Blood Collection Survey for HRM and West Hants: What we heard

Blood Collection Survey for HRM and West Hants: What we heard Introduction In the Halifax Regional Municipality (HRM), patients can choose where to have their blood collected for testing. They may go to one of a number of publicly provided blood collection centres operated by the Nova Scotia Health Authority (NSHA) or the IWK Health Centre. NSHA offers a drop-in service where no appointment is required. A recent pilot project expanding hours at three locations into the evening and Saturday has been well received, with indications that the public appreciates the improved accessibility. Patients can also choose go to an independent blood collector (phlebotomist) in a clinic setting or in their home where they pay a fee as established by the business owner. These private services are not covered under Nova Scotia s public health insurance. Independent phlebotomists (IPs) offer a convenient service to the public, and they play a role supporting the demand for blood collection in our community. Approximately 30 per cent of the blood specimens collected in the Central Zone (former Capital Health District) come from IPs, while the remaining 70 per cent are collected in the publicly operated clinics. The public system does not currently have the resources to address all the demand for blood collection services, such as in-home service. Background Pathology and Laboratory Medicine (PLM) initiated a five-phase pilot project in May 2014 intended to address some blood collection service and access issues brought about by the cancellation of a large IP contract. A number of improvements have been implemented, and PLM continues to monitor the impact of expanding the blood collection hours of service at St. Margaret s Bay, Bayers Rd, and Dartmouth General Hospital, looking at all aspects of the service including wait times, patient volumes and use of resources. PLM opened a new Page 1 of 34

location, Woodlawn Blood Collection, in Dartmouth on July 13, 2015 and is investigating options to address other service gaps, particularity in the community of Spryfield. Overall, there are a number of issues that led to the need to engage stakeholders around improvements in blood collection in the HRM. These include: Quality and Patient Safety: Hospitals and laboratories are required to gather information and report on events that have potential to cause harm to a patient. The average percent error rate on samples collected by IPs is more than 12 times higher than the percent error rate on specimens that are collected by laboratory staff in publicly operated outpatient clinics. Following up and managing quality issues for safe patient care places an increased cost on both the health care system and the patient. We need to better understand this issue in order to address it properly. Access: The Central Zone of NSHA directly serves an estimated 40 per cent of Nova Scotians and has boundaries that extend from Halifax to Sheet Harbour to Windsor. There are 13 outpatient blood collection locations (including the IWK) that operate as part of the public health system and serve this large area and population. For some patients access to a public blood collection site is not ideal. Factors to consider when looking at accessibility include: costs associated with expansion of service hours impact on the laboratories receiving specimens number of patients accessing service current location of publicly operated clinics public transportation and parking mobility of patients requiring the service, and direct cost to patients; many patients are willing to pay for convenience while others cannot afford this option Page 2 of 34

Connectivity: Physicians and other health care providers rely on electronic information systems for their patients laboratory results. When a patient uses a NSHA or IWK clinic they are registered in a system that connects physicians to laboratory test results through a provincial computer portal (called Share ). Patients whose specimen is collected by an independent phlebotomist are not registered into this system so their results are not easily shared with their physician. Access to the Central Zone registration system is not possible for private businesses due to privacy and security regulations. Wait times: The number of independent blood collection businesses has increased dramatically in recent years while publicly operated services have struggled to keep up with the demand for service while meeting fiscal targets. This has resulted in patients experiencing an increased wait despite the implementation of efficiencies. The recent expansion of hours at Central Zone collection centres has resulted in improved access but patients may still experience a shorter wait time when they visit an IP clinic, in part due to the fact that registration is not performed prior to collection. Workload and Workflow: A number of issues arise from IP collections that have a direct impact on the workflow at the laboratory, creating additional workload and delay in processing. The registration of these samples at time of receipt in the laboratory is more time consuming than registering patients directly at an NSHA or IWK blood collection clinic. Issues such as incomplete patient information, delays in transportation and incorrect specimen collection may result in cancellation of specimens. Documentation of errors and subsequent follow-up is costly and time consuming. Even samples that are unacceptable must still be registered so there is a record of the incident and a report can be generated for the physician. It is important to understand that it takes longer to process a rejected sample than a properly collected sample. Customer Service: Our patients have a right to high-quality service every time. We provide training to all staff to help ensure that each patient encounter is Page 3 of 34

