Listening, Learning, Improving

The patient voice in health care.

Deborah Schaler, MHPol, PhD Candidate

Menzies Centre for Health Policy

University of Sydney

Partnering with patients – policy drivers

• Health services are urged/required to partner with patients at:– individual level– service level– organisational level

• Drivers include national quality and safety standards and frameworks, accreditation standards, and local consumer participation policies and consumer advocacy organisations.

Partnering – why and how?

• The overarching aim of health services partnering with patients is to improve individual patient experience and to improve the safety and quality of health care services.

• ‘Partnering’ strategies include a range of patient feedback methods:– Consumer feedback management;– Patient and carer surveys; and– Collection of narrative.

Research aims

• To assess the effectiveness of 3 patient feedback methods (complaints, satisfaction/experience surveys and collection of narrative) in facilitating improvement to health service safety or quality.

• To develop a method for health services to analyse and link patient feedback data to service improvement and meet the new Australian National Safety & Quality in Healthcare Standards (Standards 1 & 2) related to patient feedback.

NSQHC Standards 1 & 2

• Standard 1 (Governance)– 1.15 Implementing a complaints system that includes

partnership with patients and carers

• Standard 2 (Partnering with Consumers)– 2.9 Consumers and/or carers participate in the evaluation of

patient feedback data and development of action plans.

Methods

• Case study (ACT Health) - Mixed Methods including Grounded Theory and situational analysis mapping

• Review of peer reviewed and grey literature including policy documents; case study: review of patient feedback data; and safety & quality governance

• Semi-structured interviews/ focus groups with health service staff – 44 staff comprising clinical, administrative, and safety & quality staff.

• Development of a method to analyse aggregated patient feedback and incident data to facilitate linking of the data to service improvement.

Results

• A more personal and immediate approach to managing complaints (core theme from staff interviews: degree of separation).

• Challenge: current policy treats complaints the same way regardless of clinical/other seriousness; bureaucratic process.

• Opportunity: risk management approach to complaints.

• Patient feedback as a service improvement tool.• Challenge: differences in priorities across professional groups.• Opportunity: patient feedback in a patient safety intelligence

network.

Results (cont)

• Narrative = powerful; drives service improvement.• Challenge: balance of + and - stories; data reports lack narrative.• Opportunity: narrative in data reports; capture & report compliments

better. Community based services implement multi-service QI wrapped around ‘types’ of patient journeys.

• Tools • Challenge: patient satisfaction surveys• Opportunity: new tools e.g. Patient Experience Trackers; patient

experience surveys. Improve quality of data reports.

Results (cont)

• Patient feedback data analysis• Challenge: data silos; no method to aggregate and analyse patient

feedback or to link patient feedback and incident data.• Opportunity: study to develop method to aggregate and analyse

data across sources that will also meet the new NSQHC Standards.

Opportunities to improve

• Risk management approach to complaints:– Risk matrix applied to complaints.– Level of risk determines type and timeframe for response.

• Patient feedback data system and reports:– Data reports include narrative; reports provided at service level.– Consistent data codes enable aggregation of data.

• Governance related to quality/service improvement:– Governance structure facilitates analysis of patient feedback to

drive service improvement.

Policy implications of project

• Health agencies might re-consider:– their selection of patient feedback methods.– their processes related to patient feedback management.– governance structure to facilitate translation of patient feedback

to service improvement.

• Clinicians and health service managers have an effective method to analyse aggregated patient feedback data and link it directly to quality and safety improvement activity.

References

• Ward, JK; Armitage, G. (2012). Can patients report patient safety incidents in a hospital setting? A systematic review. BMJ Qual Saf 2012;21: 685-699

• King, A; Daniels, J; Lim, J; Cochrane DD; Taylor, A; Ansermino, JM; (2010). Time to listen: a review of methods to solicit patient reports of adverse events. Qual Saf Health Care 2010;19 148-157

• Reader, TW; Gillespie, A, Roberts, J. (2014) Patient complaints in healthcare systems: a systematic review and coding taxonomy. BMJ Qual Saf 2014;0: 1-12

• Roberts, G; Cornwell, J; (2011) What matters to patients? Policy recommendations . Department of Health and NHS Institute for Innovation and Improvement

• Coulter, A; Fitzpatrick, R; Cornwell, J; (2009) The Point of Care: Measures of patient’s experience in hospital: purpose, methods and uses. London. The King’s Fund

• Goodrich, J; Cornwell, J (2008): Seeing the person in the patient. The Point of Care review paper. London. The Kings Fund www.healthissuescentre.org.au

• Davies, E; Cleary, PD; (2004) Hearing the patient’s voice? Factors affecting the use of patient survey data in quality improvement. Qual Saf Health Care 2005: 14:428-432

• Davies et al Factors affecting the use of patient survey data for quality improvement in the Veteran Health Administration BMC Health Services Research 2011, 11:334

• Coulter, A; Ellins, J ; (2006) Patient-focused interventions. A review of the evidence. Picker Institute Europe • Draper et al (2001) Seeking consumer views: what use are results of hospital patient satisfaction surveys?

International Journal for Quality in Health Care 2001; Volume 13, Number 6: pp.463-468• Luxford et al (2011) Promoting patient-centred care: a qualitative study of facilitators and barriers in healthcare

organizations with a reputation for improving the patient experience International Journal for Quality in Health Care 2011; Volume 23, Number 5:pp510-515

Questions ??

• Contact: deborah.schaler@act.gov.au