Patient Satisfaction: Measurement in Ontario

Patient Satisfaction: Measurement in Ontario
1
Presentation Overview
• Overview of CIHI’s work in Patient Satisfaction
measurement - Hospital Report Series
• Canadian Hospital Reporting Project
• Project overview
• Development of Patient Experience Dimension
• Next Steps
• Questions
2
CIHI’s Stakeholders
Health Council of Canada
Health Canada
LHINS
Researchers
Accreditation Canada
Statistics Canada
Advocates
Ministries of
Health
Professional
Associations
Regional Health
Authorities
Health facilities
Public and
Private Sector
Organizations
3
Ontario Hospital Report Series
Research Partners:
CIHI in collaboration with
researchers from
University of Toronto,
ICES, and the Hospital
Report Research
Collaborative (HRRC)
Target Audience:
Ontario Hospital Boards,
CEOs, directors, clinical
managers, decision
support analysts, LHIN
CEOs and planners &
general public
Sectors:
Expanded from one to five
sectors (Acute Care,
Emergency Department,
Complex Continuing Care,
Rehabilitation, & Mental
Health)
4
Balanced Scorecard
Financial
How do our funders see us?
Internal Business
Customer
How do we compare
on quality of care?
What is the patient’s
perspective?
Innovation and Learning
How are we preparing for the future?
Kaplan and Norton, 1992; Baker and Pink, 1995
5
Ontario Hospital Report
• CIHI responsible for providing analyses for all sectors (Acute
Care, Emergency Department, Complex Continuing Care
and Rehabilitation) and for all dimensions, including patient
satisfaction from 2001 – 2008.
• In consultation with HRRC researchers, CIHI developed
indicator and risk adjustment methodologies for all indicators
• Collaborated extensively with survey provider (NRC Picker)
and obtained data directly in order to conduct analyses
6
Inpatient Acute Patient Satisfaction Indicators
Prior to 2005 (SHoPSS)
2005 to 2008 (NRC Picker)
 Global Quality
 Overall Impressions
 Process Quality
 Communication
 Outcomes
 Patient Consideration
 Unit Based
 Responsiveness of Care
 Physician Care
 Other Caregivers
 Support Services
 Housekeeping
Givers
ED Patient Satisfaction Indicators
Prior to 2005 (SHoPSS)
2005 to 2008 (NRC+Picker)

