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Walking the talk of patient-centredness: Maximizing the value of the patient voice

Executive Director, Charlene McBrien-Morrison, comments on why listening to and acting on patient feedback and input is critical to “walking the talk” of a patient-centred healthcare system.

I greatly appreciated my colleague Kyle Kemp’s HQCAMatters piece about patient experience and how it is a wonderful complement to the suite of measures from which our health system should be reflecting. His perspective prompted me to probe further into the question:

Why do we survey patients on their experience in our healthcare system?

Like Kyle, I believe that listening to those we serve is invaluable. I want to take this a step further and assert it is central to assessing if we are a truly patient-centred healthcare system.

What does being a patient-centred healthcare system mean? The Institute for Patient- and Family-Centered Care (IPFCC) defines it as, “Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families.” The Institute goes on to say that, “Patient- and family-centered care leads to better health outcomes, improved patient and family experience of care, better clinician and staff satisfaction, and wiser allocation of resources.” It is crucial, therefore, to have those using our system tell us about their experience, and whether they really feel that “mutually beneficial partnership”. (1)

The Institute for Healthcare Improvement (IHI) speaks to the importance of actively learning from the patient and family by considering “the perspective of the individual as he or she interacts with the health care system (i.e., patient experience surveys)”.

The patient’s voice can be captured in many ways. Surveys (which Kyle mentioned), one-on-one interviews, focus groups, concerns/complaints, and resident and family councils are just a few examples. A cross-section of ways to capture experience is important, because “patient-centered organizations recognize that data is broader than numbers and includes the qualitative perspective of patients, families, and staff.” (2) The HQCA has also used qualitative methods to provide a more in-depth understanding of patient experience in specific sectors of the healthcare system such as our report about the experiences of seniors living in supportive living. “Qualitative approaches provide opportunities for dialogue, moving beyond the standard -always, -sometimes, or -never responses found on traditional surveys. The sharing of complete stories may very well shed light on areas for improvement not identified previously through the survey process.” (3)

This expanded train of thought led me to an even more important question:

Are we maximizing the value of the patient voice in moving us towards a patient-centred health system?

I’m not sure that we are; however, where organizations and teams are sincerely listening to and acting on patient feedback, the results are impressive and worth celebrating.

Just ask Westview Care Community, a long-term care centre in Linden, Alberta, where 100 per cent of families would recommend this care centre to others. “Propensity or likelihood to recommend” is one measure of the patient experience dimension suggested in the IHI’s A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. This would suggest that Westview is certainly demonstrating a patient- (resident-) centred approach in how they deliver care and identify improvement opportunities.

Being a patient-centred health system is not an end goal, but a continuous journey. “This journey approach also means that there are always opportunities for improvement, no matter how long your organization has been on the path to patient-centeredness. Sustaining a patient-centered culture demands adaptability and flexibility to meet the needs and expectations of your patients, families and staff―needs that will inevitably evolve over time.” (4) So, we need to continuously walk the talk of patient-centredness and never stop listening to, embracing, and acting upon the patient voice in all that we do.

To continue this conversation, I have posed a question to the HQCA’s Patient and Family Advisory Committee members:

How can we (healthcare leaders focused on improving healthcare quality) do a better job of “walking the talk” of patient-centredness by listening to and acting on the voice of those we serve?

I have invited our patient advisors to prepare a HQCAMatters article about their recommendations, and look forward to hearing their perspectives. Please follow us on social media (links at the bottom of the page), to see a notification when their response is posted in the coming months.

 

(1) Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. (Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012) (Available on www.IHI.org)

(2-4) Susan Frampton et al., Patient-Centered Care Improvement Guide. (Planetree, Inc. and Picker Institute; 2008)

HQCAMatters is published monthly and presents HQCA representative perspectives on topics or issues relevant to healthcare in Alberta.

Quality Exchange Virtual Open House- Wing Kei Care Centre

Wing Kei Care Centre was the second of a four-part series highlighting facilities that are making improvements in long-term care across Alberta. The staff at the Wing Kei Care Centre joined the HQCA in this webinar experience to explain how they used feedback from family members to improve the resident experience. To learn more click here.

Quality Exchange- Wing Kei Care Centre

Quality Exchange shares information about positive things happening in Alberta’s healthcare system. Whether it’s featuring innovation in clinical practice, or humanizing the way healthcare is delivered, Quality Exchange shares initiatives that have impacted outcomes and experiences of staff, families, patients, residents, and clients.

The HQCA is pleased to profile Wing Kei Care Centre as the second in a four-part series featuring positive stories from long-term care facilities in Alberta . These facilities either demonstrated improvements or maintained good results in our Long-term Care Family Experience Surveys.

HQCA 2017-18 A Year in Review: Inspiring Improvement

The Health Quality Council of Alberta is extremely proud of our accomplishments this year. Our 2017-18 annual review records the ways we are making an impact.

The road to improvement can take more than one path. With our patient and health system partners, we continue to objectively examine Alberta’s health system. We work collaboratively with our stakeholders to identify opportunities for improvement; we have the relentless vision to navigate possibilities to drive progress.

We invite you to read the report.

