National Danish Survey of Patient Experiences - KOPA · National Danish Survey of Patient Experiences UNIT OF PATIENT EVALUATION, Copenhagen County ... Comparative study of in-patient

National Danish Survey of

Patient Experiences

UNIT OF PATIENT EVALUATION, Copenhagen CountyOn behalf of the Ministry of Interior & Health and the Regional Councils

Comparative study of in-patient evaluation at 54 public Danish hospitals

September 2005

National Danish Survey of Patient Experiences Comparative study of in-patient evaluation at 54 public Danish hospitals

UNIT OF PATIENT EVALUATIONGlostrup University Hospital, section 87Nordre RingvejDK-2600 GlostrupTel. (+45) 43 23 34 55Fax. (+45) 43 23 44 72E-mail: [email protected]

National Danish Survey of

Patient ExperiencesComparative study of in-patient evaluation at 54 public Danish hospitals

UNIT OF PATIENT EVALUATION, Copenhagen CountyOn behalf of the Ministry of Interior & Health and the Regional Councils

�

National Danish Survey of Patient ExperiencesComparative study of in-patient evaluation at 54 public Danish hospitals

© Unit of Patient Evaluation, Copenhagen County, september �005ISBN: 87-915�0-09-6

Unit of Patient Evaluation, Copenhagen County, on behalf of the Ministry of Interior & Health and the Regional Councils

Trine OesterbyeRikke Gut Majbritt PetersenMorten Freil

Statistics: Anders Joergen JensenData management: Salim El-Haj KhalilSecretary: Christina Rasmussen

This publication is a summary of a Danish report.The publication can be purchased or downloaded at the website: www.efb.kbhamt.dk

Contact:Projectkoordinator Trine OesterbyeUNIT OF PATIENT EVALUATIONGlostrup University Hospital, section 87Nordre RingvejDK-�600 GlostrupTel. (+45) 43 �3 34 55Fax. (+45) 43 �3 44 7�E-mail: [email protected]

Design and print: Peter Dyrvig Grafisk Design & PJ Schmidt Grafisk produktion, Denmark

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Introduction

Aims and ObjectivesThe aim of the survey is to establish a foundation for comparison of patient evaluation between hospitals. The themes investigated includes: care, clinical services and patient safety, patient – staff continuity, patient involvement and communication, information, course of treatment, discharge, shared care, physical frames and premises of the hospital, waiting time and free hospital choice.

The survey was first conducted in �000, and subsequently repeated in �00� and �004. Hence it is possible to compare the patients’ experiences over a period of time. The results, along with other national quality projects, are to be used for targeting areas of quality improvement at each hospital.

Knowledge of patient experiences and their evaluation of the Danish hospitals have a high priority in the development of the Danish healthcare system, which aims to comply with the public wishes. Based on a collaboration between the Ministry of Interior and Health and the Regional Councils, a common patient experiences and evaluation survey is thus performed in all hospitals every second year. The Regional Councils own and run all public and major hospitals in Denmark.

OrganizationThe survey is conducted by The Unit of Patient Evaluation in Copenhagen County, which is a research centre working for patient involvement. The unit carries through surveys and research and development projects concerning patient experienced quality.

The survey is financed by the Regional Councils, which administer the hospitals.

A professional working group and a steering committee have been formed, consisting of representatives of the Councils and the Ministry of the Interior and Health.

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Material & Methods

MaterialAmong patients discharged from one of the 54 Danish public hospitals in the departments of internal medicine, orthopaedic surgery, organ surgery or gynaecology/obstetrics in the period between mid Marts to mid June �004, a representative sample of �6.31� persons was selected. In late August the selected patients were posted a questionnaire to their home address and requested to evaluate their hospital stay. Two weeks after having received the questionnaire the patients received a reminder. In �004 the response rate was 53%.

MethodsThe themes and questions asked were selected on the basis of experiences from a number of prior surveys, conducted locally at regional and hospital level and a total of 37 questions were asked. Validity of the survey was supported by preliminary interviews of �9 patients aged 30-90 from five departments at five hospitals. All in all 77 interviews were carried through in the three surveys.

In order to make the results from the survey comparable, the patient sample was drawn from The National Patient Registry and the sample for each of the 54 hospitals was stratified by speciality (internal medicine, orthopaedic surgery, organ surgery or gynaecology/obstetrics). Furthermore the data were standardized by age, gender and admission form (acute/remitted).