Overall satisfaction with
physicians and medical
treatment
 Consideration

Willingness to return to the ED
 Communication

Satisfaction with the facility
 Overall Impressions

Satisfaction with waiting times
in the ED

Satisfaction with bedside care

Satisfaction with staff in the
ED
 Responsiveness
Canadian Hospital Reporting
Project (CHRP)
CIHI’s New Tool to Measure and
Improve Hospital Performance
CHRP Overview
• A pan-Canadian quality
improvement tool focused
currently on clinical and
financial performance
indicators
• Facility-level indicators
comparable across
jurisdictions
• A tool for all hospitals
• Interactive web-based tool
• 10 participating
jurisdictions in Year 1
10
CHRP Goals
• Monitor progress in quality of care
• Increase operating efficiency
• Support improvements in
hospital performance
• Drive better value for money
across the system
• Demonstrate successes to
hospital boards
11
Background:
Changing Landscape of Health System Performance
• Governments sought to increase accountability
and transparency
• Quality of care became a key priority for hospitals in
Canada and around the world
– Some facilities adopted business intelligence tools
and performance dashboards to measure and track
performance, but most do not have the necessary
tools or resources
• No standardized pan-Canadian measures existed
for peer comparisons
12
Background: What We Did
• Leveraged expertise, standards, access to
data and relationships
– Sought advice from ministries, regions and facilities
– Collaborated with technical experts
• Developed an interactive tool
– Aligned with privacy policies
– Included support for understanding and use
13
How Is CHRP Different?
1. Content
2. Report Design
3. Features
14
What Makes This Different:
1. Standardized pan-Canadian Indicators
• Analyze data at different levels across the country
• In 2010, private facility-level information released focusing on
–
–
Clinical outcomes – 23 indicators
Financial performance – 10 indicators
• Private prototype project based on the balance scorecard
approach
• Balanced and evidence-based with rigorous methodologies
and technical documentation
• Accompanying support for understanding and use
• Framework to be expanded to cover other dimensions
of performance
15
What Makes This Different:
1. Standardized pan-Canadian Indicators
Category
Indicator
Efficiency
• Financial (current ratio, average age of equipment)
• Productivity (administrative service, hours per weighted case, etc.)
• Human resources (benefit hours, earned hours)
Effectiveness
• Mortality following surgery
• In-hospital mortality
• Readmission rates
Safety
• Nursing-sensitive adverse events
• Obstetrical trauma
• Birth trauma
• In-hospital hip fractures for elderly
Accessibility
• Wait time for hip fracture surgery
Appropriateness
• C-section rate
• Vaginal birth after C-section
• Use of angiography following AMI
16
What Makes This Different:
2. Appropriate for All Hospitals
• Comparative and actionable for all facilities, from
large teaching to small hospitals
• Four pre-defined standard peer groups plus ability
to customize
• More than 40 data elements for hospital profile
information, including
–
–
–
–
Operating statistics
Financial data
Patient complexity and capacity
Key clinical services
17
What Makes This Different:
3. Additional Features
CHRP feature
Allows hospitals to . . .
Capacity for flexible
benchmarking
Compare structural and patient characteristics among similar
facilities using peer groups
Capacity to drill down
Break down indicators—including transfers, patient groups and
admissions—to better understand results
Expansion to other
sectors and
dimensions
Track and monitor quality improvement across the continuum,
supporting measurement of integrated care pathways
18
Patient Experience – Why Measure It?
• An important component of a balanced scorecard
approach
• Patient centered outcomes have taken center stage as
the primary means of measuring the effectiveness of
health care delivery
• Information can be used to stimulate improvements in
health service delivery
• Information is a priority in many jurisdictions
19
Patient Experience – What’s the Goal?
Goals:
1. To provide national comparisons for a high-level coreset of patient experience measures (10 -12 questions)
•
Once piloted in acute care setting, expansion into other
sectors (i.e. ED)
2. Foster communication and collaboration among
regions/facilities (by way of peer groups) to understand
the context behind the results.
20
Guiding Principles and Selection Criteria
• Current focus: Acute Care. However, exploring
domains that can be transferable to other sectors (i.e.
ED)
• A few items, therefore, few domains
• Include most important domains ‘critical’ for national
comparisons
• Questions to be “general” in nature - for comparison
purposes. Not detailed for improvement, therefore, no
large, multi-item indices
• Existing patient survey results analyzed in order to
include domains/items that are important to patients
21
Survey Development Process – Where Are We?
Environmental
Scan/Literature
Review
Survey Process
Design
Stakeholder
Consultations
Review of Potential
Domains and Items
using survey data
Cognitive Testing
and Pilot Testing
Field Test
Stakeholder
Consultations