the best experience possible, understanding that wait times, access issues, hours of operation and other factors can create stresses for patients that lead to disappointment, or worse, conflict with staff. Although staff who work under independently operated blood collection services are not employed by PLM, complaints from the public are often directed to PLM or the Department of Health and Wellness (DHW). These complaints can influence if a contract with an IP will be renewed. Methodology In light of the challenges facing blood collection, PLM, in conjunction with Patient & Public Engagement at the NSHA, formed an Advisory Committee composed of stakeholders and citizens. The committee was tasked to provide insight into the following: What changes must NSHA Central Zone make to its community blood collection services to better meet the needs and expectations of community, address quality and safety issues, and inform a plan for expanding laboratory capacity? The Committee featured representation from local Community Health Boards, the Group of IX Seniors Advisory Council of Nova Scotia, the IWK Health Centre, the former Capital Health, Independent Phlebotomists, Long Term Care, the Nova Scotia College of Medical Lab Technologists (NSCMLT), Patients/Citizens, Physicians, and the DHW. Between December 8, 2014 and April 13, 2015, the Advisory Committee met six times. Over the course of the meetings, the Committee helped create and review a survey for members of the public, in conjunction with an associated communications brief. Once the survey was completed, members of the Advisory Committee also helped identify the top issues as determined from the survey. Page 4 of 34

Survey: The survey was a 15-item measure administered using the Select Survey online software, with paper copies distributed to blood collection site waitingrooms and prepaid envelopes distributed to independent phlebotomists for inhome and other independent service users. The survey included both qualitative and quantitative components. A copy of the survey is included in appendix A. The online survey was open to respondents between February 23 and March 9, 2015. In total there were 3,585 complete and incomplete online survey responses. There were another 233 paper surveys that were submitted by inhome users of IP services and respondents who completed the survey in a public blood collection facility waiting-room. After the survey data was collected, Advisory Committee members were asked to come to consensus regarding the top issues identified in the survey response data. The committee also created a list of things to consider from the survey data. An external consultant was tasked with disseminating the qualitative and location data from the survey. Page 5 of 34

Survey Results Participant demographics: Overall, survey participants represented a wide range of ages, with almost half of all respondents between the ages of 45 and 64. Table 1. How old are you? % of Age respondents Under 18 0.3% 18-24 2.1% 25-44 24.9% 45-64 48.3% 65 or older 24.4% Total 100.00% Page 6 of 34

While specific location data was not collected, respondents were asked to provide the first three characters of their postal code. The majority of respondents reside in the Halifax/Dartmouth metropolitan area, with a number of other areas in the Halifax Regional Municipality also represented. Geocoding of the postal code data was completed by Novima Solutions. Figure 1. Where do you live? (First three characters of postal code only, e.g. B3L) Source: Novima Solutions Page 7 of 34

Every blood collection site in the Central Zone of NSHA was represented in the survey. The two largest public blood collection sites represented were Bayers Road and Dartmouth General Hospital, while about a quarter of all respondents used independent services most often. Table 2. Where do you normally go to have your blood taken for testing? If you go to more than one location, please choose the one you use most often. % of Location respondents Independent Service (clinic) 23.60% Bayer's Road Blood Collection 18.50% Dartmouth General Hospital 18.40% Cobequid Community Health Centre 12.30% St. Margaret's Bay Blood Collection 9.40% Halifax Infirmary Site, QEII 5.40% Twin Oaks Memorial Hospital 2.90% Victoria General Site, QEII 2.40% IWK 1.90% Hants Community Hospital 1.70% Independent Service (in-home) 1.60% Eastern Shore Memorial Hospital 1.00% Musquodoboit Valley Memorial Hospital 0.70% Don't get my blood taken/this is my first time 0.30% Independent Service (long term care) 0.10% Page 8 of 34

