Patient Satisfaction: Measurement in Ontario

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1 Patient Satisfaction: Measurement in Ontario 1

2 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

3 CIHI s Stakeholders Health Council of Canada Health Canada LHINS Researchers Statistics Canada Accreditation Canada Ministries of Health Regional Health Authorities Health facilities Public and Private Sector Organizations Advocates Professional Associations 3

4 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

5 Balanced Scorecard Financial How do our funders see us? Customer What is the patient s perspective? Internal Business How do we compare on quality of care? Innovation and Learning How are we preparing for the future? Kaplan and Norton, 1992; Baker and Pink,

6 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 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

7 Inpatient Acute Patient Satisfaction Indicators Prior to 2005 (SHoPSS) Global Quality Process Quality Outcomes Unit Based Physician Care 2005 to 2008 (NRC Picker) Overall Impressions Communication Patient Consideration Responsiveness of Care Givers Other Caregivers Support Services Housekeeping

8 ED Patient Satisfaction Indicators Prior to 2005 (SHoPSS) Overall satisfaction with physicians and medical treatment Willingness to return to the ED Satisfaction with the facility 2005 to 2008 (NRC+Picker) Consideration Responsiveness Communication Overall Impressions Satisfaction with waiting times in the ED Satisfaction with bedside care Satisfaction with staff in the ED

9 Canadian Hospital Reporting Project (CHRP) CIHI s New Tool to Measure and Improve Hospital Performance

10 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

11 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

12 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

13 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

14 How Is CHRP Different? 1. Content 2. Report Design 3. Features 14

15 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

16 What Makes This Different: 1. Standardized pan-canadian Indicators Category Efficiency Effectiveness Safety Accessibility Appropriateness Indicator Financial (current ratio, average age of equipment) Productivity (administrative service, hours per weighted case, etc.) Human resources (benefit hours, earned hours) Mortality following surgery In-hospital mortality Readmission rates Nursing-sensitive adverse events Obstetrical trauma Birth trauma In-hospital hip fractures for elderly Wait time for hip fracture surgery C-section rate Vaginal birth after C-section Use of angiography following AMI 16

17 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

18 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

19 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

20 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

21 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

22 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

23 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

24 DRAFT List of Domains Coordination Help (responsiveness) Respect Listening Pain Information Involvement in Decision-Making Transition Outcome Overall Quality Safety 24

25 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

26 Stakeholder Feedback 26

27 Questions? 27

28 Canadian Hospital Reporting Project (CHRP) CIHI s New Tool to Measure and Improve Hospital Performance For more information

29 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

30 The Excellent Care for All Strategy 1. Organization The Excellent Care for All Act, 2010 (Bill 46) 2. System ECFAA became law on June 8th, 2010 Establishes a number of requirements for health care organizations, starting first with hospitals 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

31 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

32 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

33 The patient voice in quality improvement Patient Declaration of Values > Excellent Care for All + Patient Relations Process + Patient Satisfaction surveying + Critical Incident reporting Developed in consultation with the public Process reflects content of declaration of values Conducted at least once per fiscal year 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

34 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

35 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

36 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

37 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

38 Would you recommend this hospital to your friends and family?* *Indicator is included as QIP core indicator 74% 57% > 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

39 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

40 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

41 For more information > with questions and to subscribe to ECFAA bulletins > Website: Ontario.ca/excellentcare Ontario.ca/excellencedessoins

42 The Patient Experience in Ontario Patient satisfaction with ER services Julian Martalog Director, Access to Care Informatics Cancer Care Ontario 42

43 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

44 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

45 Overall Patient Satisfaction Province and LHIN Summary - Patient Satisfaction Ratings (Q1 2010/11) 0% 20% 40% 60% 80% 100% Provincial 17% 58% 25% Erie-St.Clair 19% 55% 26% South West 11% 56% 33% Waterloo Wellington 15% 62% 22% Hamilton Niagara 19% 59% 21% Central West 29% 56% 15% Mississauga Halton 16% 60% 24% Toronto Central 18% 57% 26% Central 23% 60% 17% Central East 22% 56% 21% South East 11% 59% 31% Champlain 12% 59% 29% North Simcoe 13% 53% 34% North East 18% 56% 26% North West 17% 59% 24% Poor/Fair Good/Very Good Excellent 45

46 Highest ER Patient Satisfaction Scores 46

47 Satisfaction Dimension Ratings 47

48 Dimension Ratings by Question 48

49 Dimension Ratings by Question 49

50 Dimension Ratings by Question 50

51 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

52 Leading Practices in Measuring the Patient Experience Ontario Hospital Association March 23, 2011 Linda Corso RN BScN MA Nancy Cobb RN BScN Linda Corso: Nancy Cobb:

53 Content Outline Background & History Worldwide Trends 5 Cornerstone Issues Leading Practices Hospital Strategies Conclusions Linda Corso: Nancy Cobb:

54 What did we do? Process Selection of Key informants What are the trends? NHS & Australia USA Canada Linda Corso: Nancy Cobb:

55 1. Improving Patient Access 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: Nancy Cobb:

56 1. Improving Patient Access 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: Nancy Cobb:

57 1. Improving Patient Access C. Examine ancillary cycle times and improve as necessary. Collaborate with other departments (lab & radiology) to improve turnaround times for test results Linda Corso: Nancy Cobb:

58 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: Nancy Cobb:

59 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: Nancy Cobb:

60 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: Nancy Cobb:

61 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: Nancy Cobb:

62 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: Nancy Cobb:

63 3. Providing a Responsive Environment 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: Nancy Cobb:

64 3. Providing a Responsive Environment 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: Nancy Cobb:

65 3. Providing a Responsive Environment 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: Nancy Cobb:

66 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: Nancy Cobb:

67 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: Nancy Cobb:

68 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: Nancy Cobb:

69 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: Nancy Cobb:

70 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: Nancy Cobb:

71 Questions?? Linda Corso: Nancy Cobb:

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