Patients' imaginative solutions can fuel healthcare innovation

Routinely collected patient experience surveys provide an opportunity for patients to share their creative ideas for improvement, according to a new study at Columbia University Mailman School of Public Health. Researchers in Health Policy and Management developed and assessed a methodological strategy that validates questions designed to elicit creative ideas from patients. Until now the pace of translating patient insights into innovation has been slow and its effectiveness inadequate. The findings are published in the journal, The Milbank Quarterly.

"Our study contributes to the generation of ideas in the following ways: First, it enriches understanding of an overlooked form of patient knowledge-;patients' creative ideas. Second, it contributes to health services research by offering a rigorously tested methodology for eliciting their creative ideas and how their experiences could be improved within the context of their own health systems," said Yuna Lee, PhD, Health Policy and Management professor and first author. For the past decade, the National Academy of Medicine has envisioned learning health systems in this way for American health care – using knowledge obtained directly from their patients to achieve high-quality, patient-centered care while containing costs at the same time."

It is critical for health care organizations to consider how to report and use these data in health care delivery and quality improvement, according to Lee. "Our research is the first to fully assess the potential of creative ideas of patients across diverse populations. My colleagues and I believe that a valid and reliable method for eliciting creative ideas from patients can be deployed as part of routine quality improvement in health care organizations."

Lee and colleagues conducted multistage mixed- method studies of patients' creative ideas in two field study stages. The first stage included survey development and testing with a representative sample of 600 adult patients from New York State and their creative ideas. The survey evaluated narrative elicitation methods that integrate open-ended questions into routine survey operations, Of four options tested, the final open-ended question generated roughly double the number of actionable items and highly creative ideas. This question was distinct in its approach to induce creativity explicitly.

They also found that certain subgroups of patients possessed a unique vantage point for especially actionable and/or especially creative ideas. "We contend that 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," observed Lee. "Inviting patients to generate and share their creative idea may support their agency and autonomy in health care systems that need more of both and that seek to create more opportunities for patient feedback and empowerment."

The second-stage field study was a real-world health systems test with a sample of 2,948 creative ideas from 1,892 patient surveys from a large health system in New York City. Lee and team collected ideas from patients who completed patient care experience surveys over 18 months from July 1, 2020, to December 31, 2021).

They found four possibilities for patients' creative ideas to enable learning for innovation: they could solve extant challenges and identify patient experience "pain points", specify new interventions when generating solutions is important, amplify exceptional practices or people which may enhance morale of clinicians and staff, or forecast hopes for the future, providing important input for strategic planning.

While patients are routinely recognized as an important source of knowledge, and their insights have been routinely extracted, the pace of translating these insights into innovations has been slow and effectiveness inadequate. Learning from patients' creative ideas through effective methods, the research team hypothesized that these shortfalls could be at least partly rectified.

While not all patient recommendations may be immediately put into practice, they can infuse fresh perspectives into existing practices and proposed innovations, helping to identify those meriting resource or time investment, according to Lee.

In a journey from idea generation to implementation, patients' creative ideas as a source of knowledge are a valuable starting point, providing important input for organizational strategic planning and forecasting, and providing a sense of what patients value and hope for the future."

Yuna Lee, PhD, Health Policy and Management professor and first author

Co-authors are Rachel Grob, University of Wisconsin; Ingrid Nembhard, The Wharton School, University of Pennsylvania; Dale Shaller, Shaller Consulting Group: and Mark Schlesinger, School of Public Health, Yale University.

The study was supported by grant U18 HS016978 from the Consumer Assessment of Healthcare Providers and Systems V of the Agency for Healthcare Research and Quality and grant NYSF-18-06107 from the New York Health Foundation.