Figure 2. Proportion of public and IP service users among respondents Most respondents were casual users of blood collections services, using the service at least once every six months, or at least once a year. Table 3. How often do you have your blood taken for testing? Frequency % of respondents Once a week or more 1.6% At least once a month 11.9% At least once every 6 months 40.9% At least once a year 32.3% Less than once a year 12.4% Never/First Time 0.9% The vast majority, over 87 per cent, of respondents who indicated that they used IP services most often also indicated they have used public blood collection services at some point previously. Page 9 of 34

Table 4. Have you ever had your blood taken at a Capital Health or IWK location? (Independent Phlebotomy users only) Response % of respondents Yes 87.1% No 11.6% Don't Know/Prefer not to say 1.3% Almost half of IP users indicated they prefer the service because of a longer wait for public blood collection services. Table 5. Why don't you get your blood taken at a location run by Capital Health or the IWK? (Independent Phlebotomy users only) % of Reason respondents Wait for public services is too long 45.20% Inconvenient 32.40% Accessibility issues 8.90% Prefer home/business 2.80% Not exposed to germs 2.50% Require in-home for health reasons 2.00% Parking concerns 1.80% Professionalism of staff 1.30% Can't take time off work 1.30% Ability to make own appt 0.90% Rapport with staff 0.70% Previous negative experience with CH 0.10% Privacy 0.10% Total 100.00% Page 10 of 34

Service preference: When asked about what they liked about their blood collection location, most respondents chose parking, followed by being located close to home and hours of operation. Table 6. What do you like about this location? Please check all that apply. Response % of respondents Response % of respondents Parking 17.63% Skilled/professional staff 0.30% Close to home 17.27% Easy registration 0.19% Hours of operation 13.36% Close to other services 0.10% Short wait times 13.17% Accessibility 0.09% Staff 13.08% Child friendly 0.04% Facility is clean 12.56% Not exposed to germs 0.04% Close to doctor's office 5.23% Prefer public 0.04% Close to work 4.11% Scent Free 0.03% Close to public 2.44% Waiting area 0.02% transportation No cost 0.30% Page 11 of 34

When asked about what they did not like about their blood collection location, most respondents selected long wait times. However, respondents were also displeased with the hours of operation of their location, along with the parking. Table 7. What do you not like about this location? Please check all that apply. Response % of respondents Response % of respondents Long wait times 42.31% Far from public transit 1.42% Hours of operation 14.25% Not child friendly 0.82% Parking 12.83% Waiting area 0.75% Far from home 7.48% Registration 0.41% Far from work 4.56% No longer in operation 0.26% Fee for service 4.45% Not private 0.26% Far from doctor's office 3.63% Infrequent Service 0.11% Staff 3.44% Not aware of wait time 0.07% Facility not clean 2.92% When asked about their preferred hours of operation, respondents selected times earlier in the day, the morning and early morning, as their overall preferred hours of operation. Table 8. What hours of operation work best for you? Please check all that apply. Hours of operation % of respondents Morning 26.7% Early morning 20.9% Weekend 16.4% Evening 14.7% Early afternoon 10.7% Late afternoon 10.6% Page 12 of 34

When asked what is most important when choosing where to have your blood collected, more than 70 per cent of respondents chose wait times as very important, followed by quality of service and walk-in service. This is in contrast with in-home service which over 50 per cent of respondents ranked as not at all important, followed by access to public transit which more than 50 per cent of respondents ranked as slightly unimportant. Figure 3. What is most important to you when choosing where to have your blood collected? Where 1 is very important and 5 is not at all important. Wait times Close to other services Close to home Quality of service In-home service Walk-in service Ability to set own appointment Access to public transit 5 (not at all important) 4 (slightly unimportant) 3 (neutral) 2 (fairly important) 1 (very important) Access to parking No fee for service Days and hours of operation 0% 20% 40% 60% 80% 100% Page 13 of 34

