Patient Experience: Involvement in Decisions about Their Care

Involvement in care decisions: When you see your doctor or nurse practitioner, how often do they or someone else in the office involve you as much as you want to be in decisions about your care and treatment?
Direction of improvement: increase

Summary/Analysis

There is a common trend of focusing on the administration of surveys themselves (i.e. what questions are being asked and how they are worded, compliance with HQO standard questions) rather than direct care. Organizations are identifying a need to have a good survey to achieve valid results that can then be acted on.

Effectiveness:

Scarborough Academic ? high performance already, focussing on continual administration of surveys and responding to feedback

Trent Hills ? adding more specific questions to survey ? might influence responses if they are already thinking about different aspects of care they are receiving

West Durham ? great initiatives suggested to involve patients in their care -> patient education about health issues and using advanced care planning

Aurora ? Newmarket: creating care plans for patients and engaging them in feedback surveys

Health For All: approach involved ease of access on surveys (combining questions to make surveying and collecting data easier)

Southlake: modification to survey administration to allow individual doctors to see their specific feedback so they can improve care based on those responses

Recommendations:

Initiatives that work to make patients feel more involved, aid in the care they receive and give them a better perception of their health care providers. A combination of a strong survey as well as engaging patients during their visits, especially via an individual care plan, produces strong results for patient satisfaction.

 

DETAILS

Scarborough Academic?????? 88.00 ?> 90.00

• Continue to collect information on patient perceptions like this to stay within or at desired target

-> Use patient satisfaction survey

• This is the second year patient survey was successfully administrated
• Improvements in survey methodology are being considered, staff are aware of surveys importance and see basis for changes being made in our operations ? we will continue to be responsive to patient input via surveys

Trent Hills??????? 79.00 ?> 83.12

• Improving access
• Revise survey to ask more specific questions about individual practices to help improve other services

-> Use patient satisfaction survey

????????????? -> Revise primary care survey to add more specific questions

• Added questions from HQO Primary Care Patient Experience Survey draft
• High positive responses to appointment experience (confidence in provider, usefulness of information, privacy, overall experience); and clinicians? teamwork (knowing medical history, consistent information about care/treatment, working well together)
• Only third of patients found it easy to get care after hours (evening, weekend, holiday) without going to the ED

West Durham?????? 85.00 ?> 93.50

• One health Provider will engage elderly and other patients in Advanced Care Planning discussions

• for advanced care planning, we have strong physician leadership ? the process for implementing this change idea has been planned, refined, and documentation has been standardized
• a nurse will be trained and designated as the lead for program in FY15/16
• hoping to have more advanced care planning discussions and track this info over next 6 months

• Raise patient awareness about health issues to discuss in order of priority

-> EMR consistent documentation and stamp

????????????? -> Interview providers involved in PDSA

• Tried to implement this idea, found it too vague and not required
• Survey data continues to reflect that we exceed target set, patients continue to have highly positive relationship with their providers which is also reflected in the open ended questions

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Kawartha North?????? 97.00 ?> 94.06

• Identify and address, as possible, concerns of any patients who did not respond always/often -> repeated surveying on at least an annual basis
  • Comments section provided valuable insight into possible QI initiatives

 

Peterborough????? 98.3 ?> 94.29

• Expand on ?dashboard? reporting to stakeholders (add ?what are we doing well? What can be improved?)

-> For patients: poster in waiting room of survey results

-> For board of directors: a report on patient survey

-> For FHT staff: develop quality improvement FHT newsletter to communicate QI initiative progress

• Updated patient experience survey results highlighting key metrics were shared on external website
• Additionally FHT, FHO ad practice specific results were provided to FHT members (these results included a 2013/14 to 2014/15 comparison)

• Explore feasibility to deliver as an ongoing test of improvement rather than a ?special event? twice a year
  -> put surveys and a collection box in each practice to permit patients to complete a survey after any visit, create posters in waiting rooms to encourage feedback, continue with online survey on FHT website
  • Survey boxes were left in each waiting room to give patients an opportunity to provide feedback throughout the year in addition to the one-time blitz that was conducted in May-June
• Formalize the FHT patient relations policy
  -> develop standard operating procedure for documenting patient calls, including escalation procedure

-> Include process for suggestions/complaints on all public FHT communications

-> Develop patient rights and responsibilities policy

• Policy is in draft format

• Increase sample size to increase statistical validity of survey -> use student to conduct half day patient experience survey with each practice over two time periods ( may and oct.)

-> Explore use of tablet for survey

-> Explore using OMR technology for data capture

-> Advertise on FHT communications ?please take our survey?

• Survey ?blitz? done May and Dune (675 surveys) plus additional 146 surveys from boxes
• Used OMR software for data collection ? minimized data entry, sped up results turnaround time
• Collecting surveys was time consuming ? like to look at electronic options in future for surveys

• Participate in HQO pilot for standardized patient experience survey -> as prescribed by pilot
  • Didn?t participate, FHT is content with current surveys content and format ? may explore at later date
• Revise patient experience survey to include exact HQO worded questions to improve consistency for comparability
  -> add question wording from MoH tech. specifications doc.

Aurora ? Newmarket FHT: 95.00 ? 97.20

• Create care plans with patients, ensure we engage them during each visit
• Involve patients by having them complete feedback surveys to tell us how we can improve
• Participating in HQOs pilot for surveys in the 2014/15 FY to help measure patients satisfaction

Health For All FHT: 87.00 ? 97.98

• Two separate patient survey questions concerning 1) involvement in decisions about care and 2) opportunity to ask questions were combined into one question to ease survey administration and data collection

Key Learnings: similar indicators and or patient survey questions may benefit from careful review and editing to reduce and improve survey methodology

Impact of Change Ideas: little room for improvement from positive responses

Advice: look for opportunities to integrate indicators and/or survey questions for ease of access, data recording and analysis

 

Southlake FHT: 82.00 ? 84.85

• Modify current survey to accurately capture patients reporting ?always? or ?often?
• Provide patient survey response report to healthcare providers who are interested in improving their patient centeredness -> not done b/c current survey doesn?t allow determination of which doctor patients were referring to

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