways to frame questions to draw the kind of information they were seeking. "We wanted to get at the ways in which patients interact with the people they come across during a visit and elicit the information that would be most useful for clinicians and consumers," he says.
The protocol developed by the researchers is a framework of questions that they believe prompts patients to openly tell their stories. The questions guide the narrative by asking patients what their expectations were when they went for the visit, whether those expectations were filled, and if unfulfilled, what they did about it.
Schlesinger and his colleagues are continuing their research to answer questions such as whether the protocol does what is expected when field tested and exactly how the narratives can be used in healthcare surveys.
Lessons from the National Health Service
Using narratives to gather patient feedback is not new. The Centers for Medicare & Medicaid Services' HCAHPS program (Hospital Consumer Assessment of Healthcare Providers and Systems) has spawned an industry of private firms willing to survey hospital patients for a price. But the information is private and only seen by certain healthcare leaders within the hospital. The information is not transparent, Schlesinger says.
In the United Kingdom, where most healthcare is free to all UK residents, things are different. The National Health Service allows patients to post their stories, good or bad, about hospitals and physicians on its public website. Patients rate their encounters by stars and hospital and providers have an opportunity to post their response to the narratives.
Schlesinger says the U.S. isn't anywhere near that level of gathering and using narratives to inform consumers or healthcare workers when choosing providers or hospitals. But, he says, "A lot of people in the field think there is a need for this type of work and that it needs to be taken seriously."
To use narratives on the same scale as the NHS means gathering stories from millions of patients across the country and then hiring people to comb through the data and weed out information that is inappropriate. "It requires a big commitment of money and resources to make this work," he says.
Schlesinger believes, however, that when it comes to patient surveys, "The right story is the full story."
Janet Boivin, RN, is senior quality editor at HealthLeaders Media. 
