ISQUA16-1444DEVELOPING A PATIENT-LED ELECTRONIC FEEDBACK SYSTEM FOR QUALITY AND SAFETY WITHIN AN EXISTING ELECTRONIC HEALTH RECORD

Abstract

Objectives: Explore the feasibility of renal patients, healthcare professionals and researchers working in partnership to develop a patient-led quality and safety feedback system within an existing electronic health record (EHR), known as Renal Patient View (RPV). Adapt RPV to accommodate a patient-led quality and safety feedback system and collect a range of qualitative data from patients and staff to establish the main components of the prototype and assess usability. Method(s): This study was informed by Catwell and Sheikh's model designed to evaluate eHealth interventions. Renal patients, healthcare professionals and researchers acted as co-creators, and co-evaluators. Phase 1 (inception) focus groups and phase 2 (requirements) cognitive walkthroughs and 1:1 qualitative interviews involved both patients and healthcare professionals. Heuristic evaluation guided the process of evaluating how the prototype was used. A patient ledsteering group was formed, consisting of renal patients, healthcare professionals and the research team to oversee the research process. A Joint Services Expert Panel (JSP) was convened, consisting of patients, a carer, front line staff, the research team and governance leads. The purpose of the JSP was to review the findings from phase 1 and agree on the key components of the system prototype. Focus groups were analysed using a thematic approach. Members of the research team met to compare their individual analyses and to agree a coding framework. Findings were discussed with the patient-led steering group and agreed at the JSP. Data from phase 2 were analysed using the components of heuristic evaluation, resulting in a list of key components for the system prototype. Result(s): In phase 1, nine focus groups with 57 participants were conducted, including a non-English speaking patient focus group. Barriers and facilitators to patients feeding back on quality and safety concerns were identified: 1. Anonymity: patients wanted an anonymous feedback system, but healthcare professionals were concerned that this would limit their ability to investigate concerns. 2. Inclusion of a feedback mechanism for patients: patients expressed their desire to receive individual feedback from staff. Healthcare professionals were concerned that this would be too burdensome. 3. Avoidance of the word "reporting" and using "feedback" instead: participants felt that the system should be about sharing information between patients and staff, and avoid the use of the word reporting. 4. Importance of being able to feedback positive experiences as well as concerns. In phase 2, 34 cognitive walkthroughs and interviews were completed with patients, carers, healthcare professionals and other staff members. The fourteen members of the JSP agreed on seven key principles for the system prototype: the title of the system, the inclusion of forms for both positive experiences and concerns, the need for anonymity, the use of two-tier filtering system for dealing with patient feedback, individual feedback acknowledgment, the use of unstructured feedback forms and the inclusion of a severity score. Conclusion(s): All stakeholders were able to work together to identify key components for an electronic patient quality and safety feedback system in renal services. Tensions arose due to competing priorities, particularly around anonymity and feedback. Careful consideration should be given to the feasibility of integrating a new component with differing priorities into an established system with existing functions and objectives.