title: Experience-based design for integrating the patient care experience into healthcare improvement: Identifying a set of reliable emotion words.
abstract: BACKGROUND
  Experience-based design is an emerging method used to capture the emotional content of patient and family member healthcare experiences, and can serve as the foundation for patient-centered healthcare improvement. However, a core tool-the experience-based design questionnaire-requires words with consistent emotional meaning. Our objective was to identify and evaluate an emotion word set reliably categorized across the demographic spectrum as expressing positive, negative, or neutral emotions for experience-based design improvement work.
  
  
  METHODS
  We surveyed 407 patients, family members, and healthcare workers in 2011. Participants designated each of 67 potential emotion words as positive, neutral, or negative based on their emotional perception of the word. Overall agreement was assessed using the kappa statistic. Words were selected for retention in the final emotion word set based on 80% simple agreement on classification of meaning across subgroups.
  
  
  RESULTS
  The participants were 47.9% (195/407) patients, 19.4% (33/407) family members and 32.7% (133/407) healthcare staff. Overall agreement adjusted for chance was moderate (k=0.55). However, agreement for positive (k=0.69) and negative emotions (k=0.68) was substantially higher, while agreement in the neutral category was low (k=0.11). There were 20 positive, 1 neutral, and 14 negative words retained for the final experience-based design emotion word set.
  
  
  CONCLUSIONS
  We identified a reliable set of emotion words for experience questionnaires to serve as the foundation for patient-centered, experience-based redesign of healthcare.
  
  
  CONCLUSIONS
  Incorporation of patient and family member perspectives in healthcare requires reliable tools to capture the emotional content of care touch points.
authors.affiliation: Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Lauren R
authors.initials: LR
authors.lastname: Russ
authors.affiliation: Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Phillips
authors.affiliation: Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Keely
authors.initials: K
authors.lastname: Brzozowicz
authors.affiliation: Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Lynne A
authors.initials: LA
authors.lastname: Chafetz
authors.affiliation: Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Plsek
authors.affiliation: Virginia Mason Medical Center, Seattle, WA, USA. Electronic address: Craig.Blackmore@vmmc.org.
authors.forename: C Craig
authors.initials: CC
authors.lastname: Blackmore
authors.affiliation: Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Kaplan
keywords: Emotion; Experience-based design; Patient-centered care