Developing consumer experience indicators for NZ · 2014-07-10 · 12 April : 19 April . 26 April : 3 May . 10 May : 17 May . 24 May : 31 May . 7 June : 14 June . 21 June : 28 June

Developing consumer experience indicators for NZ

Introducing the project

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Encouraging and supporting partic ipation and collaboration in decision making by patients, consumers, carers and families

% of patients who said they had been sufficiently involved in decisions about their care as much as they wanted to be

To be determined

To be determined

% of patients, 18 years and over, with a chronic condition(s), who actively partic ipated in the development of a treatment plan with their provider over

the past 12 months

To be determined

To be determined

Encouraging and supporting participation and collaboration in decision making by patients,

consumers, carers and families

% of patients who said they had been sufficiently involved in decisions about their care as much as they

wanted to be

To be determined

To be determined

% of patients, 18 years and over, with a chronic condition(s), who actively participated in the development of a

treatment plan with their provider over the past 12 months

To be determined

To be determined

Partnership

Communication Partnership Coordination Physical and emotional needs

National

DHB

Service-level

1 Covers the sector 2 Imposes minimum burden 3 Involves key stakeholders 4 Can be benchmarked 5 Is research based 6 Is transparent 7 Is owned & accepted 8 Builds upon existing work 9 Provides clear line of sight

Drives performance

To identify consumer experience measures at three levels: 1. National: HQSC indicator framework 2. DHB-level: Accountability 3. Service-level: Improve services Scope: The health system – DHB funded services.

Project objectives and success factors

An opportunity for New Zealand to ‘leap-frog’ the rest of the world!

Leiopelma pakeka: Victoria University of Wellington

National DHB Service- level

Success:


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Project approach and timeline

Week ending

29 March 5 April 12 April 19 April 26 April 3 May 10 May 17 May 24 May 31 May 7 June 14 June 21 June 28 June

1. Project initiation

2. Current state analysis

3. International practice gap analysis

4. Draft and consult

5. Recommendations and plan

Today


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Blair Wightman

An international review team

HQSC / Ministry representatives Principal Advisor Quality

Improvement Health Quality & Safety Commission

Director of Quality Evaluation Health Quality & Safety Commission

Principal Technical Specialist Performance Ministry of Health

Gillian Bohm – Project Lead Richard Hamblin Liz Stirling

Kathryn Cook Project leader

Dr. Bernadette Eather

Prof. Dr Marc Berg SME – Netherlands

Core team

Mike Bazett

Malcolm Lowe - Lauri SME – UK

International specialist team

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Why develop consumer experience indicators?


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International experience

Mid-Staffordshire (UK) Garling report (NSW)

Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals (Commissioner Garling, 2009) The report states “Patient experience and satisfaction is one of the most important indicators alongside access to hospital services, clinical performance, safety and quality of the clinical care, costs associated with the provided clinical care, staff experience and satisfaction and sustainability”.

Listening to consumers. What it really means

The Trust Board was weak. It did not listen sufficiently to its patients and staff or ensure the correction of deficiencies brought to the Trust’s attention

“ ”

The patient voice was not heard or listened to, either by the Trust Board or local organisations which were meant to represent their interests. Complaints were made but often nothing effective was done about them

“

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■ Benefits of listening and acting A patient centred approach to healthcare involves understanding and acting on what matters to patients

Improvements in patient experience, health outcomes

and other organisational

benefits

Acting on what

matters to patients

Listening to patients


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Benefits of listening and acting: Patient access and performance with resulting decrease in: ■ Average length of stay ■ Waiting times

Improved patient safety in: ■ Medication management and

reconciliation

Improved patient outcomes ■ Self reported recovery and return to

work rates

Cost efficiency in: ■ Lower cost per case ■ Staff productivity

King’s Fund, UK • Understanding current problems in care delivery • Informing continuous improvement and redesign of services

• Helping professionals reflect on their own and their team’s practice

• Monitoring the impact of any changes • Facilitating benchmarking between services/organisations • Comparing organisations for performance assessment purposes

• Informing referring clinicians about the quality of services • Informing patients about care pathways • Helping patients choose high quality providers • Enabling public accountability.


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Current practice in NZ

DHBs form three groups:

A high level of interest across DHBs for new measures of consumer experience

We can’t afford not to do it

“ ”

Innovative methods 13%

No current DHB-wide indicators

37%

National Patient Survey 50%


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Current practice in NZ and the opportunity

Car parking / Gardens

Food

Sign-posting

Clinical areas

Patient information brochures

Appointment letters

Receptionareas

Educationon privacy

Reporting adverse events

Cleanliness

ConsumerExperience

information has led to

improvements in…

Shifting from a focus on Consumer Satisfaction to the full consumer

experience

Full Consumer Experience

Current position Future opportunity


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A B C D E F G H I J K L

Sco

re o

ut o

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DHB (anonymised)

DHB’s assessment of current position

Median score 3/10

Mean score 4/10

Currently 4/10. …Significant room for improvement

Consumer experience international practice


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Summary of domains internationally

What is best for New Zealand?

