The importance of patient reported outcome measures – How Southern Cross are normalising patient feedback

Southern Cross Health Society (SCHS), a member owned friendly society, is New Zealand’s largest health insurer, with over 850,000 members. Last year, it paid $830 million in health insurance claims – more than $2 million every day — which is well over 70 per cent of the country’s health insurance claims overall.

SCHS has a proud history of supporting Kiwis’ health and wellbeing. They know that supporting members means closely understanding the health outcomes expected from treatment and listening to their experiences as patients. When SCHS wanted to build up their approach to gathering and acting on patient feedback, they partnered with Cemplicity, who are leaders in this field.

Working with the Cemplicity platform, SCHS can gather a comprehensive view of members’ health experiences and outcomes while maintaining privacy and independence. Cemplicity has provided the infrastructure to integrate internationally established and validated questionnaires into the SCHS Quality Programme. Having a real-time, ongoing understanding of healthcare experiences and outcomes from the patients’ point of view is helping to promote improvements in healthcare.

This famous quote by Donald Berwick (1997), underpins the modern view that a patient’s view of their own health is the most important one.

 “The ultimate measure by which to judge the quality of medical effort is whether it helps patients (and their families) as they see it. Anything done in health care that does not help a patient or family is, by definition, waste, whether or not the professions and their associations traditionally allow it.”

An interesting part of the SCHS work with Cemplicity is the delivery of the Patient Reported Outcome Measures programme, commonly known as PROMs. Using a short, globally established survey, patients are asked about their health before and after treatment. This provides invaluable insight into the shifts associated with different treatments, how they affect people’s quality of life, their daily functioning, and their psychological and physical wellbeing — all those dimensions of health and wellbeing that only a patient can really know.

“Measuring quality of outcomes from a member’s perspective is growing in importance for us,” says Glenn Martin, Head of Provider Quality, SCHS. “Clinical outcomes are usually measured within a hospital environment, but it is less common for a specialist to have access to patient reported outcome measures to inform practices.”

“We’re in the unique position of being able to facilitate a wide-scale patient feedback programme because of our IT systems, large membership base and our relationships with many providers across a wide range of specialties.”

SCHS has valued working with Cemplicity, an organisation with a unique, strong commitment to health. It means SCHS and other parties with which they share the results can be confident the information is gathered independently, that it is a true and fair representation of members’ views, and protects the privacy of the individuals providing feedback. They also know the methods and instruments used are internationally validated. “Cemplicity is helping us build trust and confidence in the information being gathered,” says Glenn.

It is helpful to have Cemplicity working with other organisations in the health environment across a number of countries, (including all DHBs and the Health and Safety Quality Commission in NZ), to capture and report patient feedback. It supports the routine and consistent use of PROMs in the health sector in New Zealand for quality improvement.

“The great thing about working collaboratively with Cemplicity, with their ‘Software-as-a-Service’ approach, is leveraging the development work Cemplicity undertakes with other healthcare providers. There is a community of interest around this, and an open source mind-set that is a win-win for all.”

Gathering a consumer perspective of any service is common in many businesses and it’s important those providing healthcare services do the same, he adds. “This information is a key asset for clinicians, to be able to view and reflect on the patient perspective, and potentially make some improvements based on patient feedback.”

Surveys are emailed out daily to SCHS members, who are invited to provide feedback before they undergo treatment. They are then invited to assess their health and wellbeing 90 to 180 days after treatment (the length of time varies according to the type of procedure involved). The most fascinating aspect of the PROMs programme is that the Cemplicity dashboard shows the change in health state before and after treatment – incredibly rich information when viewed across specialties, facilities and patient demographics.

Over the past two years, more than 120,000 surveys have been sent out with a 25 to 30 percent response rate which, while strong by international standards, is still being optimised.

“Members have welcomed the chance to give personal feedback,” says Glenn, “to have their voice heard and contribute to the collective view that will lead to improvements in the quality of their own healthcare and that provided to others. We are constantly surprised at the time and thought people put into their responses, it’s clear people understand how their feedback can help others who may have the same treatment in future. As fee-paying members, they’re also pleased to know we are measuring outcomes and experience on their behalf. They see this as Southern Cross taking care of their health and wellbeing, and that we’re looking after members’ interests.”

The image below is a view of the SCHS Dashboard.

Patient feedback is not something that healthcare professionals need to be anxious about; in fact, the survey results indicate that healthcare in New Zealand is of a high standard, and the feedback points to a good news story. Clinicians can view data in its entirety, comparing feedback they’ve received to that received by anonymised peers.

“This is giving clinicians a chance to embrace the positive feedback, and identify areas where they could improve.”

Aggregated information is also shared with medical colleges and associations, and at medical conferences. Glenn’s confident that the PROMs programme is helping improve healthcare in New Zealand. “Because getting information on the patient view is now being normalised throughout medical communities, and that’s influencing daily practices. Individual medical associations have also commented on how valuable this is,” explains Glenn.

Patient reported outcome measures are being increasingly recognised internationally as an important method in assessing healthcare, addressing quality-of-life questions that are the very reasons most patients seek care in the first place. “Our understanding is that Southern Cross Health Society is leading in this space in New Zealand with the help of Cemplicity.”