The standardized ratings of each hospital were compared with the ratings of all hospitals: ‘above’, ‘on’ or ‘below’ average.

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Results

ResultsThe survey showed that patients generally have a positive experience at the Danish hospitals. 90% of the respondents rated their hospitalization experience as ‘good’ or ‘very good’. Despite the overall positive ratings the survey also points out areas for improvement (figure 1) and for each of the 37 questions asked there was a great range of dispersion of scores among the hospitals (figure �).

Areas where the hospitals achieve the best results

• The clinical service ratings were higher than the ratings of other areas. 93% of the patients answered that they “to a large extent” or “to some extent” were comfortable with the professional skills of the doctors and 95% of the patients were “to a large extent” or “to some extent” comfortable with the skills of the nurses.

• The patients also rated the communication between patients and staff. 90% of the patients found that the doctors listened to their description of their disease “to a large extent” or “to some extent”. Furthermore 9�% of the patients found that the care giving staff “to a large extent” or “to some extent” were responsive to their needs.

• Questions examining the patient’s experiences in the course of treatment show that 85% of the patients found that the treatment plan made was kept “to a large extent” or “to some extent” and 90% rated the collaboration between the nurses and the doctors as “very good” or “good”.

• The ratings for the process of discharge show that 80% of the patients did have a conclusive conversation with a doctor or a nurse and 87% felt “very secure” or “secure” returning home when discharged.

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• When asked about the interface between primary and secondary sector, 90% of the patients found that the hospital departments were “very well” or “well” informed about their situation when admitted. Nevertheless 17% of the patients waiting to be admitted answered that they did not know who to approach if their condition changed while waiting to be admitted.

• Furthermore 85% of the patients rated the physical frames and premises of the hospital as “very good” or “good”

Primary target areas:

• Generally the hospitals achieved low results concerning the continuity between patient and staff. 58% of the patients answered that they “to a large extent” or “to some extent” were informed of who to approach with questions during their admission. Moreover 5�% answered that they experienced that 1-� doctors had a primary responsibility for their treatment and 57% answered that they experienced that 1-� nurses had a primary responsibility for their care.

A total of 7�% of the patients answered that they experienced that 1-� doctors and/or nurses had a primary responsibility for their treatment/care.

• There also seems to be potentials of improvement in matters concerning information. One type of information, written information, is nevertheless rated relatively high by the patients. A total of 96% answered that they experienced the written information as “very good” or “good”. But the number of patients who answered that they did receive written information prior/during their hospital stay is quite low with a total of 45%. The content of the oral information was rated “very good” or “good” by 86% of the patients and 79% found the extent of the information “satisfactory”. Additionally 83% of the patients answered that they experienced that there was correspondence between the information received from different staff members. At the discharge 87% of the patients found that they had been “very well” or “well” informed about their medication and 55%

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of the patients found that they had been “very well” or “well” informed about the future consequences of their illness.

• A total of 18% of the patients in Danish hospitals answered that they had experienced medical errors during their admission. Among these 5% experienced the errors as distribution of wrong medicine, 7% as injuries during the surgery and 13% experiences other types of errors. Most patients discovered the errors themselves (61%) and 30% of the patients who experienced errors found that the staff handled the errors “very poorly” or “poorly”.

• There also seems to be improvement potential in matters concerning involvement of the patients. 81% of the patients found that they “to a large extent” or “to some extent” were sufficiently involved in the decisions related to their treatment, 18% found that they were “not sufficiently” involved and 1% found that they were “too involved”. Moreover 74% of the patients answered that their relatives were sufficiently involved in the decisions concerning treatment and care, �5% found that their relatives were involved “too little”, while 1% found that their relatives were involved “too much”.

• In matters concerning waiting time there also seems to be a potential for improvement. 63% of the patients signed up for admission answered that the waiting time from their referral to the hospital to the actual admission were “suitable”. In addition 70% of the patients did not experience any significant waiting time during admission which prolonged their stay in hospital.

• Some of the questions concerning the interface between primary and secondary sector show room for improvement. As to the transition between the hospital and the public home care after the hospitalization, 8�% of the patients rated the collaboration between the two as “very good” or “good” and 78% found that their general practitioner was “very well” or “well” informed about what had happened during their hospital stay.

