Unit-level Acute Care Patient Experience Survey: Getting Started February 2015 Survey Toolkit 1
You can read through the entire survey guide or link directly from a line in the table of contents to a particular section. Contents 1 Introduction...3 1.1 What is the unit-level Acute Care Patient Survey?... 3 1.2 Why survey patients about their experience?... 3 1.3 Who is this toolkit for?... 3 1.4 The purpose of this toolkit... 4 1.5 How to use this toolkit... 4 1.6 Icons used in this toolkit... 4 2 Unit-level Acute Care Patient Surveying Options...4 2.1 The standardized 11 question survey is available on:... 4 3 Setting Up Your Survey...6 4 Getting Ready to Survey your Patients...6 4.1 Create an Implementation Plan... 6 Choosing patients to survey...6 Determine the number of patients to survey...7 How to administer the survey to patients...8 4.2 Communication... 9 4.3 Create Standard Work... 9 4.4 Train those involved... 10 5 Submitting the Surveys... 10 6 Accessing Your Results... 11 7 Sharing Your Survey Results... 12 Appendix A Unit-level Acute Care Patient Experience Survey... 13 Appendix B Planning Worksheet... 15 Sharing the Results... 16 Appendix C Survey Tracker... 17 Appendix D Communication Poster... 19 Appendix E Examples of Standard Work... 20 Appendix F Survey Scripts... 21 Appendix G Response Cards... 22 Appendix H Guidelines for Teleform... 23 2
1 Introduction 1.1 What is the unit-level Acute Care Patient Survey? The unit-level acute care patient experience survey is a standardized questionnaire that captures the experience of care from the point of view of the patient. The Saskatchewan Health Quality Council (HQC) has collaborated with representatives of health organizations across the province in a Patient Experience Survey (PES) Advisory group to inform the development and pilot testing of this survey. It has been designed for individual acute care units to implement on their own as part of their efforts to improve patient experience; because it is standardized, it can also be used by entire facilities or health regions as part of a coordinated strategy. Units that participate in the survey can submit their completed surveys once per month to the Health Quality Council, who will analyze the results and produce graphs and tables that the unit can use for improvement. 1.2 Why survey patients about their experience? Understanding and respecting patients values, preferences and expressed needs are the foundation of patient-centered care -Harvey Pickard Patients are experts, as they are the only ones who experience the entire journey of care; Understanding patient experience is key to understanding the overall quality of care in your unit; Patients experiences of care are directly related to their health outcomes; and, Engaged patients are more likely to be actively involved in selfmanagement of their health. Improving patient experience is about working with the people who access our services to make these services better. By surveying patients experiences, we can gain insights into which processes on the unit are working effectively, and which processes can be improved. 1.3 Who is this toolkit for? This toolkit is written for health care staff who want to capture and use patient experience to effectively improve acute care processes that meet their patients needs. 3
1.4 The purpose of this toolkit This Getting Started toolkit focuses on how to collect the patient experience using the standardized unit-level acute care patient experience survey. It provides support and guidance on preparing acute care units for surveying, survey implementation, and how to access survey results. 1.5 How to use this toolkit This toolkit is comprised of a number of sections, including: Surveying options currently offered by HQC; How to access the survey tool; Guidelines on how to prepare and administer the survey on acute care units (i.e., survey process); Accessing survey results; and, Tested tools and templates (Appendices). 1.6 Icons used in this toolkit Icons are used throughout this toolkit to highlight practical tips and links to tools and Work Standards from acute care sites currently using the survey. This is what they mean: An example of Standard A tool to support A tip from other acute care Work implementation units 2 Unit-level Acute Care Patient Surveying Options 2.1 The standardized 11 question survey is available on: Paper. See Appendix A for paper survey format. AND/OR Online. We are currently using SurveyMonkey to administer the survey. You can choose to use either method exclusively, or to use a combination of the two. Below is an overview of the process for administering, processing, and analyzing the paper and online surveys, and a table showing the advantages 4
and disadvantages of each. For further details and recommendations on implementing the survey, please refer to Sections 3 and 4. Traditional Paper Survey Online Survey Advantages -Familiar format for patients -Inexpensive to complete (no electronic device required) -As data is collected electronically, results can be accessed at any time via SurveyMonkey results link Disadvantages -Must have a process in place to ensure completed surveys are faxed/mailed each month to HQC - Paper copies can be misplaced -Paper data has to be processed to be electronic -Require technology to access survey (tablet, smart phone, etc.) -Patients may not be comfortable with using technology Pick the survey method that best fits your patients and unit s needs. If you require additional information and/or support in choosing a method contact: acsurveys@hqc.sk.ca. 5
