International Journal for Quality in Health Care Advance Access originally published online on February 2, 2007
International Journal for Quality in Health Care 2007 19(2):105-112; doi:10.1093/intqhc/mzl073
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Patient, carer and staff experience of a hospital-based stroke service
Bristol Clinical Psychology Training Programme, University of Plymouth, 29 Park Row, Bristol, BS1 5NB
Objective. Here, the aim is to study the experiences of patients, carers and staff throughout a hospital stroke care pathway.
Design. Focus groups of patients, carers and staff followed a semi-structured format to elucidate experiences. The groups were recorded, transcribed and subjected to thematic analysis. Analyses were verified by researchers and participants.
Results. Patients and carers produced four overlapping themes: ‘information’, ‘staff attitudes’, ‘availability of care/treatment’ and ‘considering the whole person in context’. The carers' group produced two additional themes: ‘accommodation of patients’ individual needs' and ‘burden of care’. Their experiences were complex and multi-faceted; positive views of the whole service co-existed with negative views of some aspects. The staff groups produced six themes: ‘specialist service’, ‘split service’, ‘availability of care’, ‘consistency of care’, ‘staff morale’ and ‘wish for change’. Positive views of the specialist service were tempered by problems with physical and professional separation, staff shortages and ‘hierarchical practice’ that reduced collective decision-making.
Conclusion. Some of the patients' and carers' perspectives have not been previously reported in the stroke literature, including a desire for individualized treatment, the consideration of wider, non-physical needs and the carers' sense of burden. In addition, the study revealed how staff, carers and patients viewed each other and the service and demonstrated the concordance of their perceptions. However, staff showed little insight into the users' need for information and negative experiences of care. In contrast with previous research, lack of emotional care, poor continuity of care and lack of staff knowledge and skills were not identified as problems.
Keywords: stroke, health care quality assessment, quality of health care
Address reprint request to Reg Morris, Clinical Psychology, 29 Park Row, Bristol, BS1 5NB. E-mail: reg.morris{at}bris.ac.uk
Accepted for publication December 9, 2006.
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