David Stockwell Clinical Biochemistry Service Manager ABMU NHS Trust Tim von Pokorny Pathology Quality Manager Gwent He

1. The User’s Perspective of Quality David Stockwell Clinical Biochemistry Service Manager ABMU NHS Trust Tim von Pokorny Pathology Quality Manager Gwent Healthcare NHS Trust

2. Quality Management System Overview Policies User requirement Standards SMART objectives -Accuracy Timeliness Relevance Cost Benefit Framework

3. National Strategy Local/Corporate Strategy Policies User requirement Standards SMART objectives -Accuracy Timeliness Relevance Cost Benefit Framework

4. National Strategy Local/Corporate Strategy Strategic alignment Policies User requirement Standards SMART objectives -Accuracy Timeliness Relevance Cost Benefit Framework

5. User Requirement Legislation National Strategy Local/Corporate Strategy Policies User requirement Standards SMART objectives -Accuracy Timeliness Relevance Cost Benefit Framework

6. User Requirement Legislation National Strategy Local/Corporate Strategy Policies User requirement Standards SMART objectives -Accuracy Timeliness Relevance Cost Benefit Framework Service Delivery Model Technology/Workforce

7. User Requirement Legislation National Strategy Local/Corporate Strategy Policies User requirement Standards SMART objectives -Accuracy Timeliness Relevance Cost Benefit Framework Service Delivery Model Technology/Workforce Procedures

8. User Requirement Legislation National Strategy Local/Corporate Strategy Policies User requirement Standards SMART objectives -Accuracy Timeliness Relevance Cost Benefit Framework Service Delivery Model Technology/Workforce Training & Competency Assessment Procedures

9. User Requirement Legislation National Strategy Local/Corporate Strategy Policies User requirement Standards SMART objectives -Accuracy Timeliness Relevance Cost Benefit Framework Service Delivery Model Technology/Workforce Training & Competency Assessment Procedures Output

10. User Requirement Legislation National Strategy Local/Corporate Strategy Policies User requirement Standards SMART objectives -Accuracy Timeliness Relevance Cost Benefit Framework Service Delivery Model Technology/Workforce Training & Competency Assessment Procedures Output Audit Meet SMART objectives? Accuracy Timeliness Relevance? Meet user requirement?

11. Why Measure User Satisfaction “Ongoing evaluation and improvement processes are essential to ensure that the service provided by the laboratory meets the needs and requirements of users” CPA standards V2.00 September 2007

12. User Requirement Legislation National Strategy Local/Corporate Strategy Policies User requirement Standards SMART objectives -Accuracy Timeliness Relevance Cost Benefit Framework A B Service Delivery Model Technology/Workforce C D Training & Competency Assessment E F Procedures G Output Audit Meet SMART objectives? Accuracy Timeliness Relevance? Meet user requirement? H

13. An approach to measuring User Satisfaction

14. User Satisfaction …Measure of how your organisation’s total product performs in relation to a set of customer requirements. “How to Measure Customer Satisfaction”. 2nd edition.

15. Capturing information on user satisfaction • Compliments • Complaints • Meeting forums • One to one conversation • Correspondence (email, letter) • Questionnaires

16. Questionnaire Structure • Importance • Satisfaction • Comments

17. Q1. How important is the availability of access to advice / information from the Pathology Department? Clinical Biochemistry NA 1 2 3 4 5 6 7 8 9 10 Cytology (Gynae.) NA 1 2 3 4 5 6 7 8 9 10 Cytology (non Gynae.) NA 1 2 3 4 5 6 7 8 9 10 Haematology NA 1 2 3 4 5 6 7 8 9 10 Histology NA 1 2 3 4 5 6 7 8 9 10 Microbiology NA 1 2 3 4 5 6 7 8 9 10 How satisfied are you with the availability of access to advice / information from the Pathology Department? Clinical Biochemistry NA 1 2 3 4 5 6 7 8 9 10 Cytology (Gynae.) NA 1 2 3 4 5 6 7 8 9 10 Cytology (non Gynae.) NA 1 2 3 4 5 6 7 8 9 10 Haematology NA 1 2 3 4 5 6 7 8 9 10 Histology NA 1 2 3 4 5 6 7 8 9 10 Microbiology NA 1 2 3 4 5 6 7 8 9 10 Comments:

18. Survey Analysis

19. Response Analysis Cross Discipline

20. Graph showing combined mean importance score vs combined mean satisfaction score for each question

21. Priorities For Improvement (PFI)

22. Attributes requiring the greatest improvement in performance for our Primary Care Users

23. Quick Win PFIs

24. User Comments

26. Satisfaction Index

27. Mirror Survey • Survey Employees • Highlights Underestimation of Importance • Facilitates Internal Feedback

28. WEQAS on-line survey Project Aims - Seek to demonstrate the potential of structured assessment of user requirement and satisfaction as a reliable, valid, robust indicator of service quality and its continued improvement. • Potential benefits: • Demonstrate the potential of user satisfaction as a reliable indicator of service quality. • Promote and roll out good practice – do once and share. • Reduce duplication of effort. – CPA requires regular surveys to be carried out • Giving all services access to “good” survey question design. • The results of structured all Wales surveys following a schedule of topics, will inform • future service planning and improvement. • Compare within and between lab performance of meeting user requirement by use of • the overall “satisfaction index”. • Contributing to developing key performance indicators that capture the value of • Pathology services.

