ISQUA18-1307The Development, Implementation and Outcomes of a National Patient Experience Survey and Associated Quality Improvement Infrastructure: Lessons from Ireland

Abstract

Objectives: Patient experience surveys are regularly conducted in many countries in order to gather patient perspectives on the quality and safety of health systems, and inform approaches to quality improvement. However, there is evidence that insufficient consideration is given to the mechanisms for translating survey data into effective quality improvement. Barriers to using patient experience data for quality improvement include a lack of management support, timeliness of feedback and insufficient staff expertise in interpreting results. In developing Ireland's first national patient experience survey, authorities sought to address these barriers by leveraging a partnership approach between the health service, policymakers and regulators to build quality improvement into the design of the survey. The primary objectives were to develop and implement a robust survey to gather patient insights on their hospital stay, create an online dashboard for hospital staff to access tailored feedback in a timely manner, and produce clear quality improvement plans in response to survey findings. Methods: A cross-sectional survey design was used. Patients aged 18 and older who were admitted to a public acute hospital in May 2017 were eligible to take part. Participants received their questionnaire two weeks after discharge and were invited to reply online or via post. Hospital patients and staff were involved in developing the questionnaire, which ultimately comprised of 61 closed- and open-ended items on patients' experiences from admission through to discharge. Quantitative responses were standardised and compared using z-tests. National and hospital priorities for improvement were identified by calculating correlations between scores on each item and ratings of overall experience. Qualitative comments were analysed using a framework approach. An online dashboard was created to allow hospitals to access survey responses as soon as they were uploaded in order to inform local quality improvement initiatives. The survey received ethical approval from the Royal College of Physicians of Ireland. Results: 13,706 patients from each of Ireland's 40 acute public hospitals took part, representing a 51% response rate. National priorities for improvement included emergency department waiting times, patient involvement in their care and issues with discharge. Patients admitted on an emergency basis were significantly more likely to report a negative overall experience than other patients (p < 0.001). Health service personnel used data gathered through the online dashboard to create specific and time-bound quality improvement plans for each participating hospital, which were launched publicly at the same time as the overall survey results. Survey findings were integrated into the corpus of material used by the regulatory agency to monitor hospitals. Conclusion: The partnership approach adopted in Ireland facilitated the development and implementation of a robust patient experience survey and related quality improvement initiatives. Every hospital received timely and specific insights on their patients' experiences, enabling the creation of hospital-specific quality improvement plans. Extensive engagement and training helped foster management and staff buy-in to the survey, overcoming potential barriers to successful implementation. The initial success of the survey is encouraging but progress in achieving associated quality improvement must be monitored over the longer-term to comprehensively assess its impact.