Hospital Authority Hospital-based Patient Experience and Satisfaction Survey

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1 For discussion on HAB-P211 Hospital Authority 2013 Hospital-based Patient Experience and Satisfaction Survey Purpose This paper reports to Members the findings of the 2013 Hospital-based Patient Experience and Satisfaction Survey (HB-PESS) conducted by the Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong (CUHK), and the recommendations arising from the HB-PESS. Background 2. Experience of patients is a key feature of quality improvement in modern healthcare delivery. In Hospital Authority (HA), the first Patient Experience and Satisfaction Survey (PESS) conducted in 2010 was well received by staff, patient groups and the public. To strengthen governance arrangements on PESS, a corporate strategy has been formulated as follows: (a) (b) (c) Building PESS expertise and capacity; Building a robust follow-up mechanism; and Developing a Corporate PESS Service Plan. 3. The 2010 PESS on 5,000 patients was cluster-based using the HK Inpatient Experience Questionnaire (HKIEQ) - a validated tool containing over 100 questions. To facilitate efficient and effective capturing of key patient experiences by individual hospitals, CUHK was commissioned through tender in 2013 to develop and validate the Short Form HK Inpatient Experience Questionnaire (SF-HKIEQ), as well as conducting a pilot HB-PESS. The chief aim of the survey was to pilot the validated short questionnaire and hospital-based, in anticipation for future cycles of PESS. SF- HKIEQ was used in the survey on over 3,500 patients in seven major acute public hospitals (one from each Cluster) and carried out from October to December Objectives of the Hospital-based Patient Experience and Satisfaction Survey 4. The key objectives of the HB-PESS are: (a) to develop a valid and efficient tool (questionnaire) for individual hospitals to measure and monitor patients experience and satisfaction;

2 - 2 - (b) (c) to establish a baseline from which subsequent surveys can be carried out to monitor changes in patient experience and satisfaction over time; and to identify areas for services improvement for follow-up by HA. Survey Aspects, Key Findings and Recommendations 5. The Questionnaire (SF-HKIEQ), a simplified version of HKIEQ, provides a representative picture of inpatient experience in hospital setting. It covers four aspects of hospital care, following the patient s journey from admission to discharge: (a) (b) (c) (d) Provision of Care by Hospital Staff - Confidence and trust in doctors and nurses - Answering important questions by doctors and nurses Provision of Care and Treatment - Explanation on condition and treatment - Opportunity to talk to doctor - Discussion on worries/providing comfort - Privacy - Pain control Provision of Information on Leaving Hospital - Explanation on how to take medication - Explanation on medication side effects to watch for - Advice on danger signals to watch for - Advice on care after discharge Overall Impression during hospitalization - Treated with respect and dignity - Care received from doctors, nurses and healthcare assistants - Overall care received - Overall inpatient experience 6. Respondents were asked to evaluate their experience and satisfaction on the services of the respective HA hospitals on these aspects along their patient journey from admission to discharge. The results of this Survey and recommendations for improvement from CUHK can be found in Pages 36 to 79 of the HB-PESS Report (which will be tabled at the Board Meeting with electronic access by then available at the HA internet website: Corporate News Special Reports). The Executive Summary of the Report is attached to this paper (Annex) for advance perusal by Members. The Way Forward 7. PESS findings have given an overview of the seven hospitals services and highlighted areas for quality improvement. In response to the PESS Report, HA

3 - 3 - will study and analyse the survey results, develop plans and prioritize areas for quality improvement. Internal and External Communication 8. To ensure buy-in by relevant stakeholders, regular communication is arranged with patients, the public and staff on the objectives and operational details of the PESS at different phases of the launching of the PESS. 9. With a view to proactively communicating the PESS results, a comprehensive communication plan has been drawn up for internal and external communication. These include press release and briefings, posting up the Full Report on HA website, contributing articles in the HASLink and newspapers, briefings at appropriate staff seminars and patient forums, etc. Publicity 10. As explained in paragraphs 8 and 9 above, there are regular communication arrangements on the objectives and operational details of the PESS. Proactive communication will continue to share the HB-PESS findings and recommendations for all relevant stakeholders including patients, the public and staff, etc. Advice Sought 11. Members are invited to: (a) (b) note the HB-PESS findings and the CUHK s recommendations for improvement as contained in the Report; and advise on the way forward as proposed in paragraph 7 above. Hospital Authority HAB\PAPER\ September 2014

