Open access Original research BMJ Open: first published as 10.1136/bmjopen-2019-034543 on 6 August 2020. Downloaded from Mangomoments - preconditions and impact on patients and families, healthcare professionals and organisations: a multi- method study in Flemish hospitals Kris Vanhaecht ,1,2 Elly Van Bael,1,3 Ellen Coeckelberghs,1 Charlotte Van der Auwera,1,4 Fien Claessens,1 Luk Bruyneel ,1 Dirk De Ridder,1,5 Massimiliano Panella,6 Maureen Bisognano,7 Pedro L Delgado,7 Deborah Seys 1,8 To cite: Vanhaecht K, Van ABSTRACT Strengths and limitations of this study Bael E, Coeckelberghs E, Objective Understanding how small unexpected acts et al. Mangomoments - or gestures by healthcare professionals, known as preconditions and impact on ► By using a multi- method study, an under investigat- Mangomoments, are translated into practice, what their patients and families, healthcare ed area in the field of patient safety and quality of preconditions are and what their impact is on patients and professionals and organisations: care was explored: positive moments in healthcare a multi- method study in families, healthcare professionals and organisations. and its impact on patient, family and healthcare Flemish hospitals. BMJ Open Design A multi- method design was used based on four professionals. 2020;10:e034543. doi:10.1136/ phases: (1) A (media)campaign to collect Mangomoment ► Based on 120 interviews, 3 focus groups and 1 con- bmjopen-2019-034543 stories (n=1045), of which 94% (n=983) were defined as sensus meeting, a framework for Mangomoments Mangomoments; (2) Semi- structured interviews (n=120); ► Prepublication history and was developed. (3) Focus group interviews (n=3); and (4) A consensus additional material for this ► Peer debriefing, data and investigator triangulation paper are available online. To meeting. promote the validity and credibility of the study, but view these files, please visit Setting Respondents from a hospital and primary care a member check was not conducted. http://bmjopen.bmj.com/ the journal online (http:// dx. doi. setting. ► A heterogeneous sample of family, patients, health- org/ 10. 1136/ bmjopen- 2019- Participants Patients, family, healthcare professionals, care professionals, management and healthcare 034543). managers, researchers and a policymaker participated. policymakers shared a large number of positive sto- Results Mangomoments are mainly classified in the Received 25 September 2019 ries that helped define Mangomoments, but further Revised 02 July 2020 dimensions ‘Respect for values, preferences and needs’ research must include neutral and opposite views Accepted 08 July 2020 and ‘Emotional support’. Differences in importance of the towards this concept. dimensions were found between healthcare professionals, ► Mangomoments may be influenced by culture, oncological patients and family and non- oncological therefore additional studies in other settings should patients and family. The results of the interviews, focus be initiated to understand possible differences be- on September 25, 2021 by guest. Protected copyright. groups and consensus meeting were visualised by the tween various types of patient groups. Mangomoment model. It identifies several preconditions on the level of patients, healthcare professionals and leadership. For each of these preconditions a catalyst was identified to increase the prevalence of Mangomoments. healthcare professional. Leadership should shape several In general, Mangomoments improved the patient and preconditions and catalysts which can lead to positive family experience and facilitated adherence to therapy resonance and loyalty of patients and professionals. and led to a positive perception on the healing process. © Author(s) (or their Positive effects for professionals include personal INTRODUCTION employer(s)) 2020. Re- use accomplishment and anti- burnout, joy in work and a Healthcare quality and safety research mainly permitted under CC BY-NC. No positive team atmosphere. This led to positive resonance focusses on negative aspects. Recently the commercial re- use. See rights by a relationship of trust between the patient and the and permissions. Published by healthcare professionals, feelings of tolerance during Safety II concept was introduced to shift the BMJ. 1 negative experiences and open communication and a focus to learning from positive processes. For numbered affiliations see safe climate. Overall, patients and healthcare workers Attention should not only be given to posi- end of article. concluded that Mangomoments led to loyalty to the tive processes to make healthcare safer, but Correspondence to healthcare organisation. maybe we also need to further understand Dr Deborah Seys; Conclusion Mangomoments do not only have a