Cemplicity’s incubator was the New Zealand health system. Within this respected, high functioning yet small system, we have had the opportunity to engage with people across the sector, from the Ministry of Health to ward staff and GPs. We have co-designed national methodologies and seen the the results of our work through participation in governance groups and close feedback loops. As we step out onto the international stage, we realise how fortunate we have been to have started in NZ.
Priorities are clearly articulated in the NZ Health Strategy, and funding lines and improvement frameworks encourage alignment between secondary and primary care providers. Remarkably compared with some other countries, NZ has refined its measurement of system performance down to only six metrics called System Level Measures (SLMs, albeit that each measure is underpinned by contributory measures). One of these six SLMs is patients’ experiences of care. Small steps have been taken to link these SLMs to performance (value) based payments.
These strategies have been strong influences on our software design and processes, holding us in good stead as we work with other health systems taking the same strategic direction. This case study shares some of our lessons and provides links to information on the NZ Health Quality and Safety website that could help others involved in national programmes.
Continuous surveying to drive local improvement
New Zealand’s first national Cemplicity programme, implemented for the Health Quality and Safety Commission, captures real-time patient feedback across all public hospitals following a robust mixed-mode approach using email, SMS and paper surveys. While the methodology mandates quarterly surveying, most hospitals now opt in to continuous surveying of all their patients for whom they have email addresses. They use this feedback to drive local improvement. As the local programmes roll on each week, results are seamlessly reported in both the national and local reporting portals during the quarterly sampling periods.
Following the success of this first programme, Cemplicity was selected to implement an ambitious programme across every general practice in the country.
Understanding patients’ experiences of care integration
Importantly, the purpose of this programme is not just to understand patients’ experiences of their general practice, but to understand their experience of care integration across the whole of the NZ health system. As people come in and out of ED, hospitals, specialist and allied healthcare, and diagnostic services, they are asked to give feedback about both their access to services and the joined-up nature of care. This is producing a wealth of invaluable insight, and alongside the hospital survey, encourages primary and secondary care providers to work together to streamline and improve patient experiences.
These programmes offer valuable lessons for others wishing to implement Patient Reported Measures programmes at-scale, including:
- Know your purpose. Have clarity about the purpose of your programme, to ensure the right questions are asked and the right stakeholders engaged.
- Go digital-first. Digital-first approaches save money and improve reach, participation, timeliness and the actionability of results.
- Consider all stakeholders. Consider the needs of different stakeholders in the design of the survey and reporting so that everyone gets value from the programme. Without wide sector support, change will not happen.
- Communication is key. Excellent communication is essential but often not prioritised. (The Ireland national inpatient experience programme is a superb example of how excellent communication can drive high patient participation and stakeholder engagement).
- Take action. Close the loop by acting on feedback and communicating changes. If staff and patients are to participate in these programmes in the long-term, they need to know that their contribution is driving real change.
- Have patience. Acknowledge that national programmes take time to implement and mature but, when well-implemented and reaching maturity, drive a powerful and sustained patient-centeredness that makes all the hard work worthwhile.
Purpose & Methodology
Read more about the Primary Care programme including the methodology for the Primary Care and Inpatient Experience surveys. Here’s a great list of practical resources.
Understand how the Primary Care survey is structured to cover all aspects of the health system and click through online. Also interesting to read about the survey development process. Read about how Secondary and Primary Care networks now create joint improvement plans to achieve more integrated care and better patient experiences.
Read how HQSC encourages and supports local improvement, how they report the national Inpatient Experience results. Read HQSCs first report on the Primary Care year 1 pilot. Here is an example of sector communication that highlights the transformational impact a programme can have as it matures.
See this exceptional example of how patient experience results can be used to prioritise projects and how high achieving teams can contribute to national improvement – in this case in the safe use of medication.