When asked about changes to blood collection services, respondents ranked shorter wait times as the most important followed by more blood collection sites and extended hours. Figure 4. Please rate the following changes on how much you think each would improve blood collection services. Shorter wait times Extended hours 5 (Not at all) 4 (Very little) 3 (Neutral) 2 (Somewhat) 1 (A lot) More blood collection sites 0% 20% 40% 60% 80% Service experience: Almost a quarter of respondents said that blood collection staff were friendly and courteous the last time they had their blood taken. Less than 1 per cent of respondents indicated that staff exhibited none of the above behaviours. Page 14 of 34

Table 9. How did the staff act towards you? Please check all that apply. % of Staff behaviour respondents Friendly/courteous 23.60% Communicated clearly 17.10% Were knowledgeable 14.30% Called me by name 13.50% Seemed to care about me 11.70% Listened to me 10.80% Introduced themselves to me 8.30% None of the above 0.8% Overall, respondents reported an average wait time of over 34 minutes for the last time they had their blood collected. This varied between 15.9 minutes for IP users and 40.9 for public clinic users. Table 10. In minutes, how long did you have to wait to have your blood drawn? Average time (minutes) Public 40.9 IP 15.9 Overall 34.4 Page 15 of 34

Both IP and public users thought 10-30 minutes was an acceptable wait time to have your blood taken. Table 11. What do you think is an acceptable wait to have your blood taken? % of respondents Less than 10 minutes 10-30 minutes 30 minutes-1 hour 1-2 hours Over 2 hours IP 26.2% 69.2% 4.3% 0.3% 0.00% Public 8.6% 70.9% 19.5% 1.0% 0.00% Overall 13.1% 70.5% 15.6% 0.8% 0.00% Open-ended responses: At the end of the survey, we provided respondents with an opportunity to discuss any issue or concern that wasn t already addressed on the survey. Four dominant themes emerged from the qualitative data. Coding and graphs were completed by Novima Solutions. Theme 1: Opinion of Survey Happy to be Consulted: A number of respondents were pleased that their feedback was being considered. Most also expressed an interest in receiving results of the survey. Concern Regarding Survey Access: Several people expressed concern with access to the survey, mentioning they only had access to it by chance (e.g. they happened to drop into IWK). Mailed Version of Survey Helpful to Seniors: The mailed version was helpful to senior residents, who are less mobile and who may not utilize the internet. Page 16 of 34

Figure 5. Survey respondents comments regarding survey Source: Novima Solutions Theme 2: Experience with Staff Satisfied: These respondents praised the overall attitudes of the staff, with many complimenting the conviviality and understanding of the staff. In particular, respondents appreciated the good humour of staff despite patrons being ill-tempered, understanding the fear of needles, and using a gentle touch when taking the blood sample. [The staff] are like a well-oiled machine, constantly on the go, very friendly, and keeping everything moving at a steady pace; their ability to multi-task is phenomenal. Concerned: Respondents had varying concerns with their experiences with staff, which ranged from personal preferences to generalizations of staff attitudes. The most common concerns were about staff talking and gossiping too much (and the impression of violating privacy), roughness in taking blood/finding a vein, lack of awareness of phobias, and an overall expression that customer service needs to improve. Blood collection should be patient focused not worker focused. Page 17 of 34

Figure 6. There were 163 respondents who commented on their experience with blood collection staff Source: Novima Solutions Theme 3: Wait times Morning Fasting: An interest in giving prioritization to those who have fasted. This was a particular concern for those who are diabetic. When fasting is required, need an express service for individuals with diabetes and others adversely impacted by delaying meals." Pre-booking/Pre-registration: Many suggest that new technology could be leveraged to introduce/improve pre-registration. This also included the suggestion of showing current wait times publically online. Having an allotted time rather than an unknown wait time upon arrival was broadly supported. People live with smartphones now. Make it possible for us to book our own appointments through an app thus having shorter wait times. Page 18 of 34