the impact of positive experiences such as a Deborah. seys@ kuleuven. be positive impact on patient and family but also on the hug, laugh or even a small moment of positive Vanhaecht K, et al. BMJ Open 2020;10:e034543. doi:10.1136/bmjopen-2019-034543 1 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034543 on 6 August 2020. Downloaded from Figure 1 Overview of the research project. emotion. These micromoments of positive resonance, 2018. Stories were not selected if they were unclear and as defined by Fredrickson (2013) and Pronovost (2016) included limited information or when the act or gesture might give people the essential daily nutrients besides was not possible during normal care activities (for healthy food.2 3 In 2018 the Mangomoment concept was example, organising a wedding for a palliative patient). introduced and was defined as ‘small unexpected acts or The second part of our research is related to (1) under- gestures, which are of great value in the care experience of standing the preconditions of Mangomoments and (2) patients, residents, families and healthcare professionals. evaluating the impact of Mangomoments on patients, They take place during normal care activities and require family and healthcare professionals. This part contains 4 nearly no additional resources, time or energy.’ Mango- three phases. In the first phase, respondents who shared moments are different from events like Make- a- Wish or a Mangomoment were contacted. Inclusion criteria were, 4 visits by celebrities to children’s hospitals. Although the based on information from phase one: (1) gave written concept has been defined and is taken to heart by many consent to be interviewed, (2) shared all demographic http://bmjopen.bmj.com/ healthcare organisations, the impact stays unclear. variables and (3) submitted a story that met the defini- In this study we want to (1) understand how the Mango- tion of a Mangomoment. Respondents were then selected moment concept is translated into practice. Next, we purposefully in order to enhance information richness. want to (2) understand what preconditions are needed to Cases with a wide range of variation were sought: varia- establish Mangomoments and (3) evaluate the impact of tion in demographics, variation in dimensions of patient- Mangomoments on patients, their family and on health- centred care and information- rich cases. Interviews were care professionals. performed with patients, family and healthcare profes- sionals in both oncological and non- oncological care on September 25, 2021 by guest. Protected copyright. METHODS processes in hospital setting and primary care. Data were Participant recruitment and data collection collected and audio- recorded between August 2017 and A four phase multi- method design was used in a multi- August 2018 via semi-structured interviews in person centre setting. Figure 1 demonstrates an overview of the or by video call using Skype or FaceTime. Interviews in research project. The first part of this study is related to person took place at a location chosen by the respondent. understand how the Mangomoment concept is translated The interview guide consisted of open-ended questions into practice. Therefore, a media campaign was launched covering following topics: (1) Why did that specific Mango- and Mangomoments were collected via the Mangomo- moment give you a good feeling, why did it happen?, (2) ment website ( www. mangomoment. org). Respondents What was the impact on yourself? (3) What was the impact could share their Mangomoment story anonymous or on the patient-family- professional relation?, and (4) Are share their demographic data (type of organisation, there contextual factors or preconditions which will influ- Mangomoment shared by patient/family or healthcare ence the prevalence of Mangomoments? Field notes were professional, gender, year of birth, level of education, taken during the interviews and discussed within the professional status, home status, oncological care setting research team. During weekly peer debriefing meetings, or not). They could also mention if they agreed to be saturation was evaluated and there was consensus that contacted for an interview and/or next steps of the study. ‘data saturation’ was achieved after 106 interviews since Data were collected between March 2017 and August new data repeated what was expressed in previous data.5 2 Vanhaecht K, et al. BMJ Open 2020;10:e034543. doi:10.1136/bmjopen-2019-034543 Open access BMJ Open: first published as 10.1136/bmjopen-2019-034543 on 6 August 2020. Downloaded from Although saturation was reached, 14 additional interviews and consisted of six persons: three senior researchers (two were performed as they were already scheduled and the women and one man, all with