Factors that shape the patient's hospital experience and satisfaction with lower limb arthroplasty: an exploratory thematic analysis

OBJECTIVE: It is generally accepted that the patients’ hospital experience can influence their overall satisfaction with the outcome of lower limb arthroplasty; however, little is known about the factors that shape the hospital experience. The aim of this study was to develop an understanding of what patients like and do not like about their hospital experience with a view to providing insight into where service improvements could have the potential to improve the patient experience and their satisfaction, and whether they would recommend the procedure. DESIGN: A mixed methods (quan-QUAL) approach. SETTING: Large regional teaching hospital. PARTICIPANTS: 216 patients who had completed a postoperative postal questionnaire at 12 months following total knee or total hip arthroplasty. OUTCOME MEASURES: Overall satisfaction with the outcome of surgery, whether to recommend the procedure to another and the rating of patient hospital experience. Free text comments on the best and worst aspects of their hospital stay were evaluated using qualitative thematic analysis. RESULTS: Overall, 77% of patients were satisfied with their surgery, 79% reported a good–excellent hospital experience and 85% would recommend the surgery to another. Qualitative analysis revealed clear themes relating to communication, pain relief and the process experience. Comments on positive aspects of the hospital experience were related to feeling well informed and consulted about their care. Comments on the worst aspects of care were related to being made to wait without explanation, moved to different wards and when they felt invisible to the healthcare staff caring for them. CONCLUSIONS: Positive patient experiences were closely linked to effective patient–health professional interactions and logistics of the hospital processes. Within arthroplasty services, the patient experience of healthcare could be enhanced by further attention to concepts of patient-centred care. Practical examples of this include more focus on developing staff–patient communication and the avoidance of ‘boarding’ procedures.