Special report: National health survey ‘the first real effort’ to hear patients’ voices

Ireland’s first National Patient Experience Survey is “the first real effort” to hear the voice of the patients, according to Health Minister Simon Harris.

Minister for Health Simon Harris TD chatting with Sheila O'Connor from Patient Focus

At the survey launch in Dublin yesterday, he said it went “beyond the headlines” and the “political debate” to “actually talk to people who use the services”.

The results presented “a different picture to the one we focus on”, Mr Harris said.

“You see absolutely shortcomings, but you also see the overwhelming majority of people rating their experience in the Irish health service as good or very good and certainly, that’s not a normal part of our health discourse in this country.”

The survey, conducted by the Health Information and Quality Authority, Hiqa, found 84% of patients rated their experience within our 40 public acute hospitals as “good” or “very good”.

It also found that:

  • More than four in five felt they were always treated with dignity and respect in both the emergency department (ED) and throughout their stay in hospital;
  • The majority (85%) said they were always given enough privacy when being examined or treated on the ward;
  • More than nine in 10 felt they received clear answers from doctors and nurses on the ward either always, or sometimes.

The bulk of the 13,700 patients who responded to the survey also said they had confidence and trust in hospital staff. Almost all patients — 96% — felt their ward was very clean or fairly clean. And 82% felt staff did everything they could to help control pain.

On the downside:

  • 70% who came through the ED waited longer than the target time of six hours before being admitted to a ward;
  • Two in five said they did not always have enough time to discuss their care with a doctor;
  • More than a third (36%) said they were not always involved in decisions about their care.

About half of those surveyed — all adults who spent more than 24 hours in a public acute hospital in May — felt they could not always find a staff member to discuss their fears.

Sheila O’Connor, of Patient Focus, the national patient advocacy organisation, said while they were “relieved to see that a large number of patients said that they were treated with dignity and respect”, the issue of patients feeling they were “not involved enough” in decisions about their care needed to be addressed.

“We know from research that patients who are engaged in their healthcare decisions have better outcomes. We now have the opportunity to hear what the patient is saying and address these issues so that our health service can be improved for the benefit of all,” said Ms O’Connor.

A number of concerns were raised around discharge. Hiqa said it was “clear people did not have very positive experiences of discharge or transfer compared to other stages of care”.

Hiqa said patients who “are not sufficiently informed about their condition, their medication regime and how to care for themselves at home are at a higher risk of complications and of being admitted to hospital”.

Mr Harris acknowledged that the survey identified particular challenges in relation to discharge from hospitals. He said it brought him back to thinking about “the need for a statutory home care scheme in this country which we are working on and which we are going to deliver within another two years”.

“We’ve just gone out to public consultation. We need to make sure that when people actually leave the hospital they can go home and they can have support in their home. It’s very interesting that that is a significant area of concern that we obviously need to address as we move forward,” Mr Harris said.

The survey also found differences in patient experience between hospital groups and people of different age groups. The Saolta Group — taking in Letterkenny University Hospital, Portiuncla, Mayo, Merlin Park, Roscommon, Sligo and University Hospital Galway — emerged as the best performing in terms of care on the ward, examinations, diagnosis, treatment and discharges. The RCSI group, taking in Beaumont, Our Lady of Lourdes, Drogheda, Connolly, Cavan and Louth County, had the lowest patient scores for the same categories of care.

The Ireland East hospital group had the highest rating for admissions, while the UL hospital group, including University Hospital Limerick, had the lowest score in this area.

In terms of age groups, those under the age of 50 consistently reported more negative experiences of care than older age groups.

‘Dreadfully long’ waiting times in our hospitals

Leo Varadkar

Taoiseach Leo Varadkar said the country’s first national patient survey had highlighted experiences of dissatisfaction in hospitals, including concerns over waiting times, writes Joyce Fegan.

“There are also lessons to be learned,” he said.

“Many pointed out dreadfully long waits for admission from emergency departments,” Mr Varadkar said, at the launch of the National Patient Experience Survey.

University Hospital Limerick (UHL) was one of the hospitals where patients had to endure a long waiting time, but management there has already taken steps to improve the situation.

UHL overall scored 7.9 in terms of patient satisfaction but 83% of its patients said they had to wait more than six hours before being admitted to a hospital ward.

Limerick City TD Maurice Quinlivan said UHL was highlighted as a “weak spot” in the national survey.

