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Diane Watson | Research to improve public confidence and views on quality in the Canadian health care system
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Diane Watson | Research to improve public confidence and views on quality in the Canadian health care system

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Dr Diane Watson, (then International Visiting Health Services Research Fellow at the Sax Institute from the University of British Columbia, Canada) spoke with the HARC network in April 2009 about ways ...

Dr Diane Watson, (then International Visiting Health Services Research Fellow at the Sax Institute from the University of British Columbia, Canada) spoke with the HARC network in April 2009 about ways to strengthen public confidence in the hospital system through research and analysis.

HARC stands for the Hospital Alliance for Research Collaboration. HARC is a collaborative network of researchers, health managers, clinicians and policy makers based in NSW, Australia managed by the Sax Institute.

HARC Forums bring members of the HARC network together to discuss the latest research and analysis about important issues facing our hospitals.

For more information visit saxinstitute.org.au.

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Diane Watson | Research to improve public confidence and views on quality in the Canadian health care system Diane Watson | Research to improve public confidence and views on quality in the Canadian health care system Presentation Transcript

  • Research to improve publicconfidence and views on qualityin the Canadian health caresystemDiane Watson PhD MBAInternational Visiting Health Services Research FellowThe Sax Institute29 April 2009
  • Outline• Health care and reform in Canada• The “confidence conundrum”• Research evidence to inform efforts to: – Build public confidence – Improve overall views on quality – Publicly report on progress• Who needs to know what …
  • Outline• Health care and reform in Canada• The “confidence conundrum”• Research evidence to inform efforts to: – Build public confidence – Improve overall views on quality – Publicly report on progress• Who needs to know what …
  • Canada
  • Health Care Expenditure per Capita by Source of Funding in 2004$7,000 Adjusted for Differences in Cost of Living (US$ PPP)$6,000 Private Spending Out-of-Pocket Spending$5,000 $2,572 Public Spending$4,000 $803$3,000 $483 $444 $342 $354 $148 $472 $239 $906 $313 $370 $28 $582 $113 $396$2,000 $238 $389 $359 $2727 $2,475 $2,350$1,000 $2,210 $2,176 $1,894 $1,940 $1,917 $1,832 $1,611 $0 a ab a United Canada France Netherlands Germany Australia United OECD Japan New States Kingdom Median Zealand a2003 b2002 (Out-of-Pocket) Source: The Commonwealth Fund, calculated from OECD Health Data 2006.
  • International Comparison of Spending on Health, 1980–2006 Average spending on health per capita ($US PPP)$7,000 United States$6,000 Germany Canada Netherlands$5,000 France Australia United Kingdom$4,000$3,000$2,000$1,000 $0 90 94 92 96 98 00 02 06 04 80 84 82 86 88 19 19 19 19 19 20 20 20 20 19 19 19 19 19 Data: OECD Health Data 2008 (June 2008).
  • Apr 2001: PrimeMinisterestablishes RoyalCommissionSenateestablishes aCommitteeFeb 2003: FirstMinisters’ HealthAccordSept 2004: FirstMinisters’ 10-Year Plan toRenew HealthCare in Canada
  • Outline• Health care and reform in Canada• The “confidence conundrum”• Research evidence to inform efforts to: – Build public confidence – Improve overall views on quality – Publicly report on progress• Who needs to know what …
  • Overall Confidence in the Health Care System Among Adults in Seven Countries, 2007 100 “Very confident” in “getting high quality and safe care” when “needed” 80 59 60% of all adults 40 34 35 30 28 28 24 20 0 Australia Canada Germany Netherlands New Zealand United Kingdom United States Source: 2007 Commonwealth Fund International Health Policy Surveys.
  • Population Perspectives on Health Care System Reform Among Adultsin Seven Countries, 1988-2007 100 "Overall the system works well, only minor changes are needed" 80 Australia 60 Canada % of all adults Germany Netherlands New Zealand 40 United Kingdom United States 20 0 1988/1990 1994 1998 2001 2004 2007 Sources: 1998, 2001, 2004 and 2007 Commonwealth Fund International Health Policy Surveys; Harvard, Harris and Baxter, 1988.
  • Outline• Health care and reform in Canada• The “confidence conundrum”• Research evidence to inform efforts to: – Build public confidence – Improve overall views on quality – Publicly report on progress• Who needs to know what …
  • Public Confidence in Health Care: Anationwide exploratory analyses in Canada• Research questions: – What underlies confidence among the general public that they will get high quality, safe care when they need it? – What underlies views that everything is fine the way it is/ only minor reforms are needed?• Telephone survey of the general population, 2007 – Confidence/ views on reform – Use and experiences with primary health care, specialists, hospitals and emergency departments – Views on overall quality of care received in the past year
