It is well known that patient experience (PX), as an integral part of the healthcare system, is recognized as an independent, person-centered aspect of healthcare quality. This encompasses a wide range of interactions with the healthcare system, including timely examinations, easy access to information, physician-patient relationships, treatment under health insurance programs, and the clinical performance of healthcare professionals. In other words, PX is the sum of all interactions shaped by a healthcare institution's culture and its patient perceptions across the continuum of safe and high-quality care. Equally important, PX consistently correlates positively with patient safety and clinical effectiveness across a wide range of disease areas, research settings, populations, quality of care, staff engagement, financial performance, discharge experience, and more.

Essentially, a proper patient discharge procedure ensures a coordinated chain of care is established and maintained between the hospital and the patient—a process that significantly determines the patient's future health. However, nearly 20% of patients experience adverse events within 30 days of discharge, three-quarters of which could have been prevented or mitigated with a better discharge procedure.

In the second quarter of 2019, as part of the transformation of the Saudi healthcare system and to promote a value-based approach, the King Abdulaziz Armed Forces Hospital in Dhahran, Saudi Arabia, launched a quality improvement research project to explore how to improve average PX. To improve the quality of patient care at discharge, a multidisciplinary team was formed, including medical administrators, nurses, quality specialists, and a PX head.

The team addressed various aspects of care using a variety of methods and best practices. First of all, a set of key performance indicators (KPI) was established. The KPIs of the current research included both process and outcome measures and provided a broader perspective in achieving the research aim.

The project was planned, implemented, monitored, and completed over five Plan-Do-Study-Act (PDSA) cycles. We also considered tools such as the IDEAL (Include, Discuss, Educate, Assess, and Listen) strategy, which focuses on actively engaging the patient and caregiver in the discharge process. We used, the Teach Back method to confirm a patient's understanding of healthcare procedures and state in their own words what they need to know or do about their health. We considered Re-Engineered Discharge (RED) model to provide a personalized hospital discharge plan for patients with the goal of reducing all-cause readmissions within 30 days and improving safety during patient transitions. Additionally, the Patient Education Materials Assessment Tool (PEMAT) was applied. This is a useful tool that assesses aspects such as comprehensibility (when patients with different backgrounds and levels of health literacy can understand and explain key messages) and applicability (when patients with different backgrounds and levels of health literacy can determine what they can do based on the information presented). Finally, we used the SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) approach, which is a structured goal-setting method that can significantly improve professional effectiveness.

As a result of five PDSA cycles conducted from Q1 2020 to Q2 2023, PX scores on patient discharge increased by 2.92 points, higher than the initial target of 2 points, achieving a rank above the 80th percentile in PX on patient discharge among healthcare facilities in the Gulf Cooperation Council (GCC), according to the Press Ganey PX report for the GCC region. Of the seven selected KPIs, six were successfully met, and only the average percentage of patients discharged before 12 noon remained unchanged before and after the improvements. We believe one explanation for this is that no other changes or KPIs had a direct impact on this metric, which is the subject of further research and improvement.

The application of the IDEAL model has confirmed the importance of collaboration between the physician, patient, and caregivers throughout the discharge process. We confirm that having a well-thought-out discharge plan is essential, but equally crucial is communicating this plan to relevant healthcare providers and the patient. Open dialogue and discussions with Saudi patients and their families have had a positive impact on patients, ensuring the quality of care every patient deserves.

As part of the IDEAL concept, we also applied the Teach-Back method to educate not only patients but also healthcare professionals to improve the quality of care through posters, information cards, lectures, educational videos, and surveys. This approach allowed patients to explain medical information in their own words and improve their health literacy. Finally, using RED as a set of activities and materials to improve the discharge and follow-up process proved to be a significant advantage, as the best results were achieved not only during but also after discharge, thanks to a tailored way of informing patients about the service based on their needs and the physician's decision, as well as follow-up phone calls after discharge.

Ultimately, although the aforementioned methods have proven to be reliable tools for improving the quality of care for Saudi setting, this study confirms that using a single method is insufficient to achieve sustainable change. Achieving success requires a multifaceted approach based on an implementation plan, including identifying patient improvement needs, KPIs, collaboration across the healthcare system, provider flexibility to change, and the use of data-driven practice changes.