Case Study 03
Auckland District Health Board - Patient Experience Surveys
Listening to patients’ perspectives can help us better understand how the care District Health Boards (DHB's) deliver can be improved.
Patient Experience Surveys provide staff and management with feedback that is relevant, timely and actionable.
In 2011, Point Research, alongside online technology company Buzz Channel and the Auckland District Health Board, began a project focussed on using patient feedback to improve clinical outcomes and the quality of the care delivered.
Best practice
Four factors were considered when designing the patient experience surveys. In order to apply best-practice, the surveys needed to be:
1. Actionable: Information produced must lead to action
2. Evidence-based: The experiences we ask patients about must make a difference to their level of satisfaction.
3. Affordable: The programme needed to work within existing health budgets and in an environment of growing demand for health services.
4. Equitable: While online feedback is the most efficient way of gathering patient feedback, the approach must be easy for people who cannot access email.
International review
We undertook an international scan of patient satisfaction approaches and evaluations and found that:
Robust international evaluations of existing approaches consistently found a number of important shortcomings, namely that
Collaborative Solution
Together with the Auckland DHB and Buzz Channel, we developed a system designed to collect feedback and address these shortcomings.
1. Dimensions of care
To keep the survey short for patients, and to bring focus to the most important things, the survey covers the fourteen core dimensions most strongly correlated with patient satisfaction (one of these is ‘other’). They are asked several questions on each of these dimensions and the results can then be benchmarked against results from international patient experience studies.
The survey concludes by asking people to tell us what went well and what could have been better, and by asking for any final comments.
2. Driving Action on the things that matter most to patients
At the start of the survey patients are asked to select the three things that are most important to them (including other). When they get to each of these three areas in the survey, they are then asked: “You said that [x] is important to you. How did we do? Give us a rating from 0 to 10”. Once they have given a rating, ADHB asks: “Why did you give us this rating? Give us some examples or suggestions of what you felt we did well or could do better”.
These are the critical questions to drive action. Staff reading the reports can understand not only what is most important to patients, how well they did or didn’t perform, they also know exactly what they need to change to improve patient experience.
3. Reporting
The reporting is undertaken in four parts. Reports are audience-focused and designed to be accessed in multiple ways.
4. Cost effectiveness
The survey is designed to get feedback from a large group of patients in a cost effective way. Regular audits are taken of who is currently completing the on-line survey so that alternative methods can be used to augment feedback from population groups under-represented in the survey.
Outcomes
The In-patient experience survey has been running at ADHB since November 2011.
Communication, having confidence in the quality of their care and treatment and getting consistent and coordinated care while in hospital, are the three things that patients say make the most difference to their hospital care and treatment.
An outpatient survey has also been implemented as part of the programme and the Counties Manukau and Capital and Coast District Health Boards are surveying patients using their version of the in-patient experience survey.
The patient experience project had sufficient credibility to be nominated and subsequently shortlisted as a finalist for an ADHB Health Excellence Award in 2012.
Patient Experience Surveys provide staff and management with feedback that is relevant, timely and actionable.
In 2011, Point Research, alongside online technology company Buzz Channel and the Auckland District Health Board, began a project focussed on using patient feedback to improve clinical outcomes and the quality of the care delivered.
Best practice
Four factors were considered when designing the patient experience surveys. In order to apply best-practice, the surveys needed to be:
1. Actionable: Information produced must lead to action
2. Evidence-based: The experiences we ask patients about must make a difference to their level of satisfaction.
3. Affordable: The programme needed to work within existing health budgets and in an environment of growing demand for health services.
4. Equitable: While online feedback is the most efficient way of gathering patient feedback, the approach must be easy for people who cannot access email.
International review
We undertook an international scan of patient satisfaction approaches and evaluations and found that:
- Understanding the views and priorities of patients is critical to improving both safety and the quality of services;
- Asking people to relate their experiences was found to be a more robust and consistent measure than asking them about their satisfaction;
- There are literally hundreds of dimensions to a patient’s experience of a hospital. Only a small number are important to patients and correlate strongly with patient satisfaction.
Robust international evaluations of existing approaches consistently found a number of important shortcomings, namely that
- Patients are not asked what is important to them;
- Many of the current surveys are onerous for patients to complete;
- The results from current surveys do not provide the insights that can lead to action if a hospital received a poor rating for doctors’ communication e.g. what does this actually mean? What should they change to improve their rating?
- The survey results tend to be delivered to Executive Teams and are not delivered to those most able to influence change, such as frontline staff;
- The results are neither audience-focused nor accessible in multiple formats;
- There are substantial delays between the time that patients are surveyed and the results are received.
Collaborative Solution
Together with the Auckland DHB and Buzz Channel, we developed a system designed to collect feedback and address these shortcomings.
1. Dimensions of care
To keep the survey short for patients, and to bring focus to the most important things, the survey covers the fourteen core dimensions most strongly correlated with patient satisfaction (one of these is ‘other’). They are asked several questions on each of these dimensions and the results can then be benchmarked against results from international patient experience studies.
The survey concludes by asking people to tell us what went well and what could have been better, and by asking for any final comments.
2. Driving Action on the things that matter most to patients
At the start of the survey patients are asked to select the three things that are most important to them (including other). When they get to each of these three areas in the survey, they are then asked: “You said that [x] is important to you. How did we do? Give us a rating from 0 to 10”. Once they have given a rating, ADHB asks: “Why did you give us this rating? Give us some examples or suggestions of what you felt we did well or could do better”.
These are the critical questions to drive action. Staff reading the reports can understand not only what is most important to patients, how well they did or didn’t perform, they also know exactly what they need to change to improve patient experience.
3. Reporting
The reporting is undertaken in four parts. Reports are audience-focused and designed to be accessed in multiple ways.
- Using the online reporting system designed by Buzz Channel, the results are accessible online to the ward staff in real time i.e. they go straight to the staff that can make the most difference to patient care.
- Each month a hospital-wide focus is taken on one of the core dimensions, looking at what is most important to patients, tracking satisfaction, and looking at what `good care’ looks like and what `poor care’ looks like from ADHB patients’ perspective. These short reports are distributed through email and hard copy.
- The data is mined and reported on to inform projects and areas of strategic focus.
- Highlights are reported in Nova, ADHB’s quarterly staff magazine.
4. Cost effectiveness
The survey is designed to get feedback from a large group of patients in a cost effective way. Regular audits are taken of who is currently completing the on-line survey so that alternative methods can be used to augment feedback from population groups under-represented in the survey.
Outcomes
The In-patient experience survey has been running at ADHB since November 2011.
Communication, having confidence in the quality of their care and treatment and getting consistent and coordinated care while in hospital, are the three things that patients say make the most difference to their hospital care and treatment.
An outpatient survey has also been implemented as part of the programme and the Counties Manukau and Capital and Coast District Health Boards are surveying patients using their version of the in-patient experience survey.
The patient experience project had sufficient credibility to be nominated and subsequently shortlisted as a finalist for an ADHB Health Excellence Award in 2012.
