Patient Experience in Elective Surgery

Cath Harmer

Manager, Policy & Strategy

Quality Safety & Patient Experience

Victorian Department of Health

catherine.harmer@health.vic.gov.au (03) 9096 6176

Why measure consumers’ health experiences?

Quality Improvement

Patient experience is an important tool for:

• judging how well a health care system is operating;

• guiding improvement in the processes and outcomes of health care services;

• reflecting on the practices of individual providers and teams;

• contributing to the effective design of services and systems to optimise value; and

• valuing if the service provided was beneficial to the consumer.

Patient experience is not a health status reported outcome measure (www.nihpromis.org )

Measuring ‘experience’ and ‘satisfaction’

Victorian Patient Satisfaction Monitor (VPSM)

• Since 2000 adult in-patients have been providing their

feedback on Victorian public health services on the

VPSM

• Patient rated strengths and weaknesses of the

provision of health care

• Valuable source of patient input to performance

monitoring and the continuing improvement of

Victoria’s public hospital system (Consumer

Participation Indicator and Overall Care Index)

http://performance.health.vic.gov.au/Home/Categories

/QualityAndSafety.aspx#Anchor

VPSM results for Elective Surgery

Overall Care Index

Year

Stay Type 2001 2002 2003 2004 2005-

06

2006-07

2007-08

2008-09

2009-10

2010-11

2011-12

Same Day n/a n/a n/a n/a 79.9 78.8 79.2 78.9 79.9 80.7 81.6

Overnight n/a n/a n/a n/a 79.2 77.7 78.0 78.6 78.3 79.0 79.5

Medical n/a n/a n/a n/a 79.2 77.9 77.8 78.4 78.2 78.9 79.5

Surgical n/a n/a n/a n/a 79.6 78.4 79.2 79.2 79.5 80.4 81.2

Emergency n/a n/a n/a n/a 78.7 77.2 77.7 78.2 77.8 78.3 78.9

Elective n/a n/a n/a n/a 79.6 78.6 78.8 78.9 79.1 80.0 80.8

Maternity 78.1 79.4 80.0 79.7 80.2 78.5 79.1 79.7 81.4 81.7 82.2

Sub-acute 76.8 73.9 76.7 78.7 74.7 74.1 72.1 73.5 73.7 74.0 75.0

Statewide 79.6 80.0 80.2 79.7 79.0 78.1 78.1 78.2 78.3 79.1 79.9

Table VPSM: Yearly Overall Care Index by Stay Type

There were small increases in OCI scores for 2011-12 for all stay type subgroups. The increases for the Same Day, Medical, Surgical and Elective subgroups and statewide were statistically significant.

Consumer Participation Indicator on the VPSM

Table VPSM: Annual CPI by Stay Type

CPI scores for 2011-12 have increased for all stay types in 2011-12. The increases for the Same Day, Overnight, Medical, Surgical, Emergency and Elective stay types and the statewide were

statistically significant.

Stay Type

Year

2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12

Same Day 81.8 80.7 81.1 81.0 81.5 82.5 83.6

Overnight 80.5 79.5 79.1 79.9 79.6 80.2 81.1

Medical 80.6 79.8 79.2 79.9 79.4 80.4 81.2

Surgical 81.5 80.3 80.7 80.9 81.1 82.0 83.1

Emergency 79.3 78.5 78.2 79.0 78.6 79.3 80.4

Elective 81.0 80.3 80.2 80.5 80.4 81.3 82.4

Maternity 85.4 83.1 83.3 84.3 85.7 85.8 87.0

Sub-acute 75.1 74.8 73.1 73.8 73.6 74.2 75.3

Statewide 80.5 79.8 79.5 79.8 79.7 80.6 81.6

Example of a hospital’s results on VPSM

Table VPSM Health Service: Hand hygiene – Elective (%)

Question

Response options

Your hospital Wave 22

Your hospital Wave 21

Category $@&^

Wave 22

State-wide

Wave 22

Elective

During your stay, were you aware of the hospital’s hand cleaning policies or procedures?

No 19.8 18.4 20.5 21.8

Yes 80.2 81.6 79.5 78.2

How often did you observe hospital staff cleaning their hands between attending patients?

Never 2.7 6.3 5.2 7.6

Hardly ever 7.1 3.2 4.5 3.9

Some of the time

24.8 27.8 26.8 28.1

All of the time 65.5 62.7 63.5 60.5

Measuring ‘experience’ vs ‘satisfaction’

Experience and Satisfaction

• Patient satisfaction measures the patient’s evaluation of the

experience of care.

• Patient experience provides the patient’s perspective on the actual

experience of care.

• Patient experience questions, because they are asking about

experiences, are less subjective and less susceptible to the effects

of expectations and response tendencies.

• However, it should be noted that individual patient

experiences are by definition subjective and it is unlikely that

the effect of differential expectations can be eliminated

entirely.