29. Method: A proof of concept on-line survey using Survey Monkey has been conducted Pilot to All Wales distributed to Quality Managers April 2009: On line survey for national use distributed comprising 10 questions from the Gwent Healthcare NHS Trust user survey Pilot to local users in ABMU (Swansea/Bridgend area) April 2009: On line survey for local use distributed using the survey principles of the Gwent Healthcare NHS Trust user survey

30. http://www.surveymonkey.com

31. How does it work? Step 1 – Design the survey

32. Users receive an email with a link to the survey: To complete the survey- please follow the attached link: http://www.surveymonkey.com/s.aspx?sm=ZpY5MHue4oUTAPLMI6Ui4Q_3d_3d

33. ….. or post the link on your local trust web site:

34. Step 2 – User completes survey

35. Step 3 – Collect the results

36. Results for all user types…

37. or filtered by user category… (in this case Consultant medical Staff)

38. and if you have asked for comments click “view ….”

39. Export the results to calculate the satisfaction index score….

40. Satisfaction Index Calculation Performance assessment - the satisfaction index (parametric example) Mean and standard deviation of the “importance” and “satisfaction” responses will be calculated for each question. A weighting factor will be calculated from the (mean importance / ∑ importance). The “mean satisfaction” value will be multiplied by a weighting factor to calculate a weighted score based on importance. Satisfaction index (%) = ∑ weighted score *10 A satisfaction index is calculated for each Laboratory (and a sub-score for each discipline). Performance is assessed within and between Laboratories using the Satisfaction Index.

41. Further reading: “How to Measure Customer Satisfaction” 2nd Edition, Nigel Hill, John Brierley and Rob Mac Dougall. Gower Publishing Limited. ISBN 0-566-08595-X “Handbook of customer satisfaction and loyalty measurement” 2nd Edition. Nigel Hill and Jim Alexander. Gower Publishing Limited. ISBN 0-566-08194-6 www.leadershipfactor.co.uk

42. http://www.nliah.com/portal

43. A&E – sample questions • Is there an agreement between A&E Consultant staff regarding requesting certain tests e.g. Thyroid function? • Does your Pathology deliver a service compatible with achieving A&E targets? • Is there a difference between the Pathology service: • Out-of-hours and within working hours • Between-Pathology disciplines • Form filling: • How dissatisfied are you with manual filling in of request forms? • How important is electronic test requesting? • Add-on tests: • How important is the ability to retrospectively add on tests? • How easy do you find this?

44. On-call mortician • How important is your on-call mortician service? • How satisfied are you with your on-call mortician service? • Toxicology: • Are you satisfied with the local toxicology service that is provided? • POCT pregnancy: • Do you use POCT pregnancy testing? • Are you satisfied with local provision? • POCT glucose: • How satisfied are you with the training and assessment of competency of users of POCT glucose devices?

45. POCT blood gases: • How compliant are medical staff with POCT blood gas analysis procedures? (e.g. individual password use, disinfection etc) • Results: • How important is the paper report? • How important is it to see on the computer whether the sample has been received yet by the laboratory (even if not yet analysed)? • Incidents: • How responsive is your Pathology Service to investigating relevant incidents which arise in A&E? • Emergency Planning: • Does your Trust have one system for assigning emergency specimen numbers for a major incident? • Does your A&E department have a stock of in-date tubes for sample collection for chemical incidents?

46. Who to contact? • To whom should questionnaire be sent? • Suggest: • All lead Consultants • Named Lead Nurse • Service Manager

47. Results • Report for All-Wales • Sub-report for each individual Trust • ABMU to provide support for collation of results

48. In summary • The assessment of user requirement and satisfaction is a CPA requirement. • It informs your policies • It is important to have a structured approach to measuring this. • The degree of user satisfaction is as legitimate and important a measure of quality • as the more traditional assessments of accuracy/precision and timeliness. • Electronic survey methods enable Laboratories to compare their satisfaction scores • (when distributing identical surveys) and set bench marking standards. • It is a driver for continuous service improvement Thank you