Enhancing the Patient Experience at Lakeridge Health, Oshawa

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1 Lakeridge Health report_05_layout :37 AM Page 1 Enhancing the Patient Experience at Lakeridge Health, Oshawa Final Report of the Patient Experience Panel August 2016

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3 EXECUTIVE SUMMARY I came to the Emergency Department and they treated me poorly; I told them what was wrong and they didn't listen; I complained and nothing happened, so here I am on social media to share my story. That is a paraphrasing of the issues Lakeridge Health, Oshawa (LHO) faced earlier this year. The situation unfolded as follows: In February, 2016 an Oshawa woman visited the Lakeridge Health Emergency Department (ED) in Oshawa with her six-year-old daughter twice without resolving her child s complaints. The woman then took her daughter to SickKids in Toronto where she said her daughter was admitted, spent three weeks in the hospital, and was diagnosed with Kawasaki disease. Another woman visited the Oshawa ED in February after her two-year-old daughter was gagging intermittently and had trouble swallowing. An X-ray taken at the Ajax hospital days later showed the girl had a button battery lodged in her esophagus. The child was taken by ambulance to SickKids where the battery was removed four days after she first swallowed it. Both mothers posted their stories on Facebook, created a Facebook page called What happened to you at Lakeridge Health Oshawa? and started a petition calling for changes at the hospital. Speaking to the media, interim Lakeridge Health president and CEO Tom McHugh committed to addressing the issues raised by these incidents. He was quoted as saying there had been a negative trend in feedback regarding the Oshawa ED and that the hospital needed to address this trend. On April 7, 2016 a four-member Patient Experience Panel (PEP) was appointed to review the patient experience of the ED at the LHO site and review the process for how the hospital listens and responds to formal patient concerns. In preparing their report, Panel members held meetings with patients, patient experience advisors, staff and physicians at Lakeridge Health. On-site visits to the Emergency Department at the Oshawa site as well as the site as a whole were conducted. Panel members also reviewed relevant documents and policies relating to Lakeridge Health (LH) including the strategic plan, patient reported experience measurement reports, the policy on patient/family complaints and compliments and the hospital social media policy for employees. The PEP makes a number of observations and recommendations with respect to patient relations, the patient experience at the LHO ED and for better using social media for patient engagement. In its strategic plan, LH says it wants to be recognized nationally as a leader in delivering the best patient and family experience. Based on what the Panel saw in the culture of the LHO ER, they have a very long way to go. Many of the recommendations focus on improving the patient experience at LHO as well as in improving the formal patient relations process. The recommendations focus on changing the organizational culture of staff, physicians and volunteers to make all patient and family visits to Lakeridge Health the best experience possible. Changes are also recommended to make the patient relations process more transparent and accessible for patients and family. While it is felt that responding to patient issues is the responsibility of all employees, the Panel recommends more clarity for staff and physicians about how the formal complaints process should work. A number of recommendations and options deal with improving the timeliness with which patients are seen in the ED and improving the environment and patient experience within the department. The PEP calls for education and training to improve communications among staff, physicians and volunteers and patients and family. Recommendations concerning social media focus on making better use of these tools and platforms and in ensuring patient issues posted to social media are responded to in a timely and effective manner. 1

4 BACKGROUND ENHANCING THE PATIENT EXPERIENCE AT LAKERIDGE HEALTH, OSHAWA In February, 2016 an Oshawa woman visited the Lakeridge Health Emergency Department (ED) in Oshawa with her six-year-old daughter and said she was sent home with antibiotics to treat the child s complaints. After completing the course of antibiotics with no change in the girl s condition and returning to the ER 10 days later, the woman told reporters hospital staff just told her that sometimes kids get sick. The woman then took her daughter to SickKids in Toronto where she said her daughter was admitted, spent three weeks in the hospital, and was diagnosed with Kawasaki disease. According to media reports, she had infections in her joints, and encephalitis, requiring five spinal taps. Another woman visited the Oshawa ED in February after her two-year-old daughter was gagging intermittently and had trouble swallowing. She said she was also sent home after being told her daughter likely had a cold or flu. After receiving similar advice from her family doctor, a walk-in clinic and the Markham Stouffville ER, an X-ray taken at the Ajax hospital days later showed the girl had a button battery lodged in her esophagus. The child was taken by ambulance to SickKids where the battery was removed four days after she first swallowed it. Both mothers posted their stories on Facebook and created a Facebook page called What happened to you at Lakeridge Health Oshawa? and started a petition calling for changes at the hospital. The Facebook page subsequently hosted several stories critical of conditions at Lakeridge Health and the behavior of staff at the hospital. Speaking to the media, interim Lakeridge Health president and CEO Tom McHugh committed to addressing the issues raised by these incidents. He was quoted as saying there had been a negative trend in feedback regarding the Oshawa ED and that the hospital needed to address this trend. I think we have seen a pattern around communication in the emergency room, we ve seen a pattern of people who raise concerns with us... even if they got good care, the perception of their good care was coloured by the fact that communication wasn t the best, McHugh said. Internal reviews were conducted by LH on both cases for the purposes of quality improvement/education. Such reviews are done on many cases with adverse outcomes as part of LH s quality oversight program. MANDATE AND PANEL ACTIVITIES On April 7, 2016, LH appointed a four-member Patient Experience Panel (PEP) to review the patient experience of the ED at the LHO and review the way the hospital listens to and acts on patient issues. Specifically, the Panel was mandated to review, develop and support implementation of sustainable systems and processes to enhance the patient experience in the Emergency Department at Lakeridge Health, Oshawa; improve the formal patient complaint process; and 2

5 Final Report of the Patient Experience Panel improve interactions with patients through social media. As the PEP began its work, a patient representative was added who participated fully in all meetings and in preparation of the final report. Biographies of the Panel are included in Appendix I. In addition to responding directly to recent incidents involving the LHO Emergency Department, the Panel was also created to help Lakeridge Health carry out the vision in its new five-year strategic plan: Excellence every moment, every day. More specifically, the Panel was asked to provide input on one of the key strategic directions of the new plan to provide the best experience for you and your family. Two goals of the plan call for putting patients and their families at the centre of decision making and to have LH be recognized nationally as a leader in delivering the best patient and family experience. In announcing the Panel, interim Lakeridge Health president and CEO Tom McHugh stated: The people of Lakeridge Health deliver excellent care and we care deeply for our community. So when our community asks us to do even better, we not only rise to the challenge, we embrace it. We ve listened and responded thoughtfully by pulling together a strong team of highly qualified experts who will help us improve. We re excited to welcome these leading experts to our hospital and we re confident they have the skills, experience and knowledge to address the concerns we ve heard and help us deliver on our Strategic Plan s goal of making Lakeridge Health a national leader in the patient and family experience. The Panel was charged with focusing on three key deliverables: Reviewing the current state and conducting a gap and root cause analysis as well as confirming key priorities Determining the preferred future state based on best practices and benchmarking with peers Developing a final written report, including recommendations for implementation The guiding principles for the project were: Accountability: The Panel reported to the senior management team (SMT), who will be accountable for delivering on its recommendations and report to the board. During the work of the Panel, regular meetings were held with a hospital task force who fully supported and facilitated Panel activities. Visibility: LH Communications will report to the hospital and to the community on the ongoing activities of the Panel to show the full commitment of the organization to the process. Measurability: The Panel must make recommendations that are practical and quantifiable, and whose application will directly impact patient care. Transparency: While experts in the three key areas are informing the Panel, the work must be done together and openly with patients, patient advisors, staff and physicians to be successful. The hospital committed to making the report public upon its completion. 3

