Context / probleemstelling of aanleiding

Probleemstelling (inclusief theoretische onderbouwing en onderzoeksvraag/vragen):

Patient feedback can play an integral part in quality improvement and healthcare professionals’ professional development. In their role as “end-users” of healthcare, patients are experienced experts. Yet, given busy workplaces and daily routines, trained healthcare professionals and hospital staff might not always recognize patient feedback. Feedback literature has repeatedly shown that feedback providers’ characteristics, status and experience affect credibility and usefulness of feedback. These challenges diminish learning opportunities in, for and from practice and may bypass performance feedback as powerful tool for lifelong learning. Additionally, patients may confuse physicians’ performance with system issues, which might diminish their comments’ credibility and relevance. To understand how patient feedback can be facilitated and used for lifelong learning, we must first explore patients’ and healthcare professionals’ needs regarding patient feedback. Therefore, this research explores: what are patients’ and healthcare providers’ perspectives regarding the use of patient feedback for lifelong learning?

Methode:

We used a pragmatic approach for this qualitative study. We conducted semi-structured interviews with 12 healthcare providers (gynaecology & obstetrics) and 9 patients. We used thematic analysis to better understand interviewee’s experiences and shared meaning regarding patient feedback, and the underlying social and cultural context. We applied an inductive approach to thematic data analysis, meaning that we discussed initial codes of healthcare professional interviews before looking for themes. Themes included ‘importance of patient feedback’, ‘diverse/different perspectives’, ‘barriers to patient feedback’, and ‘requirements’. CS continued to code all healthcare professionals interview transcripts, combining and comparing relevant codes to then review existing and generate new themes around ‘patient-centeredness’. Those themes were discussed in the research team before CS and MB continued to analyse the remaining patient interviews. Newly generated themes were compared to relevant existing ones and revised. Towards the end, the analysis became more deductive, looking for themes and relevant quotes around ‘using patient feedback for lifelong learning on different levels’.

Resultaten (en conclusie):

Patients and healthcare professionals alike described the importance of patient feedback in patient-centred care. Based on the interviews, we were able to discern perceived inhibiting and facilitating factors and requirements for valuable use of patient feedback. Barriers included feelings of dependency and hierarchy in the treatment relationship, a lack of time, trust or a safe space. In contrast, a trusting relationship, open attitude and meta-communication could aid solicitation of patient feedback and overcome these barriers. Tuning into diverse patient preferences and expectations can empower patients in providing feedback to improve their patient-professional relationships and that of other patients. Additionally, patient feedback can be used for personal growth, as well as professional development of healthcare professionals under the right conditions and when solicited adequate.

Discussie (beschouwing resultaten en conclusie in het kader van de theorie):

Patients and healthcare providers see a role for themselves in giving or inviting patient feedback and thereby contributing to their lifelong learning but often miss the tools to do so. To structurally invite patient feedback and use it for one’s own learning, it is necessary that healthcare professionals create a safe space in which patients are empowered to provide feedback. This requires attention to hierarchy and feelings of dependence in the treatment relationship, which may change over time. It also requires facilitation and training to routinely invite and consequently use patient feedback, for both patients and healthcare professionals.

Referenties:

Baines, R., Regan de Bere, S., Stevens, S. et al. The impact of patient feedback on the medical performance of qualified doctors: a systematic review. BMC Med Educ 18, 173 (2018). https://doi.org/10.1186/s12909-018-1277-0

Sehlbach, C., Teunissen, P.W., Driessen, E.W., et al. Learning in the workplace: Use of informal feedback cues in doctor-patient communication. Med Educ 54, 811– 820 (2020). https://doi.org/10.1111/medu.14148