You’d be hard pressed to find anyone who would choose a hospital stay over a trip to Disneyland. However, as Fred Lee controversially pointed out almost a decade ago in If Disney Ran Your Hospital, there are many points of overlap when it comes to customer—or patient—experience and satisfaction. The focus on measuring and improving patient experience has grown by leaps and bounds since the early 2000s. Where does Accreditation Canada fit in this picture?
As part of the accreditation process, Accreditation Canada client organizations that provide acute care services are required to administer a patient/resident experience survey at least once during the accreditation cycle and report the results. They have the option of using their own survey tools and processes, a vendor’s, or resources from Accreditation Canada. This requirement is being extended to organizations providing long-term care and corrections health services, effective January 2015. The intent is to ensure that the experiences of those who use the services are being monitored and the information is used to inform quality improvement initiatives.
However, measuring patient experience is just one part of the puzzle. In the past few years, Accreditation Canada has been exploring how to go that extra step. How to help our client organizations actively and consistently improve patient experience? This led to a comprehensive shift in focus throughout the accreditation program. In keeping with our patient safety strategy and progress in the field, and following extensive consultation, Accreditation Canada re-vamped the standards to strengthen and broaden the patient- and family-centred components. This change reflects and promotes the need for honest and real involvement by patients and families throughout the care process.
Accreditation Canada’s standards and criteria address the policies, practices, and processes that need to be in place to provide safe, high-quality care. Specific and targeted patient- and family-centred care elements have been integrated throughout the majority of the standards, covering all aspects of planning, delivering, and evaluating services. The process included identifying different levels of patient engagement and collaboration that were expected, as follows:
- The activity is the responsibility of the organization’s care team. Patient and family engagement is not required, but it is also not precluded.
- The activity is conducted in collaboration with patients and families, defined as either:
- In partnership with the client and family: The team collaborates directly with each individual client and their family to deliver care services. Clients and families are as involved as they wish to be in care delivery.
- With input from clients and families: Input from clients and families is sought collectively through advisory committees or groups, formal surveys or focus groups, or informal day-to-day feedback, and their perspectives are used to inform service delivery.
In addition, while current standards emphasize “who” is responsible for a particular action, the approach has been changed to emphasize (a) what is expected and (b) how patients and families are to be engaged.
Throughout, the focus is on creating and nurturing mutually beneficial partnerships among and between the organization’s staff and the people they serve. It means working collaboratively with patients and their families to provide care that is respectful, compassionate, culturally safe, and competent, while being responsive to their needs, values, cultural backgrounds and beliefs, and preferences (adapted from the Institute for Patient- and Family-Centered Care (IPFCC) 2008 and Saskatchewan Ministry of Health 2011). As part of this process, Accreditation Canada adopted the following four values that are fundamental to this approach, as outlined by the IPFCC:
- Dignity and respect: Listening to and honouring patient and family perspectives and choices. Patient and family knowledge, values, beliefs, and cultural backgrounds are incorporated into the planning and delivery of care.
- Information sharing: Communicating and sharing complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete, and accurate information so they can effectively participate in care and decision-making.
- Partnership and participation: Encouraging and supporting patients and families to participate in care and decision making to the extent that they wish.
- Collaboration: Collaborating with patients and families in policy and program development, implementation and evaluation, facility design, professional education, and delivery of care.
The Beryl Institute defines patient experience as “the sum of all interactions, shaped by an organization’s culture that impact patient perceptions across the continuum of care.” How can we create a culture where patient experience is front and centre? It’s more than smiles and sunbursts. It’s putting care providers in patients’ shoes … or their wheelchairs. It’s acknowledging and respecting how it feels to be in a health care environment, often involuntarily, when you are feeling sick, anxious, and vulnerable.
We know that the changes to the accreditation program—being released in 2015 for on-site surveys starting in 2016—may pale next to a ride on Space Mountain or a photo with Mickey. But they will provide support and direction to our client organizations as they work to truly improve patient experience across the board. And that’s no small success.