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

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

Study objectives

• To examine the amount of variation in patient experiences:

• Between hospitals at a national level • Between wards or departments within hospitals

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

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.

Example National Results, UK 2006

Did you ever share a sleeping area withpatients of the opposite sex?

Did you ever use the same bathroom orshower area as patients of the opposite sex?

Were you ever bothered by noise at night fromother patients?

Were you ever bothered by noise at night fromhospital staff?

In your opinion, how clean was the hospitalroom or ward that you were in?

How clean were the toilets and bathrooms thatyou used in hospital?

How would you rate the hospital food?

Were you offered a choice of food?

Example National Results, Denmark 2006

Example Ward Variation, Sweden 2006

Ward Result

AVA 65Kardiologi, avd 52 51Medicin, avd 23 50Kirurgi, avd 36 46Medicin, avd 26 44Kirurgi, avd 67 43Kirurgi, avd 56 42Ortopedi, avd 64 41Medicin, avd 55 40Medicin, avd 37 35Ortopedi, avd 34 34Kardiologi, avd 31 33Kardiologi, avd 51 32Kirurgi, avd 57 31

Was there one doctor in charge of your care?

Example Ward Variation, Denmark 2006

Medicinsk Endokrinologisk Klinik 65,4

Nefrologisk Klinik 61,5

Medicinsk Gastroenterologisk Klinik 59,7

Onkologisk Klinik 56,4

Urologisk Klinik 54,9

Tand-mund- og kæbekirurgisk Klinik 52,9

Kirurgisk Gastroenterologisk Klinik 50,0

Epidemiklinikken 47,8

Hjertemedicinsk Klinik 47,6

Ortopædkirurgisk Klinik 46,4

Karkirurgisk Klinik 45,7

Øre-næse- og halskirurgisk Klinik 44,7

Respirationscenter Øst 43,8

Was there one or two doctors in charge of your care?

Klinik for Plastikkirurgi og Brandsårsbehandling 43,7

Klinik for Rygmarvsskader 42,9

Neurokirurgisk Klinik 42,6

Hepatologisk Klinik 39,5

Neurologisk Klinik 38,9

Gynækologisk - Obstetrisk klinik 34,1

Endokrin- og mammaekirurgisk Klinik 30,0

Pædiatrisk og Børnekirurgisk Klinik 28,9

Reumatologisk Klinik 28,1

Thoraxkirurgisk Klinik 26,3

Hæmatologisk Klinik 23,3

Øjenklinikken 20,6

Example Ward Variation, UK 2006

Inpatient Survey

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Q41 Overall rating ofcare

Q19 Amount of privacywhen being examined or

treated

Q16 Involvement indecisions about care and

treatment

Q14 Were there enoughnurses on duty

Q10 Did doctors talk infront of you as if you

weren't there

Q5 Cleanliness of toiletsand bathrooms

Q3 Ever bothered bynoise at night from staff

<- wor se per f or man ce sc or e bet t er - >

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

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.