Hospital Patient Care Surveys
September 2002
Putting the patient first is a challenge that requires not just a huge change in the mindset of all the stakeholders in healthcare provision, but also the means by which to measure the levels of satisfaction of patients, and to discover what matters to them before, during and after their visit to any hospital.
Patient quality initiatives, with their softer, experiential focus than clinical audit, with its precise and scientific methods of measurement, demand different measurement techniques. Often, the most effective means is to adapt from the survey techniques widely practised in social research and market research by using surveys and objective self-completion questioning techniques. Yet, without careful management, the measurement teams can drown in a sea of questionnaires. Surveys are labour intensive, so it makes sense to use software developed to handle surveys in this context too, and make the process into something that can be managed by the small teams usually given this responsibility within the hospital.
In this focus, we see two hospitals, Cork University Hospital in Ireland, and Wexham Park Hospital in England, where using Snap Survey Software has transformed the work of each hospital’s respective Quality Unit and Clinical Audit departments, and allowed them to cope with a massive increase in the throughput of work without the need to take on extra permanent staff to handle the data entry or processing of the questionnaires.
Case study 1: Cork University Hospital Snap relieves the burden of growth in an expanding quality program
Cork University Hospital, one of Ireland’s two leading academic teaching hospital outside Dublin, has used Snap to bring quality and satisfaction monitoring to all aspects of its care from the patient’s operation right through to the bedside cup of tea. For this busy, 550 bed general hospital serving the largely rural region of Munster, it is part of a co-ordinated initiative to put the patient at the centre all the hospital does, by implementing a programme of continuous quality improvement or CQI across all the hospitals departments and disciplines.
The hospital formed a dedicated Quality Unit, with four full-time and one part-time member of staff, to monitor the effectiveness of the CQI initiatives. The team has developed from the former clinical audit department and now focuses on all aspects of patient care. Its principal tool is the survey, created and processed using Snap, many of which are completed by patients while at the hospital. Others are completed by staff, or used directly by the Quality Unit’s staff as an efficient way to gather data from hospital records.
For Marie Fitzgerald, Head of the Quality unit, a major advantage of using Snap the appearance of the printed questionnaire form. "People find it is eye catching," Marie reports. "They are quite impressed and that means they are more inclined to fill in a survey in that format than something just typed out.
For Marie Fitzgerald, Head of the Quality unit, a major advantage of using Snap the appearance of the printed questionnaire form. "People find it is eye catching," Marie reports. "They are quite impressed and that means they are more inclined to fill in a survey in that format than something just typed out. We also found our service providers were very impressed when we started sending these out. The whole layout and design gives it a professional appearance and makes it is much easier to fill it in."
With a mixture of nursing, clerical and research backgrounds in the Quality team, no-one claims to be a technology expert, yet everyone has been using the Snap software with great effect to design new surveys and to analyze the results, from the day Snap was installed. "Everyone can use it," Marie claims. "You don’t have to be an IT person or a computer specialist to use Snap."
As the QCI programme has developed across the hospital, the Quality team has found the number of surveys it undertakes grow to beyond sixty a year. Just one copy of Snap gave this small team the capacity to handle the initial growth. As the number of surveys grew, entering all the data was creating a backlog. Three new KeyStation licences, which include only the data entry capabilities of Snap, provided an affordable and cost-justifiable solution, freeing up the main licence for survey set-up and analysis.
The greatest benefit is the independence that the technology has brought to the team. Marie explains: "We can carry out the projects from beginning. Without this, I would have to depend on someone skilled in programming and who would probably be tied up permanently with this level of activity. It is a resource we just do not have."
It has also made the unit’s work more efficient. Marie estimates it has saved her staff a lot of time. "I don’t know how we would manage without it now," she says. "Our turnaround time is faster, from beginning to end. But the key is when you start cross-tabulating it all. People always want more when it comes to the results. Trying to do the same in a database or spreadsheet requires a higher level of skill, but this is something that anyone in the office can use."
Case Study 2: Snap More than a ten-minute wonder at Wexham Park Hospital
Wexham Park Hospital brought a new meaning to the phrase "a ten-minute survey" when Jane Hartley, its Head of Clinical Governance Development, managed to set-up an overlooked feedback survey from scratch, and get the copies distributed, all in a record-breaking ten minutes, thanks to Snap.