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5 Foreword I am pleased to present the report of the 2013 Hospital-based Patient Experience and Satisfaction Survey of the Hospital Authority (HA). Thanks to the commissioned work by the School of Public Health and Primary Care of The Chinese University of Hong Kong in developing a validated tool and conducting the survey on over 3,500 patients from seven major acute hospitals. Through the during their hospital stay. On behalf of HA, we would like to extend our sincere gratitude to our patients for their support. Their active participation is indeed a big encouragement. The views collected in the Survey are important in helping us better plan and organise our services, and enhancing quality of care for all patients. Professor John C Y LEONG Chairman Hospital Authority Hospital-based Patient Experience and Satisfaction Survey

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7 Foreword The Hospital Authority (HA) embarked on the first Patient Experience and Satisfaction Survey (PESS) in 2010 using a validated tool of international standards. Riding on the fruitful experience of the 2010 Cluster-based Survey, the HA has developed a PESS Corporate Service Plan for long term In 2013, the School of Public Health and Primary Care of The Chinese University of Hong Kong was commissioned to design and conduct a pilot personal experience and satisfaction throughout the inpatient journey. With the help of this validated tool, individual hospitals could focus on their own findings and service improvement to address specific needs of their local patients. I would like to thank the research team for their dedication towards the Survey. My heartfelt gratitude also goes to our patients, who have actively participated in the Survey, and provided their valuable opinions and feedback. I look forward to having continued support from our patients and healthcare workers in future surveys. Dr P Y LEUNG Chief Executive Hospital Authority Hospital-based Patient Experience and Satisfaction Survey

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9 Report on 2013 Hospital-based Patient Experience and Satisfaction Survey Hong Kong Hospital Authority Executive Summary Prepared by The Jockey Club School of Public Health and Primary Care Faculty of Medicine The Chinese University of Hong Kong September 2014 Hospital-based Patient Experience and Satisfaction Survey

10 2013 Hospital-based Patient Experience and Satisfaction Survey in Hong Kong Hospital Authority Research Collaborators: 1) Hospital Authority 2) The Jockey Club School of Public Health and Primary Care (JCSPHPC), Faculty of Medicine, The Chinese University of Hong Kong (CUHK) Principal Investigator: Professor Eliza Lai-yi WONG Associate Professor Division of Health System, Policy and Management JCSPHPC, Faculty of Medicine, CUHK Co-investigators: Professor Eng-kiong YEOH, GBS, OBE, JP Director / Head of Division / Professor of Public Health Division of Health System, Policy and Management JCSPHPC, Faculty of Medicine, CUHK Dr Siu-fai LUI, MH, JP Clinical Professional Consultant Division of Health System, Policy and Management JCSPHPC, Faculty of Medicine, CUHK Ms Annie Wai-ling CHEUNG Research Assistant Division of Health System, Policy and Management JCSPHPC, Faculty of Medicine, CUHK 6 Hospital-based Patient Experience and Satisfaction Survey 2013

11 Ms Carrie Ho-kwan YAM Research Associate Division of Health System, Policy and Management JCSPHPC, Faculty of Medicine, CUHK Ms Nicole Fenwei HUANG Research Assistant Division of Health System, Policy and Management JCSPHPC, Faculty of Medicine, CUHK External Consultant: Professor Angela COULTER Associate Professor Nuffield Department of Population Health University of Oxford England, United Kingdom (Ex-Chief Executive of Picker Institute Europe) Hospital-based Patient Experience and Satisfaction Survey