3 Setting Up Your Survey Once you ve decided which survey method (paper and/or online) to use on your unit, please connect with HQC by sending an email to acsurveys@hqc.sk.ca with the following information: Health region; Facility name(s); Unit/ward name(s); and, First name, last name, and email address of all people who will require access to the results. HQC will customize and provide you with an electronic version of the survey tool with your unit s information. HQC will ensure data sharing agreements with your region are in place and create a user account/password to access your monthly results from the HQC file server. 4 Getting Ready to Survey your Patients Before you start using your survey, there is some preparation required. We recommend the following activities before implementing your survey: Create an Implementation Plan Communicate Create Work Standards Train those who will be involved 4.1 Create an Implementation Plan This section will help you set up your unit s survey process to make sure a comprehensive view of all patients experiences is captured with the survey. You may find the worksheet in Appendix B helpful in developing your implementation plan Choosing patients to survey Patients can receive a survey if they: are 16 years of age or older, and had at least a 24-hour stay in the hospital. It is not necessary to survey every patient on your unit you can select a sample of patients to receive the survey. The sample should be a good representation of the population of patients on your unit to ensure that your results are not biased. Choosing a random sample of patients is the ideal way to try to eliminate bias from your results. However, this is not a research project; it is data collection for 6
improvement purposes so it is not necessary to select a completely random sample. To ensure that you get a good sample, be sure to hand the survey to a variety of patients in a variety of situations (i.e., younger, older, male, female, day shift, night shift, weekday, weekend, short stay, long stay, etc.) Determine the number of patients to survey A common expression in quality improvement when thinking about collecting data is: just enough data, and just good enough data. We recommend surveying a minimum of 10 patients per month. You may ask, Why 10? Results of this survey will be reported as results for each question on the survey. Since patients may skip questions and choose not to answer some questions, even if you handed out surveys to 10 patients, for some questions you may have much fewer responses. In improvement work, a sample size of at least 5 is recommended to help ensure reliable results. Therefore, to make sure you have 5 responses for each question on the survey, we recommend surveying at least 10 patients. How you distribute survey data collection within a month is a decision you need to make as a unit. If you have higher number of discharges on your unit, you may choose to survey 20 patients a month. This would make your results more reliable. We do not advise surveying more than 20 patients per month, as increased sample size beyond a point does not have a good return on your effort. On track? The survey tracking template in Appendix C can help visually track how many surveys have been completed. When posted on the unit, whoever is administrating the surveys can simply make a tick mark to indicate the number of surveys completed. You could also insert additional columns to track the representativeness of your sample.. 7
When creating your implementation plan, be sure to include those who work on the unit and are involved in the process (E.g., managers, educators, point of care staff, volunteers). They will have the best ideas on how to set up successful surveying on the unit. How to administer the survey to patients How you choose to administer the survey to your patients is a decision you need to make as unit. We recommend connecting with other units in your facility and/or health region that may already be using the unit level acute care survey to learn what process they have been using and decide whether or not you want to standardize this process as a facility and/or health region. Regardless of which survey method you chose (paper and/or online), you may consider: Patient Family Advisors or volunteers to administer the survey. One major advantage of having a Patient Family Advisors or volunteers work with the patient in answering the questions is that it allows for collection of some qualitative feedback which assists in explaining results and may identify specific improvement ideas. Self-administered method in which patients complete the survey on their own. If you are using the online survey this would require patients to have access to an electronic device with internet capabilities. This does not provide additional feedback, however it does provide anonymity. Respondents may be more willing to truthfully answer questions that they would not answer if another person was present. Provide patients with a card with the link to the online survey to complete at a later time. You can download and use the sample card you see in Appendix I; download it from the Health Quality Council Patient Surveying webpage. Please see Appendix E for examples of how other units have chosen to administer the survey. If you have discovered other methods of administering your surveys that worked well on your unit, we d like to hear about them for future revisions of this toolkit. Please send us your ideas to acsurveys@hqc.sk.ca. 8
