Patient survey results as a basis for benchmarking and quality improvement in 3 countries

1. Patient survey results as a basis for benchmarking and quality improvement in 3 countries A comparison of variation between hospitals against variation between departments/wards Bruster S, Freil M, Fallberg L, Straw P, Oesterbye T

2. Background • Increasing number of countries are implementing national surveys of healthcare users • For example UK, Denmark and Norway have ongoing programmes. Sweden & Scotland are developing new programmes • Mandated by government to monitor performance of healthcare providers • Results often available at an organisation level only • Limited evidence of quality improvement at organisational level over time

3. Study objectives • To examine the amount of variation in patient experiences: • Between hospitals at a national level • Between wards or departments within hospitals

4. Surveys • Denmark: All providers are mandated to carry out a survey each year • At organisation level (Mandatory) • At ward level (voluntarily) • England: All providers are mandated to survey patients annually • At organisation level (Mandatory) • At ward level (voluntarily) • Sweden: A significant percentage of providers carry out patient surveys voluntarily. National surveys begin 2008. • Results at ward and hospital level • In UK and Denmark national results are published annually and reports for individual providers also made public

5. Survey Methods • Questionnaires developed through a long consultation process • Cover the issues of direct concern to patients • Questionnaires tested using cognitive techniques and formally pilot-tested. • Validation testing has been carried out. • Mailed self-completion questionnaires sent to patients at home. • Up to 2 reminders • Asking patients to report on “what happened” to them rather than to rate their satisfaction. • Based on random samples of patients recently discharged from the hospitals. • National and local surveys for each of the countries, have been carried out in an identical way at each hospital to ensure comparability of results.

6. Example National Results, UK 2006 Did you ever share a sleeping area with patients of the opposite sex? Did you ever use the same bathroom or shower area as patients of the opposite sex? Were you ever bothered by noise at night from other patients? Were you ever bothered by noise at night from hospital staff? In your opinion, how clean was the hospital room or ward that you were in? How clean were the toilets and bathrooms that you used in hospital? How would you rate the hospital food? Were you offered a choice of food?

7. Example National Results, Denmark 2006

8. Example Ward Variation, Sweden 2006 Was there one doctor in charge of your care?

9. Example Ward Variation, Denmark 2006 Was there one or two doctors in charge of your care?

10. Example Ward Variation, UK 2006

11. Different data, different purposes • Surveys at hospital level • Top-level data • Identifies good performance and areas for improvement at a hospital level • Accreditation • Star-rating • Surveys at ward/clinic level • Local ward/clinic/department results for front line staff • Quality improvement

12. Conclusion and perspectives • Healthcare providers need additional information at ward level in order to plan and implement quality improvement initiatives successfully. • Local staff responsible for providing care can be given results provided by their patients, and quality improvement efforts can be prioritised for those wards that are under-performing.