patient experience in elective surgery
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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
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