Most recently, I had the pleasure of being invited to speak at the Improving Healthcare International Convention 2015 on the topic of Patient Experience case studies from the NHS, UK.

There is a growing body of evidence on patient experience measurement and linking financial incentives to them are starting to influence the thinking around patient experience measurement and improvement in Australia.

The last week I was having coffee with Michael Greco, the CEO of Patient Opinion in Australia. Patient Opinion is a website developed in the UK where patients can place elaborate comments, stories and experiences on a platform, such that it increases the transparency of how services are delivered in hospitals. The technology platform from the UK that Energesse introduced is called MES Experience, a multichannel platform for collecting patient feedback (patient experience/satisfaction) data at point-of-care and reporting meaningful analytics for managers.

As we are both heavily involved in mechanisms for improving patient experience through better data, it dawned on us that one of the major challenges in making a difference in Australia (compared to the UK) was that, we still do not have a single, clear national standardised metric for measuring improvement of patient experience.

Within the NHS there has been implementation of a standard measure of patient experience called the ‘Friends and Family Test’. Whilst there has been much debate about the measure over the last 5 years of its implementation, the one thing it has done is has raised the bar on the conversations and investments on how healthcare services should be measured and delivered in a truly patient-centred way, with input from patients.

Australian public hospitals are required to improve quality metrics around patient experience set around Standard 2, one of the 9 quality standards set by the Australian Commission for Safety and Quality in Healthcare. This standard calls for effective partnerships between consumers, healthcare providers and healthcare organisations which are deemed essential for safe and high quality care in national health policy in Australia.1-3

This standard aims to guide health services to become responsive to patient, carer and consumer needs and actually partners with consumers in the implementation of all other NSQHS Standards. However, according to the Commission reports, some health services have found the implementation of systems to meet the requirements of Standard 2 challenging⁴.

Private sector hospitals on the other hand are utilising their own divergent set of Patient Reported Experience Measures (PREMs), largely based upon surveys from the US healthcare system (HCAHPS) as well as the incorporating from other major payors such as health insurance funds. I’ve had conversations with several CEO’s and Directors of Clinical Governance who have really taken the lead in this space with patient experience measurement, and have evolved their own systems for managing it.

However, it remains clear that in general, Australian health services and hospitals are still at their infancy in terms of executing the latest strategies to collect, analyse, measure and improve patient experience. The lack of a standard national metric and the complexity of survey questions and aggregated data sources can further confuse management decision-making and budget allocation in this space.

Guidance from organisations such as the Picker Institute and Beryl Institute are helpful, yet implementation of these questions do require tailoring to local needs, such as in translation of survey questions to local ethnic languages. There also needs to be electronic mechanisms in place to complement paper-based collection in order to improve response rates, engagement and obtain meaningful insights in real-time.

Most importantly is the need to close the feedback loop and take action from patient experience data. Whilst some ward staff and executives may see this process as a ‘tick-box’ exercise, patient experience data collection is actually a driver for organisational strategy and a source for targeting innovation initiatives with real financial outcomes.

Why?

Because from my years as strategist in the corporate health sector (including for very successful pharmaceutical company with over $1bil in annual revenue), I learned one major fact – organisation that is close to its ‘customer’, is the most financially viable over the long term. Hospitals that are sensitive to understanding the needs and wants of its patients, will be the best performing over the long term.

Analysing patient complaints and frustrations may seem like a dreary task, however these ‘warning signs’ are particularly useful when coming directly from patients or front-line staff. Alleviation of patient concerns in an early stage acts as an ‘early warning system’ that can reduce systemic errors and multi-million dollar lawsuits. There are also often many positive stories that can be effectively shared in the organisation to lift morale and staff engagement.

One of the most neglected aspects of patient feedback is the long form narrative where the rich depth of patient insights often lie. In the business world, market research companies understand that these ‘long form narratives’ provide a rich source of insights on how an organisation should innovate its services. However, one of the reasons many surveys tend not to encourage these narratives is that they are difficult to analyse manually in high volumes.

Fortunately, many technologies now exist that can perform automated free text analysis to extract deeper actionable insights from this type of data and to keep service managers updated. Among them are tools like PanSensic, InVivo and SAS, some of which are customised for analysing patient experience data. Some of these tools are also able to analyse compassion, staff attitude and quality of communication.

From helping implementations of patient experience initiatives, here are 8 tips I’ve observed that can help Clinical Governance and Patient Experience managers:

1. Have a systematic annual strategy and implementation plan that you’ve shared with a cross section of stakeholders in the hospital.
2. Design your data collection, analysis and dissemination process so the right person gets the right data at the right time.
3. How you design the questions for local use and ask the questions is critical – some patients/consumers will love doing a survey electronically at point of care, others may want to do it from home post-discharge – give them options.
4. Analyse data effectively to translate them into actionable insights. Many ‘big data’ technologies that can save managers time, and perform these tasks more objectively and effectively than humans.
5. Implement changes through a prioritisation process involving a multi-displinary team (that involves ideally 2 consumer representatives).
6. Visibly demonstrate the results of feedback and management actions to drive culture change, motivation and results over the long term. Front line clinical staff want to know that their daily hard work is appreciated. It also helps them improve the quality of their care and communication if they understand that these aspects can actually be measured via patient feedback.
7. Finally, monitor experience with a ward’s performance metrics to ensure that interventions are effective are continuously aligned with patient needs – many wards now have visibly transparent performance dashboards on the ward. The right way to do this is to have 3-4 main high priority metrics visible (not 20 metrics that cannot be easily seen by busy staff)
8. Have the discipline to iterate the process to achieve continuous improvements to outcomes. Repetition is key to behaviour change. For any person, in any industry.

What are your thoughts on developing one standard metric for patient experience in Australia?

Do check out the Patient Experience Australia LinkedIn Community if you’d like to engage other leaders on this topic.

References

1. Australian Charter of Healthcare Rights. Commonwealth of Australia, 2008. (Accessed 28 August 2014, at http://www.safetyandquality.gov.au/national-priorities/charter-of-healthcare-rights)
2. Australian Safety and Quality Framework for Health Care. Australian Commission on Safety and Quality in Health Care, 2010. (Accessed 28 August 2014, at http://www.safetyandquality.gov.au/national-priorities/australian-safety-and-quality-framework-for-health-care/)
3. Australian Safety and Quality Goals for Health Care Partnering with Consumers: Action Guide. ACSQHC, 2012. (Accessed 28 August 2014, at http://www.safetyandquality.gov.au/publications/goal-3-partnering-with-consumers-action-guide/)
4. Safety and Quality Improvement Guide Standard 2. Partnering with Consumers. Embedding partnerships in Healthcare. Australian Commission on Safety and Quality in Healthcare. (Accessed 4 December 2015, http://www.safetyandquality.gov.au/publications/safety-and-quality-improvement-guide-standard-2-partnering-with-consumers-october-2012