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Disparity between hospitals and specialities There is great variation in the hospitals results, particularly in relation to the primary target areas. Between the highest and lowest placed hospital in regard to whether or not the patients received written information there was a variation of 73 percentage point. Furthermore there is a 30 percentage point variation between the highest and lowest placed hospital as to whether the patients experienced that 1-� doctors had a primary responsibility for their treatment. The variation between the results of the hospitals indicate that the primary target areas are not necessarily the same for all the hospitals.

There were no essential differences between the four specialities.

Results 2004 compared with the 2000 & 2002 In a comparison between the �004 survey results and those of �000 and �00� there has generally been a statistical significant increase in the positive ratings in the period. This is particularly visible in relation to the following topics: information, waiting time and shared care. The rating of the content of the written information has gone up from a 87% in �000 to a 96% in �004. Furthermore the extent of information and the correspondence between the information received from different staff members has gone up, as well as the ratings for the waiting time between referral to the hospital to the actual admission and waiting time during the hospital stay which prolonged the stay in hospital. Also the patients increasingly find that their general practitioner has been well informed of their hospital stay.

The only statistical significant drop, of � percentage points in the period from �000 to �004, is concerning information of who to approach with questions during the hospital stay.

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Conclusion

The survey shows that patients overall have a positive view of their hospital stay. 90% of the respondents rate their hospitalization experience as “good” or “very good”. Despite this there is still need for improvement, especially concerning continuity, information, involvement and medical errors.

The results of the survey, along with other national quality projects, are to be used to maintain or improve the quality level at the hospitals and to target improvement initiatives to be carried out in each hospital.

It is expected, that the national survey will become an important tool in the accreditation process in Denmark as a baseline and follow-up measurement of patients experiences.

Figure 1 Overview of the national results.

Question 22Content of the written information 96% 4%

Question 27Confidence in the professional skills of the care takers 95% 5%

Question 26Confidence in the professional skills of the doctors 93% 7%

Question 11The responsiveness of the nurses 92% 8%

Question 9Information from the hospital ward at admission 90% 10%

Question 36Overall impression of the hospital stay 90% 10%

Question 28The collaboration by the nurses and doctors in the care and treatment 90% 10%

Question 10The amenability of the doctors 90% 10%

Question 33Feeling secure at the discharge 87% 13%

Question 31bInformation at discharge on medication 87% 13%

Question 23The content of oral information during the hospital stay 86% 14%

Question 17The observance of plans 85% 15%

Question 35Overall impression of hospital premises 85% 15%

Question 5Knowledge of who to approach if conditions changed while waiting to be admitted 83% 17%

Question 25Correspondence between the information received from different staff members 83% 17%

Question 18Errors during admission 82% 18%

Question 32The collaboration at discharge by the hospital and municipal health visitors 82% 18%

Question 15Involvement of patients 81% 19%

Question 30Conclusive conversation at discharge with a doctor or nurse 80% 20%

Question 24The extent of information during the hospital stay 79% 21%

Question 34Information given to general practitioner 78% 22%

Question 16Involvement of relatives 74% 26%

Question 31cInformation at discharge of ancillary equipment in the home 73% 27%

Question 31aInformation at discharge of post-treatment/rehabilitation 72% 28%

Question 20The handling of errors by the staff 70% 30%

Question 29Waiting time during the hospital stay, which prolonged it 70% 30%

Question 4Waiting time between referral and admission 63% 37%

Question 31dInformation at discharge of the influence of lifestyle on health 63% 37%

Question 12Information of who to approach with questions during the hospital stay 58% 42%

Question 141-2 nurses with a special responsibility 57% 43%

Question 31eInformation at discharge of the consequences of the illness for the future 55% 45%

Question 131-2 doctors with a special responsibility 52% 48%

Question 21Received written information in connection to the hospitalization 45% 55% (prior or/and during the hospital stay)

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

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

Positive %

Negative %

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Figure 1 Overview of the national results.

