Case Study

How Ireland’s Bon Secours Health System group stay ahead of changing JCI standards

Bon Secours Health System is Ireland’s largest independent hospital group.

Bon Secours has 3000 staff and treats 280,000 people a year across five sites. Based on Catholic principles, it is a not-for-profit organisation which prides itself on compassionate care and world-class treatment.

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JCI accreditation standards

In the latter half of 2020, it comfortably met Joint Commission International (JCI) accreditation standards. It is confident it now also meets with new 7th edition JCI Standards on incorporating patient experience data into clinical practice, released in January 2021.

Bon Secours believes that its partnership with patient experience software company Cemplicity is key to its patient engagement strategy. Having worked with the organisation since 2016 to develop online feedback systems, Bon Secours continues to see Cemplicity as an essential aspect of the exceptional care it provides.

The hospital group can also show demonstrable improvements in patient experience across many areas, over three years.

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2020 discharge satisfaction scores are up from 91% in 2017
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2020 respecting privacy scores are up from 88% in 2017

Patient scoring of the discharge experience has lifted from 91% in 2017 to 94% in 2020, while scores on respecting people’s privacy have risen from 88% to 92%.

There have also been sustained improvements in all experience scores, with anything below 90% now considered ‘poor’. The group’s Net Promoter Score (NPS) metric has risen from 81 in 2017 to 86 in 2021.

Patient feedback

Bon Secours Health System’s CEO Bill Maher initially contacted Cemplicity because of its international reputation for Patient-Reported Experience Measures (PREMs) and Patient-Reported Outcome Measures (PROMs) software and consultancy. The company has clients in six countries and a reputation for striving for improvement rather than simply measuring patients’ experiences of and outcomes from care.

Bon Secours’ leadership team was impressed with the ‘can-do attitude’ it saw and signed off on a trial at Galway hospital. Today, Cemplicity’s PREMs system is used at all the group’s hospitals and in 2020, it launched a PROMs system for orthopaedics.

The brief was to implement a digital system to replace paper-based feedback cards. At the time, the cards were getting a 2.7% response rate in Cork which was not untypical compared to other sites. Now response is at 32% across the group – a more than tenfold increase.

The low return rate was not helped by the fact that every hospital did things slightly differently. Feedback cards were generally left in patients’ rooms, but questions weren’t standardised and there was no easy opportunity for benchmarking.

Cemplicity provides an easy, co-ordinated way to collect data. Patients who agree to take part are sent a link to the survey either by SMS or email invitation 7 – 15 days after discharge. Those that don’t respond after the first week are sent a gentle reminder. Email response for Bon Secours is currently 40% for email compared to 23% for SMS.

Cemplicity advised Bon Secours on what questions to include, to show how well hospitals were delivering each of the group’s seven core values of Respect, Justice, Integrity, Stewardship, Innovation, Compassion and Quality.

Cemplicity encourages the use of standardised questions from globally-validated providers, in Bon Secours’ case from Picker Institute Europe, with some inspiration from Ireland’s National Inpatient Experience Survey (NIES). Data from these sources are particularly useful because a client’s answers can be compared in aggregated form against data from other healthcare providers.

‘The ability to benchmark is really important to us… In fact, it’s key to driving performance.’- says Maeve Goggin, Bon Secours Health System Group Risk Officer.

Real-time patient feedback

Cemplicity’s platform gives staff access to real-time patient feedback – a big step forward compared to the weeks or months it can take to input data from a paper system.

Staff can access information easily on tablets and computers via an intuitive and powerful dashboard. Different staff can be given different levels of access to see the information most relevant to them. With Bon Secours, the majority of nursing staff see anonymised results down to ward level, making it possible to identify trends – and opportunities to improve their local service. What’s more, the fact the feedback is real-time means issues can be nipped in the bud before they affect other patients.

Four years ago when Bon Secours started working with Cemplicity, Margaret McHugh and Maeve were Quality and Risk Managers at Bon Secours Galway Hospital and Bon Secours Cork Hospital respectively, and were both part of the leadership team reviewing how the group collected patient feedback.

Margaret, now the Bon Secours Health System group’s Chief Nursing, Quality & Patient Safety Officer, and Maeve, agree that Cemplicity helped implement changes to the system quickly and efficiently.

‘It was a busy time for us,’ says Maeve, ‘but Cemplicity was always available. They helped manage the interaction with Picker and the integration with Bon Secours’ IT systems in a very straightforward way.

They made it easy.’

Bon Secours believes that having the information has made two big differences to its business.

Motivation and incentives

Firstly, it has helped motivate and incentivise staff at every level. Figures are presented quarterly to the clinical governance committee, which includes board members and clinical heads (the last set provoked ‘very robust discussion,’ says Maeve). Hospital managers look at Net Promoter Scores as avidly as any commercial brand marketeer. And individual hospital managers mine the data for positive feedback, which they display on their quality boards. It’s particularly helpful that the Cemplicity approach encourages patients to tell their stories. These have a lot of impact on staff, both when positive or when they highlight opportunities to improve.

‘We’re trying to reflect back to staff where patients see them actually living the values of Bon Secours such as compassion and respect,’ says Maeve. ‘You’re looking for comments that are in addition to those about nurses, doctors and clinical staff, comments about our healthcare assistants, reception staff, cleaning, catering cark park attendants and all those support services.

When they get feedback, it means a lot to them. And we expect everyone from the front door to the back door to treat patients as the centre of all we do.’

Patient experience driven improvements

The second major difference is the way patient experience data has driven improvements. Bon Secours believes that Cemplicity has been good at helping to analyse feedback, identify areas of concern and re-frame surveys to capture how well those concerns have been addressed. Or as Maeve puts it: ‘We’re on a journey and Cemplicity has helped guide us.’

One such area of partnership was around discharging people. Bon Secours was initially unsure about whether to ask the questions at all, but Cemplicity ‘nudged’ them towards it, knowing how important it was. Cemplicity suggested doing more work on the question: ‘Did a member of staff tell you about any danger signals before going home?’. Although not low, they felt results could be higher.

After looking more closely at what they were doing, Bon Secours realised that the paperwork given to patients when they went home outlined symptoms for concern but did not explicitly call them ‘danger signals’. By changing this – and tracking how patients reacted – they were able to drive improvements. ‘You’re always looking for your lowest answers and asking “what can I do better here?”’ says Margaret.

This kind of dialogue has helped grow the relationship. As well as introducing the orthopaedic patient-reported outcome measures, Cemplicity recently shortened the main Patient-Reported Experience Measures survey, making it even more effective by SMS. “As we’ve used (Cemplicity’s systems) we’ve adapted the survey at intervals’, says Maeve. ‘We’ve changed requirements in how we want the data presented and they’ve patiently changed that for us.’

Global knowledge

This trust when it comes to constantly reviewing things is one of the reasons why Bon Secours was well prepared for their accreditation survey and for the changes to JCI accreditation standard requirements in January 2021. And working with an international company like Cemplicity helps them anticipate the next international standards that the JCI may hold them to. With links that are as good in Asia as they are in Europe, Margaret says: ‘Cemplicity is more global than local. I feel that that has given us an added advantage.’

And it’s an important advantage in a marketplace where customers have a choice, not only between Bon Secours Health System and Ireland’s good public healthcare service but against other private providers in a sophisticated market. In the end, Margaret says choosing the right patient experience software partner is vital because:

‘Our patients choose us – and they have to choose us – because we’re a private organisation. We are totally and utterly dependent on how our patients experience our care and we are, as a ‘Health System’ committed to providing exceptional care to our patients and to continuous cycles of improvement.’

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