improving the patient experience through feedback …€¦ · patient experience is an important...
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IMPROVING THE PATIENT EXPERIENCE THROUGH FEEDBACK AND VIRTUAL CAREHALTON HEALTHCARE / OAKVILLE VIRTUAL CARE PROGRAM
www.reacts.com
Better communication.
Better efficiency.
Better care.
An inside look at how Halton Healthcare
improves the patient experience through
constant collection and implementation of
patient feedback and pre- and post-operative
eVisits.
The state of affairs
Patient experience is an important and commonly used indicator for
measuring quality in healthcare. It affects clinical outcomes, the timely,
efficient, and patient-centered delivery of quality healthcare, recovery
time and patient retention. Patient experience is thus a proxy but
effective indicator to measure the success of doctors and hospitals, and
communication is a crucial aspect of how patients perceive their care.1
The Canadian Institute for Health Information’s 2019 Patient Experience
in Canadian Hospitals survey2 indicates that while adequate, the
experience of Canadians in our healthcare system leaves room for
improvement. Results show that only:
• 62% of patients said that their overall hospital experience was very good
• 2/3 of patients said that doctors and nurses always listened carefully and explained things clearly
• 54% of patients felt that their medication was always explained well
• 1/2 of patients felt that their care was always well coordinated by hospital staff
• 40% of patients said they didn’t receive enough information at discharge
The Canadian Institute for Health Information’s 2019
Patient Experience in Canadian Hospitals survey
indicates that:
• Only half of patients felt that their care was always
well coordinated by hospital staff
• 40% of patients said they didn’t receive enough
information at discharge
• Pop. served: 400,000
• Staff: 4,022
The importance of collecting patient feedback
Many studies are now showing that patients’ expectations affect their
outcomes after surgery.3 Also, patients’ expectations are largely
influenced by their experiences – which include physicians’ manner,
timely compassionate nursing care, clean surroundings and respectful
and courteous treatment.
Ironically, despite the great number of hours of continuing medical
education required of physicians, they are not trained in customer
service, the patient experience, or health care communication skills.
They are trained to focus on outcomes and on patient care.4
Halton Healthcare is an award-winning healthcare organization
comprised of three community hospitals and numerous
community-based services in southwestern Ontario. They take pride in
offering some of the finest technology and healthcare expertise
available in their region. They are also among a growing number of
healthcare organizations adopting a systematic methodology in
assessing their patients’ experiences and acting on that feedback to
continuously improve those experiences.
The Oakville Trafalgar Memorial Hospital surgical program, for example,
has started to use readily available internet-based survey tools, and
endeavour to assess every single patient encounter in every single
division, including surgical day care, ambulatory care, and the inpatient
units, every single day. They then use this information to guide training
in great patient customer service.
“I remember having a video chat with Dr. Rozario the next day at
noon, and he asked for feedback. I was so thrilled to share what an
amazing experience I’d had. “
– Jane Gaynor, surgical patient
Oakville Trafalgar Memorial Hospital
https://www.haltonhealthcare.on.ca/
https://www.haltonhealthcare.on.ca/locations/oakville-trafalgar-memorial-hospital
Healthcare’s existential pivot to virtual care
Unfortunately, access to medical care is filled with a variety of barriers,
including financial barriers such as time off work and parking costs.
There are time constraints, including the need for childcare and
household responsibilities. There is the requirement for transportation,
sometimes over tremendous distances. There are physicians’ limited
number of hours and days, and the fact that most payers do not
remunerate for telephone/video calls or texting with patients. There’s
also the question of need: does going to my physician give me value, or
could I just use Google on my smartphone to find health advice?5
But there is in fact great need; 4.5 million Canadian residents who don’t
have family doctors turn to crowded clinics or emergency rooms for
routine issues.6 40,000 Canadians visit an ER every year just to renew
prescriptions; 68% of Canadians skip or avoid medical appointments
due to barriers like long wait times.7
And when it comes to virtual healthcare in Canada, a great divide exists
between current demand for it (71%) and its current rate of adoption (9%).8
The Ontario Telemedicine Network (OTN), a provincial organization
that facilitates encrypted real-time video communication with patients
to improve access, reported 770 000 virtual visits out of a total of 124
million patient visits in 2018, representing only 0.62% of total visits. (By
contrast, Kaiser Permanente in the U.S. reported that 52% of its 110
million physician-patient interactions in 2016 took place virtually.9)
The upside is that 86% of Canadians own smartphones, and just as many
have broadband access at home - two key requirements for virtual care.
This could allow us to increase the number of touchpoints between
caregivers and patients, and add to the patient experience. Research
indicates that 70% of ER and clinic visits could be replaced by virtual
consultations without any impact on care quality.10 (And in the U.S., 68%
of patients rated virtual video visits at 9 or 10 on a 10-point scale.11)
• When it comes to virtual
healthcare in Canada, a
great divide exists
between current demand
for it (71%)
and its current
rate of adoption (9%).