6 Lakeridge Health report_05_layout :38 AM Page 4 Enhancing the Patient Experience at Lakeridge Health, Oshawa In its strategic plan, LH says it wants to be recognized nationally as a leader in delivering the best patient and family experience. Based on what the Panel saw in the culture of the LHO ER, they have a very long way to go. In the course of preparing their report, PEP members held meetings with patients, patient advisors and staff at Lakeridge Health. Specifics of these meetings are detailed in the Appendices to this report. On-site visits to the Emergency Department at the Oshawa site as well as the LH site as a whole were conducted. Observation of activities in the ED included visits by two students who observed activities in the department and the behavior of staff and physicians without identifying their role in assisting the work of the Panel. The PEP also reviewed relevant documents and policies relating to Lakeridge Health including the 2016 Strategic Plan, patient reported experience results for the ER from the patient surveys conducted by National Research Corporation Canada (NRCC) on behalf of Lakeridge Health, the policy on patient/family complaints and compliments and the hospital social media policy for employees. Actual complaints dealt with by the hospital, with names omitted to protect the anonymity of those involved, were also reviewed. 4

7 Lakeridge Health report_05_layout :38 AM Page 5 Final Report of the Patient Experience Panel Best practices in patient relations, patient experience in the ED and use of social media in health care settings were identified in the literature and through the experiences of Panel members. Excluded from the scope of work for the Panel was any review of the clinical competencies of staff or physicians at Lakeridge Health. While improving the patient experience and patient relations at LHO formed the core of the recommendations from the Panel, use of social media by the hospital also forms a part of the final report. Patients continue to use direct contact, phone and as the main conduits for communicating with the hospital. However, given the specific incidents prompting this review and the lack of published materials on best practices in use of social media by health care institutions it was felt this area warranted special attention. In its strategic plan, LH says it wants to be recognized nationally as a leader in delivering the best patient and family experience. Based on what the Panel saw in the culture of the LHO ER, they have a very long way to go. 5

8 Enhancing the Patient Experience at Lakeridge Health, Oshawa FINDINGS I came to the Emergency Department and they treated me poorly; I told them what was wrong and they didn t listen; I complained and nothing happened, so here I am on social media to share my story. The focus of the work of the PEP aimed to address the main issues paraphrased above. To do this, on-site evaluations of the ED at LHO were conducted by PEP members in addition to holding individual and focus-group meetings with ED staff, physicians and patients. Additional meetings were held with various representatives of the Patient Relations Department as well as patients and Patient Experience Advisors. As a result of these evaluations and interviews, a number of opportunities were identified to improve the patient experience in the hospital emergency department. Culture Some of the suggested recommendations relate to purely cosmetic enhancements within the ED while others are options for improving the patient flow within the department. The most fundamental concerns identified by Panel members relate to the culture of staff and physicians working within the ED and the need to change this to focus more on improving the patient experience. Several conversations with Lakeridge staff revealed that, currently, budgetary and efficiency concerns often take priority over maximizing patient satisfaction and care in the ED. The PEP felt there was a need to balance this need to be efficient with a commitment to taking the time to listen to what patients and families want and need. Despite the dedication of Lakeridge staff, physicians and volunteers in the ED, Panel members feel initiatives are needed to develop a comprehensive, patient-centred culture and a welcoming environment for patients in the ED. Exemplary behavior was observed in some staff, physicians and volunteers, but this was not consistent. Unfortunately, instances were reported where patients and their concerns were viewed in a negative light. The PEP heard that, in some instances, patients don t come forward with complaints because they don t feel their concerns will be addressed and in other cases they fear being labelled as problem patients if they do voice a concern. Part of the culture change requires a new perspective on patient complaints that adopts the attitude of What can I (we) learn from this complaint? rather than just taking the complaint as a personal affront. It was pointed out to the PEP that patients in the ED want a definitive diagnosis within a reasonable period of time. They also want to feel reassured they will be treated with empathy and compassion. No matter how busy the ED is, and how large the patient caseload, the PEP felt it was important that staff and physicians take the time to listen to the patient. Having a better experience with the staff and physicians can make the world of difference in the ED experience. This can be accomplished by taking a number of steps well described in the literature that require the 6

9 Final Report of the Patient Experience Panel demonstration and ongoing use of specific behaviours. Examples include having the physician sit (even briefly) when taking the history; a dedicated focus on what the patient is trying to convey (i.e. presence); active listening; accounting for time; and the use of a tool such as the Studer Group s AIDET (a tool developed to aid all health care providers in communications with patients). A clear need was identified to change the culture of the institution to put the patient first and make patient relations the responsibility of all staff, physicians and volunteers at Lakeridge Health. How Lakeridge communicates and responds to patients and families from the moment they come to a Lakeridge Hospital site needs to be clearly understood by all staff, physicians and volunteers. Changing the culture so all staff, physicians and volunteers make patient experience a priority should also reduce the number of complaints received by the Patient Relations Department and the process of having to deal with these issues formally. Awareness Another significant issue identified at LH was the lack of awareness among patients and family members about the Lakeridge Health policy and practices on patient issues and the process for bringing forward a concern or even a compliment about the institution. Much more can, and should, be done to make it clear to patients and family how they can raise an issue or voice a concern about care or service at Lakeridge and to alleviate the fear of bringing a complaint forward. Patient Experience Advisors noted that information on how to file a complaint was not easy to find, navigate or understand. Simple initiatives such posting the complaints/compliments process prominently on the hospital website can make a big difference. Making business cards of managers available in all patient care units is another positive approach which has already been tested as a pilot project at Lakeridge. Patient Experience Advisors identified that a well formulated procedure with expected timelines, acknowledgement of initial contact, continuity of person(s) accountable and an apology are key elements of the process. They also stressed that it is important for LH to acknowledge that something did occur and that complaints be taken seriously. Operational Performance The need to enhance to the patient experience at the LHO ED begins before patients even enter the department with the need for better signage to help people find the ED. Emergency Department patients are stressed physically and emotionally and are often unfamiliar with hospitals and EDs. Patients and their families need to know where the ED is, where to park, how to enter the ED, etc. Being disoriented or lost only exacerbates what may already be an anxiety-provoking situation. The negative impact on hospital image, confidence in the facility and its caregivers and trust is significant. Good directional signage both external and internal to the ED is important. Studies show that the physical environment for emergency care can influence overall perceptions of health care. Research demonstrates that patients want a safe, comfortable place to wait, including pleasant surroundings, comfortable seating, as well as providing for groups such as children, the elderly, those with behavioural disturbances, and people with disabilities such as people with hearing and/or sight issues. Waiting rooms need to provide privacy in a public space and be flexible enough to accommodate different types of waits and users. It needs to provide comfort in uncomfortable situations and support learning and education within the boundaries of space. Various options exist to improve the situation when patients arrive at the ED. These range from ensuring the existing waiting room is clean and welcoming to revisiting the need for a waiting room for all patients in emergency. Currently, patients with various conditions including those with mental 7

