NATIONAL PATIENT EXPERIENCE SURVEY IN NEW ZEALAND
In 2014 New Zealand’s Health Quality and Safety Commission (The Commission) embarked on an ambitious journey to introduce The National Patient Experience Survey (NPES) to evaluate inpatient experience and measure quality of care across all twenty District Health Boards (DHBs). The challenge was to bring a consistent measure of the core dimensions of patient experience in public hospitals across strongly independent health providers.
To date, the NPES has captured feedback from nearly 50,000 adult inpatients about the core drivers of a good patient experience including over 100,000 patient stories. These stories provide rich qualitative data on the aspect of care the patient is commenting on.
ASKING THE RIGHT QUESTIONS
The survey was designed through a programme of work in partnership with KPMG and then cognitively tested and refined locally by Point Research. The survey uses Picker Institute validated questions, covering four domains of care: Communication, Partnership, Coordination of Care, Physical and Emotional Needs.
In each calendar quarter all DHBs participate in surveying a sample of recently discharged adult inpatients with their responses collected and collated by Cemplicity. This provides DHBs with access to KPI dashboards, trend charts and qualitative feedback about their patients’ hospital experience. DHBs have the option to add extra questions to their sample group or to adopt a continuous survey programme that runs fortnightly with an Action Register to manage contact requests. Building on the quarterly programme, DHBs can expand their survey offering into other areas of service such as Outpatient, Emergency Department and Community Care Experience activities.
CAPTURING FEEDBACK FROM PATIENTS
To ensure that the responses are representative, surveys need to reach people across all demographics. This is achieved by using a mixed-mode survey to ensure all recipients can respond. Each DHB securely supplies to Cemplicity an extract of patients to be contacted and this is used to invite patients to take part in the survey. To maintain statistical validity each DHB has a predefined sample size with email as the preferred method of invitation. Patients without an email address are invited via SMS or sent a paper copy of the survey which they can complete online using a unique code or by returning it to their DHB for processing. Approximately 30% of people receiving the paper survey choose to enter it themselves online.
A study completed by Zuidgeest et al1 found that having a mixed-mode survey design as an alternative to postal surveys yields comparable response rates across groups of respondents all at lower costs. Moreover, quality of health care was not rated differently by respondents in the mixed-mode or postal survey. To bring familiarity to the survey, invitations are automatically formatted to the likeness of the DHB attended and are signed off by that DHB’s survey manager. Cemplicity has the capability to handle multiple invitation and survey templates which for some programmes can run into the realm of 1000s.
ANALYSING RESULTS IN REAL-TIME
The programme is run at least quarterly, with many DHB’s electing to run it every 2 weeks to ensure more continuous feedback. Typically, patients are invited to participate in the survey two weeks after they were discharged – ensuring they have experienced the discharge and coordination of care post-discharge processes, and have enough time to reflect on their entire experience. As data is collected, intuitive analytics are provided to users in real-time within Cemplicity’s reporting portal. Our solution tailors access to data based on user roles, giving access that is relevant to each group of users within an organisation – for both The Commission and each acute hospital within a DHB. This ensures the relevant people get the information they need to take the action and promote improvement while still protecting patient privacy.
A user’s role defines whether they will be able to make comparisons at a national level or view specific hospital data. Cemplicity’s reporting tool provides a set of filters to make comparisons, refine the results and provide granular analysis about performance across ethnicity, age, gender and ward.
One of the many views comparing the performance of each DHB
A view of the national dashboard
DRIVING POSITIVE ACTIONS
Crucial to the success of an improvement programme is the ability to take action in areas that are being reported as performing poorly. Conversely, high achieving areas can be identified, teams praised for their successes and best practices developed by learning from others. All patients have the option to be contacted to discuss their feedback. A request for contact results in a dedicated team member receiving an email alert to allow them to follow up with the patient. DHBs running a fortnightly programme also have access to an Action Register allowing users to contact patients when requested, take notes and assign investigation to someone in their team, all within the Cemplicity portal.
Results from the NPES are proving valuable in bringing about change at a national level in New Zealand. Since the programme began there have been two questions, Medication Side Effects and Condition Management, that have consistently scored lowest across the country. The Commission recently brought Ogilvy Change on board to conduct an independent report on these questions.2
The report sought to:
- Understand why patients gave a negative response, and
- Design a cost-effective interventions programme for DHBs to roll out with the objective to improve patient outcomes, reduce re-admission rates and lower the costs associated with re-admission.
Ogilvy Change also conducted a secondary analysis of NPES results and worked closely with four DHBs to conduct staff interviews and focus groups to facilitate discussions on the reasons for low ratings in these areas. Results from the study have provided a framework for DHBs to improve patients experiences. The recommendations provided Quick Wins, aimed at giving DHBs the ability to make changes quickly and without committing resource, and Big Wins that will require larger resource investment and process improvement to help drive significant change overtime.
A view of a DHB’s Action Register
The NPES programme is well regarded across the world for its ability to:
- Capture feedback from patients in a mode that suits them.
- Deliver results as soon as they are collected from patients, in real-time to health providers to provide timely, relevant and actionable feedback.
- Give health providers a flexible approach to extend the programme to suit their own needs of continuous improvement.
- Be a cost effective solution for patient experience and feedback compared to the historical approaches of large-scale, paper-only sampling techniques.
The programme has a Governance Committee established to drive continuous improvement of how the information collected from patients can be used to enhance the experiences of adults inpatients across New Zealand.
1. Zuidgeest, M., Hendriks, M. C. P., Spreeuwenberg, P. M. M., & Rademakers, J. (2011). A comparison of a postal survey and mixed-mode survey using a questionnaire on patients’ experiences with breast care. Journal of Medical Internet Research, 13(3).
2. https://www.hqsc.govt.nz/assets/Consumer-Engagement/Publications/Raising_the_bar_ on_the_National_Patient_Experience_Survey_-_May_2017.pdf