Survey results are to be anonymous. When collecting additional comments/feedback from patients, be sure to connect with your privacy officer for any regional policies on what to do if a patient includes their own personal information (or anyone else s, including staff names) in their response. 4.2 Communication Your goal with patient surveying is to understand and improve patient experience. To achieve that, you will need to engage all of your staff, providers, patients, and families in the process. It s a team effort. When everyone understands and supports the same goal, you can create a good, reliable process for surveying, collect useful information, and make meaningful improvements on the unit. A communication plan is not intended to be a formal document, nor should it be a large amount of work it is simply a way to put your thoughts in order about how to communicate with unit staff, providers, patients and families. There are a few key questions that people often want answers to when introducing a new idea or process (see Appendix B). Consider your options for different communication mechanisms (posters, huddles, daily visual management boards, meetings, information conversations, newsletters, etc.). A communication poster template can be found in Appendix D. 4.3 Create Standard Work Once you ve created your implementation plan, to help all those involved in understanding and implementing the survey process, consider creating Standard Work to outline the steps in the process. As you learn from implementation, you can revise the steps on the Standard Work to create a process that works most effectively for the units within your organization. Excerpts of Standard Work on how to survey patients on the unit can be found in Appendix E. These were developed by health regions who piloted the survey. The Standard Work template can be found on the Provincial Improvement Office SharePoint Site. If you do not have access to this site, please contact your regional Kaizen Promotion Office or HQC at acsurveys@hqc.sk.ca for the template. 9
4.4 Train those involved Once Standard Work has been developed, ensure all those who will have responsibilities related to the survey have the information they need and have been trained for the role they will play in the process. Be specific about identifying and assigning roles and responsibilities and that the Standard Work is posted and made available for people to review as needed. Depending on the survey administration method you chose, you may want to consider writing a script for Patient and Family Advisors, volunteers, and/or staff. Sample scripts can be found in Appendix F. If PFAs and/or volunteers are administering survey, be sure to orientate them to the unit where they will be surveying and introduce them to staff (E.g., Does the unit have daily huddles where these introductions can be made and communication about the surveying process can be held?) Once you get going with the surveying, include a plan to routinely check in with Patient and Family Advisors, volunteers, patients and staff to find out how people are feeling about the surveying process and make improvements as needed. Volunteers and patients from the Cypress Health Region found it helpful to have laminated response cards when administering/completing the survey. It s a good visual that clearly displays response options. By using this visual, patients don t have to remember all of their survey response options. The template for these cards can be found in Appendix G. 5 Submitting the Surveys Paper Surveys Mail or fax the completed Patient Experience Surveys to HQC for processing. Note that surveys must arrive at HQC s office by the last day of each month to be included in that month s report. The surveys are processed using Teleform software and the data is used to generate monthly reports. Teleform allows a large number of surveys to be processed in a short amount of time with minimal manual work, but there 10
are guidelines that must be followed so that surveys can be processed efficiently. Mailing address: 241-111 Research Drive Saskatoon, SK S7N 3R2 Fax: (306) 668-8820 If you are planning to submit paper surveys, please refer to Appendix H for more information about Teleform requirements. Online Surveys We are currently using SurveyMonkey as our online survey tool. HQC will access the data directly from SurveyMonkey to generate monthly reports. Surveys entered into SurveyMonkey by the last day of each month will be used to generate the report for that month. 6 Accessing Your Results Monthly reports are generated and uploaded onto the HQC File Server. Unit reports are made available within 9 business days after the last day of each month. As outlined in Section 3, in order to access your results, please contact acsurveys@hqc.sk.ca with the following information: Health region; Facility name(s); Unit/ward name(s); and, First name, last name, and email address for all people who will require access to the results. HQC will send you instructions and your account details through email. Online Surveys If you are using the online survey, you will also be provided with a user name and password and can access results generated by SurveyMonkey. These results are available at as soon as surveys are submitted online. Public Reporting Surveys results are also made available online at www.qualityinsight.ca. 11
7 Sharing Your Survey Results This unit level survey was designed to support the work of improving the patients experience. It is recommended to spend time planning and discussing with staff, as a unit, how you will share and use the survey results to generate and test improvement ideas (Appendix B). For more information, please contact: If you have any questions on the survey results, have suggestions for improvement or need support in interpreting your results, email acsurveys@hqc.sk.ca. 12
Appendix A Unit-level Acute Care Patient Experience Survey 13