Participating in decision making about care and

treatment

Patient experience is a key measure of “participation”:

Consumer, Carer and Community Participation • Occurs when consumers, carers and community members are

meaningfully involved in decision making about health policy and planning, care and treatment and the wellbeing of themselves and the community (Doing it with us not for us, 2006, 2009, 2012. Available at: www.health.vic.gov.au/consumer/participate

Person and Family Centred Care • an … approach to the planning, delivery, and evaluation of health

care that is grounded in mutually beneficial partnerships among health care providers, patients and families. Patient- and family-centred care applies to patients of all ages and it may be practiced in any health care setting. (Institute for Patient and Family Centred Care. Available at www.ipfcc.org/faq.html . Viewed 19 October 2012)

Patient experience is a measure of participation

A range of methods are used to collect Consumer Feedback at

Peninsula Health including:

VPSM

Inpatient Consumer Feedback (motel slip)

Ambulatory Services Consumer Feedback

Community Advisory Groups (14)

Executive Rounds

Consumer representatives on numerous committees: Consumer

Information, Infection Control, Medication Safety

Complaints

Voice of the Consumer DVD

Community Participation Plan – 50 projects 21 completed May 11

Volunteers

www.health.vic.gov.au/patsat/presentations.htm

Communication, Health Literacy & Information

Centre for Health Communication and Participation (LaTrobe University)

• Festival of Evidence and Experience www.latrobe.edu.au/chcp/

• Making Sense of Multiple Sclerosis Research Does this apply to me?

What we know about the people included in the studies

If I am similar to the people in the studies, can I expect the same results? www.makingsenseofmsresearch.org.au/

• The Knowledgeable Patient is an essential guide to a new era of complex healthcare. Integrating consumer stories and evidence from systematic reviews, it examines key communication and participation issues in a range of contexts, including:

– surgery

– safe medicine use

– chronic disease self management

– the complexity of multimorbidity

– notification of rare disease risk.

Centre for Health Communication and Participation

Cochrane Systematic Review findings:

• Decision aids performed better than usual care interventions by

increasing knowledge

• Exposure to decision aids compared to usual care continued to

demonstrate reduced choice of : major elective invasive surgery

in favour of conservative options

http://decisionaid.ohri.ca/docs/develop/Cochrane_Summary.pdf

Viewed 12 November

• Dr. Dawn Stacey, Associate Professor in the School of Nursing,

University of Ottawa. In June 2010, she became Director of the

Patient Decision Aids Research Group at the Ottawa Hospital

Research Institute

Decision Aids – communication strategy

• Patient decision aids are tools that help people become

involved in decision making by making explicit the decision that

needs to be made, providing information about the options and

outcomes, and by clarifying personal values.

• They are designed to complement, rather than replace,

counseling from a health practitioner.

http://decisionaid.ohri.ca/index.html

• Being more person and family centred

• Reducing unwarranted practice variation

• Means of complying with provision of information accreditation

standards in new National Safety and Quality Health Service

Standards

Decision Aids

The specific aims of decision aids and the type of decision support they provide may vary slightly, but in general they:

1. provide evidence-based information about a health condition, the options, associated benefits, harms, probabilities, and scientific uncertainties;

2. help patients to recognize the values-sensitive nature of the decision and to clarify, either implicitly or explicitly, the value they place on the benefits, harms, and scientific uncertainties (to accomplish this, strategies that may be included in the decision aid are: describing the options in enough detail that clients can imagine what it is like to experience the physical, emotional, and social effects; and guiding clients to consider which benefits and harms are most important to them); and

3. provide structured guidance in the steps of decision making and communication of their informed values with others involved in the decision (e.g. clinician, family, friends).

Decision Aid summary example

Title Heart Disease: Should I Have Bypass Surgery?

Health Condition Coronary Artery Bypass Surgery

Type of Decision Aid Treatment

Options Included Have coronary artery bypass surgery.

Try angioplasty or medical therapy instead.

Audience People with coronary artery disease for whom CABG surgery is an option.

Developer Healthwise

Where was it

developed?

www.healthwise.org Healthwise US

Year of last update or

review

2012

Format Web, paper

Language(s) English

How to obtain the

decision aid

The decision aid is publicly available for free from a number of Web sites, the

URL for only one of them is listed. Versions localized for Canada may also be

available.

http://decisionaid.ohri.ca/AZsumm.php?ID=1318

Using Patient Experience

Individual care level – Improvements using the consumers’

experiences

• Charter in 26 languages, Easy English, Braille & audio file

www.health.vic.gov.au/patientcharter/

• Victorian Public Health Care Awards

www.health.vic.gov.au/healthcareawards/winners/index

• Quality of Care Reports (individual health services’ websites)

• Participate in Health Conferences

www.health.vic.gov.au/consumer/conferences

• Evaluating Effectiveness of Participation projects

www.health.vic.gov.au/consumer/conferences.htm

Using Patient Experience

Values

• an aid to improve health outcomes and the quality

of health care (VQC 2003, ACHS 2002, Henry 2004, Consumer

Focus Collaboration 2001)

• an important democratic right (Draper 1997, Hindess 1997,

Pickars et al 2002, Victorian Government 2005)

• a mechanism to ensure accountability (DHS 2000,

Strategic Health Authority Patient and Public involvement Leads

Network 2003)

Doing it with us not for us is available at:

ww.health.vic.gov.au/consumer/participate