Implementation of a patient-collected audio recording audit & feedback quality improvement program to prevent contextual error: stakeholder perspective
Posted on 2021-08-31 - 03:39
Abstract Background Using patient audio recordings of medical visits to provide clinicians with feedback on their attention to patient life context in care planning can improve health care delivery and outcomes, and reduce costs. However, such an initiative can raise concerns across stakeholders about surveillance, intrusiveness and merit. This study examined the perspectives of patients, physicians and other clinical staff, and facility leaders over 3 years at six sites during the implementation of a patient-collected audio quality improvement program designed to improve patient-centered care in a non-threatening manner and with minimal effort required of patients and clinicians. Methods Patients were invited during the first and third year to complete exit surveys when they returned their audio recorders following visits, and clinicians to complete surveys annually. Clinicians were invited to participate in focus groups in the first and third years. Facility leaders were interviewed individually during the last 6 months of the study. Results There were a total of 12 focus groups with 89 participants, and 30 leadership interviews. Two hundred fourteen clinicians and 800 patients completed surveys. In a qualitative analysis of focus group data employing NVivo, clinicians initially expressed concerns that the program could be disruptive and/or burdensome, but these diminished with program exposure and were substantially replaced by an appreciation for the value of low stakes constructive feedback. They were also significantly more confident in the value of the intervention in the final year (p = .008), more likely to agree that leadership supports continuous improvement of patient care and gives feedback on outcomes (p = .02), and at a time that is convenient (p = .04). Patients who volunteered sometimes expressed concerns they were “spying” on their doctors, but most saw it as an opportunity to improve care. Leaders were supportive of the program but not yet prepared to commit to funding it exclusively with facility resources. Conclusions A patient-collected audio program can be implemented when it is perceived as safe, not disruptive or burdensome, and as contributing to better health care.
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Ball, Sherry L.; Weiner, Saul J.; Schwartz, Alan; Altman, Lisa; Binns-Calvey, Amy; Chan, Carolyn; et al. (2021). Implementation of a patient-collected audio recording audit & feedback quality improvement program to prevent contextual error: stakeholder perspective. figshare. Collection. https://doi.org/10.6084/m9.figshare.c.5594760.v1
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AUTHORS (19)
SB
Sherry L. Ball
SW
Saul J. Weiner
AS
Alan Schwartz
LA
Lisa Altman
AB
Amy Binns-Calvey
CC
Carolyn Chan
CF
Corinna Falck-Ytter
MF
Meghana Frenchman
BG
Bryan Gee
JJ
Jeffrey L. Jackson
NJ
Neil Jordan
BK
Benjamin Kass
BK
Brendan Kelly
NS
Nasia Safdar
CS
Cecilia Scholcoff
GS
Gunjan Sharma
SS
Soumya Subramaniam
FW
Frances Weaver
MW
Maria Wopat