Development of a patient satisfaction survey for Acute Medicine. Liz Lees Consultant Nurse & Clinical Dean Acute Medicine

Transcription

1 Development of a patient satisfaction survey for Acute Medicine Liz Lees Consultant Nurse & Clinical Dean Acute Medicine 4 th International Conference, Society for Acute Medicine, Edinburgh 7-8 October 2010

2 Why design your own survey? Danger of being subsumed as A&E Huge conduit for thousands of assessments Huge conduit for thousands of admissions Nothing off the shelf Focus Action and links to HIA, CQUIN plus more!

3 Why is patient satisfaction Public accountability Quality improvement Macro-level: important? system performance management benchmarking competition/contestability through markets (PCT) Micro-level: feedback to professionals and managers acceptability of processes Thompson, A.G.H., Sunol R., (1995) Expectations as determinants of patient satisfaction. International Journal of Quality Healthcare 7 (2)

4 The basis of satisfaction Imprecise, subjective, changes Different meanings Ideal: what we would like to happen, irrespective of reality Normative: what we believe ought to happen Predicted: what we really think will happen Perneger TV (2004). Adjustment for patient characteristics in satisfaction surveys, International Journal for Quality in Health Care, 16 (6),

5 Where are the drivers? CQUINS (commissioning for quality and innovation) Three dimensions of quality identified are safety, effectiveness user experience High Quality Care for All, DH (2008). 1. Reduce avoidable death, disability and chronic ill health from Venous thromboembolism (VTE) 2. Improve responsiveness to personal needs of patients worth 570,000 to Trust CQUIN - DH, (2010).

6 Survey design

7 Walking the pathway - framework Arrival and welcome Waiting Care & Treatment Pain control Privacy and dignity Infection control Mixed sex accommodation (single sex) Overall impressions Relatives Discharge arrangements

8 Patient involvement

9 Patient diaries Two patients Different pathways into AMU Retrospective accounts Demonstrated the different perceptions of the journey despite both being in AMU Using patient feedback (2009): a practical toolkit, Picker Institute Europe.

10 Two pathways into AMU Ambulance arrived with the blue lights flashing and the crew were very kind Had a needle in my arm and Oxygen mask and my wife followed in the car Heart tracing in the ambulance Had a monitor on and it was very noisy really busy with people dying in the next cubicle High on a trolley had a sheet on it Waited ages in X-Ray needed the loo Had two needles in different places to take blood Got into a really comfy bed, so tired Consultant came to see me GP rang the Hospital I brought a letter Wife got stuck in traffic on the way Waited by a big desk, very busy Clerks took my details down wrong Two Doctors came to see me together Sat in a busy waiting room for my results Wasn t really clear what to do you know what was going on Shown into a bay with my bed & toilet Nurses were really kind

11 PCT led commissioning target selected 5 questions Questions: 2009 % result 1 Were you involved as much as you wanted to be in decisions about your care and treatment 2 Did you find someone on the Hospital staff to talk to about your worries and fears 3 Were you given enough privacy when discussing your treatment or condition 4 Did a member of staff tell you about medication side effects to watch for when you went home? 5 Did Hospital staff tell you who to contact if you were worried about your condition after you went home? 62% 57% 76% 41% 70% Improve 8 points on last years score - 09/10 = 61.2%

12 Phrasing the questions (30) Were you satisfied with nursing care Yes or No I was very satisfied with the quality of nursing care: Strongly agree / Agree / Disagree / Strongly disagree Comments:

13 Time as a measure of quality (Pt 1) didn t have a watch on the whole time (Pt 2) no recollection of time passing About right time, too long, too short.

14 Survey pre test involving patients Gave to both patients Length Questions phrasing New scales Incentive to return

15 Methodology Self completion questionnaires Mailed to 2 samples (SAE) 250 in each January to March respondents (AMU1) = 28% return 110 respondents (AMU2) = 44% return Measurement scales: Closed, Likert, Comments Questions devised from: Patient pathways, Patient diaries, Picker, Nursing Metrics, AMU standards. O Leary, Z. (2004) The essential guide to doing research, Sage, London; citing Likert, R., 1932, A technique for measurement of attitudes, New York Press.

16 Quick word about response & rates Responding alone -(without help), more positive Significant others family often more negative Immediate responders (1 st mailing), more positive Later responders - tend to be older, widowed and needing help to answer Adapted from Oliver RL (1993). Cognitive, affective, and attribute bases of the satisfaction response. J Cons Res, 20, 418.

17 Making the survey work for you

18 AMU 1 room to improve Arrival:- Only 1 in 9 patients were happy with the way they were greeted Waiting: 41% felt overcrowding was an issue in the waiting area Care and treatment: not enough privacy when being given bad news. Discharge (medications): side effects of medications not explained Discharge (time): 9 in 10 patients said they waited a long time to be discharged

19 AMU 1 where patients were satisfied Waiting (information): 7 out of 10 patients received the right amount of information - condition or treatment. Care and treatment (Nurse call buzzer): 76% were happy with staff reaction times Pain management: 73% happy with time to receive pain management. Overall impressions: 8 in 10 patients would rate their overall care as excellent or good. Relatives: 91% of relatives were given help to locate family.

20 Contrasting comments I think the whole team on AMU are polite, well mannered and care about my well-being every time I am admitted into their care; whenever I need to see someone or if I am in pain, they work very hard and are due credit where credit is due. Personally I was not happy with my Mom s care she was left in bed for 3 days it has taken ages to get her confidence back!

21 Where from here? Blended measures advocated Small regular re sampling NAPP patient focus groups Suggestion boxes IT near patient computers Use volunteers to raise issues at the time PALs interviews & data