A large public hospital commits to continuous improvement using post-discharge surveying
This hospital had been running a paper inpatient satisfaction survey to a periodic, small sample of patients receiving 7.8 out of 10 for satisfaction over several years and without any understanding of why people gave their ratings or what they could change to make things better.
For the same cost, we replaced this with an electronic inpatient experience survey to all patients who provided an email address on admission, at that time 7% of patients and now close to 25%. The survey closely focuses on the proven key drivers of a good patient experience and, critically, includes opportunities for patients to tell their stories in their own words.
Over 300 staff at the hospital have direct access to the feedback from the patients they care for, seeing their ratings alongside benchmarks for the whole hospital. Where something goes wrong or patients request contact, staff receive email notifications and use our Action Register to understand why patients are requesting contact and to manage issues through to resolution. Key to the success of this continuous improvement process is that feedback is captured and reported on a timely basis. Supporting this process, for no more investment than the process we replaced, our partner provides attractive monthly deep-dive analysis and reports on topics selected by the Hospital executive team. These drive a targeted top-down focus on opportunities for improvement and ensure the patient perspective is alive and strong at all levels.
This client has now widened their patient experience work to include Outpatients and Emergency Department experience.
A real-time view of patient experiences across an entire country
The NZ Health Quality and Safety Commission is committed to stimulating improvement in health service quality and understand the role of measurement in bringing this about. Patient experience of health care is an internationally recognised measure of health care quality and a tool they wished to adopt at-scale across the country. After a robust competitive tender process, Cemplicity was selected to deliver a Picker Institute adult inpatient survey tool across all New Zealand public hospitals. This national programme provides tailored and timely results to key teams across the sector from the national users to local hospital teams. Read more here.
This carefully designed programme stipulates a minimum level of participation for public hospitals, with a quarterly survey cycle and core question set. Under a national agreement, hospitals then have the option to set into a continuous improvement approach where they survey all their patients on a fortnightly basis, can add additional questions and use our notification and action tools to manage issues as they arise.
At a national level, this programme enables benchmarking of hospitals and service streams and also a clear view of the strengths and weaknesses of patient experiences across the continuum of care – useful for the prioritisation of centrally led health improvement initiatives.
A universal view of patients’ experiences of the integration of care through their general practices
Following the successful implementation of a national inpatient experience survey, the NZ HQSC committed to implementing a real-time programme across all NZ general practices, using a survey tool designed to measure patients’ experiences of the integration of care through their general practice. The survey questions themselves were designed after an international evidence search, expert review and careful stakeholder engagement with GPs, professional bodies and most importantly, patients themselves.
The implementation has been aided by the alignment of national health policy, which now stipulates patient experience measurement as one of the 6 System Level Measures that will be used to measure the performance of the whole health system.
The survey results will provide fascinating insight into system strengths and weaknesses as experienced by patients. Key strengths of the programme design include the timeliness of results and the fact, when fully implemented, every general practice in the country will be participating. Read more here.
A strong link between a great experience and active referral to friend and family
Our private hospital clients are just as committed to achieving great patient experiences and health outcomes as our public sector clients. However, private hospital groups also have the imperative of running a successful business so it’s a win-win that companies that focus on a systematic approach to optimising patient experiences are also significantly more profitable than companies that don’t.
A number of private hospitals use Cemplicity to reach patients post-discharge for feedback on their experiences. These programmes don't replace phone calls to patients the day after procedures but have replaced the paper feedback forms that were handed out on discharge. With the change from paper forms to the Cemplicity platform and with the assistance of our research partners, we’ve taken the opportunity to turn questions towards important key drivers of good experiences and away from satisfaction ratings.
Our clients are delighted with the impact of the change. The ability to reach many more patients and make it easy for them to give anonymous and constructive feedback is often noted, as is the timeliness of hearing about opportunities for improvement. Across the chain of care, from admission to post-discharge experiences our programmes are helping quality and executive teams to focus their strategies on those aspects of care that matter most to patients and then provide quantitative proof of the impact of changes. The live benchmarking across hospital groups is also making it easier to spot outliers and share knowledge for improvement opportunities.
Getting visibility of client experiences in the challenging field of community care
Cemplicity has recently launched its first Community Care client experience programme, adding to our range of work across inpatients, outpatients, ED, primary care and Patient reported outcomes. Community care settings have specific differences and challenges including the need to touch base with clients over time (rather than just once after a service interaction or treatment) and the range of conditions that clients may be receiving care for, including aspects that make it difficult for a client to respond directly e.g. due to cognitive impairment.
These factors are also key considerations in designing programmes for aged care in residential settings.
Our multi-mode approach (using paper, email, SMS and tablets) is critical in the design of these programmes as well as clear strategies for reaching clients and their families, or at least ensuring responses are independent of carers working with the person from whom feedback is sought. There are no silver bullets or ‘one solution fits all’ for programmes in the community or aged care settings but we continue to learn and observe different approaches around the world and can actively contribute to design decisions to make your programme useful and robust.
Growing attention on the value of patient reported outcomes
This at-scale PROMs survey across a number of surgical procedures, using the EuroQol EQ-5D-5L Quality of Life survey, provides a powerful new perspective of service quality. With changes in patients’ health reported by surgeon and facilities we will be well placed to draw attention to consistently excellent outcomes and opportunities for improvement.
Policy makers and health sector funders are increasingly shifting attention to outcomes-based measurement aiming to shift funding towards successful outcomes rather than simply ‘services delivered’. In more advanced health systems, money has already been allocated for outcome-based payments. Mechanisms such as patient experience and patient-reported outcome measures are being adopted as one of the bases for payments.
Increasingly, we see Cemplicity’s ability to implement large scale programmes with wide and timely reach across patient populations as key to enabling outcomes-based funding. A large volume of feedback from representative populations, delivered on a timely basis, is key to robust measurement that people will trust and support as the basis for payments.