Then, we invite you to:

  • SHARE this report link with people who might not know the HQCA. Having more Albertans know about us, and giving them the opportunity to participate in their health experience gives improvement a voice that isn’t easily ignored.
  • PARTICIPATE in the road to improvement. On the second last page (37), we’ve suggested a number of simple ways you can participate. Together we can seek opportunities to improve Alberta’s health system.
  • CONTACT – if there’s anything you’d like to discuss in greater detail, we welcome the conversation.

We are proud to make a meaningful contribution to our healthcare system, for the benefit of each Albertan.

HQCA announces new Board Chair and new Board member appointments

New HQCA Board member appointments

The following individuals have been appointed by Alberta’s Lieutenant Governor in Council to the HQCA Board of Directors, effective Nov. 6, 2018:

  • Dr. Trevor Theman (Edmonton) as the organization’s new Chair of the Board of Directors
  • Sandi Kossey (Edmonton)
  • Shirley Kine (Canmore)
  • Mohammad Masood Peracha (Edmonton)

Congratulations to these individuals on their appointment.

The HQCA looks forward to working with these new Board members as we continue to pursue our mandate to improve patient safety and health service quality across the province.

Deepest thank you to Deborah Apps, who stepped forward as Acting Chair after Dr. Tony Fields’ term came to a close last May. Her commitment to this organization and its mission to improve patient safety and health service quality for Albertans is greatly appreciated.

The value of gathering patient experience data

Kyle Kemp, Senior Data Manager and Lead, HQCA, talks about the importance of patient experience surveys and how they can help capture the patient perspective to ultimately improve healthcare. 

You have just received a telephone call, knock on the door, letter in the mail, or an email asking you to complete a survey about your experience. You might get these requests after you visit your local bank, grocery store, fast food restaurant, or even healthcare clinic or hospital. Like many, you may ask, “Why should I do this?”, or “Why do they want this information?” These are important questions to ask and get answers to.

I may be a bit biased (part of my job is to analyze experience surveys), however I think there is tremendous value in getting feedback directly from customers. To illustrate this point, here is an example from my own family from earlier this year.

One night, in the rush between work, school, home, and the soccer field, our family stopped for dinner at a favourite fast-food restaurant. My wife and two young sons proceeded to find a table. After I placed our order, I was waiting at the counter when my attention was grabbed by a set of screens behind the counter, above the drive-thru window.

I quickly realized that these screens provided indicators about drive-thru performance. Staff were receiving information about things like time taken to serve each car, and the number of cars served in an hour. Data was displayed in red, yellow, or green, depending on how they were doing. Their own ranking was also compared with other drive-thrus across the city.

I received our order and returned to the table to tell my wife about these performance measures. She was quick to angrily reply that she had just had to clean up other people’s garbage, and wipe globs of ketchup off a table and chair, all while keeping our little ones out of trouble. Despite having one of the fastest drive-thrus in the city at the time, my wife’s experience was more strongly impacted by the lack of cleanliness in the restaurant. My wife’s experience wasn’t captured on that set of screens, but could have provided some important feedback to this hard-working team.

Like my example from the fast-food industry, there is a huge potential benefit in asking “customers” of the healthcare system (e.g., patients and their families) about their experience. Patient experience data is used to assess care processes and interactions with staff, through the eyes of patients and family members. This feedback can be a tremendous catalyst for change. It can also serve as a valuable teaching tool, and for giving credit when patients and family members have reported receiving great care.

Patient experience data can be a wonderful compliment to a hospital or organization’s existing set of performance measures, as patients and families can provide information not readily available with traditional performance measures. For example, a hospital may note that their emergency department revisit rate is high compared to their peers (a common performance indicator; a high rate is seen as an indicator of poorer performance). Patient feedback can be used to help determine why this is happening. Patients may report that they did not receive clear instructions on how to care for themselves when returning home from hospital, or that they did not understand how and when to take their newly-prescribed medications. Addressing these patient concerns may minimize additional burdens to patients, families, and the healthcare system, and may also improve the revisit rate.

As I mentioned before, it is my job to analyze and report the data gathered from experience surveys. At the Health Quality Council of Alberta, this means patient (primary care and emergency department), resident (supportive living), client (home care) and family (long-term care) experience surveys. By staying in touch with those we share our reports with, I also have the opportunity to see how this data ultimately helps improve healthcare for Albertans.

So, the next time you are asked to participate in a survey about your care, please consider saying “yes!”. Your voice makes a difference and the more voices and stories we can capture, the more impactful the data will be. To those of you who have already taken the time to provide feedback about the healthcare services that you or a family member has received, thank you. Whether it was by completing a survey, filling out a comment card, taking part in an interview or focus group, or by any other means, this information about your lived experience is invaluable! I hope that all Albertans continue to provide their feedback – good, neutral, and bad. It all helps improve the quality of care Albertans receive.

To learn more about the HQCA, our mandate, or our current surveys, please go to www.hqca.ca.

HQCAMatters is published monthly and presents HQCA representative perspectives on topics or issues relevant to healthcare in Alberta.