12 Acknowledgement Professor Eng-kiong YEOH JCSPHPC Director Professor Eliza Lai-yi WONG Principal Investigator We would like to express our appreciation to the Hospital Authority (HA) for affording us the valuable opportunity to design and conduct the first Hospital-based Patient Experience and Satisfaction Survey (PESS) in Hong Kong public hospitals using Shortform Hong Kong Inpatient Experience Questionnaire (SF-HKIEQ). We also wish to thank the Patient Relations and Engagement Department of the HA Head Office for their kind assistance in the logistics for conducting the survey; and staff in 7 HA acute hospitals for supporting and coordinating the survey. Last but not least, we are grateful to all patients who participated in the survey by providing their valuable opinions and feedback to guide participation and engagement, the survey would not have succeeded. 8 Hospital-based Patient Experience and Satisfaction Survey 2013

13 Executive Summary Background The Jockey Club School of Public Health and Primary Care (JCSPHPC), Faculty of Medicine, The Chinese University of Hong Kong (CUHK) was commissioned by the Hospital Authority (HA) in 2009 to develop a tool for measuring patient experience and satisfaction. A locally-validated instrument, the Hong Kong Inpatient Experience Questionnaire (HKIEQ), which was adapted from the General Inpatient Questionnaire of the Care Quality Commission in England, was used to conduct the first territory-wide patient satisfaction survey among 5,030 discharged patients in the 7 clusters of HA hospitals. experience of the different aspects of their care during hospitalization. The instrument has 80 items, of which 54 are evaluative questions in 9 dimensions of patient care. Based on the international experience, it was considered that a short form of HKIEQ hospital on a regular basis. The feedback from patients could enhance patient engagement in the care process and help identify areas for continuous improvement. JCSPHPC, CUHK was thus commissioned by the HA in 2012 to develop a short and validated version of HKIEQ (termed Short-form Hong Kong Inpatient Experience experience and satisfaction levels; and to conduct the first Hospital-based Patient Experience and Satisfaction Survey (PESS) using SF-HKIEQ in This report disseminates the findings of the first Hospital-based PESS using SF-HKIEQ. Hospital-based Patient Experience and Satisfaction Survey

14 Study Objectives The objectives of the study were: 1) To test the applicability of the SF-HKIEQ for individual hospital; 3) To identify areas for improvement in delivering patient care. Study Methodology The SF-HKIEQ was designed and validated by the JCSPHPC through a rigorous, mixed methodology of qualitative and quantitative studies, taking into account the local context and the public hospital system in Hong Kong. A cross-sectional telephone survey was then conducted for patients of 7 acute HA hospitals discharged from 18 October to 5 December 2013 inclusive, using the validated SF-HKIEQ. Survey Aspects The SF-HKIEQ had 18 items derived from the full version of the HKIEQ to provide a representative picture of inpatient experience in hospital setting. SF-HKIEQ covered (1) provision of care by hospital staff, (2) provision of different components of care and treatment, (3) provision of information on leaving hospital, and (4) overall impression to Survey Population The survey was conducted in 7 HA acute hospitals (one from each HA cluster). An adequate sample of eligible patients who had been discharged between 18 October and 5 December 2013 was recruited. Recruits must be aged 18 or above and have at least one overnight stay in the hospital during the survey period. Patients admitted under the care of Psychiatric, Obstetric, Dentistry, Hospice, Infirmary, Paediatric and Intensive care services were not included in this survey. 10 Hospital-based Patient Experience and Satisfaction Survey 2013

15 A total of 3,566 patients from the 7 acute HA hospitals responded to the survey. The overall response rate was 73% (ranging from 62% to 84% among 7 hospitals). Of the respondents, 71% were emergency or urgent admissions, 25% were admitted from a waiting list or planned admission, and 3% were from other sources, such as hospital transfers. Survey Data - Standardisation and Presentation To facilitate individual hospital in interpreting findings in relation to the overall results of the participating hospitals, relative weighting on age and gender was applied to individual had been shown to have an influence on response). It was noted that a comparatively smaller proportion of respondents living in old age homes was included in the survey in comparison with the overall discharge population in the survey. In addition to a descriptive presentation of the responses for each of the questions (percentage of response), a score was calculated for each evaluative question by converting the range of responses into a score on a scale of 0 to 100 (very poor to very good experience). The range of calculated scores among the 7 hospitals was also provided to highlight outstanding areas and identify areas for further study for improvement. Hospital-based Patient Experience and Satisfaction Survey

