Through our patients eyes

1
Through our patients eyes

• BRITISH COLUMBIAS
• PATIENT EXPERIENCE SURVEY INITIATIVE
• Presented to Patients as Partners
  Collaborative
• Presented by Kevin Samra
• BC Patient Satisfaction Steering Committee
• September 24th, 2009

2
Presentation Overview

• Background
• Provincial Patient Experience Survey Initiative
• Current Surveys
• Questions

3

• Why are science and practice still so far
  apart? Dr. Don Berwick,
  CEO
• 
  Institute for Health Care Improvement

Personal Experience
Clinical Technical
4
What kind of care do patients really want?

• Care that is
• Safe
• Minimizes pain
• Respects individual values and choices
• Efficient, effective, timely, equitable
• Patient-/resident-centered and relationship based
• Institute of Medicine

5
Sources of Patient Feedback on their Experience
of our Care and Services
critical incident interviews walk-throughs
focus groups families on rounds
talking/listening to front line employees
customer advisory councils patient/family
faculty programs videos by patients/families
Unexpected
surveys comment cards telephone follow-up
Requested
incidents complaints (personal contacts,
letters, phone calls)
Assumed
Laura Adams, IHI, 2003
6
Patient-Centred Health Care in BC

• June 2002
• The British Columbia Patient Satisfaction
  Steering Committee is established.
• Leadership Council appoints representatives from
  the MOH and each HA to form the Steering
  Committee and to develop a provincial strategy
  for the measurement of patient satisfaction
• In order to
• enhance the public accountability of B.C.s
  health system, and
• 2. support the quality improvement initiatives
  of health care providers and the Health
  Authorities

7
BC Patient Satisfaction Steering Committee
Representatives

• FHA Barb Rusden
• IHA Bev Lacasse
• NHA Lexie Gordon
• PHSA Kris Gustavson
• VCHA Serena Bertoli-Haley/Janet Lakusta
• VIHA Evelyn Thompson-Smith
• MoHS Kevin Samra, Lois Stewart
• Co-chairs Lena Cuthbertson, Providence/MoHS
• Elisabeth Wagner, MoHS

Page 7
Page 7
8
B.C. Patient Satisfaction Steering Committee
Mandate

• To develop and implement a
• coordinated
• cost-effective
• scientifically rigorous
• provincial approach
• for the measurement of the patients
  experience.

9
Guiding Principles for Sector Surveys

• Promote a common, provincial approach to
  measurement of patient experience / satisfaction
• Work towards evidence-based benchmarks that will
  enable objective comparisons
• Compliment existing national and/or provincial
  measurement strategies
• Minimize data collection burden for Health
  Authorities
• Provide satisfaction data that supports and
  promotes quality improvements efforts at the
  point of service
• Support the accountability of the health care
  system
• Recognize that the strategy and process for a
  complex undertaking such as this will evolve over
  time

10
Strategy
To develop or endorse a common suite of
sector-specific valid and reliable survey
tools to be used by all facilities in BC, and to
sample at the point of service to provide
unit based results roll up results (unit to
facility to HSDA/HA to province) to provide
system level results utilize or establish peer
groups for local, regional, and national
comparison of results
11
Protection of Personal Health Info

• The information collected for the BC Patient
  Satisfaction Surveys is limited to information
  needed to
• 1. contact patients to participate in a survey
  about their experience of Emergency care and
  services on a voluntary basis (address
  information to mail surveys)
• 2. categorize the survey results into groups of
  patients receiving similar services or who have
  similar characteristics.
• Patients are given the option to opt out.
  Notification posters are in all facilities, and a
  contact name/number is included in the cover
  letters sent to patients with the survey.
• A Privacy Impact Assessment is completed and
  submitted to the Office of the Information and
  Privacy Commissioner of BC.
• Surveys are sent to parents/guardians of patients
  under 12. Patients 12 to 19 years of age are
  sent surveys directly in unmarked envelopes
  (where applicable).
• Vendor held accountable to requirements of BC
  Privacy Protection Schedule, and is subject to an
  onsite privacy and information security audit.

12
Surveys designed to best meet information needs
in BC by using

• Dimensions of care
• Access Coordination of Care
• Emotional Support
• Information Education
• Physical Comfort
• Respect for Patient Preferences
• Continuity Transition
• Plus
• Overall Impressions Questions
• Health Status Questions
• BC Custom Questions

13
Cross Sector Comparison
14
Sector Surveys To date

• The BC Patient Satisfaction Steering Committee
  has completed six coordinated, province-wide
  patient surveys, with two surveys in-progress,
  and two more in the planning stages
• 2003 Emergency Department Care
• 2004 Long Term Care (Residents)
• 2004 Long Term Care (Family/Frequent Visitors)
• 2005 Acute Care (Inpatient, Maternity,
  Pediatrics)
• 2006 Outpatient Cancer Care
• 2007 Emergency Department Care
• 2008 Emergency Department Care (pilot project of
  continuous surveying from May 1/2007 to March
  31/2010)
• 2008 Acute Care (Inpatient, Maternity,
  Pediatrics) (in field)
• 2009 Mental Health Addictions (in planning)
• 2009 Ambulatory Care/Day Surgery (in planning)
• Note Also in 2007/08 the SC funded a survey of
  patients discharged from Riverview Hospital,
  i.e., patients integrated into tertiary and other
  Mental Health settings