  • Public Confidence in Health Care: Anationwide exploratory analyses in Canada• Age, gender, income and health status matter; but are not strong predictors of public confidence.• Utilization of family doctors, emergency departments and hospitals was not significantly related to confidence or positive views on reform.• Use of specialists was negatively associated with both outcomes with high users less likely to be confident and less likely to think everything is fine/ minor reform is needed.• The key drivers of public confidence? – first-hand experiences with care – people overall views on the overall quality of care that they received in the past 12 months.
  • Very confident/ Everything is fine the Adjusted odds ratios confident get way it is/ some quality/ safe care minor-tune-upsNo regular medical doctor or place 0.37*Experience at least one unmet need (past year) 0.51*Wait in ED 4+ hours 0.38**Use of specialists 1-3 times 0.65* 4+ times 0.56*Difficulty getting specialist care (past year) 0.51* 0.55*Overall quality of care Very good 0.46** Good 0.35** 0.47** Fair/poor 0.20** 0.37** Source: Watson et al. What drives public confident in the health care system? An exploratory look at the contribution of health care use and experiences with care.
  • If our intention is to build/ maintain publicconfidence … • Health care policy makers, managers and providers need to know about/ improve: – Regular source of care, unmet need, excessive times in emergency departments and access to specialists – Patients ratings of overall quality of care and the issues that drive it • Researchers need to investigate why high use of specialists is associated with lower levels of public confidence
  • Outline• Health care and reform in Canada• The “confidence conundrum”• Research evidence to inform efforts to: – Build public confidence – Improve overall views on quality – Publicly report on progress• Who needs to know what …
  • Systematic reviews/ primary research: Whatunderlies patient overall ratings of quality of care?• Staff courtesy/ respect• Provider/ patient communication• Teamwork among providers• Comprehensiveness/ unmet needs• Access/ timeliness Larson et al. The relationship between meeting patients’ information needs and their satisfaction with hospital care and general health status outcomes. Int J Qual Health Care 8: 447-56. Taylor C. Benger JR. 2004. Patient satisfaction in emergency departments. Emergency Medicine Journal 21: 528-32. Wong S et al. 2008. What do people think is important about primary health care. Healthcare Policy 3: 89-104. Grol R. et al. 1999. Patients’ priorities with respect to general practice: An international comparison. Family Practice 16: 4-11.
  • Patient Ratings of Overall Quality of Care, NSWOvernight inpatients, 2008 and 2007Top 5 key drivers:• Doctors and nurses working well together• Treating patients with respect and dignity• The availability of nurses• Confidence and trust in nurses• Courtesy of nurses Source: NSW Health, Patient Survey 2008.
  • Patient Ratings of Overall Quality of Care, NSWAdmitted patients, 2007• Overall, 90% of those who were admitted to hospital rated their care as excellent, very good or good.• The remainder rate care as fair (6%) or poor (4%).• The main reasons for rating care as fair/ poor were: – excessive wait time for care (18%) – inadequate medication/ management (15%), – poor quality accommodation (14%) – poor attitude of staff (13%) – not enough staff (13%) – poor technical skill of staff (13%) – communication problems (12%) Source: NSW Health, Population Health Survey 2007.
  • Patient Ratings of Overall Quality of Care, NSWNon-admitted emergency patients, 2008 and 2007• Top 5 key drivers: – Giving patients complete information – Giving patients an explanation of what was done to them – The availability of doctors – Courtesy of emergency department staff – Doctors and nurses working well together Source: NSW Health, Patient Survey 2008.
  • Patient Ratings of Overall Quality of Care, NSWemergency department patients, 2007• Overall, 79% of those who presented to an emergency department rated their care as excellent, very good or good.• The remainder rate care as fair (11%) or poor (9%).• The main reasons for rating care as fair/ poor were: – waiting time (61%) – poor or adequate service (17%), – not enough staff (12%) – poor attitude of clinical staff (8%) – communication problems (7%) Source: NSW Health, Population Health Survey 2007.
  • Outline• Health care and reform in Canada• The “confidence conundrum”• Research evidence to inform efforts to: – Build public confidence – Improve overall views on quality – Publicly report on progress• Who needs to know what …
  • Public priorities for HOSPITAL performance reporting inCanadaRating 9 to 10 Skill of medical staffout of 10 Patient satisfaction with care Serious medical errors Use of latest technology and equipmentRating 8 to 9 Extent to which nurses are sensitive and caringout of 10 Level of coordination: hospital-outside services Patients provided with useful information at discharge Job satisfaction of hospital staffRating 7 to 8 Wait time for ED for urgent, non-life threateningout of 10 Wait time for non-emergency surgery Source: Sandoval GA. 2007. Sustained public preferences on hospital performance across Canadian provinces. Health Policy 83: 246-256.
  • dwatson@chspr.ubc.ca