Dossier n. 245/2014 [Abstract] Listening and changing! Citizens’ remarks and perceived quality in Health Trusts

Since more than 20 years, listening and involving health services’ users and citizens is a main goal of Emilia-Romagna Health Trusts.

In 2007 the Regional Laboratory for listening and involving citizens, community and health professionals was created at the Regional Agency for Health and Social Care; its flexible and dynamic nature makes it a container of constantly evolving tools for social research (questionnaires, focus groups, interviews, audits, open space technology, ...). These tools have different features (kind of service, target) but they all refer to a common theoretical model called dialogical approach, meant to promotes a shared knowledge among health professionals, patients and communities.

Among the activities developed by the Laboratory, this document presents:

• the informatics system to collect and manage citizens’ remarks;
• the surveys on perceived quality in ward services.

Since 2003 an informatics system was implemented in all the Health Trusts of Emilia-Romagna to collect and manage citizens’ remarks (complaints, praises, notes, suggestions); this system allows health organizations to have a feedback on their activities and to get data and information in order to improve care paths, to recognize their strengths and to increase citizens’ confidence in the Health system.

The volume presents the analysis of all remarks registered from January 1st through December 31st, 2013 and a study on the 2010-2013 trend of all kinds of remarks.

In 2013 21,769 remarks were presented (20,212 by citizens), in particular:

• 9,497 praises (43.6% of the total),
• 8,298 complaints (38.1% of the total),
• 3,047 notes (14% of the total),
• 431 suggestions (2% of the total),
• 496 improper remarks (3% of the total).

A constant increase of remarks can be noticed, with the only exception of 2012 with a little decrease.

The 2003-2011 trend analysis on the different types of remarks highlights a progressive reduction of the distance between complaints and praises, and in 2011 the inversion of the two trends is reached. The surprising aspect of 2013 is that the distance between praises and complaints is even more clear; compared to 2012 praises have consistently increased in both absolute and percentage values (+999, +3.4%) while complaints have decreased (-409, -3.1%).

Technical professional aspects” and “relational aspects” are the two areas that collect most remarks (12,122, 56% of the total); this demonstrates that citizens give importance to the competence and kindness of professionals.

In particular, as in previous years, technical professional aspects collected most remarks (38% of the total); this demonstrates that citizens pay attention to the quality of provision both in negative and in positive terms: the category received 1,977 complaints (corresponding to 24% of total complaints) and 6,159 praises (65% of total praises). The 2010-2013 trend analysis shows a very slight increase of complaints (+3%) and a strong increase of praises (+15%) for these aspects.

Relational aspects” collected more praises (2,774, corresponding to 29% of total praises) - in particular for “courtesy and kindness” (1,366, corresponding to 49.2% of praises for these aspects) - than complaints (850, 10% of total complaints). However, praises in this category do not have a constant positive trend, and between 2010 and 2013 a decrease of 119 (-6%) is registered.

The analysis of remarks distribution in the Health Trusts of Emilia-Romagna offers interesting indications as it represents an indicator of how each Health Trust uses the informatics system and also of how the population of that area believes that their opinion will be listened by the health organization. In particular, some aspects can be studied:

• general trend of remarks for each type;
• analysis of remark content;
• trend analysis per type, Health Trust and care function;
• analysis of remarks that can be useful for risk management;
• environments where remarks arise;
• remark analysis per outcome.

In the period 2010-2012 a large survey of perceived quality in ward services was implemented in 13 out of 17 regional Health Trusts, using a shared methodological protocol and a common questionnaire.

In the three years 32,918 questionnaires were collected, that is an amount of information that allowed to define validated and homogeneous data collection procedures and a rich reporting system at regional and Health Trust level.

Data show a general high level of satisfaction (average = 4.84 on a 1-6 scale); also in single quality areas referred to the dimensions that form the service, values are over the level of adequacy, and some of them confirm the results of the informatics system to collect and manage citizens’ remarks. In particular, the satisfaction for physicians (average = 4.84) and nurses (average = 4.97) reaches very high values; one of the aspect that represent an excellence aspect in the relationship between patients and professionals is “courtesy and kindness” (70% of extreme satisfaction).

The lowest values - still in a satisfaction level - are for:

• hospitality services: food quality, timetable, possibility to choose menu (average = 4.27);
• time between booking and effective hospitalization (average = 4.53);
• environments: space and temperature in rooms, quietness, bathroom cleanness (average = 4.61).

The survey on perceived quality in Health Trusts highlights large and interesting chances of in-depth analysis as specific improvement paths can be implemented to respond to criticalities found in single quality dimensions. The potentialities of reports allow to produce precise analyses on the basis of maps of perceived quality by patients; it is also possible to identify which kinds of patients (male/females, high/low level of education, urgent/programmed hospitalization) are more or less critical for each aspect. In this way the Trust improvement can be adjusted and modulated at best.

Both listening systems offer large reading possibilities and contributions to build quality indicators from user’s point of view, to evaluate the performance of Health Trusts and of the Regional Healthcare System.