10 Enhancing the Patient Experience at Lakeridge Health, Oshawa health issues share the waiting room with those who have already seen a physician and are awaiting further care and those who have been asked to return for further investigation and care. The Panel felt Lakeridge Health should investigate various options to remedy this situation one option being a total elimination of a common waiting room outside the ED. After checking to ensure a patient is not infectious there is no reason to keep patients waiting outside the department. If a waiting room is maintained, measures can be taken to fill unoccupied time such as providing stations to recharge mobile devices for patients forced to wait for a long time and ensuring video screens are functioning. Uncertain waits feel longer than known, finite waits. The issue of ED overcrowding also arose. When the ED hallways are overloaded with admitted patients, the Panel felt LH may want to consider whether it would be better for patients if they were distributed through the large number of hallways on the patient care units rather than concentrated in the hallways in the ED. This would bring patients closer to the nurses specialised in looking after their type of problem, put them in quieter hallways where sleep might be possible, and frees up ED space from being so crowded the overcrowding impedes care of ED patients. The Panel acknowledges there are numerous implications to this change that LH would have to consider before its implementation. Nevertheless, having a surge plan that removes admitted patients from the ED so the ED can look after ED patients effectively is best practice. During the evaluation of the LHO ED by the PEP, a number of other issues were identified that impact various services not related to the specific complaints addressed in the report. For example, it was felt certain aspects of reporting could be improved to better reflect the status of the ED. The bed flow status report for the ED patients often shows 35 admitted patients in the morning and in the afternoon this number is down to 20. There are still 35 patients in the ER the new number just means they ve been assigned to a bed but have not been moved to the bed; thus, everyone outside the ER feels that the backlog has been addressed when it has not been addressed at all. Other specific issues involving various services in the LHO ED were identified as requiring attention. Specialist services Specialist coverage in general was seen as lacking in the Lakeridge ED. Specialists were reported to not be responsive to pages in a timely fashion, and often backload patients until they have completed their other tasks. During most evenings the ED gets backed up by about 5 p.m. with all the patients waiting for specialists, and all the specialists trying to find space to see the patients. Psychiatry The provision of psychiatry services was seen as a patient flow and satisfaction issue. Collaboration between emergency physicians (EPs) and the crisis team is needed to optimize the care for patients with mental health issues so they can be evaluated and discharged promptly. For example, if the EP sees a patient initially, refers to the crisis worker (CW) and the CW feels the patient is dischargeable, it is best practice for the CW to return to the same or a different EP to re-assess the patient and institute a commonly agreed-upon plan. If the CW attends the patient before the EP does, such a discussion can take place when both have seen the patient. The CWs should be a resource to the ED, and not only to the psychiatrists. If the CW feels the patient needs a formal psychiatry evaluation, it is best practice that the psychiatrist attend the patient promptly and that the patient be placed in a therapeutic milieu on the patient care unit as soon as possible, and not spend many hours or days in the ED. 8

11 Final Report of the Patient Experience Panel Intoxication with various substances makes patient assessment unreliable. The serum concentration of most of these substances cannot be measured by the lab. Those that can be measured do not impact the clarity of the sensorium in a predictable way for example, a blood alcohol level of X or Y does not reliably predict how clear the sensorium is. For this reason, a patient s suitability for CW interview should be clinically assessed; substance serum concentrations are not normally used to determine this. Internal medicine Extending the hours when general internal medicine (GIM) consults are available in the ED could improve patient flow and satisfaction levels. A number of hospitals currently offer 24-hour access to internists and this is viewed very positively by emergency physicians working at those centres. Panel members felt an ED which sees as many patients as LHO should aspire to a similar level of service. The Panel also feels there would be value in having LH emergency physicians and internists collaborate to optimize the workup and turnover of patients requiring internal medicine services. It is noted that a robust hospitalist (non-internist GIM) service fills in hours not covered by internists at LHO, and is useful and appreciated. Some of the more complicated, obscure, or complex GIM presentations, however, require the services of internists. Urgent care In addition, it was noted Lakeridge ED patients do not have access to an Urgent Medicine-type clinic that is standard in large EDs. This is a clinic, usually operating daily, staffed by internists, that within a day or two of discharge can follow up patients who are sent home with some acute health issues still outstanding. It allows the discharge of patients from the ED who would otherwise either stay in ED longer, or be admitted, and is an essential tool for reducing the patient s length of stay and lowering the admission rate. Sedation Patients requiring sedation often wait long periods of time before being able to get a bed and nurse so they can be sedated. Either the wait generates dissatisfaction, or attempts to do the procedure without sedation (sometimes followed by failure, further wait, and then repeat procedure under sedation) generates dissatisfaction. An effort should be made to ensure that when sedation is required that the process not be delayed despite the challenges involved in doing this. While acknowledging that such a change may be resource-intense, the Panel felt this issue needs to be addressed. Diagnostic Imaging Access to diagnostic imaging modalities such as CT and ultrasound scans during off hours could be improved. In the current environment, patients requiring diagnostic imaging after midnight who are medically stable go home and come back the next morning during the busiest time of the day for the ED. Paying for parking twice is one of their annoyances, as well as having to wait twice to be seen by the EP. Fracture Clinic The fracture clinic could be more patient friendly. If a patient misses a fracture clinic appointment, they cannot re-book at the fracture clinic they must attend again at the ED and be referred again to the fracture clinic. 9

12 Enhancing the Patient Experience at Lakeridge Health, Oshawa Staff and Physician Engagement Issues relating to better communications between the LHO ED care team and the need to improve leadership in the ED were also identified. The Panel stressed the ED leadership need to adopt a boots on the ground mindset. During extremely busy periods it was felt the ED leadership team needs to be visible to staff and more importantly to patients and must interact with both groups. The PEP also feels it is essential that LH leadership as a whole be at the forefront of initiatives to change the culture at the hospital to make it more patient- and family-centred. The Panel was made aware of concerns voiced by ED staff and physicians about the need for more support from the rest of the organization. There was felt to be a lack of role modelling and visibility from those in leadership positions in the ED as well as insufficient sharing of information concerning patient issues. This went as far as some ED staff not being aware that patient satisfaction surveys are conducted at Lakeridge Health or being made aware of the results. This lack of communication hinders development of a more congenial environment and the ability to take joint responsibility for the patient experience. The need for skills-based training on the patient experience was felt by the PEP to extend to volunteers within the ED so there is a consistent, articulated set of expectations of how to address patients and families. As with the ED, enhanced leadership was identified by the Panel as a requirement for maturing the formal patient relations process at LH. It was noted that gaps in the skills and knowledge of leaders including physicians when it comes to patient relations was a reoccurring theme. Leaders may have some discomfort or be reticent to follow-up with a patient or family concern, showing the need for coaching and education in responding. Education on the process, patient relations, patient experience, chart reviews and difficult conversations plus a patient relations toolkit were identified as fundamental issues to address. Leaders also identified that education and guidance in this area for all LH staff and physicians is key. In addition, more clarity is needed about the roles and responsibilities of Patient Relations Department staff and the Communications Department in the formal process for managing patient issues and complaints that come through social media as some confusion currently exists in this area. The role of every individual within the complaint process needs to be defined. There is an understanding that responding to a complaint, especially in the early stages, often keeps it from escalating and ending up with Patient Relations Department staff. Managers understand that this is a key component of their role however they identify lack of time as a concern. LH would benefit from identifying how patient relations can be better prioritized and integrated into workflow. Social Media Best practices in social media, also deal with the need for timely responses to issues raised on social media platforms and channels. 10

13 Final Report of the Patient Experience Panel While a few major hospitals monitor communications channels on a 24/7 basis to respond to patient queries and complaints, the remainder monitor social media to the extent possible with existing staff and resources. Contrary to popular thought, social media is not free. True effectiveness in the social sphere requires budget. Most healthcare organizations reserve just a small portion of the budget for these efforts, but a few marketing departments have sufficient in-house staff to devote the required time to monitoring of metrics and creation of content. Realistically, organizations must understand that the start-up period requires more resources. Over time, as communications and leaders become more proficient, expenses should decrease. From: Applying Social Media Technologies in Healthcare Environments In the era of social media and instant communications, a timely response to a patient complaint or query is seen as essential and critical to improving the patient experience at Lakeridge Health. The standard best practice is to acknowledge the comment as soon as possible on the platform on which it was delivered and then provide a secure address or other channel for the patient to discuss the issue directly with a patient relations staff member. Despite acknowledging the value of two-way communications with patients through social media, communications experts advise against entering into a debate or argument with a dissatisfied or angry member of the public. Leading hospitals recognize that social media can add value throughout the enterprise to better connect with the hospital community and engage patients and the public productively. This evolution has occurred rapidly since the emergence of the first social media platforms a decade ago but holds great potential for health care institutions who want to communicate effectively with their patients in a world where the use of social media is ubiquitous. A review of the literature on social media use in North American hospitals and interviews both in Canada and the U.S. confirms this trend. This review shows that while Lakeridge Health is on par with other hospitals in its basic use of social media tools, it could do more to improve how it uses these innovative approaches. Interviews with leading experts in Canada and the U.S. informs how this approach can be undertaken. Those interviewed included Craig DuHamel, VP of Communications and Stakeholder Relations at Sunnybrook Health Sciences Centre and Colleen Young, who manages the online communities for the Mayo Clinic and is a Canadian authority on online patient communities. A discussion of how LH can make better use of social media to improve the patient experience throughout the hospital follows in Appendix II). Patient Relations In order to improve the patient relations process as a whole at LH a comprehensive review of best practices in this area was undertaken. Evidence and experience demonstrate that easily accessible and robust patient relations processes allow patients and their family members to raise concerns about 11