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Appendix B Planning Worksheet Planning for collecting Patient Experience Surveys on Acute Care Unit Worksheet Selecting patients who meet criteria to survey: patients 16 years of age or older; had at least a 24-hour stay in the hospital; Our unit will be using: online survey When will we survey our patients? (Is there a specific time or day that would be significant for the survey?) How many patients will we survey and how often? (note: recommend a minimum of 10 patients per month) Who will identify the patients to survey? online survey Who will administer the survey to patients? Will surveys be completed with a Patient/Family Advisor (PFA) or Volunteer? Or, if patients are to complete survey on their own, who will administer survey to the patients? If PFA/Volunteer: Who will the PFA or volunteer connect with when they arrive on the unit to survey? If PFA/Volunteer: Who is the primary contact for PFA/volunteer if they have questions and/or concerns during the surveying process? If paper survey: Where will surveys be dropped off when completed? If paper survey: Who will 15
fax/mail to HQC? (note: surveys to be at HQC by last day of the month) Communication How will we communicate to our staff, providers, and patients about the Unit-level Acute Care Patient Experience Survey? Key questions that people often want answers to when introducing a new idea or process: Why are we doing this? What will it look like to me? What will it mean to me? What will you do to support me? What do you want me to do? Sharing the Results Where will the results be displayed? Who will be responsible for posting the results? When and how often will we discuss results? How will suggestions to improve the survey be tracked? 16
Appendix C Survey Tracker Unit-level Acute Care Patient Experience Survey Month/Year: / Please indicate the # of PES completed in chart below. TARGET: Complete 10 surveys per month Week 1 Sunday Monday Tuesday Wednesday Thursday Friday Saturday Week 2 Week 3 Week 4 17
Areas for Improvement (provide comments in space below) What is working well? What ideas do you have to improve the Patient Experience Survey Process?. 18
Appendix D Communication Poster 19
Appendix E Examples of Standard Work Standard Work: excerpt from Saskatoon Health Region Standard Work: excerpt from Sun Country Health Region 20
Appendix F Survey Scripts Unit-Level Acute Care Patient Survey Scripts If using Patient and Family Advisors to administer online and/or paper survey: Good morning/afternoon. My name is [ADVISOR] and I am a Patient and Family Advisor with the [HEALTH REGION]. Do you have a few minutes to chat? If no, ask if you can come back. If not, thank them for their time If yes, proceed Great, as I mentioned, I am a Patient and Family Advisor with the health region. What that means is that I work with staff and physicians to help improve the care that we are able to provide while you are in the hospital. This unit really wants to find out how things are going, and what they can do differently to improve your experience. To do this, we are using a patient experience survey. If it is ok with you, I just wanted to spend about 10 minutes to work through, and discuss, the survey questions to find out how things are going. If ok to proceed, read through top box on survey (online and paper). This explains the survey is voluntary. It also provides contact information and patient s consent. Proceed with survey questions. Thank you so much for your time. Your input will be really valuable to the staff and physicians on the unit. If survey is be self-administered: We want to improve the care experience for our patients and families on this unit. To do that we need to understand what our patients and families need and want from our unit. By filling out a patient experience survey, you will be helping us know what is most important to you and what we need to work on to improve. If no, thank them for their time 21
If yes (online survey): provide patient with link to survey If yes (paper survey): provide patient with paper copy of survey and provide instructions on where to leave survey when completed as per your implementation plan/standard Work Please think about your stay on this unit when filling out your survey. Thank you so much for your time. Your input will be really valuable to the staff and physicians on the unit. Appendix G Response Cards 22
Appendix H Guidelines for Teleform Guidelines for Success with Teleform While Teleform is a great tool, there are certain guidelines that have to be followed. Following these guidelines helps us get your data back to you quickly and efficiently. The following guidelines should be shared with anyone on the team who is working with the surveys: Keep the four black boxes in the corners of the page fully visible. o What does fully visible mean? That no part of the square is covered. Things to watch out for: Photocopies when photocopying, check to make sure the boxes are not cropped. Example of what works: Example of what does not work: Remove all staples. o Documents cannot be scanned when they are stapled. Make sure staples are removed before you send the hard copies to HQC. Do not fold pages. o Surveys are processed in batches using the scanner s feeder tray. Folded surveys often do not scan properly, so each folded page must be manually scanned one at a time. Print a new copy every month for photocopying o Teleform cannot read the surveys if the same page is photocopied so many times it becomes faded. Print a new copy of the survey each month before you make photocopies. 23
Remind patients not to write their names, or identify anyone else by name, on their survey to ensure that the results remain anonymous. Appendix I Cards with online survey address 24