“The results for our main local hospital, UHL, are of concern as overall results from the patient survey indicate patient experience was below the national average.

“These responses are unsurprising as the trolley crisis and bed shortage in UHL is well documented and, unfortunately, shows no signs of improving with 878 people recorded on trolleys last month,” he said.

However, management at the hospital said a new emergency department opened at the end of May 2017. This was after the survey was distributed to patients, management said.

The new department has numerous private cubicles and treatment areas and a private end-of-life care area for patients and families.

There are also three projects underway in the hospital to improve waiting times and extra beds are now available with a short stay ward recently opened.

Another hospital that scored badly, was University Hospital Waterford (UHW), which received the lowest rating with a 7.7 mark.

Managment said they are taking steps to improve the patient experience of its emergency department with an acute medical assessment unit for investigation of non-emergency medical presentations being established.

Management said this will lead to reduced demand on the department. A transfer team has also been established to reduce the turn-around time for inpatient beds.

Dr Susan O’Reilly, CEO of the Dublin Midland Hospital Group (DMHG), which includes seven hospitals such as the Midland Regional Hospital Portlaoise and St James’s Hospital, said the survey provided the health service with a “baseline” of essential data.

“This is the first-time patients have been asked about their experiences in such a direct and joined-up way nationally. It provides the management and staff, across our group, with a crucial baseline information dataset from which to develop services and continuously enhance their delivery.

“This survey also helps to create and foster an environment, as it should be, where patients are central to shaping our hospital services and how they are rolled-out into the future,” Dr O’Reilly said.

Minister for Health Simon Harris said the survey highlights specific challenges that need to be addressed.

“The lowest amount of satisfaction was when it came to being discharged from hospitals, so 60% of people had a good or a very good experience when it came to being discharged or being transferred,” said Mr Harris.

Patient concerns to be addressed through action plans

Tony O’Brien and Simon Harris

Each of 40 public acute hospitals which took part in a National Patient Experience Survey has devised an action plan that responds directly to patients’ concerns, write Joyce Fegan and Catherine Shanahan.

That’s according to Tony O’Brien, director general of the HSE, who said the survey had “given us very specific information as to how each hospital can improve the way it interacts with every patient”.

“We can learn from this and improve the health service and that’s really what this experience survey is about,” he said.

The action plans were launched yesterday to tie in with the launch in Dublin of the survey, conducted by health watchdog Hiqa.

The HSE has set up a new governance structure to lead the development of a national plan to improve the quality of care in Irish hospitals.

The overall finding was that patients largely regarded their experience in hospital as positive, with 84% of the 13,700 who took part rating their experience as “good” or “very good”.

Rachel Flynn, Hiqa director of health information and standards and programme director for the National Patient Experience Survey, said she believed there was “a genuine will to make things happen in the hospital groups”.

She said they had given hospitals the heads-up on what patients were saying in relation to them throughout the survey so that they could begin improvements straight away.

A lot of patients had rated answers from doctors very positively, she said, but felt they did not always have enough time with them, or that family members didn’t have enough time.

“The clear message is that patients want themselves and their families to have more time to talk to doctors and hospital staff,” said Ms Flynn.

They also wanted more involvement in making decisions about their care.

“We know from research that those involved in and engaged in their care have better outcomes,” she said.

These were the types of comments fed back to the hospitals. There were three open-ended questions in the survey, which generated more than 21,500 patient comments, which Ms Flynn said provided “an incredibly rich source of data”.

Ms Flynn said the survey had been completed in three months and that Hiqa had been determined to get the results out this year to keep it relevant.

The survey extended to adult patients who spent more than 24 hours in a public acute hospital during the month of May.

Health Minister Simon Harris said there were “a number of things that need to be fixed in individual hospitals and also at a systems level”.

“The HSE has now put in place improvement plans for individual hospitals, this includes trying to improve our hospital food.

“We now have a team of people working in relation to that.”

“I, at the Department of Health, am about to conclude a bed capacity review where we identify the bed needs for the health service, not just now, but for the next 30 years. This will finally give us an opportunity to link demographic pressure with bed needs,” he said.

Eye and ear hospital scores top rating

The Royal Victoria Eye and Ear Hospital in Dublin received the highest ratings from patients, scoring 9.3 overall, writes Joyce Fegan.

A total of 83% of patients rated their overall experience as very good. This is against a national average of 54%.

Just 2% said they had a bad experience, whereas nationally this stood at 16%.

