September '19

Sandro Luna, BS, SASI Teaching Assistant, Current Columbia Medical Student

Presenting my first research project: from concept to completion

My Experience Presenting Research at the 2019 International Forum on Quality and Safety in Healthcare

“That would be awesome!

I was ecstatic to see such an enthusiastic response. I emailed Dr. Chu in October 2016 to ask if he was interested in a patient centered research project, which I had started thinking about after working with Medicine X in 2015. His response is above, and we initiated a fascinating research journey evaluating patient experiences at Stanford Health Care.

For context, the US is moving toward value based payment models; this means health care providers can be rewarded for achieving certain quality goals. Patient experiences, specifically their feedback, is integrated into these value based compensation formulas. Why is the US making these changes? One reason is that our proportion of Gross Domestic Product (GDP) spent on health care is higher than any other developed nation in the world: 17.9%. If we spend so much, aren’t we getting better outcomes? Not necessarily. The U.S. also has one of the lowest rated health care systems in the developed world despite its high expenditures, having a relatively low life expectancy at birth, high infant mortality rate, and among the highest rates of ischemic heart disease per 100,000 persons. Clearly, we aren’t getting the best value for our health care dollars.

 


  • Enter Same Day Feedback, a patient experience program at Stanford Health Care and the center of this research. Created in 2009, SDF members visit inpatients and conduct semi-structured bedside interviews to assess their hospital experiences and address any concerns. HOWEVER, SDF interview data has never been systematically evaluated. Critical to this research was a transition in SDF members. From June 2009 May 2013, members were SHC hospital staff. From June 2013 to present, members are Patient and Family Partners, volunteers who are former patients or relatives of former patients themselves.

    Based on this transition in interviewers, we had two questions: how did patients in the cancer unit assess their physicians, and how did these assessments differ across four needs?

    Emotional
    Practical
    Physical
    Informational

    While research was being completed, we realized we needed specialized help in order to analyze the decade of quantitative and qualitative data we had collected. This is where SASI came in! I was a TA for the 2017 program and was able to work with many wonderful, bright students. One of these students was Ujwal Srivastava, a high school senior at the time. We both stayed in touch with Dr. Chu throughout the year, and he loved the patient centered research we were doing. Ujwal happily joined the project and has been a great team member! At the same time, we also started working with Dr. Amy Price, who’s academic background, research interests, and personal story became an inimitable part of our team.

    We hypothesized that patient responses would differ in the interviewer groups, and we were very intrigued by the results we found! In short, patients interviewed by PAFPs complimented their physicians by focusing on themes of relationships and trust. These patients also used Narratives of Care to describe their experiences: stories of their hospital stay filled with rich detail about the people, events, and outcomes that they faced. In contrast, patients interviewed by staff had shorter responses (“My doctors are great”) that were equally complimentary, but used significantly less Narratives of Care.

    I presented this research at the 2019 International Forum on Quality and Safety in Healthcare hosted in Glasgow, Scotland, a place I had never been. There were over 3,400 people at the conference! The whole city was in-tune to the events that were taking place that week, and it was an honor to be able to attend. When I got to my presentation room, it was a full house; almost every seat was filled. I was a little nervous, only because I wanted to do my best, and I was the only student in the room! I’d be sharing this research with heads of health care systems, executive administrators, international policy makers, patients, and many more stakeholders.

When it was my turn to speak, the presentation went off without a hitch. In my mind, it flew by! I was so excited to have the opportunity to share this patient centered research which started out as an idea just a few years ago. Being able to meet all the attendees and share our ideas about the future of health care was inspiring and uplifting. There are so many people around the world doing excellent research on the front-lines of care, and this conference brings them together. When we join together for the common cause of improving health care, we present a united front for the ultimate good of the patient.

I made great connections with other attendees and presenters working on similar initiatives in different countries, and learned a lot from their implementations. For example, empowering psychiatric patients to track their own progress with a personalized online portal that the doctor can view with them. Another project talked about PDSA cycles and emphasized quick turn around of improvements based on feedback gathered. There were many fascinating parallels to the SDF program research!

At the end of the day, we do not work in isolation and our collaboration is key to improvement: this includes the patients. Collaborating and including patients in the design, implementation, and evaluation of feedback makes sense. This idea was a resounding theme of the conference proceedings, and I am hopeful for the future of medicine— one that is optimized to be patient centered. I encourage you to think about how SASI fosters this same patient centered approach to health care, and pursue opportunities that let you champion the patient voice.