16 Survey Findings Patient experience in terms of proportion description (Dashboard 1-5) and satisfaction by calculated score (Dashboard 6) in four aspects of patient journey are described in this section. (I) Hospital Staff When you had important questions to ask a doctor, did the doctor provide a clear and understandable answer to you? Yes, always = 66%, Yes, sometimes = 30% and No = 5%; Calculated score = 81 (hospital range 70-87) Did you have confidence and trust in the doctors treating you? Yes, always = 83%, Yes, sometimes = 14% and No = 2%; Calculated score = 90 (hospital range 87-92) When you had important questions to ask a nurse, did the nurse provide a clear and understandable answer to you? Yes, always = 67%, Yes, sometimes = 28% and No = 5%; Calculated score = 82 (hospital range 70-91) Did you have confidence and trust in the nurses treating you? Yes, always = 88%, Yes, sometimes = 11% and No = 1%; Calculated score = 93 (hospital range 90-95) 12 Hospital-based Patient Experience and Satisfaction Survey 2013

17 Hospital-based Patient Experience and Satisfaction Survey

18 (II) Patient Care and Treatment Were you told the detailed aspects of your condition, treatment, operation or procedure and its result in a way you could understand? Yes, completely = 64%, Yes, to some extent = 26% and No = 10%; Calculated score = 77 (hospital range 74-80) If your family or someone else close to you wanted to talk to a doctor, did they have enough opportunity to do so? Yes, definitely = 38%, Yes, to some extent = 30% and No = 31%; Calculated score = 54 (hospital range 44-64) Whenever you got worries or fears about your illness or the treatment, did the healthcare workers discuss / comfort you about your condition? Yes, definitely = 54%, Yes, to some extent = 25% and No = 22%; Calculated score = 65 (hospital range 50-80) Were you given enough privacy when discussing your condition, treatment or procedure? Yes, always = 85%, Yes, sometimes = 9% and No = 6%; Calculated score = 90 (hospital range 81-96) Did you think the hospital staff have done everything they could to help control your pain? Yes, definitely = 92%, Yes, to some extent = 5% and No = 4%; Calculated score = 94 (hospital range 92-96) 14 Hospital-based Patient Experience and Satisfaction Survey 2013

19 Hospital-based Patient Experience and Satisfaction Survey

20 (III) Information on Leaving Hospital Did a member of staff tell you in clear and understandable way on how to take your medication? Yes, completely = 85%, Yes, to some extent = 11% and No = 4%; Calculated score = 90 (hospital range 89-92) Did a member of staff tell you about medication side effects to watch for when you went home? Yes, completely = 35%, Yes, to some extent = 15% and No = 50%; Calculated score = 43 (hospital range 31-53) Did a member of staff tell you about any danger signals you should watch for after you went home? Yes, completely = 55%, Yes, to some extent = 16% and No = 29%; Calculated score = 63 (hospital range 54-77) Did the doctors or nurses give your family or someone close to you all the information they needed for your care and recovery? Yes, definitely = 34%, Yes, to some extent = 25% and No = 41%; Calculated score = 47 (hospital range 39-60) 16 Hospital-based Patient Experience and Satisfaction Survey 2013

