Deborah Schaler - EHPR 2014 - Patient Feedback Research
1. Listening, Learning, Improving
The patient voice in health care.
Deborah Schaler, MHPol, PhD Candidate
Menzies Centre for Health Policy
University of Sydney
2. Partnering with patients – policy drivers
• Health services are urged/required to partner with
patients at:
– individual level
– service level
– organisational level
• Drivers include national quality and safety standards
and frameworks, accreditation standards, and local
consumer participation policies and consumer advocacy
organisations.
3. Partnering – why and how?
• The overarching aim of health services partnering with
patients is to improve individual patient experience and
to improve the safety and quality of health care
services.
• ‘Partnering’ strategies include a range of patient
feedback methods:
– Consumer feedback management;
– Patient and carer surveys; and
– Collection of narrative.
4. Research aims
• To assess the effectiveness of 3 patient feedback
methods (complaints, satisfaction/experience surveys
and collection of narrative) in facilitating improvement to
health service safety or quality.
• To develop a method for health services to analyse and
link patient feedback data to service improvement and
meet the new Australian National Safety & Quality in
Healthcare Standards (Standards 1 & 2) related to
patient feedback.
5. NSQHC Standards 1 & 2
• Standard 1 (Governance)
– 1.15 Implementing a complaints system that includes
partnership with patients and carers
• Standard 2 (Partnering with Consumers)
– 2.9 Consumers and/or carers participate in the evaluation of
patient feedback data and development of action plans.
6. Methods
• Case study (ACT Health) - Mixed Methods including Grounded
Theory and situational analysis mapping
• Review of peer reviewed and grey literature including policy
documents; case study: review of patient feedback data; and safety
& quality governance
• Semi-structured interviews/ focus groups with health service staff –
44 staff comprising clinical, administrative, and safety & quality staff.
• Development of a method to analyse aggregated patient feedback
and incident data to facilitate linking of the data to service
improvement.
7. Results
• A more personal and immediate approach to managing complaints
(core theme from staff interviews: degree of separation).
• Challenge: current policy treats complaints the same way regardless
of clinical/other seriousness; bureaucratic process.
• Opportunity: risk management approach to complaints.
• Patient feedback as a service improvement tool.
• Challenge: differences in priorities across professional groups.
• Opportunity: patient feedback in a patient safety intelligence
network.
8. Results (cont)
• Narrative = powerful; drives service improvement.
• Challenge: balance of + and - stories; data reports lack narrative.
• Opportunity: narrative in data reports; capture & report compliments
better. Community based services implement multi-service QI
wrapped around ‘types’ of patient journeys.
• Tools
• Challenge: patient satisfaction surveys
• Opportunity: new tools e.g. Patient Experience Trackers; patient
experience surveys. Improve quality of data reports.
9. Results (cont)
• Patient feedback data analysis
• Challenge: data silos; no method to aggregate and analyse patient
feedback or to link patient feedback and incident data.
• Opportunity: study to develop method to aggregate and analyse
data across sources that will also meet the new NSQHC Standards.
10. Opportunities to improve
• Risk management approach to complaints:
– Risk matrix applied to complaints.
– Level of risk determines type and timeframe for response.
• Patient feedback data system and reports:
– Data reports include narrative; reports provided at service level.
– Consistent data codes enable aggregation of data.
• Governance related to quality/service improvement:
– Governance structure facilitates analysis of patient feedback to
drive service improvement.
11. Policy implications of project
• Health agencies might re-consider:
– their selection of patient feedback methods.
– their processes related to patient feedback management.
– governance structure to facilitate translation of patient feedback
to service improvement.
• Clinicians and health service managers have an effective
method to analyse aggregated patient feedback data
and link it directly to quality and safety improvement
activity.
12. References
• Ward, JK; Armitage, G. (2012). Can patients report patient safety incidents in a hospital setting? A systematic
review. BMJ Qual Saf 2012;21: 685-699
• King, A; Daniels, J; Lim, J; Cochrane DD; Taylor, A; Ansermino, JM; (2010). Time to listen: a review of methods to
solicit patient reports of adverse events. Qual Saf Health Care 2010;19 148-157
• Reader, TW; Gillespie, A, Roberts, J. (2014) Patient complaints in healthcare systems: a systematic review and
coding taxonomy. BMJ Qual Saf 2014;0: 1-12
• Roberts, G; Cornwell, J; (2011) What matters to patients? Policy recommendations . Department of Health and
NHS Institute for Innovation and Improvement
• Coulter, A; Fitzpatrick, R; Cornwell, J; (2009) The Point of Care: Measures of patient’s experience in hospital:
purpose, methods and uses. London. The King’s Fund
• Goodrich, J; Cornwell, J (2008): Seeing the person in the patient. The Point of Care review paper. London. The
Kings Fund www.healthissuescentre.org.au
• Davies, E; Cleary, PD; (2004) Hearing the patient’s voice? Factors affecting the use of patient survey data in
quality improvement. Qual Saf Health Care 2005: 14:428-432
• Davies et al Factors affecting the use of patient survey data for quality improvement in the Veteran Health
Administration BMC Health Services Research 2011, 11:334
• Coulter, A; Ellins, J ; (2006) Patient-focused interventions. A review of the evidence. Picker Institute Europe
• Draper et al (2001) Seeking consumer views: what use are results of hospital patient satisfaction surveys?
