What is it about?

The use of healthcare diaries often involves the patient completing a diary from a clinician’s perspective, by recording information related to diagnosis or medication compliance. We wished to better understand the patient’s hospital-stay experience from their perspective, by asking patients to complete an unstructured diary written in their own words about the positive and negative experiences of their care journey from hospital admission to discharge. We recruited 113 patients undergoing vascular surgery in order to collect 80 completed diaries. Patients wrote around 200 words in each of their diaries (but as much as 1672 words), and those with a tertiary education wrote more than double the number of words than those without. Three primary and eight secondary themes emerged from the analysis of diary transcripts reflecting patients’ priorities and experience. The three primary themes important to patients during their care were: (1) Communication as central to care; (2) Importance of feeling cared for; and (3) Environmental factors shaping experiences. In the great majority, participants reported positive experiences in hospital. However, a set of 12 problem areas were identified by patients with suggestions for improvement. Half of the 12 problem areas fell into primary theme 1, concerning opportunities to improve communication between healthcare providers and patients. Five of 12 problem areas fell into primary theme category 3, involving aspects of the hospital environment. Solutions to a number of the identified problem areas are known, suggesting that many can be remedied with little cost or effort, but with substantial returns in improved patient experience. Our study is consistent with the modern concept of Safety-II, which involves learning from what went right, in addition to what went wrong, in order to focus on making good performance better, as well as attempting to eliminate the relatively small number of remaining poorer experiences that continue to occur. Unstructured diaries completed in a patient’s own words appear to be an effective and simple approach to capture the hospital-stay experience from the patient’s own perspective, and to identify opportunities for improvement.

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Why is it important?

There are few methods available in the healthcare literature to directly capture patients' experience or perspectives during healthcare. Hospital-stay diaries completed by patients in their own words appear to be a useful way capture the patient's experience and to identify aspects of the healthcare journey that can be improved.

Perspectives

Previous patient diary studies ask patients to record information of interest to the clinician, and hospital evaluation surveys ask questions of interest to hospital managers. This study asked patients to engage in the making of a diary about what mattered to them during their healthcare, in which they could record anything they wished in their own words.

Associate Professor Craig Webster
University of Auckland

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This page is a summary of: Capturing the experience of the hospital-stay journey from admission to discharge using diaries completed by patients in their own words: a qualitative study, BMJ Open, March 2019, BMJ, DOI: 10.1136/bmjopen-2018-027258.
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