14 Enhancing the Patient Experience at Lakeridge Health, Oshawa their experiences of care and provide feedback that can help organizations improve care delivery. Ontario Ministry of Health and Long-Term Care. Excellent Care for All: Guidelines on How to Develop a Patient Relations Process. Toronto, 2015 A review of documents by the Ontario Hospital Association (OHA), Health Quality Ontario (HQO) and the Ministry of Health and Long-term Care (MoHLTC) identify that an effective and successful patient relations process should be all of the following: Principles based Open and transparent Accessible to all Responsive and timely Supported by senior leadership Have a framework for complaint resolution Flexible while maintaining consistency in terms of fairness and communication Able to adapt in response to changing patient and/or family needs A component of the role, understood by and supported by all staff, physicians and volunteers The Patient Relations Department at LH has a formal process for receiving and responding to patient and family concerns and compliments which follows the recommended process. In summary the key elements are: 1. Responding to and acknowledging the complaint and ensuring understanding of the concerns and expectations. Concerns are received in the Patient Relations Department via , voice mail, letter or in person. Under most circumstances the concern is acknowledged within 48 hours of receiving. The person (complainant) bringing forward the concern may be the patient, family member, relative or friend. When the complainant is not the patient consent for review of the complaint will be obtained from the patient or the substitute decision maker. 2. Explaining the role of the Patient Relations Department to the complainant. The Patient Relations representative will clarify information and summarize the concern. They will outline the process for how it will be dealt with and identify timelines and who to contact should they have questions. 3. The information, with expected timelines, identified leadership for specific issues, is then forwarded to appropriate leadership. Feedback Monitor Pro (FMPro) is the documentation system for recording, monitoring and analyzing data related to complaints and compliments. Leadership has access to the system and are accountable for entering their feedback. During this step leadership will review, investigate and/or mediate the concern. Issues and solutions or next steps are identified. Leaders may be in contact with the complainant to ensure understanding, provide follow-up and discuss next steps. Meetings with the complainant may also occur during this step. When indicated, the 12

15 Final Report of the Patient Experience Panel complainant will be updated on the progress of the review and given a realistic expectation as to when the concern may be resolved. 4. When the review or investigation is completed follow-up is conducted with the complainant. This is done through either a letter, , phone call or in person. 5. Documentation is entered and completed in FMPro and the outcome identified. The outcome is also classified as satisfied, not satisfied or unknown. A well-established patient relations structure and process, supported by the right personnel, is key to identifying gaps between patient expectations and experiences of care, and managing perceptions of patient expectations and quality of care. Gilly Mary C. Steenson William B. and Yale Laura J. (1991) Dynamics of complaint management in the service organization, in the Journal of Consumer Affairs. A review of patient complaints and concerns received with by the Patient Relations Department at LH showed these can be categorized as either minor or moderate, with few identified as being serious. It is acknowledged that the categorization by LH is a subjective determination and may not reflect that of the complainant. Most complaints involved a breakdown in communications, a perceived lack of courtesy or poor attitude by staff, or issues with accessibility. These categories are consistent with complaints received by other hospitals. While complaints were resolved on average in less than 20 days, an increase in the time to resolution has been observed over the past six months. The process for responding to patient issues at LH is consistent with that used by most hospitals and meets the requirements of the Excellent Care For All Act (ECFAA). Enacted in 2010, this Ontario legislation spells out a number of requirements for hospitals to measure and ensure the provision of quality care and patient satisfaction. The legislation requires that all Ontario hospitals have a patient relations process, and make information about that process available to the public. At a basic level, the Lakeridge process is also consistent with the Health Quality Ontario Striving for Excellence guidelines spelling out best practices for dealing with patient issues. However, the PEP identified a number of areas where changes are required to further improve and mature patient relations at LH and enhance the patient experience. It should be noted that a recognition of the need for this improvement already exists at Lakeridge and some changes are planned or being implemented. This challenge is not unique to Lakeridge. As Health Quality Ontario states in its Striving for Excellence document: As many complaints are related to issues of communication they lie at the heart of the relationship between the patient and their health care provider. More Clarity in Patient Relations Interviews and meetings with administrative and physician leaders elicited important information and understanding of the current processes. Though there is a positive relationship with the Patient Relations Department there is a lack of clarity in roles and responsibilities. This can result in confusion of who is accountable for what, where Patient Relations fits into the process, increased timeliness in responding, poor communication with patients and families and Patient Relations 13

16 Enhancing the Patient Experience at Lakeridge Health, Oshawa taking a lead role when it is the responsibility of program or service. Leaders also identified that there is a need to have the right people talking to the complainant from the beginning. The role of administrative leaders and physician leaders is not clear and should be founded on partnership and transparency. The process and accountability for escalating a complaint at LH was also identified as an area needing more clarity. There also appears to be a lack of understanding of when an issue or question can be brought forward to the Patient Relations Department. Concerns do not all have to be identified by a patient or family member. The Patient Relations Department can and should be used in a consultation role when a staff, physician and/or leader is responding to a complaint that has not come forward to the department. Lack of awareness of the department and their role may be the root cause. There needs to be an increased organizational knowledge and level of comfort in consulting with the Patient Relations Department. There is an understanding that responding to a complaint, especially in the early stages, often keeps it from escalating and ending up with Patient Relations Department staff. Managers understand that this is a key component of their role however they identify time management as a concern. LH would benefit from identifying how patient relations can be better integrated into workflow and prioritized. While of a minimum standard, the LH policy for responding to patient issues does require updating to reflect the Excellent Care for All legislation and other changes that have occurred since the February 2012 revision There are opportunities to expand the policy including the addition of a framework. Leaders identified lack of awareness of the LH Patient/Family Complaints and Compliments Management Policy and Procedures as an issue for hospital leaders, staff and physicians. The New South Wales Government Health Complaint Management Policy is an excellent example that could be followed. It was also noted that the language used in the policy itself is not patient and family-friendly and should be rewritten to be more comprehensible and transparent to those wanting to use the complaints process. Patient Relations: Measurement To track progress in dealing with formal patient issues, LH needs to identify a set of measures that can be used. These metrics should be gathered consistently and shared throughout the organization so that focused discussions can occur at huddles, staff meetings, program councils and quality committees etc. These are metrics that should also be shared with the community. In consultation with Patient Experience Advisors and using the HQO and OHA documents for guidance priority should be given to the following metrics: Percentage of complaints resolved in target turnaround time Average number of days from complaint to close Average number of days until first contact Volume and type of complaints Rate of complaints/ 1,000 patient days or patient visits The Patient Relations Department team, together with the Communications team, will undertake some simple improvement initiatives that will engage Patient Experience Advisors and continue the work already underway. These will include but are not limited to: a review of signage at the main entrance and at the entrance to the department, revision of the voice mail message, an 14