International Journal for Quality in Health Care 2001; Volume 13, Number 6: pp.463-468
• Luxford et al (2011) Promoting patient-centred care: a qualitative study of facilitators and barriers in healthcare
organizations with a reputation for improving the patient experience International Journal for Quality in Health
Care 2011; Volume 23, Number 5:pp510-515
Many of you will know about the three minute thesis competition. My presentation today aims to provide an overview of my doctoral thesis research in 8 minutes - so plenty of time.
When I refer to patients the term can be used inter-changably with health care consumer or client.
Numerous policy drivers require or encourage health services to partner with patients/consumers and carers.
This includes consumers participating at various levels in a health service with the purpose to improve patient experience, facilitate service improvement or to involve consumers in policy and planning and other aspects of corporate governance.
These Standards require health services to partner with consumers in analysing complaint data reports and, again working with consumers to link analysis of consumer feedback from all sources to service improvement.
Standard 1 (Governance)
1.15 Implementing a complaints system that includes partnership with patients and carers
1.15.1 Processes are in place to support the workforce to recognise and report complaints
1.15.2 Systems are in place to analyse and implement improvements in response to complaints
1.15.3 Feedback is provided to the workforce on the analysis of reported complaints
1.15.4 Patient feedback and complaints are reviewed at the highest level of governance in the organisation.
Standard 2 (Partnering with Consumers)
2.9 Consumers and/or carers participate in the evaluation of patient feedback data and development of action plans.
2.9.1 Consumers and/or carers participate in the evaluation of patient feedback data
2.9.2 Consumers and/or carers participate in the implementation of quality activities relating to patient feedback data.
Creswell’s Exploratory Sequential mixed methods design i.e. quantitative data collection, analysis and results followed by qualitative data collection, analysis and results leading to INTERPRETATION.
Adele Clarke’s SA maps included: situational maps, social worlds/arenas maps and a position map.
Clinicians are committed to patient safety and quality, and value patient feedback as a service improvement tool.
Challenge: different professional groups have different priorities when managing patient feedback e.g. focus on meeting time frames.
Opportunity: patient feedback as a component of a patient safety intelligence network.
All professional groups favour a more personal and immediate approach to managing complaints – better result; avoids escalation.
Challenge: current policy is to treat negative feedback (complaints) in the same way and to the same time frame regardless of clinical/other seriousness e.g. degree of harm experienced/vulnerability of patient.
Opportunity: apply a risk management approach to complaints.
Narrative is very powerful and drives service improvement; value of raw data/information/patient ‘voice’ over ‘numbers’ in data reports.
Challenge: need balance of negative and positive stories; lack of narrative in data reports makes it unclear what the issue was about.
Opportunity: include narrative in data reports. Capture and report compliments better. Community based services could implement multi-service QI wrapped around ‘types’ of patient journeys.
Challenge: Consumer feedback and survey data not fully utilised in driving service improvement.
Opportunity: staff using new methods to elicit feedback e.g. Patient Experience Trackers – immediate and targeted/service specific feedback. Improve quality of data reports.
Challenge: no method of aggregating and systematically analysing patient feedback (data silos) or to link patient feedback to the incident management system; different ‘languages’ in data systems.
Opportunity: study to develop method to aggregating and analyse data across sources that will also meet the new NSQHC Standards.
The core theme that emerged from qualitative analysis was ‘reducing the degree of separation’:
reduce the degree of separation between the patient and the health service that the feedback is about, especially in responding to negative feedback.
Reduce the degree of separation between staff and patient feedback data i.e. reduce filtering of the data and avoid ‘losing the patient voice in the numbers’.
Risk management approach to complaints:
Risk matrix applied to complaints by service area.
Type (phone call, meeting, letter) and range of timeframes for response according to risk (clinical risk and experience of harm).
Patient feedback data system:
Improved patient feedback data reports that include narrative and are provided at service level.
Change to Riskman data codes to allow aggregation of patient feedback across sources.
Governance related to quality/service improvement:
Patient safety & quality governance committees analyse and use patient feedback to drive service improvement.