Only 0.62% of total
visits were virtual in
Ontario in 2018
https://otn.ca/
Halton Healthcare / Oakville Virtual Care Program
Taking advantage of such an opportunity, the Oakville Trafalgar
Memorial Hospital (OTMH) Surgical Program introduced their eVisits in
February 2018. Services they provide via video chat include routine
follow-up visits, reviewing pathology or other test or Imaging results, or
assessing surgical incisions, all while allowing patients to remain in the
comfort of their chosen venue. In northern climates, an added benefit to
patients, particularly those with mobility issues, those in poor health and
those who are immunosuppressed from chemotherapy, is that eVisits
decrease the need to travel in poor weather.12
Unlike a phone call, video chats allow a much more profound degree of
communication, including assessment of nonverbal cues and body
language, and can help a surgeon decide whether the eVisit has been
adequate or whether an in-person visit is needed.
The OTMH Surgical Program has also started a program to
communicate via pre-booked eVisit with patients the day after surgery
to review the operation, assess pain control and optimize the patient
experience. It should be noted that such initiatives have been led by the
departments of surgery. eVisits are simply another tool in their toolbox.
Seeing patients in person, physical examinations and the therapeutic
touch will never be completely replaced.5
Understanding the importance of rapidly expanding virtual care options,
the Ministry of Health and Long-Term Care (MOHLTC) and the Ontario
Telemedicine Network are allowing care providers to test a variety of
modern virtual care solutions and receive standard fees. The Oakville
Hospital surgical department is using the Reacts collaborative platform
to provide virtual care to a wide variety of patients using readily
available smartphones or personal computers. This next-generation
application allows not only virtual care and sharing of information, but
also the use of augmented reality to enhance care provider training.
The clinical need
The Oakville Surgery team needed a
simple means to communicate at a
distance with patients pre- and
post-op in order to improve their
experience and recovery.
The requirements
The team required a secure, versatile
and reliable solution that is easy to
deploy and operate.
The solution
Adoption of a clinical collaboration
solution that can easily be used on
patients’ devices (e.g. computer,
tablet, smartphone, etc.).
The technological component
The Reacts platform allows the
Oakville Surgery team to deploy a
solution that meets their needs while
complying with Ontario’s strict IT
security standards.
The benefits
Reacts enables eVisits for remote
preparation and follow-up’s with
surgical patients, improving access
to care and outcomes. https://www.reacts.com/
“Wonderful to see a focus on virtual care! In our pilot
with Reacts we have completed over 1000 virtual visits in
7 months with a 9.5/10 patient experience rating. All
patients and caregivers in the province need access.”
- Duncan Rozario, M.D., FRCSC, FACSChief of Surgery, Oakville Trafalgar Memorial Hospital
Medical Director, Oakville Virtual Care Program
Unlike many other virtual care solutions, Reacts allows providers to call
and message patients, similar to apps like Facetime, instead of using a
chatroom model where both participants need to enter a virtual
chatroom at the same time to communicate.
In Dr. Rozario’s office, his admin books a virtual appointment over a
30-minute window and asks the patient to be logged into the app and
stay near their smartphone or computer. This gives him needed
flexibility in a busy office. Patients are sent a reminder email with details
of the appointment and are referred to the pilot project’s website
(http://oakvillesurgery.com/evisit.html), which explains how
to have a virtual visit using Reacts.
At some point over that time range Dr. Rozario calls his patient,
completes the virtual visit, views incisions as needed, and then
documents the visit in his EHR. Patients are then invited to complete a
patient experience survey online to provide feedback on how Oakville
surgery can improve. Dr. Rozario uses this system to assess all patients
within 48 hours of surgery to answer questions about their procedure
and assess pain control on their multimodal pain scale.
“Would be amazing for hospitals to mandate all staff on
tech like @ReactsApp – then we would be a text away.
It’s a game-changer.”
– Daniel Pepe, M.D.Family Physician at London Lambeth Medical Clinic
Between March and October of 2019, 700 patients and 36 physicians
participated in the pilot, completing 1,097 virtual visits. The patient
experience survey data for this period rated the eVisits pilot using
Reacts at 95% for overall patient satisfaction.
Use of Reacts’ multimedia sharing and overlay capabilities allows
healthcare providers to remotely demonstrate to patients how their
surgery went and what to expect in the progression of their healing
process, while the recording, annotation and reporting functions enable
the provider to document the consultation in the cloud for later referral
or transfer to an EMR.
Meanwhile, the Ontario Ministry of Health and Long-Term Care has been
reviewing technology options and will need to approve widespread
changes before the telemedicine and virtual care market opens up to a
variety of solutions.
