Role of Consumer Satisfaction in Psychiatric Care

Thomaskutty Idiculla, PhD, is the director of Mental Health Services Evaluation at McLean Hospital, and an instructor in psychiatry at Harvard Medical School. He is the architect of eBASIS, a robust online portal and performance measurement system, which provides quality improvement tools, reporting, and support to over 200 hospitals, and over 1000 users in six countries and five languages. He has extensive experience in validating consumer self-report measures of mental health quality and outcomes of care using qualitative and quantitative methods.

Dr. Idiculla's research interests include psychiatric assessment, outcomes of mental health and substance abuse services, patient-centered care, racial/ethnic/gender disparities in mental health, predictors of readmission, performance measurement in mental health care, patient satisfaction, and integrating technology to improve health care. He has been involved in research, publications, and seminars in the South Asian community for the last 20 years and has spoken at national and international conferences in the United States, United Kingdom, United Arab Emirates, Oman, Kuwait, and India.

How patients' perceptions of care in psychiatry or patient outcome space evolved through the years?

When we first began collecting patient-based data in the early 1990s, only a small number of psychiatric hospitals were doing so. There were very few hospitals at the time that were actively engaged in listening to patient voices, of what their concerns were in terms of their symptoms as well as their experience when they were admitted to a mental hospital. Psychologists and psychiatrists were primarily in charge of evaluating the patient's symptoms or functioning. In 1990, Dr. Susan V. Eisen reviewed tens of thousands of patient records and, based on the patient perspective, developed BASIS 32. Later, we felt the need to develop patient experience and perceptions of care (POC). Developing POC metrics for measuring the perceptions of care streamlined not only some domains of patient satisfaction in the personal aspects of care but also global aspects of care. Additionally, we added some open-ended questions about how respondents felt about the staff, their interactions, and whether they could identify specific members of the staff. If respondents had unfavorable comments, they were still free to express them.

In 2001, this data collection process became more formal, and we made sure that every patient who was admitted to the hospital was being offered this. Eventually, this has become part of an integral part of the care that is provided. We provide a qualitative report every quarter, every three months, which motivates and even empowers our clinicians and leaders on how and where these programs and units are doing their service and also we always find an opportunity to improve the care. And then, in 2005, we started offering the same services to participating other hospitals with a similar online portal called eBASIS for performance management system in psychiatry, which captures patient-reported outcomes and clinical outcomes. In addition to the POC, we all also offered the BASIS 24, which is a patient symptoms identification scale.

The eBASIS is a cutting-edge psychiatric assessment portal that was created by my department using cutting-edge resources and knowledge to help improve patient outcomes and experience in psych hospitals. Some of the most well-liked self-help tools are offered by eBASIS, including the POC, which is BASIS 24.

Around 220 mental health facilities, including VA hospitals and the US military, are currently employing our eBASIS. Our database presently contains more than 1 million patient records, and the survey is available in English and Spanish. In order to compare the data of various levels of care by age, gender, ethnicity, and other diagnostic groups, we have a reliable national benchmark. I also created a new tool for teens in 2020 since they have been a long-ignored group.

What are some of the challenges to patients' perceptions of care in psychiatry or patient outcome?

The main issue is that psychiatric patients don't always receive the same status as other patients. For instance, when it comes to gathering data, individuals wonder how on earth someone who is not mentally feeling well can complete the patient experience survey. Although there have been significant changes over the past 20 years, still finding funding for these types of initiatives and providing explanations are still frequent challenges. At McLean, we are dedicated to making sure patients and their families have access to informational and educational resources at every step of the care journey.

How do you envision the future of this space?

Real-time scoring reporting, patient care monitoring, and patient-centered assessment have a lot of value as these provide clinicians with certain measurements and a baseline to judge the situation more subjectively. As a result, training professionals in these aspects are crucial to discuss patient care, patient management, and outcomes. Having a tool is not enough for the future; one needs to consider how to adapt it to the needs of a changing population. At the same time, we must have the technology in place to gather this data in real-time, process this vast amount of data, and offer relevant graphs and statistics in a manner that doctors can comprehend. Additionally, the same tools can be used to comprehend mental health difficulties and challenges in schools, colleges, and workplaces as looking at the population; we see that the younger generation is in tremendous need of help in this area.

 What would be your piece of advice for budding professionals in this field?

The most important thing is to listen to patients' problems and the voices of their families, all of which are things that psychiatrists and other medical experts are well-versed in doing when it comes to helping patients recover from their conditions. In spite of this, we continue to observe, both from the families and the professionals, that there is a stigma associated with gathering patient data. When it comes to the patient's voice and the recovery process, it is of the utmost importance to understand both the medical professionals and the patient's family on the fact that they are all members of the same team. Second, getting to know the patient perspective increases not only patient satisfaction with care but also public accountability, evidence-based practice, and future policy making. It also aids in the search for what matters to patients and how to use that information to enhance care. However, the majority of the scales that are utilized as evaluation instruments are quite lengthy and have not been used for QI initiatives. It is essential to develop tools with a straightforward interface, making them straightforward to employ and requiring less time, both of which contribute to the delivery of data in real-time.