An Experiment to Enhance Narrative Feedback to Improve Quality of Health Care

Ingrid Nembhard, Healthcare Management, The Wharton School; Mark Schlesinger, Yale University; Yuna Lee, Columbia University; Rachel Grob, University of Wisconsin

Abstract: This project consists of a field experiment to assess a two-stage intervention intended to enrich healthcare professionals’ learning from patient experiences, as recounted in patients’ own words. For decades, health systems have surveyed patients about their healthcare experiences. These surveys are designed to provide a quantifiable metric of performance, not convey details about what went wrong or right in patient experience. Members of our team designed the first, rigorously tested narrative elicitation protocol that encourages patients to provide representative accounts of their medical encounters. We propose that this narrative insight can enable innovation and improvement by healthcare providers. Our experiment provides the first test of the impact of patient narrative feedback on quality of care, by comparing sets of outpatient clinics in terms of a) changes in their patient experience scores, b) changes in the content of their patient narratives, and (c) differences in capacity of clinicians and administrators to learn from their patients’ experiences to improve care. We will test the impact of the new form of feedback (first stage of project) as well as different report formats for staff and leaders (second stage). We will also examine the properties of feedback that prompt organizational learning and improvement efforts.