Mater Hospital

2 Methodology

Objectives of study

The objectives of the study were as follows:

The Audit Commission highlighted the need for improved communication in hospitals, as research studies over a thirty-year period have shown that patients are dissatisfied with this aspect of care. In particular, in relation to information-giving, hospital patients often experience considerable anxiety as a result of receiving too little information or information which they cannot understand . In terms of the information needs of patients, they want to "be briefed and (to) question what is being done to them" (pg. 25) , be consulted regarding their preferences for treatment , and involved in making decisions about their care . In relation to medications, the National Service Framework for older people specified that older patients need to be given the opportunity to ask questions about their medications - why they have been prescribed and any possible side-effects. Research into planning for discharge from hospital has also highlighted a lack of information provision and a need for staff to undertake more discussion with patients prior to their being discharged home . The Audit Commission emphasised that good communication with patients can reduce the stress and anxiety associated with hospitalisation, increase patient compliance with the management of chronic illness and improve clinical outcomes. In addition, good communication can also lead to increased hospital efficiency.

The study used a mapping design, that is, the patient's total hospital experience (in terms of communication and information provision) was mapped right through from admission via the Accident and Emergency department, to transfer to medical and surgical wards and following discharge from hospital. Specifically, a series of one-to-one, semi-structured interviews were carried out with a sample of patients, which explored their experiences of communication with, and information provision by, hospital staff during their periods of hospitalisation.

The data collection process involved conducting a series of qualitative interviews with a sample of inpatients. Whilst it was originally planned that a sample of twenty-five inpatients - stratified by type of admission (medical or surgical), gender and age group - would be selected over a two-week period in late November, this was not entirely successful. There was a high level of admissions of older people during the sampling period and because the study involved interviewing each patient three times, this discouraged some patients from participating and others who initially participated refused to be interviewed at a later stage. Consequently, the sampling period had to be continued throughout December 2000 and January 2001, until a sample of 19 patients - interviewed from admission through to discharge - had been obtained. The make-up of the final sample is discussed in the next section. Only adult inpatients (18 years or over) were included in the study. The following patients were excluded from the study:

Final sample

Whilst almost 40 patients were initially interviewed as part of the study, there was a high attrition rate, as discussed above. The final sample consisted of 19 patients: sixteen medical patients and three surgical patients. Consequently, the subgroup of surgical patients was very small.

The gender breakdown of the sample was almost half and half (ten women and nine men). The surgical patients consisted of two men and one woman. The medical patients consisted of nine women and seven men.

The majority of the sample (16/19) were older people (women aged 60 or over; men aged 65 or over). In addition, two other patients were in their early 50s or 60s, and the final patient was aged 30+. Over half of the older sample were women (9/16).

Each of the nineteen patients was interviewed three times, generally as follows:

All the 1st interviews were carried out within 24 hours of the patients being admitted to the admissions ward. As regards the timing of the 2nd interviews, in 16 cases, these took place between one and five days after the initial interviews. In addition one patient was interviewed five days after undergoing an operation. FM19 was interviewed eight days after the initial interview and FM02 was interviewed ten days after the initial interview. All except one of the 2nd interviews took place on a medical or surgical ward: the exception was MM18 who was interviewed a second time on the admissions ward (the day after his admission to the ward).

Whilst it was originally intended that the 3rd interviews (in patients' own homes) would be conducted 24 - 48 hours after discharge, this was generally not feasible. Specifically, it did not suit the patients to be interviewed until later, particularly as the planned timing of some of the interviews coincided with the Christmas period. As regards whether there were third parties present during these interviews, the patient was interviewed on her/his own in most cases (17/19) and the patients' spouses were present during two interviews.

Before approaching the patients for interviews, the advice of the nursing staff was sought as to their suitability for interviewing (in terms of ill-health state and psychiatric or cognitive state). The interviewer approached the patients after they were admitted to the admissions ward and asked for permission to interview them twice during their stay in hospital (once on the admissions ward and once after transfer to a medical or surgical ward) and once after discharge. At the second and third interviews, the researcher again clarified that the patients consented to be interviewed. The patients were assured that their confidentiality would be maintained and that any information they gave would not affect the care that they received from the hospital staff.

However, because the hospital interviews generally took place at the bedside, it was not possible to guarantee privacy to the patients although, as far as possible, the interviewer tried to ensure discretion. Consequently, the patients tended to be quite guarded during the hospital interviews and were more forthcoming when they were interviewed in their own homes, after discharge. In addition, there were issues raised during the post-discharge interviews which had not been raised by the patients while they were still in hospital.

Each interview was quite short (20-30 minutes), to ensure tolerance by the patients. The interviews were tape-recorded, and the patients' consent was obtained prior to commencing recording. It should be noted that ethical approval was not required for the study.

In order to maintain the patients' anonymity, each patient was allocated a code during the data analysis phase. Each code consists of a number from 1 to 19 and indicates the type of admission and the gender of the patient, as follows:
FM = Female medical patient
FS = Female surgical patient
MM = Male medical patient
MS = Male surgical patient

Data analysis

The Audit Commission specified that effective communication is a two-way process:

Consequently, the analysis of the interview data examined the extent to which the patients were listened to by the staff; their information requirements and preferences and the degree to which these were met by the staff. In addition, the extent to which the staff tailored the provision of information to the individual's particular health experiences, her/his level of understanding and communication ability was explored. The data analysis also examined the inpatient's level of satisfaction with the quality of communication by staff. Lastly, any gaps in information provision and areas where improvement in communication by staff might be needed were explored.