BACKGROUND Research shows that the way that healthcare staff experience their job impacts on their individual performance, patient experience and outcomes as well as on the performance of organisations. This article builds on this literature by investigating, with multi-disciplinary clinical teams as well as patients and relatives, what factors help or hinder changes designed to improve patient experience. METHODS Qualitative research looking at patient- and family-centred care (PFCC) on two care pathways (stroke and hip fracture) was conducted in England and Wales. A realist approach combined with participatory action research was used to account for the complexity of organisational context and power relations. Multiple methods were used, including documentary analysis, participatory steering groups with staff and patient representatives, observations of the care pathways (n = 7), staff and patient and relative focus groups (n = 8), and hospital staff, patient and PFCC staff interviews (n = 47). RESULTS Findings highlight multiple factors that support and hinder good patient experiences. Within individual care, paternalistic values and a lack of shared decision-making and patient-centred care still exist. Supportive interdisciplinary teamwork is needed to address issues of hierarchy, power and authority amongst staff and managers. At the organisational level, key issues of waiting times, patient flow, organisational resources and timely discharge affect staff's time and capacity to deliver care. In addition, macro contextual factors, such as finance, policy, targets and measures, set particular limits for improvement projects. CONCLUSIONS Given this context, improving patient experience needs to go well beyond small-scale projects at the micro and meso level to incorporate a more critical understanding of systems, the wider organisational context and how power operates at multiple levels to enable and constrain action. In order to more meaningfully understand and address the factors that can help or hinder activities to improve patient experiences, PFCC frameworks and methods need to account for how power inequities operate and require the adoption of more participatory co-produced and empowering approaches to involve patients, relatives, carers and staff in improving complex healthcare environments.

中文翻译：

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通过以患者和家庭为中心的护理方法，权力，背景和代理机构在改善患者体验方面的重要性。

背景研究表明，医护人员体验工作的方式会影响他们的个人绩效，患者体验和结果以及组织的绩效。本文通过与多学科的临床团队以及患者和亲戚一起调查哪些因素有助于或阻碍旨在改善患者体验的改变而建立在这些文献的基础上。方法在英格兰和威尔士进行了定性研究，以患者和家庭为中心的两种护理途径（中风和髋部骨折）进行了研究。现实主义的方法与参与性行动研究相结合，用于解决组织环境和权力关系的复杂性。使用了多种方法，包括文献分析，与工作人员和患者代表进行的参与式指导小组，观察护理途径（n = 7），工作人员，患者和相对焦点小组（n = 8）以及医院工作人员，患者和PFCC人员的访谈（n = 47）。结果研究结果突出了支持和阻碍良好患者体验的多种因素。在个人护理中，家长式价值观以及缺乏共同决策和以患者为中心的护理仍然存在。需要跨学科的团队合作来解决员工和管理人员之间的等级，权力和权限问题。在组织层面，等待时间，病人流量，组织资源和及时出院等关键问题会影响员工的时间和提供护理的能力。此外，宏观背景因素，例如财务，政策，目标和措施，为改进项目设置了特定的限制。结论在这种情况下，改善患者体验需要远远超出微观和中观水平的小型项目，以纳入对系统，更广泛的组织环境以及权力如何在多个层面上运行以实现和约束行动的更关键的理解。为了更有意义地理解和解决可能有助于或阻碍改善患者体验的活动的因素，PFCC框架和方法必须考虑到权力不平等的运作方式，并要求采用更具参与性的联合制作和赋权方法来使患者参与，亲戚，护理人员和员工，以改善复杂的医疗环境。更广泛的组织环境以及权力如何在多个层面上运作以实现和约束行动。为了更有意义地理解和解决可能有助于或阻碍改善患者体验的活动的因素，PFCC框架和方法必须考虑到权力不平等的运作方式，并要求采用更具参与性的联合制作和赋权方法来使患者参与，亲戚，护理人员和员工，以改善复杂的医疗环境。更广泛的组织环境以及权力如何在多个层面上运作以实现和约束行动。为了更有意义地理解和解决可能有助于或阻碍活动以改善患者体验的因素，PFCC框架和方法需要考虑权力不平等的运作方式，并要求采用更具参与性的联合制作和赋权方法来使患者参与，亲戚，护理人员和员工，以改善复杂的医疗环境。