Quality Exchange Virtual Open House- Westview Care Community

The HQCA hosted its first ever virtual open house experience. During this webinar, the staff at Westview Care Community highlighted their challenges and successes in improving resident experience and enhancing patient care. Click here to learn more.

HQCA contributes to the Canadian Health Care Facilities standard

The Health Quality Council of Alberta is helping to plan the hospitals of the future. We have contributed to the new CSA Z8000 Standard for planning and design for new healthcare facilities in Canada.

CSA-Z8000 is a publication of the National Standard of Canada for Canadian Health Care Facilities. This standard was revised and the second edition was published in 2018, with the HQCA participating in a sub-committee for the revisions. The latest revision includes new and updated information on mock-ups and simulation as part of planning and design. It specifically adopted and lists the six principles identified in the HQCA’s Simulation-Based Mock-up Evaluation Framework , and references the framework as a publicly available document which describes how to plan, design, and evaluate mock-ups as part of a health care facility design process.

The Simulation-based Mock-up Evaluation Framework is a world-recognized approach to improve healthcare environment design. The framework outlines an approach to using data from mock-up environments for improved environment design that in turn improves patient safety, staff efficiency, and user experience.  The framework is referenced in provincial hospital design standards/guidelines developed by Alberta Health, Alberta Infrastructure, and Alberta Health Services.

Re-imagine: Building a high-performing team

Kristina Watkins, HQCA employee and alumna Re-Imagine facilitator, shares a bit about the HQCA’s approach to building a high-performing team.

What an interesting time to be asked to write about the HQCA’s approach to building a high-performing team. I am feeling anxious and overwhelmed by my workload, stretched in quite a few directions. It is in these cycles of stress and intensity when my attitude lacks its usual pep and polish. My flexibility turns rigid. My olive tree has (a lot) less branches. This makes adhering to the HQCA’s social contract (the document at the core of our approach, below) difficult.

HQCA social contract – launched in February 2016.

In January of 2015, we (HQCA employees) started a process called “Re-imagine”, initiated by our executive leadership.  Re-imagine was introduced as a way of learning to connect and become more effective communicators with one another. It is meant to help us function as a high-performing team.

A team of five internal employee facilitators from across departments and levels of the organization guides this work. The facilitators’ first task was to help employees collectively develop a social contract. This social contract would be agreed to and signed by all employees to set core expectations about how we work together.

When you read the outcome of this work, the social contract above, it sounds pretty easy, right? Address issues so they don’t fester, celebrate good work, and respect your co-workers. Common sense.

I think this is easy to understand, but really hard to practice consistently. Especially the part involving feedback. What an important activity, but I have to agree with this article. Our “nice” and “kind” culture makes delivering and receiving feedback HARD.

So, we use a “balanced feedback” model developed by an external expert to overcome barriers to resolving differences and crediting accomplishments.

Our Re-imagine model incorporates elements from some of these well-known practices and models:

The team develops and maintains awareness to help us see opportunities to use this model to check assumptions and then deliver balanced feedback, if needed. However, as I mentioned, I’m writing this during one of those cycles of self-doubt and frustration. I am less likely to deliver or ask for feedback because I know there is a risk I might not be in the best position to give or receive it in a “nice” or “kind” way. I worry about the potential risk to my long-term relationship with the person I need to check assumptions and discuss feedback with. I have always lived by the adage, “Treat people the way you want to be treated.” This week that just might not be possible.

Here’s the thing I’ve learned, though. That is not an excuse to avoid feedback. If your professional environment is practicing feedback regularly, delivering or receiving it should be no more difficult than your other to do’s. Feedback does not have to create anxiety. It guides our behaviour and allows us to change our approach. Reframe a challenge. Hit a target more successfully. These feedback interactions add up and, if consistently delivered in a respectful way, can create a working environment where psychological safety is real and innovation can thrive. These are excellent reasons and incentives to embrace feedback.

While absolutely logical, I am not there yet. I don’t “walk the talk” as consistently as I should and still make awkward mis-steps that could be avoided with more practice.

The great thing about Re-imagine is that it is a process, not a goal. I make time and have the space and support to do this work. And, as the organization and individual relationships change and evolve, there will always be new opportunities to improve my practice and ultimately, our team’s performance. I welcome this personal and team development opportunity and am proud to work for an organization that makes this work a priority. Turns out taking a moment to acknowledge this at a time when I am channeling more Maleficent than Wonder Woman is part of that ongoing self-awareness and self-improvement.

For HQCAMatters updates, follow @HQCA on Twitter.

HQCAMatters is published monthly and presents HQCA representative perspectives on topics or issues relevant to healthcare in Alberta.

Quality Exchange

Introducing a new program from the HQCA.

Quality Exchange shares information about positive things happening in Alberta’s healthcare system. Whether it’s featuring innovation in clinical practice, or humanizing the way healthcare is delivered, Quality Exchange shares initiatives that have impacted outcomes and experiences of staff, families, patients, residents, and clients.

The HQCA is pleased to profile Westview Care Community as the first in a four-part series featuring positive stories from long-term care facilities in Alberta . These facilities either demonstrated improvements or maintained good results in our Long-term Care Family Experience Surveys.