Data Collection,
Transfer and
Analysis
Dry Run Testing
Develop Core Set of
Domains and Items
(Draft Questionnaire)
Reporting
22
Stakeholder Consultations (so far…)
• Patient Satisfaction Inter-Jurisdictional Advisory Group
• Comprised of provincial representatives with technical
expertise in patient satisfaction surveying
• Western CEO Performance Working Group
• Comprised of representatives from four western
jurisdictions that have come together to perform custom
analyses on health system performance indicators
• Atlantic provinces key contacts
• Accreditation Canada
• Working to align current work plans
23
DRAFT List of Domains
• Coordination
• Help (responsiveness)
• Respect
• Listening
• Pain
• Information
• Involvement in Decision-Making
• Transition
• Outcome
• Overall Quality
• Safety
24
Next Steps
• Confirm survey process, dissemination and data
collection with key players
• Cognitive Testing Phase (Summer 2011)
• Pilot test draft patient experience survey in 2 – 3
jurisdictions (Fall 2011)
25
Stakeholder Feedback
26
Questions?
27
Canadian Hospital Reporting
Project (CHRP)
CIHI’s New Tool to Measure and
Improve Hospital Performance
For more information…
[email protected]
Excellent Care for All Act
and the Patient Experience
March 23, 2011
The Emergency Department Patient Experience:
From Measurement to Outcomes
Tai Huynh, Director Excellent Care for All Strategy
Jillian Paul, Lead Excellent Care for All Strategy
Note:
This overview is presented for the convenience of reference only, and all parties should continue to refer to the legislation. Nothing
in this overview should be construed as legal advice.
29
29
The Excellent Care for All Strategy
1. Organization
 The Excellent Care for All Act, 2010 (Bill 46)
• ECFAA became law on June 8th, 2010
• Establishes a number of requirements for health care organizations,
starting first with hospitals
2. System
 Foundational elements
• Expanded mandate and capacity of the Ontario Health Quality Council
• Shift to patient-based payment for hospital services
 Near-term initiatives
• Evidence-based changes to select OHIP insured services
• Quality improvement initiatives targeting readmission reduction
The people of Ontario and their Government:
…
Believe that the patient experience and the support of patients and their caregivers to realize
their best health is a critical element of ensuring the future of our health care system
…
Share a vision for a Province where excellent health care services are available to all Ontarians,
where professions work together, and where patients are confident that their health care system
is providing them with excellent health care
…
Recognize that a high quality health care system is one that is accessible, appropriate, effective,
efficient, equitable, integrated, patient centred, population health focussed, and safe
…
Key components of ECFAA
Requirement for health care organizations, starting first with hospitals, to:
>
Establish quality committees, which would report to the board on qualityrelated issues
>
Develop annual quality improvement plans and make the plan available to
the public
>
Ensure that executive compensation is linked to achievement of the
performance improvement targets set out in the annual quality plan
>
Carry out patient, client, and caregiver surveys
>
Carry out employee / care provider surveys
>
Have a patient relations process and make information about the process
available to the public
>
Produce a patient declaration of values after consultation with the public
The patient voice in quality improvement
Patient Declaration of Values
> Excellent Care for All
+
Patient Relations Process
+
Patient Satisfaction surveying
+
Developed in consultation with the
public
Process reflects content of declaration of
values
Conducted at least once per fiscal
year
Critical Incident reporting
Aggregated summary to Quality
Committee
Quality Improvement Plan
Developed having regard to results of
surveys, data relating to patient
relations process and aggregated
critical incident data
Patient surveys
Compliance:
> Annual patient surveying is a requirement for all
hospitals
Current state:
> Approx. 95% of hospitals currently conduct
patient surveys*
What’s happening next:
> Guidance materials have been posted on
ontario.ca/excellentcare website
> Hospitals not already doing so are preparing to
survey their patients by Apr. 1, 2011
*OHA ECFAA survey, September 2010, N = 102 hospitals
Patient Declaration of Values
Compliance:
•
Hospitals must produce a patient declaration of values after public
consultation:
– Initiated public consultation by Dec. 8, 2010 (6 months after Royal
Assent)
– Publicly available by Jun. 8, 2011 (12 months after Royal Assent)
– “Public” = patients, their caregivers, and stakeholders such as patient
advocacy groups, the broader public residing in the hospital's
community, and other relevant individuals and organizations
Current state:
> Approx. 84% of hospitals currently have a patient declaration of values,
but only 42% of these were developed through public consultation*
What’s happening next:
> Guidance materials have been posted on ontario.ca/excellentcare
website
> Hospitals without DoV or who have not done public consult should be in