The highest rating from patients at the eye and ear hospital was in relation to having enough time to discuss their care and treatment with a doctor — 94% said they had an adequate amount of time to do this.

In relation to stages of care, patients rated their time on the ward as the best, with 79% saying the experience was very good.

Following closely, at 78%, patients rated their examination and treatment as very good.

People’s experience of discharge or transfer varied slightly, however, with 60% rating it as very good, 19% as good, and 21% as bad.

A total of 26% of respondents said they were not completely informed about danger signals to watch out for after they went home, and 28% said they were not told how they might expect to feel after an operation in a manner which they could understand.

In terms of food, 17% of patients rated it as fair or poor.

In relation to areas of improvement, 22% of people said they were not always as involved as they wanted to be in decisions about their care.

The eye and ear hospital is now taking steps, with a 2018 implementation date, to improve nutrition and to educate staff on improved communication at discharge.

Waterford hospital gets lowest rating

University Hospital Waterford

University Hospital Waterford (UHW) has received an overall rating of 7.7 from patients, which was the lowest experience rating of the 40 participating hospitals, writes Joyce Fegan.

A total of 75% of patients said they waited more than six hours before being admitted to a ward and 46% said they did not have sufficient time to discuss their care and treatment with a doctor.

Furthermore, 55% of people said that they could not always find someone on the hospital staff to talk to about their worries and fears.

Patients in all hospitals were asked about the various stages of their care from entry to discharge.

In UHW, 45% rated their discharge or transfer as poor and 46% were not fully informed about medication side effects to watch out for.

A total of 55% of patients also said that they did not always receive enough information from the hospital on how to manage their condition after discharge.

The average age of respondents was 62, and 76% of patients had entered UHW on an emergency basis.

Rachel Flynn, Hiqa’s director of health information and standards and programme director for the National Patient Experience Survey said it was important to point out when interpreting the UHW result that building work was underway at the hospital at the time of the survey.

She said: “They were doing construction work in UHW at the time — a lot of patients give out about that.” However “they [UHW] have lots of areas to improve”.

Standards of care varies at Cork hospitals, say patients

By Catherine Shanahan

Cork University Hospital (CUH)

83% of patients said they had a very good or good experience, compared with 84% nationally.

Patients reported positive experiences vis-a-vis information on their condition and the emotional support available when they experienced worries and fears. However, in the emergency department, 76% waited longer than six hours to be admitted. Long delays can have negative consequences for patient health.

The survey also found lack of privacy in the ward and emergency department while patients are being examined or treated.

Food is an area which also requires improvement, including the need for staff to support patients who require assistance at meal times.

Mercy University Hospital (MUH)

89% of patients said they had a good or very good experience, compared to 84% nationally.

The survey found people had confidence and trust in hospital staff and, overall, were treated with respect and dignity. Patients reported a very good standard of cleanliness in wards and bathrooms.

Areas in need of improvement include the emergency department where 81% reported waiting more than six hours to be admitted, while 13 people waited more than 48 hours.

The survey found communication with the patient during the discharge process requires improvement particularly in relation to explaining medication side effects.

South Infirmary Victoria University Hospital (SIVUH)

94% said they had a very good or good experience, compared with 84% nationally.

Staff placed a value on treating patients with respect and dignity and patients were given enough privacy when being examined or treated. Patients said they had confidence and trust in the staff, while many also said they were able to find someone to talk to about their worries and fears.

Discharge or transfer is one stage of care which needs improvement. In particular, communication during the discharge process was lacking in some cases.

Bantry General Hospital

94% said they had a very good or good experience, compared with 84% nationally.

People were treated with respect and dignity during their time in the hospital and also reported positive experiences of physical comfort and pain management. Communication as regards the discharge process is a key area for improvement; many people said they did not receive written or printed information on how to care for themselves at home. A number of patients also said they were not told about medication side effects and danger signals to watch out for after leaving hospital.

They also noted a lack of opportunities to talk to someone about their worries and fears.

Mallow General Hospital

99% said they had a very good or good experience, compared with 84% nationally.

The survey found that, in general, Mallow performed well, achieving scores above the national average for many questions. In particular, they rated highly during the examinations, diagnosis and treatment stage.

The majority reported that they were treated with privacy, respect and dignity and had confidence and trust in hospital staff. People also remarked positively about the standard of cleanliness.

However, people indicated some challenges relating to the discharge process, including a lack of printed communication about what they should or should not do at home.


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