Proposed domains and indicators


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4 overarching measurement domains are recommended for NZ, why?

The domains selected:

■ Are based on the best available international research

■ Reflect the direction of travel of thinking in this field:

– A focus on patient experience rather than patient satisfaction

– A shift towards simpler frameworks

– A focus on developing a framework for the whole health system

■ Are able to be benchmarked with other jurisdictions

■ Fit with the context and special characteristics of New Zealand.

Why four?

■ Four domains strengthen the focus and distil the best from international frameworks.


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Relationship between domains and indicators

■ Domains denote the patient experience priorities of the Commission

■ Domains frame the indicators at the national and DHB level

Domains

National indicators

DHB indicators

Service-level indicators


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The evolution of measuring patient experience

Picker and Institute of Medicine

What’s important to patients?

Measurement frameworkResearch identifying what is important to patients

Patient satisfaction to patient experience

‘Crossing the Quality Chasm’ Institute of Medicine

‘Through the Patients’ Eyes’ Picker/Harvard

Corroborating research

NHS patient

experience framework

US CAHPS

Dutch CQ-index

Other jurisdictions

Dutch QUOTE

New ZealandFour domains to measure consumer

experience

■ Cleary et al, (1991)

■ Gerteis et al (2003)

■ Cronin (2004)

■ Coulter (2005)

■ Boyd (2007)

■ Bruster (2008)

■ Coates-Duton & Cunningham-Burley (2009)

■ Sizmur & Reading (2009)


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Evidence base for national indicators

Substantial international research exists that underpins the indicators:

Jurisdictional/ international indicator development ■ People-Centred Healthcare Initiative National Indicators Project, WHO Western Pacific Region ■ Pan-Canadian Primary Health Care Indicators, by Canadian Institute for Health Information ■ Trends from the national surveys of NHS patients in England, 2002–2007 domains by Nick Richards and

Angela Coulter from the Picker Institute, ■ The NHS Indicators for Quality Improvement by the NHS Information Centre ■ Person-Centred Care Index DRAFT by International College for Person-Centred Medicine and WHO

Department of Health System Governance and Service Delivery ■ North West London Strategic Health Authority Patients’ Parliament, Patient Centred Standards for Access

to Primary Health Care Services DRAFT by Health Link, England ■ Potential Indicators of patient-centred care for the Ministry of Health, Saskatchewan, Canada ■ The Healthcare Quality Strategy for NHS Scotland ■ The Victorian Patient Safety Monitor (VPSM)

Disease/condition specific indicators ■ Development of Generic Quality Indicators for Patient-Centered Cancer Care by Using a RAND Modified

Delphi Method (Uphoff et al, 2012 from the Netherlands)20 11 ■ Development of indicators for patient-centred cancer care, Netherlands


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Recommended patient experience domains – why these?

The four domains:

■ Are based on the best available international research

■ Reflect the direction of travel of thinking in this field, based on three international trends

– A focus on patient experience rather than patient satisfaction

– A shift towards more simple frameworks

– A focus on developing a framework for the whole health system

■ Have the potential to be benchmarked with other jurisdictions

■ Fit with the context and special characteristics of New Zealand.


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Recommended patient experience domains

Communication Communicating and sharing information with patients, consumers, carers and families

Partnership Encouraging and supporting participation and collaboration in decision making by patients, consumers, carers and families

Coordination Coordination, integration and transition of care between clinical, ancillary and support services across different provider settings

Physical and emotional needs Treating patients, consumers, carers and families with dignity and respect and providing the necessary physical and emotional support

Patient experience

A good experience for patients depends on high quality and effective communication, a real partnership, coordination of care and meeting physical and emotional needs.


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Domain 1: Communication

Why does it matter to patients? Patients need to understand

■ Patients who understand the information being conveyed to them are more likely to accept their health issues, understand the treatment options available to them, modify their behaviour and adhere to follow-up advice concerning their care

It reduces risk ■ Improved communication reduces the risk of adverse events across all patient groups, particularly in patients with communication difficulties

It includes complaints

■ Effective communication includes the acknowledgement and resolution of complaints (part of Picker Principles)

‘Mid-Staffs’ ■ The failure to listen and respond to patients’ and relatives’ complaints was identified as a key factor in failing hospitals, including, most recently, at the Mid Staffordshire NHS Foundation Trust


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Domain 1: Communication – what do patients say?


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Domain 1: Communication

DHB level indicators 1 % of patients who state that health care staff answered questions

about their condition in a way that could be understood

2 % of patients who state health care staff listened to their questions and concerns

3 % of patient who state that it was easy to find someone to talk to about their concerns

4 % of patients who state that test results were explained to them in way they could understand

5 % of patients who state that they were provided with sufficient information in order to consent to treatment

6 % of patients who state that they were given information that was contradictory or confusing

7 % of patients who state that they had sufficient opportunity to ask questions

8 % of DHB written complaints acknowledged in 5 days

9 % of DHB complaints responded to in 28 days

National indicator Communicating and sharing information

with patients, consumers, carers and

families

How measured?