the process of public consultation and developing declaration of values
*OHA ECFAA survey, September 2010, N = 102 hospitals
Patient Relations Process
Compliance:
> It is expected that all hospitals will have a patient relations
process that reflects the content of the patient declaration of
values, make this information available to the public and,
develop QIP having regard to data relating to the patient
relations process and
Current state:
> Approx. 96% of hospitals currently have a patient relations
process*
What’s happening next:
> Guidance materials have been posted on ontario.ca/excellentcare
website
*OHA ECFAA survey, September 2010, N = 102 hospitals
The Quality Improvement Plan
• Safety
– CDI, VAP, Hand Hygiene,
CLI, Pressure ulcers, falls
• Effectiveness
– HSMR, Readmission,
ALC, Total Margin
• Access
– ER wait times
• Patient-Centredness
– Patients satisfied
Excellent Care for All
Would you recommend this hospital
to your friends and family?*
74%
57%
*Indicator is included as QIP core indicator
> Excellent Care for All
In FY 2008/09, three out of four hospital patients would recommend the
hospital in which they received care. Only 57% of emergency
department patients would recommend the emergency department they
visited. There has been no change in the last five years, leaving major
room for improvement.
Reference: OHQC Quality Monitor – 2010 Report on Ontario’s
Health System
Percentage of patients who felt they
were treated with respect and dignity
82
76% %
> Excellent Care for All
Eight out of 10 patients felt they were treated with respect and
dignity while they were either in the hospital or the emergency
department. However, there has been no change in the last five
years, leaving room for improvement.
Reference: OHQC Quality Monitor – 2010 Report on Ontario’s
Health System
Did you get all the medical
information that you need?
51
44% %
> Excellent Care for All
When Ontarians who were hospitalized had questions to ask a doctor or
nurse about their care and results of tests, only five out of 10 received
information they could understand. Four out of 10 emergency
department patients received information they could understand. There
has been no change in the last five years and there is lots of room for
improvement.
Reference: OHQC Quality Monitor – 2010 Report on Ontario’s
Health System
For more information
> Email [email protected] with questions and to subscribe to
ECFAA bulletins
> Website:
– Ontario.ca/excellentcare
– Ontario.ca/excellencedessoins
The Patient Experience in Ontario
Patient satisfaction with ER
services
Julian Martalog
Director, Access to Care Informatics
Cancer Care Ontario
42
Objectives of Patient Satisfaction Reporting
> Identify areas where hospitals are
performing well to drive targeted
improvements in the patient’s experience
> Use indicators that are clear and
accessible to the public and useful for
comparisons between hospitals and LHINs
> Align with the operational objective of the
ER/ALC strategy to reduce wait times
43
Report Distribution
Quarterly Report
Provincial Patient Satisfaction Highlights Report
LHIN Patient Satisfaction Highlights Report
Patient Satisfaction Hospital Comparator Report
Recipients
MOHLTC
OHA
ER Clinical Experts
MOHLTC
OHA
ER Clinical Experts
LHINs
MOHLTC
OHA
ER Clinical Experts
Hospitals
44
Overall Patient Satisfaction
Province and LHIN Summary - Patient Satisfaction Ratings (Q1 2010/11)
0%
20%
Provincial
Waterloo Wellington
21%
59%
19%
15%
56%
29%
24%
60%
16%
Central East
22%
26%
57%
18%
23%
North Simcoe…
22%
62%
Central
Champlain
26%
33%
15%
Central West
South East
100%
25%
56%
11%
Toronto Central
80%
55%
19%
Hamilton Niagara…
Mississauga Halton
60%
58%
17%
Erie-St.Clair
South West
40%
31%
59%
29%
59%
12%
North West
17%
34%
53%
13%
18%
21%
56%
11%
North East
17%
60%
56%
59%
Poor/Fair
Good/Very Good
26%
24%
Excellent
45
Highest ER Patient Satisfaction Scores
46
Satisfaction Dimension Ratings
47
Dimension Ratings by Question
48
Dimension Ratings by Question
49
Dimension Ratings by Question
50
Next Steps
> Promote the release of data on the public
website
> Add analysis on relationship between
Patient Satisfaction and Time to PIA to
existing reports
> Improve timeliness of data collected and
reported
> Include patient satisfaction results in
regular provincial ER Clinical Lead and
MOHLTC Liaison meetings
51
Leading Practices in Measuring the
Patient Experience
Ontario Hospital Association
March 23, 2011
Linda Corso RN BScN MA
Nancy Cobb RN BScN
Linda Corso: [email protected]
Nancy Cobb: [email protected]
Content Outline
Background & History
Worldwide Trends
5 Cornerstone Issues
Leading Practices
Hospital Strategies
Conclusions
Linda Corso: [email protected]
Nancy Cobb: [email protected]
What did we do?
 Process
 Selection of Key informants
What are the trends?
 NHS & Australia
 USA
 Canada
Linda Corso: [email protected]
Nancy Cobb: [email protected]
1. Im p ro vin g P a tie n t Ac c e s s
A. Efficient intake processes minimize
time required to see physician.
 Straight back triage
 Team triage
 Abbreviated or rapid triage process <90
seconds
 Self service kiosks
Linda Corso: [email protected]
Nancy Cobb: [email protected]
1. Im p ro vin g P a tie n t Ac c e s s
B. Patients move smoothly through
system.