Extended Hours: Respondents stated that they supported extended hours (morning, evening, or weekend) with Capital Health. Private clinics were noted for having better access at the times that patients needed service. There was also a concern with waiting outside for collection to open (especially in the winter). If blood collection is going to continue opening at 7:00am, then perhaps the hospital (clinic) itself should be open at 6:00am. Exposure to Communicable Diseases: Several respondents expressed concern with waiting in a space with other sick patients. This was most prevalent among respondents with compromised immune systems (e.g., cancer patients). As a cancer patient the Bayers Rd location is dangerous to my health as I have to be in this public place for such a long period of time. Satisfied with Wait Times: Some respondents explicitly stated that they had no concerns with wait times and the blood collection site that they currently use. "We feel so fortunate to have the Cobequid Health Centre close by. The staff are excellent and very courteous. We have never had a bad experience there. We think very highly of this facility and would not want to go anywhere else." More Staff: Respondents expressed a desire to see more staff in the mornings and during peak times. Several stated they are frustrated when they see empty blood collection booths when they have been waiting for an extended amount of time. Supervisors don't have enough staff assigned during the busy hours and waste money keeping it open until 7:30pm when very few people show up for blood work." Page 19 of 34

General Wait Time Displeasure: Some respondents expressed a general unhappiness with the long wait times without specifying a particular concern. Wait times are appalling, especially compared to other provinces. "Find most days I have to be there by 6 am for opening at 7 am." Figure 7. There were 371 respondents who commented on wait times Source: Novima Solutions Theme 4: Blood Collection Service Preference Support for Independent / Private Clinics: The majority of respondents under this category were happy with the time saving and convenience provided by private clinics (for both travel and wait times). Due to this, there was broad acceptance that paying a nominal fee for access to these clinics was worthwhile. Many expressed an interest in seeing an increase in private clinic sites. Parking was also a factor: many stated they were happy to pay a fee to have an efficient appointment than pay for hours of parking and wait time. Despite a preference for independent clinics, some respondents stated they had a concern with the blood testing process standards at those clinics. The St. Page 20 of 34

Margaret's Bay site was specifically highlighted as an ideally located and exceptionally well run clinic which patients did not want to see lost. I believe Capital Health should embrace the help they receive from independent collection locations. I would much rather pay and be in and out in less than twenty minutes." Prefer Capital Health Blood Collection: These respondents expressed concerns with independent clinics in terms of cost, quality, and efficiency (lack of ability to collect urine samples, have x-rays, etc.). The perception that mishandling of samples or misdiagnosis could increase due to the use of private collection services was of primary concern amongst this group. Despite this, the perception that Capital Health should still be administering blood services was tempered by the problems seen with their service. Despite supporting Capital Health, service was still perceived as superior at private clinics. I feel I should not have to pay for a basic blood collection service. If Capital Health offered better hours and locations, I would definitely use Capital Health's services instead. Theme 5: Blood Collection Service Preference Desire mobile, home or rural service: Respondents were in strong support for the continuation of a range of alternative service delivery options for blood services. Mobile service delivery that brought the process to the patients community, at home service (particularly for the elderly), and rural collection sites were all desired by these respondents. "Please add another blood collection location in Spryfield, NS." Tantallon [St Margarets Bay Rd] is a convenient location. Page 21 of 34

"Lots of people with health issues, especially chemical sensitivities, cannot go to labs and have to have blood drawn at home." General facilities or process-related suggestions: These comments varied widely, but all related to the facilities in which service was delivered or the tools involved in the process. Specifically, issues relating to parking (the cost of, or lack of it), the ticket machine used for lining up at service locations, waiting room accommodations (lack of seating, uncomfortable seating, lack of privacy, no entertainment available), and the sites being too cold were all noted. In addition, several respondents expressed a desire for better directions to facility locations, as well as better advertising of extended hours (if in place). Maybe you could put a TV monitor in the room so that people without a personal communication device would have something to distract them while they wait." Would like to have cubicles as I do not like watching others. "The electronic number sign [...] should have audio also announcing." Page 22 of 34

Figure 8. There were 269 respondents who commented on service preference Source: Novima Solutions Page 23 of 34