15
Establishing Priority Sectors for BC Patient
Surveys
Stage 4 Recommending Priorities to Leadership
Council
Stage 1 Defining Process
Stage 3 Validating Priorities
Stage 2 Defining Priorities
Priority Sectors for 2009/10 Emergency
Department Care -continue ongoing survey pilot to
March 31/2010 Ambulatory Care -develop plan to
survey this sector and implement a day surgery
sub-sector survey Mental Health Addictions
Care -survey Acute Inpatient sub-sector, and
develop family/supporter survey tool
approved by Leadership Council December 2008

• BC MINISTRY OF HEALTH
• MoHS Reps on Steering Committee confirm MoHS
  priority sectors, and
• Ascertain ADM and Ex. Director agreement to
  sectors for province-wide surveys

Emergency Department Care -with increased focus
on ED Decongestion facilities Mental Health
Addictions Care -with focus on Tertiary/Long Stay
and Acute Inpatient/Short Stay
Patients Acute In-patient Care -with increased
Surgical focus Home and Community Care -with
focus on residential care and family/visitors
LEADERSHIP COUNCIL DIRECTION
BC MINISTRY OF HEALTH SERVICES PRIORITY SECTORS

• HEALTH AUTHORITY
• HA Reps on Steering Committee confirm HA priority
  sectors, and
• Ascertain Senior Leader and CEO agreement to
  sectors for province-wide surveys

HEALTH AUTHORITY PRIORITY SECTORS

• FEASIBILITY
• available valid/ reliable tools?
• access to target population?
• cost/scope within budget?

• Accreditation Canada
• Co-Chairs confirm if/what sectors to have
  instruments in new Positive Client Experience
  Standards (2008 onward), and
• Determine interest of AC to collaborate on
  continuum surveying

STAKEHOLDER INPUT E.g. AC, BC Food Housekeeping
Survey Teams, OHS/Risk Managers, IPSWG, PCLS,
various Planning Councils,
16
What do survey results tell us?

• Survey results are a way of providing general and
  specific feedback about how a facility is
  performing.
• they do NOT explicitly tell us how to do
  something
• they highlight where there is SMOKE, not FIRE
• they do NOT provide any means of, or control
  over, improvement

17
The Challenge How to Collect and Display
Patient Experience of Care Data

• Differing needs for accountability, improvement,
  and research can lead to conflicting demands on
  many aspects of the data collection, analysis,
  and reporting processes associated with patient
  surveying
• The burden of data collection (distributing
  surveys, collating responses, formatting and
  distributing reports) can be overwhelming
• Results that are geared to system level
  improvement are often delivered too infrequently,
  are too slow to arrive, and in too complicated a
  report for front-line managers to take
  improvement action
• Only when data has been analyzed, interpreted and
  presented in a manner that make it understandable
  and useful to others, does it become information

18
Sample Survey Reports Annual and Quarterly
Action Plan Reports
19
ED Survey Quantitative ReportsMonthly
Bimonthly Management Reports
20
ED Survey Qualitative ReportsMonthly
Bi-monthly Patient Comments Reports
21
Utilisation of Survey Results

• Performance measure in the Government Letter of
  Expectations
• Results analysed and areas to target for
  improvement reported to Health Operations
  Committee (HOC)
• Follow-up by the Acute Care Council and Emergency
  Department Decongestion Group
• Measuring the impact of facility specific quality
  improvement initiatives
• e.g. Kelowna General Hospital Streaming Project
• Custom Topic Reports
• e.g. CHSPR Report on Emergency
• Accreditation, Balanced Scorecards etc

22
Current Surveys

• Planning Mental Health / Addictions and
  Ambulatory Care Surveys
• Acute Care Point in Time Survey
• 6 month point in time survey (June 1 November
  30, 2005) was completed and released in July 2006
• On October 1st 2008 a repeat survey of this
  sector was initiated
• Results will be available in Winter 2009 at the
  unit, facility, health service delivery area,
  health authority, and provincial level

23
The Acute Care Survey Design

• NRCCs generic inpatient acute care survey tool
  that addresses the following 8 dimensions of
  care
• Continuity Transition
• Coordination of Care
• Emotional Support
• Information Education
• Involvement of Family/Friends
• Physical Comfort
• Respect for Patient Preferences
• Access
• 15 additional validated maternity questions from
  NRCCs maternity survey tool
• 13 additional validated paediatric questions
  from NRCCs paediatric survey tool
• additional custom questions 5 regarding
  surgery, 4 pertaining to involvement in care, 1
  regarding ethnicity, and 3 related to patient
  safety,

24
Questions?
Kevin Samra BC Patient Satisfaction Steering
Committee Kevin.Samra_at_gov.bc.ca