Jane and her ten-strong team, five of whom specialize in clinical audit and the others in clinical research, make extensive use of Snap to design a wide range of surveys among patients and the hospital’s medical and support staff, though usually to more manageable timescales. Many of these surveys are also scanned, using Snap scan to drive an optical character recognition scanner.
"Even if we are not going to scan a particular survey, we will still do the formatting in Snap," says Jane, citing the speed of the set-up and the professionalism of the survey form created as providing major advantages over using a word processor.
Jane also makes Snap available to others in the hospital that have a need to do surveys, such as for national audits and nationally funded clinical research programmes, or career-based research that doctors are carrying out. "We encourage that those running the study use Snap and do the keying in themselves,"
Jane also makes Snap available to others in the hospital that have a need to do surveys, such as for national audits and nationally funded clinical research programmes, or career-based research that doctors are carrying out. "We encourage that those running the study use Snap and do the keying in themselves," Jane explained. "We give them support, and help them out if they get stuck, but they quickly learn how to use the software: it’s very simple to use." One recent study into transport had a sample of 2,000, so the person running that study was also taught to use the scanner. Jane advises anyone considering installing Snap to take some training first. "It was well worth it. It does not long to learn the questionnaires. Four of us went for a day’s training, because you need more than one person. Since then, we’ve been able to pass our knowledge on."
For scanning, Jane strongly advises giving someone the time to learn it properly. "It is not trivial: you probably need to devote a week over the period of a month to succeed. It is in the nature of scanning that there will be issues to resolve and you need someone who can pursue these," Jane reports. "The Snap HelpDesk are always very helpful, but it is not something where you can go on a one-day course then not use it for three months."
Snap has also removed two other major constraints on the survey process and ultimately the value of the results achieved. Jane encourages researchers to pilot or test their surveys on a very small sample. The ease and speed with which questionnaires can be revised in Snap means researchers are much more inclined to make radical changes to their questionnaires after the pilot, something Jane observes researchers were often "loath to do when designing it in Word or on paper."
The ability to scan means surveys can be constructed with much larger sample sizes. "We know we can cope with hundreds of forms without feeling daunted," says Jane.
It has encouraged the team to consider bringing in house one large, annual survey of patients which is currently conducted by a research agency at some cost. In addition, Jane and her team will be able to get much more from the data, by having direct access for the first time. "We would not contemplate this without something like Snap," Jane remarks.
The remarkable ten-minute survey, something else Jane never contemplated, occurred at a 100-strong conference she was attending at the hospital. She looked in the delegate pack as the speaker was urging the audience to complete the feedback form to realize, with horror, there wasn’t one: it had been overlooked. "Fortunately I had a template survey I could use," Jane recalls, "so I ran out of the room, spent five minutes modifying it in Snap, printed it off, photocopied it and was back handing it out in ten minutes literally hot off the press!"
How Snap can help with hospital patient research and feedback
The temptation is always there to design a survey in a word processor, in the belief that the data can be entered into a spreadsheet or database, analyzed and the results presented quickly and easily. For both of these users, such an approach would have prevented them from coping with a fraction of the work they now handle. With Snap, both have been free to keep ahead of the demands of their internal customers, and provide the kind of timely, objective and accurate information that managers and decision makers need to ensure their quality initiatives and patient-focused improvement drives are working. What Snap brings is:
- Efficiency in design, making it fast and easy to set up new surveys or adapt them from existing ones
- High quality, professional-looking survey forms or questionnaires, encouraging patients or others being surveyed to fill them in, and making it easier for them to do so
- Ease of access, so that the tool can be used by everyone in the team, not just one or two highly trained specialists or technicians
- Better accuracy throughout the data capture process, through built-in question design and data validation
- Efficiencies at every stage which save time and allow staff to handle ever larger volumes of work
- Capacity to grow, by adding new modules, networked capabilities, or automating high volume data entry through the use of scanning
- Integrated analysis, including all the basic tables and statistics needed for surveys, and graphs too, to cope with rising expectations for detailed information
- The ability to output data into specialist statistical packages or spreadsheets and databases, for participation in national research programmes or provide data to external researchers
In short, Snap brings to quality and clinical audit teams the ability to be independent, self-contained and produce results that not only look professional, but are truly professional!