Advisory Committee Top Issues Once the results were compiled and disseminated, the Advisory Committee was brought together on April 13, 2015 to identify the top issues as determined from the survey results. With small group discussions and a large group card storming consensus-building process, priority issues were identified. To reach quorum, absent members were asked to participate electronically to complete and finalize the process. Two over-arching issues were identified which informed the recommendations formed by the Committee: The public system does not always meet the expectations of the people it serves. The relationship between public and private services may impact user experience. After quorum was reached, the top four priorities were identified: 1. Wait times. 2. Fasting and priority (e.g., cancer care) patients impacted by extended wait times. 3. Staffing quality and quantity (includes volumes/scheduling, customer service, technical skills, interpersonal and communication skills). 4. Access to blood collection services (includes choice of public, private and in-home services, hours of operation and location). Page 24 of 34

Advisory Committee List of Things to Consider A number of things to consider were identified by the Advisory Committee, to assist the PLM leaders in long-term planning of blood collection services. In an effort to inform the citizens and stakeholders of blood collection services, some background is provided: What do you measure? What is success? Measure/monitor changes for effectiveness/impact: e.g., wait times, feedback from patients and stakeholders PLM continues to measuring and monitor wait times, customer feedback and error rates in order to continuously improve blood collection services. This includes monitoring the expansion of services at each phase and any future changes to services. Repeat survey PLM will continue to regularly survey clients and stakeholders of our services to ensure they have an opportunity to have input and help us to improve. Consider bus routes when planning locations Location of services is key; the right place at the right time Access to public transportation, parking and location were key considerations when the new location in Dartmouth was selected. Location will continue to be a consideration for long-term service planning. Private and public services collaborate together NSHA is committed to ongoing discussions to determine an appropriate service model to address blood collection deficiencies and support patient care. Online appointment booking Page 25 of 34

Online appointment booking is being piloted at the new Woodlawn location in Dartmouth, which opened July 13, 2015. The outcome of this new service feature will help inform long-term planning. Remember quality and patient safety! PLM will continue to make decisions and plan services that are quality and patient focused. Mobile/travelling clinic? How do you reach the hard to reach people? Accessibility was one of the top four issues identified by the Advisory Committee. One of the biggest challenges that PLM faces is how to provide blood collection services to patients who have mobility issues or live in remote locations while meeting our fiscal target and ensuring specimen quality, patient safety and sustainability of services. For many patients, paying a fee for this service is not an option. More information needs to be gathered in order to inform discussions regarding these types of service options. Transparent information, report on indicators to the public In addition to sharing survey responses publicly, PLM plans to post wait times for specific locations in real time on site (currently in place), on our website and through a mobile app. This means that patients will be able to make an informed decision when choosing where and when to get their blood taken. Connect with other stakeholders working/assessing community (e.g. community health teams, primary health care) Without question, engaging citizens and stakeholders in service planning discussions is vital to ensure we understand the needs and challenges of our communities so that we can provide the services they need. Page 26 of 34

Work together NSHA is committed to involving patients, families, citizens and stakeholders in decision making so that each can play a meaningful role in creating a better health care system our communities. Make changes. Do something! We know that changes need to occur if we want to ensure high quality, sustainable blood collection services are provided to our patients not only in the Central Zone, but throughout Nova Scotia. We will continue to work together to develop a long-term plan for blood collection services. Think provincially Ongoing discussions and planning will occur within NSHA and the IWK to develop a strategy that addresses blood collection deficiencies and disparities across the zones. Remember determinants of health Primary health care is a comprehensive approach to health and wellness that focuses on all of the factors that determine health across the lifespan, such as where people live, the state of the environment, relationships with friends and family, education and income levels, and genetics. As part of long term planning, PLM will engage the primary health care team to draw on its expertise and knowledge regarding health determinants. Why is there a fee for blood collection services? Originally a fee for-service model was introduced to support bringing service to locations away from the traditional hospital setting. We have heard that many Page 27 of 34

individuals believe they are disadvantaged by this fee-for-service modal as they are unable to pay. This issue will be discussed as part of provincial long term planning. NEXT STEPS The recommendations from the Advisory committee and the outcomes of the blood collection service expansion pilot will help support the development of a long-term strategy for blood collection services within NSHA and the IWK. Over the next several months, key stakeholders from across the province will meet to discuss the issues and inform the development of a long term strategy for blood collection services in Nova Scotia. The ultimate goal is to provide a high quality, sustainable laboratory services that meet the needs of our all patients and communities in Nova Scotia while ensuring patient safety. Page 28 of 34

