Search

Policy PointsPatients' creative ideas may inform learning and innovation that improve patient‐centered care.Routinely collected patient experience surveys provide an opportunity to invite patients to share their creative ideas for improvement. We develop and assess a methodological strategy that validates question wording designed to elicit creative ideas from patients.Health care organizations should consider how to report and use these data in health care delivery and quality improvement, and policymakers should consider promoting the use of narrative feedback to better understand and respond to patients' experiences. Context: Learning health systems (LHSs) have been promoted for a decade to achieve high‐quality, patient‐centered health care. Innovation driven by knowledge generated through day‐to‐day health care delivery, including patient insights, is critical to LHSs. However, the pace of translating patient insights into innovation is slow and effectiveness inadequate. This study aims to evaluate a method for systematically eliciting patients' creative ideas, examine the value of such ideas as a source of insight, and examine patients' creative ideas regarding how their experiences could be improved within the context of their own health systems. Methods: The first stage of the study developed a survey and tested strategies for elicitation of patients' creative ideas with 600 patients from New York State. The second stage deployed the survey with the most generative open‐ended question sequence within a health care system and involved analysis of 1,892 patients' responses, including 2,948 creative ideas. Findings: Actionable, creative feedback was fostered by incorporating a request for transformative feedback into a sequence of narrative elicitation questions. Patients generate more actionable and creative ideas when explicitly invited to share such ideas, especially patients with negative health care experiences, those from minority racial/ethnic backgrounds, and those with chronic illness. The most frequently elicited creative ideas focused on solving challenges, proposing interventions, amplifying exceptional practices, and conveying hopes for the future. Conclusions: A valid and reliable method for eliciting creative ideas from patients can be deployed as part of routine patient experience surveys that include closed‐ended survey items and open‐ended narrative items in which patients share their experiences in their own words. The elicited creative ideas are promising for patient engagement and innovation efforts. This study highlights the benefits of engaging patients for quality improvement, offers a rigorously tested method for cultivating innovation using patient‐generated knowledge, and outlines how creative ideas can enable organizational learning and innovation. [ABSTRACT FROM AUTHOR]

Background: Enthusiasm has grown about using patients' narratives—stories about care experiences in patients' own words—to advance organizations' learning about the care that they deliver and how to improve it, but studies confirming association have not been published. Purpose: We assessed whether primary care clinics that frequently share patients' narratives with their staff have higher patient experience survey scores. Approach: We conducted a 1-year study of 5,545 adult patients and 276 staff affiliated with nine clinics in one health system. We used multilevel models to analyze survey data from patients about their experiences and from staff about exposure to useful narratives. We examined staff confidence in own knowledge as a moderator because confidence can influence use of new information sources. Results: Frequency of sharing useful narratives with staff was associated with patient experience scores for all measures, conditional on staff confidence in own knowledge (p <.01). For operational measures (e.g., care coordination), increased sharing correlated with subsequently higher performance for more confident staff and lower performance or no difference for less confident staff, depending on measure. For relational measures (e.g., patient–provider communication), increased sharing correlated with higher scores for less confident staff and lower scores for more confident staff. Conclusion: Sharing narratives with staff frequently is associated with better patient experience survey scores, conditional on confidence in knowledge. Practice Implications: Frequently sharing useful patient narratives should be encouraged as an organizational improvement strategy. However, organizations need to address how narrative feedback interacts with their staff's confidence to realize higher experience scores across domains. [ABSTRACT FROM AUTHOR]

Urie Bronfenbrenner and Ernest Boyer argued for leaving the laboratory to conduct rigorous developmental research in the real world where children are found--in the places they go. Contributions to this special issue meet Bronfenbrenner and Boyer's call while at the same time recognizing the continued importance of laboratory research. These articles range from a review of research on the arts to a language intervention in Senegal to large-scale dissemination and intervention projects designed to communicate the best developmental science to families, public agencies, and schools. Together these articles illustrate how we can study development in the world and enrich our work on the factors that promote development. Taking this path presents us with a set of additional hurdles to be addressed, such as how to communicate with the public and how to scale up our interventions in the face of diversity along many dimensions.

Parental attitudes shape play opportunities afforded to children in home, community, and school settings. This study presents evaluation of an intervention designed to enrich parent's conception of play and its relationship with socially valued skills and capacities. On the basis of data from 291 racially and ethnically diverse parents/caregivers of young children (median age between 3 and 6) attending an event in NYC, we find the intervention helped parents conceptualize play in complex ways and altered perceptions of its impact on children's current--but not future--lives. Multivariate analyses reveal the causal pathway for these changes as exposure to multiple play sites, rather than time at the event--a finding with direct implications for exposing parents to developmental science in community settings.