Aggregation of positive responses to DHB indicators


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Domain 2: Partnership

Why does it matter to patients ■ Involving patients, consumers, carers and families is an important component in

patient centred care

■ Improved participation leads to:

- Improved knowledge and understanding

- Better perceptions of risk

- Improved comfort with decisions

- Treatment adherence

- High confidence and coping skills


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Domain 2: Partnership – what do patients say?


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Domain 2: Partnership

DHB level indicators 1 % of DHB organisations who currently have processes in order to

involve community input for planning the organisation’s services (e.g. advisory committees, focus groups)

2 % of patients who state they have an opportunity to participate in health care service planning

3 % of patients who said they had been sufficiently involved in decisions about their care and as much as they wanted to be

4 % of patients who state health care staff were responsive to a desire to self-manage and otherwise be a partner in care where applicable

5 % of patients who state that information is available to enable all consumers and carers, where appropriate, to choose to share in the decision-making about their care

6 % of patients, 18 years and over, with a chronic condition(s), who actively participated in the development of a treatment plan with their provider over the past 12 months

7 % of patients who state their family/whānau/carer were involved in care planning where desired

National indicator Encouraging and

supporting participation and collaboration in

decision making by patients, consumers, carers and families

How measured?



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Domain 3: Coordination

Why does it matter to patients? ■ Enables care to be organised around the patient’s needs

■ Helps the patient feel that the care pathway and transfer of information is seamless

■ Reduces emergency admissions in people with multiple chronic illnesses.


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DHB level indicators 1 % of hospital patients taking medicines home after discharge who

were told completely about the purposes of the medicine in a way they could understand

2 % of primary care patients prescribed new medicines by a GP, or nurse practitioner who felt they had been given enough information about its purpose

3 % of patients who state they were informed about which side effects to be aware of at home

4 % of patients who state they were made aware of who to contact with concerns post-discharge

5 % of patients who state they were provided information on their hospital stay prior to admission (planned admissions)

6 % of patients who state they know the role of each health care provider involved in their episode of care

7 % of patients who state their care in the Emergency Department was coordinated

8 % of patients who state they understood why they were transferred to a different provider setting where applicable

9 % of patients who state that post discharge arrangements in their home were considered prior to their discharge

National indicator Coordination,

integration and transition of care between clinical,

ancillary and support services across

different provider settings

How measured? Aggregation of positive responses to DHB indicators


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Domain 4: Physical and emotional needs

Why does this matter to patients? ■ Physical and emotional support is linked with the practical outputs of collaborative

and integrated relationships between, and within, health care providers

■ Improving support has been found to improve a person’s ability to adopt healthier behaviours and to improve their ability to self manage conditions

■ Better self management, in turn, may reduce stress or anxiety and assist people undertaking everyday functions such as working or travelling without the need for care and treatment in nursing homes

■ Physical and emotional needs also relate to doctors and nurses washing hands in between touching patients and the cleanliness of rooms.


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DHB level indicators 1 % of patients who feel their physical needs were regularly

assessed and addressed

2 % of inpatients who said they were always treated with respect and dignity while in hospital (% of primary care patients who said that the doctor always treated them with respect and dignity)

3 % of patients who stated health care staff attended to the patient’s personal values, choices and needs

4 % of patients who state that staff were available to discuss anxieties and fears

5 % of patients who state they were treated with compassion during the delivery of health care

6 % of patients who state staff responded quickly to their needs

7 % of patients who state that staff had had empathy with their emotions and actual situation

National indicator Treating patients,

consumers, carers and families with dignity

and respect and providing the necessary physical and emotional

support

How measured?


DHB level indicators continued on the next page


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Domain 4: Physical and emotional needs (cont.)

DHB level indicators (continued) 8 % of patients who state that their spiritual beliefs were respected

9 % of patients who state that space and time were made available for both quiet contemplation and communal worship

10 % of patients who state their privacy was maintained and respected

11 % of patients who state that the health care setting spaces create a first impression of ‘welcome’, ‘comfort’ and ‘healing’

12 % of patients who state their family/whānau/carer were made comfortable

13 % of patients who state that they observed hospital staff cleaning their hands before contacting them

14 % of patients who state that they were able to define ‘family/whānau’ in relation to care planning and visiting

15 % of patients who state that staff ask patients to identify family/whānau members or other support people who will participate in their care

Feedback


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The proposed domains and indicators are draft. A critical step to ensure they are right for New Zealand is to obtain feedback from as wide a range of people as possible.

Please provide your feedback using the link below:

Feedback instructions

http://snipr.com/indicatorfeedback

http://snipr.com/indicatorfeedback�

Next steps


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Next steps

■ Receive, feedback, collate and analyse. Amend draft proposals

■ Report to the Minister end of June

■ Present framework to the Minister of Health along with a proposal for how the measures and framework are linked to DHB and sector accountability arrangements

■ Finalise domains and indicators

■ July – December 2013, test data collection, analysis and reporting format

■ Implementation nationally in 2014


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Documents

Developing consumer experience indicators for NZ · 2014-07-10 · 12 April : 19 April . 26 April : 3 May . 10 May : 17 May . 24 May : 31 May . 7 June : 14 June . 21 June : 28 June