A forward perspective
We have a right to greater quality healthcare when, where and how
we need it, and an integrated system using virtual visits may
ultimately be the primary way to interact with our caregivers in the
not-too-distant future.
In order for this to happen though, physicians and administrators
need to recognize the value of virtual care and address issues of
accessibility, privacy, security, regulation, compensation and
integration, and adopt solutions that place patients at the centre of
their care. Healthcare providers must also realize that patient
expectations have risen to reflect the level of efficiency they
experience in business transactions and other areas of their lives.
The importance of measuring performance metrics and value
becomes increasingly clear in this context and will lead to more
cost-effective and efficient care13.
In the Oakville Virtual Care Program, patient engagement and
feedback clearly benefit from adoption and proper utilization of
technologies such as Reacts. This collaborative platform is used to
facilitate care coordination, patient engagement, and peer training
at a level that finally espouses the promises of virtual care.
In the modern era of cost containment balanced with the need
to enhance patient care and the patient experience, it is imperative
to use avai lable technology to optimize the methods of
communication in any hospital.14
References:
1) Bhanu Prakash, Patient Satisfaction, Journal of Cutaneous and Aesthetic Surgery, 2010 Sep-Dec; 3(3): 151–155, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047732/
2. Patient Experience in Canadian Hospitals Survey, Canadian Institute for Health Information, April 2019, https://www.cihi.ca/en/patient-experience/patient-experience-in-canadian-hospitals
3. Mondloch MV, Cole DC, Frank JW. Does how you do depend on how you think you’ll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes. CMAJ 2001;165:174-9.
4. Duncan Rozario, MD, How well do we do what we do, and how do we know it? The importance of patient-reported experience measures in assessing our patients’ experience of care, Canadian Journal of Surgery, Vol. 62, No. 1, February 2019
5. Duncan Rozario, MD, Optimization of communication in the surgical program via instant messaging, Web-based surveys, newsletters, websites, smartphones and telemedicine: the experience of Oakville Trafalgar Memorial Hospital, Canadian Journal of Surgery, Vol. 61, No. 4, August 2018
6. Statistics Canada (2014), Access to a regular medical doctor, www150.statcan.gc.ca
7. Virtual Healthcare in Canada: The Solution at Our Fingertips, A 2019 Virtual Healthcare Industry Report, Medisys Health Group
8. Vivien Brown (2019), Medisys Health Group, How Virtual Care is Reshaping the Future of Canadian Benefits Programs, https://blog.medisys.ca/virtual-care-canadian-healthcare
9. Kia Kokalitcheva, More Than Half of Kaiser Permanente’s Patient Visits Are Done Virtually, October 6, 2016, https://fortune.com/2016/10/06/kaiser-permanente-virtual-doctor-visits/
10. Truven Health Analytics (2013), Avoidable Emergency Department Usage Analysis, www.truvenhealth.com
11. American Journal of Managed Care (2019), Patient and Clinician Experiences with Telehealth for Patient Follow-up Care, www.ajmc.com
12. Ballester S, Scott MF, Owei L, et al. Patient preference for time-saving telehealth postoperative visits after routine surgery in an urban setting. Surgery 2018;163:672-9.
13. Lee TH. Turning doctors into leaders. Harv Bus Rev 2010;88:50-8
14. Ellanti P, Moriarty A, Coughlan F, et al. The use of WhatsApp smartphone messaging improves communication efficiency within an orthopaedic surgery team. Cureus 2017;9:e1040.
Employing such means, along with patient feedback, will certainly
help get providers back to medicine’s primary focus - outcomes
and patient care. The value of these means has been demonstrated
in several instances on a local scale; we must now work together
to make it happen on a national scale.
And with backing from the proper health authorities, we can
envision the day when “virtual care” will become a regular
component of exemplary “experience and care” in this country
of great means and fundamental values.
Reacts (Remote Education, Augmented Communication, Training
and Supervision), is a secure, integrated collaborative platform
created by Quebec-based Innovative Imaging Technologies Inc. (IIT).
It was designed to suit the multiple collaborative needs of healthcare
professionals and patients, and incorporates unique and unparalleled
interactive features, such as augmented reality for remote virtual
guidance, supervision and training.
Reacts is presently being used in over 80 countries, across
various medical disciplines in both clinical and educational
settings, for applications ranging from secure messaging, remote
wound care, tele-ultrasound, and teleconsultations, to interactive
tele-surgical assistance and remote procedural supervision. Strategic
partnerships include medical device manufacturers and healthcare
innovation focused organizations. For more information,
visit: www.reacts.com .
About Reacts
Discover hyperpresence!
www.reacts.com
© 2019 Innovative Imaging Technologies Inc. All rights reserved.
Better communication.
Better efficiency.
Better care.