17 Lakeridge Health report_05_layout :38 AM Page 15 Final Report of the Patient Experience Panel automatic response s sent to the patient relations address, adding office location to the website link and the development of a brochure describing the patient complaint process. CONCLUSION The PEP commends LH for their acknowledgement of the concerns brought forward by patients and families and the proactive and transparent approach that they have taken in responding to those concerns. The PEP notes that steps are already being taken by Lakeridge to address some of the issues raised. Having reviewed patient experience issues specific to the LHO ED, the formal patient relations process at Lakeridge Health and the use of social media at the institution as a whole, PEP makes the recommendations that follow. In terms of next steps, the Panel recommends that Lakeridge Health should develop an implementation plan for acting on its recommendations. Such a plan would be overseen by a committee consisting of senior hospital management, representatives of staff, physicians and volunteers and patients and would set specific timelines for action with regular public reporting to the hospital community. This committee could be a prelude for the creation of an ED improvement infrastructure. Best practice suggests making the ED a constant priority by setting in place a steering committee led by hospital executives and Emergency and Inpatient Medicine leadership with a commitment to identifying and tackling bottlenecks that prevent optimal throughput along with service excellence initiatives. The key factors that will ensure that this strategy is successful include: regular meetings with structured agendas, a clear definition of success through determination and constant tracking of key metrics and senior leader oversight, promoting accountability and signalling support for proposed initiatives. 15

18 OPERATIONAL PERFORMANCE RECOMMENDATIONS 1. LH should ensure that there is clear, patient-friendly directional information to identify hospital facilities and processes. 2. LH should improve patient access by developing efficient intake processes that minimize time required to see a physician by considering the following strategies: a. Bring the waiting room inside the ED. b. Have patients with Canadian Triage and Acuity Scale (CTAS) scores of 2-3s in a different queue from CTA 4-5s and not sharing a single waiting room. The CTAS is a tool that allows ED nurses and physicians to triage patients according the type and severity of their presenting signs and symptoms. CTAS patients having scores of 2-3 needs to be seen by a physician more quickly than those with a score of 4 or 5. c. Have a separate triage/registration area for FT-type patients vs. CTAS 2-3 patients. Patients would self-triage, but be moved to the correct area if triaged incorrectly. d. Have a nurse navigator whose only responsibility is patient flow. 3. LH should ensure that patients move smoothly through the system avoiding delays, redundancies and duplication in care by considering the following strategies: a. Provide all patients with clear expectations on timelines for waiting and care in the ED. b. Have a separate area/flow for recalls. c. Encourage handovers as handover-friendly EDs have many advantages, including that all patients can be seen until the end of each physician s shift. d. Establish a mental health area in the ED, with appropriate attention to the special needs of this group of patients e. Admit patients to hallways of programs/wards in addition to the ED. 4. LH should consider the following initiatives to improve the provision of services in the ED. a. Enhance the collaborative relationship between EPs and CWs for the evaluation of patients with mental health presentations. b. Reduce reliance on serum substance concentrations in determining when patients can be evaluated by the crisis team. c. Convene an GIM/emergency physician committee to optimize the process for working up and caring for patients requiring internal medicine services. d. Improve the availability of internist services as part of the General Internal Medicine (GIM) consultation services. e. Consider instituting a daily GIM clinic to see patients 1-2 days post discharge from the ED. 16

19 Final Report of the Patient Experience Panel f. Implement staffing and space changes to enable the ED to provide prompt sedation as required g. The fracture clinic should not require patients to attend the ED, if there is no medical need to attend the ED. They should just re-book the appointment. h. Discuss the optimization of DI hours, and for those stable patients who do have to return for DI the next day, consider a reduction in the hassle factors, such as repeat parking fees, repeat triaging and registration, etc. SERVICE EXCELLENCE 1. LH should implement a hospital-wide education process, at all LH sites, for staff, physicians, volunteers, and learners that reflects a culture of caring and compassion through deliberate actions that could include: a. Collaborating with patients to develop behavioural standards to promote staff and physician accountability. b. Enhancing interpersonal skills of physicians and nurses, e.g., offer communication workshops. c. Using patient names, making eye contact, and answering questions. d. Training staff (including nurses and physicians.) and volunteers to enquire of patients at each step of the ED journey: Is there anything else I can do for you? e. Implement purposeful rounding protocols. 2. Enhancement of communication and education with patients and families should be undertaken at LH. Consider the following strategies: a. Implement the Guide to the Emergency Department which is a form of a patient passport: a document that gives information to patients about the functioning of the ED. b. Expand the volunteer patient advocate positions to liaise between waiting patients and the ED staff. c. Focus attention on the thoughtful discharge of patients from the ED, to ensure sure they can get home safely and would be safe after arriving there. This entails getting to know the patient as a person and not just his/her medical condition. d. Provide verbal and written discharge instructions to the patient and family prior to discharge from the ED. e. Implement the teach-back strategy to ensure patient understanding of discharge instructions from the ED and the LH as a whole. 3. LH could enhance the utilization of patient feedback through use of the NRCC EDPEC survey. a. Establish a process to analyze and communicate patient experience results to all staff and physicians on a timely and consistent basis; create actionable knowledge at the department level. 17

20 Enhancing the Patient Experience at Lakeridge Health, Oshawa b. Set targets based on top box performance for the EDPEC survey. This will improve staff and physician engagement in the feedback and associated improvement strategies. Link target setting to support strategic directions. 4. Consider using positive reinforcement to create an improved patient experience; use patient feedback to recognize the positive contributions of staff and physicians. 5. LH should revise the Lakeridge Health Patient/Family Complaints and Compliments Management policy, to make it more comprehensible to patients and family members and by using a plain language approach. Expand the policy to reflect Ontario s Excellent Care for All (ECFFA) legislation, and include principles for remedying a complaint and the escalation process both internally and externally. The policy should include a framework and the standard work for each phase. Make the policy available to patients, family and the community. The Ministry of Health New South Wales, Australia, has a comprehensive and excellent example of a complaint management policy. 6. LH could clearly define the vision for the roles of the various levels of leadership and the roles of the Patient Relations Department in responding to patient feedback. Support the evolution of a coaching and consultation role for the Patient Experience Specialists. 7. Consideration could be given to adopting Health Quality Ontario s Striving for Excellence in Patient Relations Processes in Ontario s Hospitals as a guidance document for maturing the LH patient relations processes. The guide also identifies excellent provincial, national and international resources. 8. An accessibility review should be conducted to ensure that the process is accessible to persons with disabilities and meets the Accessibility for Ontarians with Disabilities Act. Where indicated, implement strategies to make the process is fully accessible. The availability of accessible formats and communication supports to be communicated through the LH venues. The OHA s Accessibility Toolkit Feedback section provides more information. 9. LH should develop a patient relations toolkit for use by all leaders including physician leaders and Implement a patient relations leadership education program. 10. LH should implement an internal and external communication and education strategy aimed at patients, families, visitors, care providers and the community identifying the venues and processes are available for bringing forth compliments, complaints and concerns. Consider the development of a tag line to encourage feedback from patients and families, e.g., We Care; Tell Us How We Are Doing; We Want To Hear From You; Feedback Welcome. Use the tag line on all communication and education materials to ensure a consistent look, approach and wording. 11. In partnership with the Patient Relations Department, Patient Experience Advisors, and the LH Communications Department should revise the complaint/feedback presence on the Lakeridge website to ensure comprehensive information is available, transparent and meaningful. See Patient Concerns and Feedback Alberta Health Services website as a possible model. 12. LH should institute regular meetings with leaders (administrative and physician) of high volume and high intensity complaint areas to review outstanding complaints, discuss what is required to move forward and what supports are necessary. 13. LH could develop initiatives to use social media channels to proactively gather public and patient input on hospital plans. 18