21 Hospital-based Patient Experience and Satisfaction Survey

22 (IV) Overall Impression Overall, did you feel you were treated with respect and dignity while you were in hospital? Yes, always = 89%, Yes, sometimes = 9% and No = 2%; Calculated score = 93 (hospital range 89-95) How would you rate the care you received from (i) doctors Excellent / very good = 18%, Good = 63%, Fair = 17% and Poor / Very poor = 2%; Calculated score = 74 (hospital range 72-76) (ii) nurses Excellent / very good = 17%, Good = 68%, Fair = 14% and Poor / Very poor = 2%; Calculated score = 75 (hospital range 74-77) (iii) healthcare assistants Excellent / very good = 14%, Good = 69%, Fair = 15% and Poor / Very poor = 2%; Calculated score = 74 (hospital range 72-75) Overall, how would you rate the care you received? Excellent / very good = 13%, Good = 64%, Fair = 21% and Poor / Very poor = 2%; Calculated score = 72 (hospital range 69-74) How would you rate the overall inpatient experience? (0 means the worse inpatient experience; 10 means the best inpatient experience) Rated 6 and above = 92% and Rated 7 and above = 86%; Calculated score = 80 (hospital range 77-81) 18 Hospital-based Patient Experience and Satisfaction Survey 2013

23 Hospital-based Patient Experience and Satisfaction Survey

24 20 Hospital-based Patient Experience and Satisfaction Survey 2013

25 The survey revealed an overall positive patient experience. However, five areas with comparatively lower scores and greater variation among 7 hospitals were identified as follows: Opportunity for a family or someone else close to patient to talk to a doctor (Calculated score 54, hospital range 44-64) Healthcare workers discuss / comfort you about your condition (Calculated score 65, hospital range 50-80) Provision of information on medication side effects (Calculated score 43, hospital range 31-53) Provision of information on danger signals to watch for after discharge (Calculated score 63, hospital range 54-77) (Calculated score 47, hospital range 39-60) Although it was challenging to achieve a high score in these areas in the public hospital setting given the high workload and resource constraints, some hospitals managed to find ways to better meet the expectations of patients and such experience could be shared among hospitals. Further discussion and study of these areas are needed for identifying and prioritizing improvement measures to enhance patient experience during their hospitalization. Hospital-based Patient Experience and Satisfaction Survey

26 22 Hospital-based Patient Experience and Satisfaction Survey 2013

27 Conclusion This first Hospital-based PESS using the newly validated SF-HKIEQ was successfully conducted in 3,566 discharged patients from 7 HA acute hospitals in The response rate of 73% was higher than that of the first Cluster-based survey in 2010 using HKIEQ, reflecting an applicable exercise in individual hospital and attentive culture of patient engagement in public hospitals. The findings from the survey were positive and encouraging. There was a very high degree of confidence and trust in the doctors and nurses, with 83% rated Yes, always (calculated score = 90) in doctors and 88% rated Yes, always (calculated score = 93) in nurses. The rating of the care provided by doctors, nurses and healthcare assistants were good, with 81%, 85% and 83% rated Excellent / Very good / Good (calculated score = 74, 75 and 74) respectively. The overall rating for the care received was good, with 76% rated Excellent / Very good / Good (calculated score = 72). The overall inpatient experience was very good, with 92% rated 6 and above and 86% rated 7 and above out of a score of 0-10 (calculated score = 80). including (i) opportunity to talk to a doctor ( Yes, definitely = 38%, Yes, to some extent = 30%, score 54), (ii) able to discuss / comfort patients about their condition ( Yes, definitely = 54%, Yes, to some extent = 25%, score 65), (iii) provision of information about possible side effects of medication ( Yes, completely = 35%, Yes, to some extent = 15%, score 43), (iv) provision of information on danger signals ( Yes, completely = 55%, Yes, to some extent = 16%, score 63), and (v) provision of all the information 25%, score 47). There was also a wide variation in these relatively lower performance items among the 7 hospitals. Hospital-based Patient Experience and Satisfaction Survey

28 Further study is needed to identify factors for the relatively lower performance items and to prioritize areas for continuous improvement to achieve a positive patient experience. Patient experience and satisfaction survey is an important element in patient engagement in the care process. By applying SF-HKIEQ which was a simplified and validated tool derived from HKIEQ, PESS provided an important insight for the hospital management and frontline healthcare professionals into delivering health care for patients, and identifying areas for service improvement. The SF-HKIEQ is applicable for individual Hospital-based surveys. It is recommended as an efficient and effective tool for capturing of key patient experiences for individual hospital. It can be used in-between surveys using the full version of HKIEQ. 24 Hospital-based Patient Experience and Satisfaction Survey 2013

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