Clinical Decision/Observation Units
 Nurse driven
 Critical pathways for common diagnoses
  relapse rates
  cost of care
  patient satisfaction
Linda Corso: [email protected]
Nancy Cobb: [email protected]
1. Im p ro vin g P a tie n t Ac c e s s
C. Examine ancillary cycle times and
improve as necessary.
 Collaborate with other departments (lab &
radiology) to improve turnaround times for
test results
Linda Corso: [email protected]
Nancy Cobb: [email protected]
2. Improving the Wait
A. The ED needs to be easy to navigate and userfriendly.
 The wait feels shorter when time is occupied
with activities (TVs, computer plug-ins,
magazines)
 Pre-process waits feel longer than in process
waits. Keep patients moving.
Linda Corso: [email protected]
Nancy Cobb: [email protected]
2. Improving the Wait
B. Patient expectations are aligned with actual
wait times and anticipated delays.
 The problem is not the waiting but not knowing
how long the wait will be.
 Give a time estimate
 Use volunteers as waiting room coordinators
Linda Corso: [email protected]
Nancy Cobb: [email protected]
2. Improving the Wait
C. The ED department consistently
communicates with patients and
families and tracks progress.

Patients need to understand how the system works

Use brochures, videos to inform patients about what to
expect

Provide information on actual wait times; normal times for
test results eg. NHS posts wait times
Linda Corso: [email protected]
Nancy Cobb: [email protected]
2. Improving the Wait
D. Family/support persons are welcomed,
encouraged to be present as far as the
facility permits.
 Group waits seem shorter than solo waits
Linda Corso: [email protected]
Nancy Cobb: [email protected]
2. Improving the Wait
E. ED Patients receive timely pain management.

Anxiety and pain makes seem longer. Pain relief
correlates with patient satisfaction.
 Pain protocols
 Educate staff and MDs re: pain management
 Simple comfort measures
Linda Corso: [email protected]
Nancy Cobb: [email protected]
3. P ro vid in g a Re s p o n s ive
En viro n m e n t
A. The Emergency Department is a safe, clean,
comfortable and welcome place.
 Provide for a variety of group needs
 Desired amenities include availability of food & drinks;
enough bathrooms close by; family-friendly facilities
 Volunteer greeter
Linda Corso: [email protected]
Nancy Cobb: [email protected]
3. P ro vid in g a Re s p o n s ive
En viro n m e n t
B. There is patient-friendly and clear directional
information to identify hospital facilities…
location, parking, bathroom.
 Being lost or disoriented makes patients more anxious
 Provide website info re: parking & costs, directions,
cafeteria, can be accessed from phone
 Victoria, Australia improved the patient experience
with better signage and wayfinding
Linda Corso: [email protected]
Nancy Cobb: [email protected]
3. P ro vid in g a Re s p o n s ive
En viro n m e n t
C. The facility design provides room for privacy
and controls for noise.
 Bedside registration
 Private exam rooms
 Reduce noise
 Background music
 Acoustic isolation room
 Infrared badges
Linda Corso: [email protected]
Nancy Cobb: [email protected]
4. Improving Provider Customer
Service Skills
A. From the time of arrival, the emergency
department staff anticipates common patient
desires and needs.
 Interpersonal skills of staff crucial
 Corporate initiatives to create Culture of Service
Excellence
 Purposeful rounding at Baptist Miami
  patient satisfaction scores
  Left Without Being Seen
Linda Corso: [email protected]
Nancy Cobb: [email protected]
4. Improving Provider Customer
Service Skills
B. ED Staff demonstrates a culture of caring and
compassion through deliberate actions.

The art of caring correlates with patient satisfaction.
It’s not WHAT you do but HOW you do it
 Stools in treatment rooms
 Customer service training for all staff and MDs
Linda Corso: [email protected]
Nancy Cobb: [email protected]
4. Improving Provider Customer
Service Skills
C. Patients are informed clearly about their care
and treatment decision.

Appropriate explanations using effective language
and tone demonstrate courtesy, caring and involves
patients/families in decision-making.
 Patient tracking systems
Linda Corso: [email protected]
Nancy Cobb: [email protected]
5. Improving Patient
Communication/Education
A. Follow-up initiatives are offered to smooth
transition from hospital to home.
 Post-visit phone calls
 Volunteer patient advocate
 Patient and Family Advisory Councils
Linda Corso: [email protected]
Nancy Cobb: [email protected]
5. Improving Patient
Communication/Education
B. Instructions, including those relating to
appropriate follow up care are given verbally
and in writing to the patient and/or family
member prior to discharge.
C. Interpreter services are available.
Linda Corso: [email protected]
Nancy Cobb: [email protected]
Questions??
Linda Corso: [email protected]
Nancy Cobb: [email protected]