How do patient feedback systems work in low-income and middle-income countries? Insights from a realist evaluation in Bangladesh.
How do patient feedback systems work in low-income and middle-income countries? Insights from a realist evaluation in Bangladesh.
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患者反馈系统如何在低收入和中等收入国家发挥作用？从孟加拉国的现实主义评估中获得的见解。
DOI：
10.1136/bmjgh-2020-004357
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发表时间：
2021-03
影响因子：
8.1
通讯作者：
Huque R
中科院分区：
文献类型：
--
作者：
Mirzoev T;Kane S;Al Azdi Z;Ebenso B;Chowdhury AA;Huque R
运转良好的患者反馈系统有助于提高医疗保健质量和系统问责制。根据公民理论和委托代理关系，我们使用现实主义评估来检查孟加拉国卫生机构的患者反馈系统。我们分两个阶段收集和分析数据，使用：文件审查；对来自公开门户网站的数据进行二次分析；与患者、卫生工作者和管理人员进行深入访谈；对反馈环境的非参与者观察；以及利益相关者研讨会。第一阶段侧重于识别和阐明患者反馈系统的初始程序理论（PT）。在第二阶段，我们通过分析数据和将新发现纳入实质性理论和实证文献，反复测试和完善这一初始理论，以得出一个完善的PT。孟加拉国运行多个患者反馈系统，主要包括收集、分析和根据反馈采取行动的阶段。关键的环境促成因素包括对问责制的政治承诺，而关键的制约因素包括患者对反馈渠道的认识有限、缺乏指导方针和文件化流程、地方政治动态和优先事项、机构等级和问责制关系。研究结果强调，关系信任可能对许多人行使公民权利和提供反馈很重要，并且具有明确问责制的适当政策和监管框架对于确保一线医疗机构内有效的患者反馈管理至关重要。公民身份和委托代理关系理论可以帮助理解反馈系统如何通过关注公民身份和代理、共享或竞争利益以及信息不对称来工作。我们通过强调患者、卫生工作者和管理人员如何同时作为委托人和代理人，以及如何解决信息不对称和可能的代理损失，扩展了对这些理论的理解。我们强调提高意识和无威胁环境的重要性，以提供反馈，为员工提供足够的支持，以记录和分析反馈，并及时采取行动。
Well-functioning patient feedback systems can contribute to improved quality of healthcare and systems accountability. We used realist evaluation to examine patient feedback systems at health facilities in Bangladesh, informed by theories of citizenship and principal–agent relationships. We collected and analysed data in two stages, using: document review; secondary analysis of data from publicly available web-portals; in-depth interviews with patients, health workers and managers; non-participant observations of feedback environments; and stakeholder workshops. Stage 1 focused on identifying and articulating the initial programme theory (PT) of patient feedback systems. In stage 2, we iteratively tested and refined this initial theory, through analysing data and grounding emerging findings within substantive theories and empirical literature, to arrive at a refined PT. Multiple patient feedback systems operate in Bangladesh, essentially comprising stages of collection, analysis and actions on feedback. Key contextual enablers include political commitment to accountability, whereas key constraints include limited patient awareness of feedback channels, lack of guidelines and documented processes, local political dynamics and priorities, institutional hierarchies and accountability relationships. Findings highlight that relational trust may be important for many people to exercise citizenship and providing feedback, and that appropriate policy and regulatory frameworks with clear lines of accountability are critical for ensuring effective patient feedback management within frontline healthcare facilities. Theories of citizenship and principal–agent relationships can help understand how feedback systems work through spotlighting the citizenship identity and agency, shared or competing interests, and information asymmetries. We extend the understanding of these theories by highlighting how patients, health workers and managers act as both principals and agents, and how information asymmetry and possible agency loss can be addressed. We highlight the importance of awareness raising and non-threatening environment to provide feedback, adequate support to staff to document and analyse feedback and timely actions on the information.
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影响因子：
2.9
作者：
Brüggemann AJ;Swahnberg K
通讯作者：
Swahnberg K
影响因子：
2.1
作者：
Hsieh, Sophie Y.
通讯作者：
Hsieh, Sophie Y.
影响因子：
4.2
作者：
Hogg, Rhona;Hanley, Janet;Smith, Pam
通讯作者：
Smith, Pam
DOI：
10.1111/j.1440-172x.2012.02057.x
发表时间：
2012-10-01
影响因子：
1.9
作者：
Hsieh, Sophie Yahui
通讯作者：
Hsieh, Sophie Yahui
影响因子：
4.2
作者：
Allan, Helen T.;Odelius, Ann Christine;Gallagher, Ann
通讯作者：
Gallagher, Ann