The Lakeridge Health hospital at Oshawa, Ontario sends out a questionnaire and covering letter to those who have been discharged after a stay in hospital. For UK users of similar questionnaires, there will be few surprises both in the ground covered and the survey approach especially when you see that the company running the exercise is NRC Picker Canada.
What impressed me the most was the quality of the covering letter which addresses questions that many managers prefer to avoid or gloss over when doing these sorts of surveys. For example, the letter confronts head on one of the main reasons why people do not respond. They are scared that if they say bad things about their stay in hospital, bad things will happen when they are back in. “Please feel free to express your opinions frankly and be assured that your future care at the hospital will not be negatively impacted.” They go on to offer more reassurance by saying that no one from the hospital will contact you about your comments – not least because they do not get any personal information from the survey company. A name and telephone number is given if people do want to talk to someone “directly regarding your care experience”.
The other nettle to be grasped is sending questionnaires out if the person has died. The way Lakeridge Health addresses the issues is first to say that they try their best not to send out questionnaires “to families of patients who have passed away”. They go on to write “If a grieving family member receives this letter, please accept our heartfelt condolences and our sincere apology”. However if people do have things they would like to get off their chest, then “If you would like to respond on behalf of your loved one, you may certainly do so, but it is not our intention to add pain to your sorrow and grief”. This is common and good practice – when we do complainant questionnaires, it is very important to avoid sending them to the families of the dead.
The fact remains that hearing from families and carers about what happened in these distressing circumstances, is actually very useful. Information can offer some very useful insights into how processes and policies in this highly sensitive area can be improved just as in any other service context. We were reminded of this when we did a group discussion amongst people who had cared for someone who had recently died where the insights offered gave us a very valuable extra dimension to the patient experiences we were collecting. However a self-completion questionnaire received out of the blue by the grieving family is a disastrous way to go about this. All of you who have had to manage a death in the family will remember how many forms had to be filled in to satisfy everyone from the Registrar of Births and Deaths to the Inland Revenue and how the heart sank with each post bringing more forms. A questionnaire enquiring amongst other things about the quality of hospital food is an unwanted extra chore.
The experience merits a more personal approach and one where specialist interviewers will help make sure that the people interviewed are treated with compassion and respect.
The topic is very relevant in a UK context given the introduction of PROMS – Patient Reported Outcome Measures – into the NHS shortly as part of the post-Darzi drive for quality in everything the NHS does. The most important measures of quality are measures of the outcomes of care, and that can include a “good death” as assessed by relatives. The best assessment of outcomes will usually be provided by the patient. Florence Nightingale had these too. All her patients on leaving hospital were recorded “relieved, unrelieved, dead”. It has taken us a long time to do as well as Miss Nightingale in many things, but from April 2009 the NHS will have pilot schemes for rather more sophisticated patient outcome measures for hip and knee replacement, inguinal hernia repair and varicose veins.
Let us hope our questionnaires on pain, mobility, depression and anxiety, and the ability to undertake the normal activities of daily life after the hospital experience are at least as tactful as the letter from the hospital in Oshawa.