1. 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

2. 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

3. Study objectives To examine the amount of variation in patient experiences: Between hospitals at a national level Between wards or departments within hospitals

4. 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

5. 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.

6. Example National Results, UK 2006 Did you ever share a sleeping area with patients of the opposite sex? Did you ever use the same bathroom or shower area as patients of the opposite sex? Were you ever bothered by noise at night from other patients? Were you ever bothered by noise at night from hospital staff? In your opinion, how clean was the hospital room or ward that you were in? How clean were the toilets and bathrooms that you used in hospital? How would you rate the hospital food? Were you offered a choice of food?

7. Example National Results, Denmark 2006

8. Example Ward Variation, Sweden 2006 WardResult AVA65 Kardiologi, avd 5251 Medicin, avd 2350 Kirurgi, avd 3646 Medicin, avd 2644 Kirurgi, avd 6743 Kirurgi, avd 5642 Ortopedi, avd 6441 Medicin, avd 5540 Medicin, avd 3735 Ortopedi, avd 3434 Kardiologi, avd 3133 Kardiologi, avd 5132 Kirurgi, avd 5731 Was there one doctor in charge of your care?

9. Example Ward Variation, Denmark 2006 Medicinsk Endokrinologisk Klinik65,4 Nefrologisk Klinik61,5 Medicinsk Gastroenterologisk Klinik59,7 Onkologisk Klinik56,4 Urologisk Klinik54,9 Tand-mund- og kæbekirurgisk Klinik52,9 Kirurgisk Gastroenterologisk Klinik50,0 Epidemiklinikken47,8 Hjertemedicinsk Klinik47,6 Ortopædkirurgisk Klinik46,4 Karkirurgisk Klinik45,7 Øre-næse- og halskirurgisk Klinik44,7 Respirationscenter Øst43,8 Was there one or two doctors in charge of your care? Klinik for Plastikkirurgi og Brandsårsbehandling43,7 Klinik for Rygmarvsskader42,9 Neurokirurgisk Klinik42,6 Hepatologisk Klinik39,5 Neurologisk Klinik38,9 Gynækologisk - Obstetrisk klinik34,1 Endokrin- og mammaekirurgisk Klinik30,0 Pædiatrisk og Børnekirurgisk Klinik28,9 Reumatologisk Klinik28,1 Thoraxkirurgisk Klinik26,3 Hæmatologisk Klinik23,3 Øjenklinikken20,6

10. Example Ward Variation, UK 2006

11. 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

12. 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.