QI/PS Hot Topic – November 2022
Informing healthcare quality through patient focus groups
Angie Marshall, MS, LSSBB – Improvement Specialist II, MMC Performance Improvement
- Discuss the utility of patient focus groups in quality improvement
- Describe how to plan and conduct a patient focus group
- Identify ways to analyze and visualize qualitative data
Focus groups are a form of qualitative research used to gain a deeper understanding of experience, opinions, behaviors and needs of the customer through a moderated, open discussion. In a healthcare setting it is important that patients can provide feedback about their experience in order to continually improve care. There are several ways to collect patient experience data, and as depicted in Figure 1. These methods vary in description and generalizability. To understand patient experience within a large healthcare system, the focus is often on collecting and reporting quantitative (or “countable”) data because it can be easily organized, analyzed and understood. Quantitative information is more generalizable to the broader population, but less descriptive about individual patients.
An effective method for collecting descriptive patient stories is through a focus group – a guided discussion about a particular topic. A group discussion with patients is a great way to delve into detail on specific topics, to understand participant’s opinions and to encourage new thoughts and ideas. Further, it gives patients an opportunity to play a role in positive change within the health system.
There are limitations to focus groups. They require a significant amount of time to organize and execute, the data can be complex to analyze and there is a potential for bias. Despite these challenges, it is still an effective tool for sampling a subset of a population about targeted topics. Below are guidelines and tips for planning and conducting an effective focus group.
How to plan for a patient focus group:
- Define the objective of the focus group. What research question needs to be informed?
- Determine the session details including date(s), location and length (1 hour is recommended). An incentive can be offered to participants to encourage participation and as a thank you for their involvement.
- Prepare a list of 8-12 open-ended questions to guide the discussion that align with the session objectives. The most important questions should be asked first to ensure they aren’t missed. An ice breaker question can be is posed at the beginning to encourage conversation.
- Select a moderator to lead the group through the discussion questions. This moderator must remain neutral throughout the session so often an outside facilitator is hired for this role.
- Determine who will be the note taker and time keeper to keep the session on track and to record important ideas. Gather consent from the participants if the session is recorded.
- To allow everyone to participate, it is recommended to have 8-12 participants join the session.
- Participants should be invited to participate at random from a pool of eligible patients.
- Invite participants to the event at least two weeks prior to the session, and give the participants a reminder call/email a few days prior to the event.
How to conduct a focus group session:
- The moderator will begin the session by stating the objectives, providing logistical details and asking the ice breaker question.
- The moderator will ask each question in order on the question list and ensure everyone has had an opportunity to respond. Follow-up questions can be asked to gather more information.
- The note taker will record important ideas and observed conversation patterns.
- At the end of the session, the moderator will ask the participants for additional input or comments and will thank them for participating.
Once the patient focus group is complete and the conversation is documented, it’s time to analyze the data and identify trends. Group the discussion notes by question and identify themes from each of the topics. Consider analyzing the results based on demographics or sub-groups. Pull out insightful quotes or stories that exemplify each of the identified trends. A word cloud (figure 2) and/or a Pareto chart can be used to visually display common themes that arose. Tie the findings back to the session objectives and goals, and identify actionable opportunities for quality improvement and/or further investigation.
Organizing and executing a patient focus group is time intensive as compared to other research methods. However, the insights and patient stories that are gleaned from the discussion provide in-depth understanding of patient interaction with a health system. Applying data trends with patient stories allows for a holistic approach to information gathering and makes a strong case for quality improvement initiatives that impact patient experience.
- Barbour, RS, 1999. The Use of Focus Groups to Define Patient Needs. Journal of Pediatric Gastroenterology & Nutrition; April 1999, Volume 28, Issue 4, pp.S19-S22. https://journals.lww.com/jpgn/Pages/ArticleViewer.aspx?year=1999&issue=04001&article=00002&type=Fulltext
- Berger, S, Saut, AM, Berssaneti, FT, 2020. Using patient feedback to drive quality improvement in hospitals: a qualitative study. BMJ Open 2020; 10: e037641. https://bmjopen.bmj.com/content/10/10/e037641
- Bombard, Y, et al., 2018. Engaging patients to improve quality of care: a systemic review. Implementation Science; 13:98. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060529/pdf/13012_2018_Article_784.pdf
- NHS England, 2016. Guide 09: A bite-size guide to run focus groups for patient and public engagement. NHS England; 05422, pp.1-9. https://www.england.nhs.uk/wp-content/uploads/2016/07/bitesize-guide-focus-groups.pdf
- Silva, D, 2013. Measuring the patient experience. The Health Foundation; 18th, pp.1-15. https://www.health.org.uk/sites/default/files/MeasuringPatientExperience.pdf
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