Question 22Content of the written information 96% 4%

Question 27Confidence in the professional skills of the care takers 95% 5%

Question 26Confidence in the professional skills of the doctors 93% 7%

Question 11The responsiveness of the nurses 92% 8%

Question 9Information from the hospital ward at admission 90% 10%

Question 36Overall impression of the hospital stay 90% 10%

Question 28The collaboration by the nurses and doctors in the care and treatment 90% 10%

Question 10The amenability of the doctors 90% 10%

Question 33Feeling secure at the discharge 87% 13%

Question 31bInformation at discharge on medication 87% 13%

Question 23The content of oral information during the hospital stay 86% 14%

Question 17The observance of plans 85% 15%

Question 35Overall impression of hospital premises 85% 15%

Question 5Knowledge of who to approach if conditions changed while waiting to be admitted 83% 17%

Question 25Correspondence between the information received from different staff members 83% 17%

Question 18Errors during admission 82% 18%

Question 32The collaboration at discharge by the hospital and municipal health visitors 82% 18%

Question 15Involvement of patients 81% 19%

Question 30Conclusive conversation at discharge with a doctor or nurse 80% 20%

Question 24The extent of information during the hospital stay 79% 21%

Question 34Information given to general practitioner 78% 22%

Question 16Involvement of relatives 74% 26%

Question 31cInformation at discharge of ancillary equipment in the home 73% 27%

Question 31aInformation at discharge of post-treatment/rehabilitation 72% 28%

Question 20The handling of errors by the staff 70% 30%

Question 29Waiting time during the hospital stay, which prolonged it 70% 30%

Question 4Waiting time between referral and admission 63% 37%

Question 31dInformation at discharge of the influence of lifestyle on health 63% 37%

Question 12Information of who to approach with questions during the hospital stay 58% 42%

Question 141-2 nurses with a special responsibility 57% 43%

Question 31eInformation at discharge of the consequences of the illness for the future 55% 45%

Question 131-2 doctors with a special responsibility 52% 48%

Question 21Received written information in connection to the hospitalization 45% 55% (prior or/and during the hospital stay)

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

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

Positive %

Negative %

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Figure 2 Differences between hospitals (percentage point difference between highest and lowest rated hospital).

Question 27Confidence in the professional skills of the care takers 9

Question 11The responsiveness of the nurses 11

Question 26Confidence in the professional skills of the doctors 12

Question 22Content of the written information 12

Question 10 The amenability of the doctors 14

Question 28The collaboration by the nurses and doctors in the care and treatment 16

Question 9Information from the hospital ward at admission 16

Question 31bInformation at discharge on medication 18

Question 33 Feeling secure at the discharge 19

Question 23The content of oral information during the hospital stay 20

Question 36Overall impression of the hospital stay 21

Question 30Conclusive conversation at discharge with a doctor or nurse 21

Question 17The observance of plans 22

Question 25Correspondence between the information received from different staff members 22

Question 5Knowledge of who to approach if conditions changed while waiting to be admitted 22

Question 15Involvement of patients 24

Question 24The extent of information during the hospital stay 24

Question 18Errors during admission 24

Question 16Involvement of relatives 25

Question 131-2 doctors with a special responsibility 30

Question 31dInformation at discharge of the influence of lifestyle on health 30

Question 31aInformation at discharge of post-treatment/rehabilitation 32

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

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Question 141-2 nurses with a special responsibility 33

Question 29Waiting time during the hospital stay, which prolonged it 35

Question 31eInformation at discharge of the consequences of the illness for the future 36

Question 34Information given to general practitioner 36

Question 20The handling of errors by the staff 36

Question 31cInformation at discharge of ancillary equipment in the home 37

Question 12Information of who to approach with questions during the hospital stay 39

Question 32The collaboration at discharge by the hospital and municipal health visitors 40

Question 35Overall impression of hospital premises 51

Question 4Waiting time between referral and admission 56

Question 21Received written information in connection to the hospitalization 73 (prior or/and during the hospital stay)

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

explanation of figure: Every bar shows number of percentage point difference between the lowest and the highest ranged hospital to each of the questions in the survey. For instance there is a 30 percentage point difference concerning 1-2 doctors with special responsibility. At the highest placed hospital 70% of the patients answered “Yes” and at the lowest placed hospital 40% of the patients answered “Yes”. The results in the figure have by direct standardization been adjusted for differences in age, gender and admission form (acute/remitted).

National Danish Survey of

Patient Experiences

UNIT OF PATIENT EVALUATION, Copenhagen CountyOn behalf of the Ministry of Interior & Health and the Regional Councils

Comparative study of in-patient evaluation at 54 public Danish hospitals

September 2005

National Danish Survey of Patient Experiences Comparative study of in-patient evaluation at 54 public Danish hospitals

UNIT OF PATIENT EVALUATIONGlostrup University Hospital, section 87Nordre RingvejDK-2600 GlostrupTel. (+45) 43 23 34 55Fax. (+45) 43 23 44 72E-mail: [email protected]