Results
We completed interviews with 16 of the 18 patients (12 patients, 2 mothers and 2 fathers), eight from hospital A and eight from hospital B. One patient withdrew his/her consent to participate and one interview was not completed because of technical difficulties. Table 2 displays the characteristics of the interviewees.
We identified three common themes concerning how patients experienced the interventions. These included 1) the importance of being involved in scheduling time for surgery; 2) individualized preparation before the hospital admission; 3) the importance of establishing relationships with a minimum number of clinicians during the hospital stay. We have structured the presentation of our findings around these themes and present patient quotes to illustrate how they experienced the changes. Additional quotes illustrating our findings can be found in the Additional file 2.
The Importance of Being Involved in Scheduling Time for Surgery
Patients at hospital A originally received their surgical appointments by mail, after the consultation at the out-patient clinic when the decision to operate was made; so they could not participate in its planning. This process was changed so that patients could choose the date of surgery and confirm the appointment during the actual pre-operative consultation. The patients reported that this option was important to them, because the elective surgery had an impact on them and their social surroundings beyond the medical condition and its treatment. The surgery affected the way each patient planned and lived their lives. The active participation in deciding the date of surgery, in combination with agreeing on the appointment in advance, allowed them to make choices to fit their personal circumstances. It allowed them to integrate the planned surgery into their lives. Patients from hospital B who were not given this opportunity, expressed that they would have preferred to participate in scheduling their surgery, and pointed to the importance of knowing the actual date of surgery earlier on.
The following quotations illustrate this finding:
Interviewer (I): Did you have any influence over the scheduling of your surgery?
Patient (P) at hospital A: Yes, I did. And that was really good. I was due for a training period, and was able to work around that. I couldn't have made it work otherwise.
I: Did you have any influence over the scheduling of your surgery?
P at hospital B: No, but that would have been a great practical advantage, as it would have made it possible to schedule around work, school, and traveling to the hospital. It is important to be able to plan ahead.
Individualized Preparation Before Hospital Admission
At hospital B, patients received practical information about their forthcoming operation in the same letter that announced the date of their operation. The patients at hospital B reported that they were satisfied with the information they received prior to surgery. Patients at hospital A received the same type of information at their out-patient consultation when the decision to perform surgery was made. In addition, hospital A started calling patients two days prior to surgery to make sure they were in good health and would keep their appointment. If patients were unable to attend their scheduled surgery, another patient was rescheduled, thereby avoiding a cancellation.
The telephone calls also had beneficial effects beyond preventing cancellations. They created a dialogue between the patient and the hospital. Patients could ask questions, staff were able to support their pre-operative preparation, and check if the patient had understood the information. Patients felt that the telephone call demonstrated that the hospital cared about their well-being and was prepared and ready for their particular situation.
The following quotation illustrates these experiences:
P (Hospital A): It was a very positive thing. I felt that somebody cared about what was going to happen and that they were more on top of things than if they had just sent a letter.
Relating to Fewer Clinicians
Hospital A established a surgical center to reduce cancellations arising from poor planning and a lack of coordination between departments. Preparation and discharges of all patients were centralized to this facility to optimize resource utilization and to ensure improved planning and coordination. Through the centralization patients had to relate to fewer health professionals during their admission, because they no longer were admitted to a regular ward. Patients from both hospitals emphasized the importance of having relationships with a limited number of health professionals, because it contributed to continuity of care and made them feel safe.
P at hospital B: One thing I thought was really good, was that the same people were there when you came in and when you woke up again. I have had a number of surgeries over the years. On other occasions, I felt like I constantly had to relate to new people, and that was downright pathetic.
I: Why is meeting the same people the whole time a good thing?
P: I think it gives a sense of security. A person met you, knows about you, and follows your progress.