21 Final Report of the Patient Experience Panel 14. Consideration could be given to prominently placing guidelines for proper conduct in the use of Lakeridge social media accounts by the public on the Lakeridge website and on the appropriate social media channels. 15. LH could strengthen the partnership between the Patient Relations and Corporate Communications departments with a focus on responding to patient or family concerns expressed through social media venues. Put resources in place to allow for timely responses to patient queries or comments on social media channels. Ensure such coverage occurs off-hours and weekends as well as during usual business hour 16. LH should identify 2-3 metrics for measuring progress in responding to patient complaints that will be regularly shared at all levels of the organization, including the board, and externally. The metrics should also be program and unit specific. The metrics should be meaningful for LH and for patients and families. Track quality improvement and patient safety initiatives that result from a concern or compliment. Initiatives to be shared internally and externally. 17. Consideration should be given to conducting an annual evaluation survey of users of the Patient Relations service. Users would include patients and families plus hospital staff and physicians. The Michael Garron Hospital has an example of a patient and family evaluation that may serve as a template. 18. LH should develop a Patient Relations Annual Report that would include both complaint and compliment information. The report should include volumes of complaints and compliments, categories, program and service areas, trending over a defined period, and improvement initiatives that have resulted. The report to be shared with the community and posted on the LH website. The Michael Garron Hospital has an excellent example. Consideration could also be given to an interim status report as a means of communicating with the community the current status of patient relations at LH and as a foundation for going forward. 19. Consider taking the following additional steps to enhance the use of social media tools and platforms at LH (an explanation of the potential wider role for social media in hospitals can be found in appendix II): a. Develop a strategic plan for integrating social media where appropriate into hospital activities b. Leadership in developing social media strategies and managing social media resources should remain with the Communications department which should be adequately resourced to support the level of social media activity required. c. Revise the Lakeridge Health social media policy to encourage employees to be more proactive in using social media to support hospital initiatives. The policy should also continue to provide guidance on what is not appropriate. d. Offer ongoing educational activities to Lakeridge staff and physicians by the Communications department to encourage their use of social media where appropriate. e. Monitor new social media tools and channels to encourage uptake of new tools such as Snapchat or Facebook Live that will offer new options for patient engagement. 19

22 Lakeridge Health report_05_layout :38 AM Page 20 Enhancing the Patient Experience at Lakeridge Health, Oshawa f. Consider using the resources offered by the Mayo Clinic and Hootsuite such as the educational courses for health care professionals and their online community for health care institutions. STAFF & PHYSICIAN ENGAGEMENT 20. LH should evaluate communication methods used to update physicians to ensure maximum impact. 21. LH could implement steps to improve collegiality between physicians from LHO and Bowmanville in the LHO ED. 22. Consider developing clear policies for inter-site issues at Lakeridge Health. 23. LH should implement a rounding with purpose practice at all levels of the organization; the practice should start with the senior management team. Rounding will put leaders in contact with direct care providers that are in the know about the intricacies of each care experience. By employing thoughtful conversation techniques and asking key questions, rounding will provide leaders with an understanding from those closest to the action. Once established, the rounding practice can be extended to all levels of leadership and to direct care providers. 24. LH should establish joint accountability for Lakeridge Health ED goals/objectives between administrative and physician leadership in the ED. Engage ED staff and physicians in developing the annual goals and objectives. 20

23 PATIENT EXPERIENCE PANEL MEMBERS APPENDIX I Marko D. M. Duic, Chief, Department of Emergency Medicine at Southlake Regional Health Centre Dr. Marko Duic has been a leader in Emergency Medicine for more than two decades and is a highly sought-after specialist in ED patient flow, efficiency and quality of care. He has led or participated in more than 30 departmental reviews and consultations across Canada and the UK. A leading thinker and presenter in best practices in the Emergency Department, Dr. Duic organizes and chairs meetings of the GTA emergency department Chiefs and Program Directors, is an Assistant Professor in the University of Toronto s Faculty of Medicine and was awarded a Fellowship in the College of Family Physicians for his exemplary teaching and academic work. Southlake Regional Health Centre, where Dr. Duic is ED Chief, has more than 105,000 visits to the Emergency Department, 22,000 in-patient admissions, and 600,000 out-patient visits each year and is a consistent provincial leader in patient satisfaction surveys. Dr. Duic co-led Lakeridge Health s review of the patient experience at Lakeridge Health Oshawa s ED with Dawn Sidenberg. Dawn Sidenberg, Director, Patient- and Family-Centred Care at Humber River Hospital Dawn has extensive experience in the health care sector; specializing in quality improvement, service excellence, and cultural transformations. Her clinical practice and administrative positions have included surgery (Operating Room), quality improvement, risk management, utilization, education and organizational renewal, and patient and family centred care. As Director of Patient- and Family- Centred Care at Humber River Hospital, Dawn is responsible for the development, implementation, evaluation and sustainability of patient and family centred care. The role includes engaging and educating leaders, establishing a patient and family advisory program and councils, and advancing patient and family centred best practices. Dawn will co-lead Lakeridge Health s review of the patient experience at Lakeridge Health Oshawa s ED with Dr. Marko Duic. Mary Lynne MacMaster, recent Director Patient Experience and Quality, North York General Hospital Mary Lynne MacMaster is a registered nurse with extensive clinical and administrative experience in both pediatric and adult acute care. Mary Lynne s progressive administrative experience has included the areas of pediatric medicine, surgery, medical imaging and critical care, in both an academic setting and a community hospital. Her adult experience has included surgery, cancer care and emergency medicine and an interim role as Chief Nurse Executive. Most recently Mary Lynne was the Director Patient Experience and Quality at North York General Hospital, where she led the organization to a 4- year accreditation with exemplary standing and reframed the patient relations role to a Patient Experience Specialist role. She partnered with patients and families on the successful implementation of the Patient/Family Advisor role and the Patient/Family Advisory 21

24 Enhancing the Patient Experience at Lakeridge Health, Oshawa Council at NYGH. Mary Lynne was a Canadian Foundation for Healthcare Improvement Coach for their Partnering with Patients and Families for Quality Improvement Collaborative. She will lead Lakeridge Health s review of the patient relations experience. Pat Rich, recent Strategic Advisor, Enterprise Marketing and Communications at the Canadian Medical Association Pat Rich is an acknowledged national and global authority on role of social media in health care and a frequent speaker on professional use of social media by physicians and other health care providers. Pat coordinated and wrote Canada s first balanced social media guidelines for Canadian physicians, helped develop internal communications, intranet and internal social media strategies for the Canadian Medical Association and is the past Editor-in-Chief of the Medical Post. Pat will lead Lakeridge Health s review of how the hospital can better respond to patient issues over social media. Robbie Stewart, Patient Advisor, Lakeridge Health, Oshawa Robbie is a graduate of Queen s University Faculty of Education in Kingston, Ontario, and recently retired as a teacher with the Durham District School Board, spending over 10 years working in the Oshawa community. After a diagnosis of Stage 4 Metastatic Colorectal Cancer and unable to continue working as an educator, he became involved as a volunteer at the hospital as a way of giving back to an organization that continues to be instrumental in where he is on his cancer journey. Robbie is currently Co-Chair of the Lakeridge Health Patient and Family Experience Advisory Council. He also sits on the R.S. McLaughlin Durham Regional Cancer Centre PFEAC, is a past member of Cancer Care Ontario s PFAC and is actively involved in ongoing projects at Lakeridge, including the Hospital s Ethics Committee, Interventional Radiology Suite Project and the Oshawa Hospital Site Fracture and Plastics Clinic Review. He is particularly proud to have been involved in the development of the Central East Cancer Region (DRCC) Strategic Plan for , as a member of the Expert Panel on Patient Centered Wait Times as part of the Ontario Cancer System Quality Index review for 2015 and as a panelist for the Ontario Government s Quality of Care Information Protection Act (QCIPA) review in Robbie continues to focus on the continued improvement of the delivery of services in all areas at Lakeridge for patients, caregivers and their families through active involvement as a Patient and Family Experience Advisor. 22