Appendix A: Survey 1. Where do you normally go to have your blood taken for testing? most often. If you go to more than one location, please choose the one you use Bayer s Road IWK Cobequid Community Musquodoboit Valley Memorial Health Centre Hospital Dartmouth General St. Margaret s Bay Hospital Twin Oaks Memorial Hospital Eastern Shore Memorial Independent service (clinic) Hospital Independent service (in home) Hants Community Hospital Independent service (long term care) Halifax Infirmary Site, QEII Other: Victoria General Site, QEII 2. How often do you have your blood taken for testing? Once a week or more At least once a month At least once every 6 months At least once a year Less than once a year I ve never had my blood taken before/this is the first time I ve had my blood taken If you use an independent blood collection service, please answer the next two questions. If you use only Capital Health or IWK blood collection services, please skip the next two questions. Page 29 of 34

In HRM and West Hants, people can choose where to have their blood collected for testing. They can go to any of a number of community blood collection centres operated by Capital Health and the IWK, or to an independent blood collector for a fee. Some independent blood collectors provide in-home collection. Capital Health and the IWK do not offer this service. 3. Have you ever had your blood taken at a Capital Health or IWK location? Yes No Don t know/prefer not to say 4. Why don t you have your blood taken at a location run by Capital Health or the IWK? Wait for public services is too long Prefer the comfort of my own Inconvenient home/business Accessibility issues (ie, can t get Require in-home services for there, don t have transportation) health reasons Other: Page 30 of 34

Please think about where you normally have your blood taken when answering the next four questions. 5. What do you like about this location? Please check all that apply. Parking Staff Close to public transportation Short wait times Hours of operation 6. What do you not like about this location? Please check all that apply. Facility is clean Close to home Close to doctor s office Close to work Other: Parking Facility is not clean Staff Far from home Far from public transportation Far from doctor s office Long wait times Far from work Hours of operation Other: 7. What hours of operation work best for you? Please check all that apply. Early morning (before 8 a.m.) Morning (8 a.m. to noon) Early afternoon (noon to 4 p.m.) Late afternoon (4 p.m. to 6 p.m.) Evening (after 6 p.m.) Weekend Page 31 of 34

8. What is most important to you when choosing where you have your blood collected? Where 1 is very important and 5 is not at all important. Wait times Days and hours of operation No fee for service Access to parking Access to public transit Ability to set my own appointment Walk-in service In-home service Quality of service Close to home Close to other services (i.e. X-ray, doctor's office, other clinics) Other: 1 2 3 4 5 Please think about the last time you had your blood taken when answering the following. 9. How did the staff act towards you? Please check all that apply. Staff were friendly and courteous Staff introduced themselves to me Staff called me by name Staff seemed to care about me Staff communicated clearly Staff listened to me Staff were knowledgeable None of the above Other: Page 32 of 34

10. In minutes, how long did you have to wait to have your blood drawn? 11. What do you think is an acceptable wait to have your blood taken? Fewer than 10 minutes 10 to 30 minutes 30 minutes to 1 hour 1 to 2 hours Longer than 2 hours 12. Please rate the following changes on how much you think each would improve blood collection services. Where 1 is improve a lot, and 5 is not at all improve. More blood collection sites Extended hours Shorter wait times Other: 1 2 3 4 5 Now, just a few questions about you so that we can understand who s using the service. 13. How old are you? Under 18 18 to 24 25 to 44 45 to 64 65 or older Page 33 of 34

14. Where do you live? (First three characters of postal code only, e.g. B3L) 15. Is there anything else you would like to add that we haven t already asked? Page 34 of 34