25 APPENDIX II SOCIAL MEDIA Christina Thielst, a Santa Barbara, California-based hospital administrator, consultant and author has been following the evolution of health care, and specifically the use of social media by health care organizations, for more than 30 years. She began a published guide for hospital administrators on the basics of using social media tools for health care leaders and hospital administrators in In 2014, Thielst edited Applying Social Media Technologies in Healthcare Environments, an anthology detailing best practices for social media use in hospitals, published by the Health Information Management Systems Society (HIMSS). In an interview, Thielst said virtually all hospitals in the U.S. at least have a Twitter or Facebook account to relay information about the hospital to the public. Anecdotal information suggests the same is true in Canada. For the most part, hospitals have figured out that they need to be there communicating with their customers. Some have found out the hard way that you have to have a good social media policy, you have to set up guidelines for people who are doing the posting, you have to train and educate people and you have to hold people accountable. Christina Thielst There are so many examples of how hospitals and doctors are using social technologies to engage with their patients, Thielst said. There are some really creative people out there who are finding ways to use these tools to engage patients and get their messages out. A similar evolution can be seen in the use of social media by Canadian hospitals. An article published on the HealthyDebate website in February 2013, documented how Canadian institutions were beginning to recognize social media s potential to improve the patient experience at that time. In that article, Ann Fuller, then public relations director and now VP for volunteers, communications and information resources for the Children s Hospital of Eastern Ontario, was quoted as saying: In Canada, in health care we re at a point where most hospitals accept the role of social media for branding and communication, but only the lead adopters are using it for patient engagement and for clinical use. Fuller says since 2013 a lot of the perceived risks and threats of social media have lessened. Using social media to help hospital departments and clinicians relate better to colleagues and their patient community is now seen as one of the key benefits of using social media. While some hospitals continue to provide central guidance to these innovators through their communications department, others such as CHEO and the Centre for Addiction and Mental Health in Toronto allow departments to manage their own channels and posts. 23

26 Enhancing the Patient Experience at Lakeridge Health, Oshawa It s not about creating a community and trying to integrate those experts into it. It s using social media to come up with a new platform for doing what they already do such as engaging patients. It s another way of bringing people together, said Dave Bourne, a former communications director for Baycrest and the Scarborough Hospital and now director of communications for Sienna Senior Living. Some major academic centres such as the Mayo Clinic are hosting online communities to allow patients to communicate with each other independent of their relationship with the hospital. For others, such as Craig DuHamel, VP of Communications and Stakeholder Relations at Sunnybrook Health Sciences Centre, an existing social media platform such as Twitter serves very well as an online patient community which can be approached for input and feedback. While Bourne and other experts note use of social media is not a magic bullet for solving things and should be treated like any other communication and engagement tools, he adds I don t think you can ignore it. Our patients are not standing in front of the hospital 24 hours a day, seven days a week, 365 days of the year. We don t want them in the hospital all the time or in their doctor s office all the time. We want them out there living their lives and to provide support to help them. Why can t we use some of these (social media) tools to provide relevant content and push relevant content to patients who have some interest in engaging with our hospital. To me that s where hospital social media needs to go. Christina Thielst Thielst writes that the best health care institutions will use social media to: Advance their goals and mission Harness the collective wisdom of staff and broaden collaboration Recognize needs of patients and their family caregivers Change how care is provided and offer online engagement opportunities that are designed with the user in mind Use enterprise-wide portals to integrate social tools with other patient-facing systems, such as the electronic health record and patient education Manage their online reputations This expanded mandate for social media beyond pushing out information about the hospital seems to be the accepted practice for leading North American health care institutions but is not as well developed in community hospital such as Lakeridge Health. Limited available evidence suggests patients place a higher value on hospitals who are visible on social media. One of the only published surveys of its type conducted by YouGov showed that 80% of patients said that hospitals with a strong social media presence were perceived as being cutting-edge, and 60% of patients said that social media was a factor in them choosing that hospital. This finding was confirmed by Lillian Albin, senior social media specialist at Boston s 24

27 Final Report of the Patient Experience Panel Children s Hospital, who said surveys they have conducted with their patients confirmed the value of being visible on social media. Isabel Jordon, a BC-based patient advocate and chair of the Rare Disease Foundation, says, the way I would like a hospital to use social media is to reach out to people to find out what we want from them; if there are going to be changes or something new coming down the pipe to reach out and engage us before something is going to happen. Social media done well is conversation and it lets you be transparent and it lets you have a two-way conversation and break down barriers between people. She said she would absolutely have more confidence in a hospital that is using social media. However, as representatives from Michael Garron Hospital in Toronto point out, such an approach cannot be undertaken until the culture of the hospital has been changed to accept the use of social tools and platforms. In the words of Irene Andress, chief nursing executive at the hospital, it can take years before an institution has the comfort to acknowledge complaints online. The PEP encourages Lakeridge to consider the type of incremental approach used by Michael Garron Hospital to integrate social media into the daily activities of the hospital. In the interview, Thielst echoed other experts in both Canada and the U.S. who stress the importance of developing good content to support their social media channels. Some institutions such as Boston Children s Hospital acknowledged to be one of the leading U.S. children s hospitals using social media can afford to have staff specifically dedicated to developing content for social media channels. However, most hospitals, including leading academic institutions in Canada, have communications staff with multiple roles that include monitoring social media channels and producing content as most are not resourced to provide dedicated staff for social media. Similarly, while a few major hospitals monitor communications channels on a 24/7 basis to respond to patient queries and complaints, the remainder monitor social media to the extent possible with existing staff and resources. Contrary to popular thought, social media is not free. True effectiveness in the social sphere requires budget. Most healthcare organizations reserve just a small portion of the budget for these efforts, but a few marketing departments have sufficient in-house staff to devote the required time to monitoring of metrics and creation of content. Realistically, organizations must understand that the start-up period requires more resources. Over time, as communications and leaders become more proficient, expenses should decrease. From: Applying Social Media Technologies in Healthcare Environments In the era of social media and instant communications, a timely response to a patient complaint or query is seen as essential. This is seen as being critical to improving the patient experience at Lakeridge Health. The standard best practice is to acknowledge the comment as soon as possible on the platform on which it was delivered and then provide a secure address or other channel for the patient to discuss the issue directly with a patient relations staff member. 25

28 Enhancing the Patient Experience at Lakeridge Health, Oshawa Despite acknowledging the value of two-way communications with patients through social media, communications experts advise against entering into a debate or argument with a dissatisfied or angry member of the public. Given the trend towards using social media to enhance patient engagement and care across all hospital activities the PEP has made recommendations that can help transform Lakeridge into a social media leader and enhance the patient experience with the hospital. SOCIAL MEDIA REFERENCE DOCUMENTS A hospital leadership guide: Digital and social media engagement Applying social media technologies in health care environments (Book) Children s Hospital of Boston: A successful social media example Connecting to patients with social media: A hype or a reality Five reasons to like patients use of social media Health care and social media platforms in hospitals Hospitals begin to recognize social media s potential to improve patient experience (Feb. 14, 2013) Hospital s social media efforts boost reputation, patient loyalty: study (March 27, 2014) Hospitals: 6 steps to create your social media plan How US children s hospitals use social media: A mixed methods study How digital engagement shapes patient engagement at Boston Children s Hospital Measuring patient-perceived quality of care in US hospitals using Twitter (Oct. 13, 2015) Now almost all US hospitals use social media. Now what? Nov, 2014 Social media and crisis management Social media: How hospitals use it and opportunities for future use The nation s most social media savvy hospitals Understanding How Hospitals Use Social Media: An Exploratory Study of Facebook Posts Use of social media across US hospitals: Descriptive Analysis of Adoption and Utilization Why is Brigham and Women s Hospital blogging about its mistakes 2015 in Review: A Social Media Benchmark & Content Summary for Children s Hospitals 20 hospitals with inspiring social media strategies INDIVIDUALS INTERVIEWED FOR SOCIAL MEDIA INPUT Lloyd Rang Senior Director, Communications, Lakeridge Health Craig DuHamel VP, Communications and Stakeholder Relations, Sunnybrook Health Sciences Centre 26

29 Final Report of the Patient Experience Panel Ann Fuller VP, Communications, Volunteers and Information Resources, Children s Hospital of Eastern Ontario Colleen Young Director of Community, Mayo Clinic Connect Lily Vautour Senior Social Media Specialists, Boston Children s Hospital Christina Thielst Hospital Administrator, Consultant and author, Santa Barbara, Calif. David Bourne Director of Communications, Sienna Senior Living Miguel Amante Social Media Coordinator, CAMH Julie Rosenberg Manager, Public Affairs, CAMH Danielle Mulvey Senior Communications Consultant, SickKids Irene Andress Chief Nursing Executive, Michael Garron Hospital Sharon Navarro Communications Director, Michael Garron Hospital Leslie Shepherd Manager, Media Strategy, St. Michael s Hospital Isabel Jordan Patient Advocate, Abbotsford, BC Annette McKinnon Patient Advocate, Toronto Patient Advisors, Lakeridge Health 27

30 APPENDIX III PATIENT RELATIONS AND PATIENT EXPERIENCE REFERENCES Patient Relations Resources, References and Documents Patient Relations Toolkit The Ontario Hospital Association Excellent Care for All Guidance on how to develop a Patient Relations Process Ontario Ministry of Health and Long-Term Care Patient Concerns and Feedback Alberta Health Services website Guide to Developing Effective Complaints Management Policies and Procedures Queensland Ombudsman, Australia Handling Concerns about the Performance of Healthcare Professionals National Patient Safety Agency, MHS, United Kingdom Engaging Patients and Caregivers about Your Patient Relations Process: A Guide for Hospitals Health Quality Ontario Patients Canada website provides advice on how to constructively navigate a complaints system Survey Findings of Hospital Patient Relations Practices Health Quality Ontario Striving for Excellence in Patient Relations Processes in Ontario s Hospitals. A Guide to Responding to Ontario Regulation 188/15 Health Quality Ontario Complaint Management Policy New South Wales Health, NSW Government Principles for Remedy Parliamentary and Ombudsman, United Kingdom Member Complaints and Grievance Process pages Kaiser Permanente, USA 10 Steps to Developing an Effective Complaints Management System (CMS) Council Queensland Ombudsman, Australia Patient Relations Annual Report 2015 Michael Garron (TEGH) Hospital, Toronto Patient Experience Office brochure, North York General Hospital, Toronto Do you have a Patient Care Question or Concern? Brochure, Humber River Hospital, Toronto Lakeridge Health documents Excellence Every Moment Every Day, Lakeridge Health Strategic Plan 2011/ /16 28

31 Final Report of the Patient Experience Panel Excellence Every Moment Every Day, Lakeridge Health Strategic Plan Position profiles Director, Patient Relations; Patient Relations representative Patient/Family Complaints and Compliments Management Policy and Procedure, February 23, 2012 Implications of the New Regulations under the Excellence Care for All Act, October 7, 2015 Complaint Management Working Group minutes July 16, 2015 current Patient Relations reports/metrics Complaints and Compliments: April 2014 March 2016 Complaints by Site: April 2014 March 2016 Complaints by Program: April 2014 March 2016 Complaints by Severity: April 2014 March 2016 Issues Count Report by Category: April 2014 March 2016 Resolution Time Reports: April 2014 March 2016 Issues Count Report by Satisfaction Level: April 2014 March 2016 Four FMPro patient/family complaint files, names redacted. PATIENT RELATIONS REVIEW MEETINGS Focus Groups Patient Experience Advisors (90 minutes) 6 advisors in person, one on teleconference + Helen Gibson, Director Patient Experience Complaint Management Working Group Elizabeth Corner, Director Medical and Academic Affairs Debby Kryhul, Clinical Manager Diagnostic Imaging Maureen Cuddy, Clinical Manager Pediatrics and Neonatal Intensive Care Denise Pearce, Patient Relations representative Mary McAvoy, Manager Stroke Unit Elaine Harvey, Patient Experience Advisor Patient Care Managers Darlene Heslop, Medicine, LHB Lori-Ann Gervais, Surgery, LHO 29

32 Enhancing the Patient Experience at Lakeridge Health, Oshawa Dolores Cook, Diagnostic Imaging Julie Rojas, Women s & Children s Health Patient Care Managers Darlene Heslop, Medicine, LHB Lori-Ann Gervais, Surgery, LHO Dolores Cook, Diagnostic Imaging Julie Rojas, Women s & Children s Health Individual meetings Leslie Motz, Vice President Clinical and Chief Nurse Executive Helen Gibson, Director Patient Experience Julie Goldstein Clinical Director, Women s & Children s Health, Quality & Risk Lorraine Carrington s Clinical Director, Medicine, Bed Allocation, IPAC and Nursing Resource team/central Staffing Office Paul McGary, Director Mental Health and Addictions, Child, Youth and Family Program, Joanne Wilvert, Manager ER and CrCU LHB Tamara Dus, Director ED and CrCU LHO and LHPP Teleconference with Dr. John Dickie, Chief of Surgery Teleconference with Dr. Lauren Linett Hospitalist Two Team meeting with Patient Relations team Helen Gibson, Director Patient Experience Denise Pearce, Patient Relations representative Melissa Casselman, Patient Relations representative PATIENT EXPERIENCE RESOURCES, REFERENCES AND DOCUMENTS Baker, S. (2011). Key-words: A prescriptive approach to reducing patient anxiety and improving safety. Journal of Emergency Nursing, 37 (6), Crane, J., Noon, C. (2011). The definitive guide to emergency operational improvement: Employing Lean principles with current ED best practices to create the no wait department. CRC Press, New York, NY. Fottler, M., Ford, R. (2002). Managing patient waits in hospital emergency departments. Health Care Manager, 21 (1), Hoelz, J. Employing the best practices to improve the patient experience. PowerPoint from Webinar. Nielsen, D. (2004). Improving patient satisfaction when triage nurses routinely communicate with patients as to reason for waits: One rural hospital s experience. Journal of Emergency Nursing, 30 (4),

33 Final Report of the Patient Experience Panel Roh, H., Hye Park, K. (2015). A scoping review: Communication between emergency physicians and patients in the emergency department. Journal of Emergency Medicine, 50 (5), The High Performance ED (2008). The Advisory Board Company. Tonges, M., McCann, M., Strickler, J. (2014). Translating caring theory across the continuum from inpatient to ambulatory care. Journal of Nursing Administration, 44 (6), Tran, T. P., Schutte, W.P., Muelleman, R. L., Wadman, M.C. (2002). Provision of clinically based information improves patients perceived length of stay and satisfaction with EP. American Journal of Emergency Medicine, 20 (6), Welch, S. (2010). Twenty years of patient satisfaction research applied to the emergency department: A qualitative review. American Journal of Medical Quality, 25 (1), Wright, G., Causey, S., Dienemann, J. (3013). Patient satisfaction with nursing care in an urban and suburban emergency department. Journal of Nursing Administration, 43 (10), Lakeridge Health Documents Excellence Every Moment Every Day, Lakeridge Health Strategic Plan 2011/ /16 Excellence Every Moment Every Day, Lakeridge Health Strategic Plan Patient Relations reports/metrics NRCC Patient Experience Scorecard for the ED: January 2014 September 2015 Complaints for ED: April 2014 March 2016 Issues Count Report by Category for the ED: April 2014 March 2016 Four FMPro patient/family complaint files, names redacted Listing of Quality Improvement Initiatives in the ED Patient Relations Review Meetings Focus Groups Emergency Department Staff and Emergency Physicians (60 minutes) 10 individuals in two separate focus groups Patient Advisors (60 minutes) 5 individuals Individual meetings Leslie Motz, Vice President Clinical and Chief Nurse Executive Helen Gibson, Director Patient Experience Tamara Dus, Director ED and CrCU LHO and LHPP Dr. Benj Fuller, Chief, Emergency Medicine & Critical Care Tereza Lynde, Emergency Supervisor Ted Sellers, Manager, Inpatient Mental Health 31

34 Lakeridge Health report_05_layout :38 AM Page 32 Enhancing the Patient Experience at Lakeridge Health, Oshawa Janet Christopher, Manager Inpatient Medicine Unit (G9) Anne Sinclair, Operations Supervisor Individual patient 32