Patient Satisfaction Monitoring Denmark

The Capital Region of Denmark
Evaluation in a complex world
- A walk in the park: Introducing continous
monitoring of patient satisfaction in the capital
region of Denmark – how it became a challenge
..And how we are meeting the challenge
Max Miller, Mads Teisen 1

Menu:
1. The ignorant strategic manager, believing everything is a
walk in the park
2. The evaluation professional, who are left with the challenge
to create a sustainable evaluation system
3. Open discussion: is this a normal dilemma? How do we
handle it?

) 3
Budget € 5,3 billion
40.000 employees
•6 hospitals
•Psychiatric Hospital
•Regional pharmacy
•Ambulance services and
Emergency rooms
•Specialized social services such
as homes for disabled people
•Environmental protection
•Regional planning
•Business development
Elected Regional Council
(41 members)
Who we are and what we do

Max and Mads
4
Programme manager,
Evaluation
Programme manager,
Strategic management

The strategic ambition
5
• The politicians back at the wheel
• Coherent and simple management system
• Focus on performance rather than activities

The Strategy, the idea
• Vision in 1 sentence
• Mission in 1 sentence
• Max 4 policy objectives
• Max 30 key performance indicators at corporate level

Strategic Map – Development Projects
Miljørigtig drift og
udvikling
Monitoring and Evaluation framework
Policy Objectives
The patient is
controlling the
process
High professional
quality
Expansive
knowledge
environment
A green and
innovative
metropolis
Mission
We stand for treatment, education and
research
in public health, and with others we
develop the capital region, where we
have particular tasks within the
environment, traffic, business,
education and social services
Vision
The Capital Region is the green and
innovative metropolis with high growth
and quality of life, as well as a coherent
healthcare service at international level
Perspectives Strategic areas
Users citizens and
business partners
Quality
Economy and
efficiency
Employees and
managers
KPI
Health-
care
Regional
Development
Social
Services
Satisfation
Delivery
Quality
Employees and
managers
Productivity

Strategic Map – Development Projects
Miljørigtig drift og
udvikling
Monitoring and Evaluation framework
Policy Objectives
The patient is
controlling the
process
High professional
quality
Expansive
knowledge
environment
Green and
innovative
metropolis
I
Mission
We stand for treatment, education and
research
in public health, and with others we
develop the capital region, where we
have particular tasks within the
environment, traffic, business,
education and social services
Vision
The Capital Region is the green and
innovative metropolis with high growth
and quality of life, as well as a coherent
healthcare service at international level
Perspectives Strategic areas
Users citizens and
business partners
Quality
Economy and
efficiency
Employees and
managers
KPI Health Care
Regional
Development
Social
Services
Satisfation
Delivery
Quality
Employees and
managers
Productivity
Managing
Development
There is a clear line in the
operational control - from
the economy, the
employee perspective,
quality, delivery, and
patient satisfaction to the
policy objectives and the
overarching vision for the
region.

Indicators: Healthcare
KPI Health Care
Satisfation Patient satisfaction
Delivery Response time, emergency phone
Waiting time, emergency room
Progress, Cancer processes
Time for diagnosis
On time Discharge summaries
Quality Use of antibiotics
Clinical databases
Preventable deaths
Patient Re-admissions
Belt fixing
Employees and managers Sick leave, employee satisfaction
Productivity
Budget compliance (Finance)
Budget compliance (activity)
Efficiency (index)

The use of data
• Data should be used at all levels of the organization
Political
accountability
Management
Improvement
in the clinic

Core Idea – the improvement meeting
Decisions and ideas are
flowing smoothly through the organization
Corporate level
Clinic

Politicians improvement meeting

Board of directors improvement meeting

Improvement meeting in the clinicDepartment for oncology, University Hospital of Denmark

The role of patient satisfaction
• Patient satisfaction is the proxy for performance
• Patient satisfaction is the link between the dayli operations
and the political vision (long term impact)
• Patient satisfaction is essential for the value chain
SatisfactionProductivity
Employees
and
Managers
Quality Delivery

• We don’t know if our work is supporting the political priorities
• We son’t know if the treatment we provide is helping anyone
• We leave the floor to dedicated professionals - both medical
and economic – but miss the patient
• We give up transperancy, prioritization and control
• We will not be able to comply with new standards for PRO
(patient reported outcome)
If we miss the outcome indicator -

You just need an evaluation
professional…

Max and Mads
19
Programme manager,
Evaluation
Programme manager,
Strategic management

Center for Patient Experience and Evaluation
• Part of the Capital Region
• We do:
• Patient Satisfaction surveys at regional and national level
• Evaluate programmes/project within the danish healtcare
system
• Develop and communicate tools that support "patient
centered care"
20

Some facts on the assignment
21
• Provide real time data on patient satisfaction based on three questions
(at all levels in the organization)
• An organization with 6 levels of leadership/management
(political, corporate, hospital, Center, department, wards/clinics
• 800 wards/outpatient clinics
• No survey solutions integrated in the patient administrative software!
• The concept of improvement meetings was not yet rolled out
• Poor experiences implementing IT-related tools in the organization
Implementation and sustainability
when designing

A tool designed for different users
22
Different groups of professions (ex. physicians/nurses)
The wards/outpatient clinics with different medical specialties
The patients
Different management levels in the organization
(Political council Clinics)

Main user focus in design phase
23
Ward/Clinic and professions
Patients
• Hospital Management
OPERATIONAL LEVEL

Engagement and ownership by:
24
• Building capacity to collect and use feedback from patients
• Delegating responsibility
• Maximizing influence and relevance
• Minimizing need for technical know-how
OPERATIONAL LEVEL

Delegating responsibility (Collecting data)
25
• Wards/clinics=Point of contact for patients
• Control of the data collection at clinic-level
Print letters
Floor or wall mounted kiosk stands
Tablets
Mix
• Different professions – different scientific ideals
• Physicians
• RCT golden standard
• Maximum control of sample
Choose between
open acces or password
• Different practical inddor arrangement
• Different ways of meeting the patients
• Patients with different capabilities
The possibility of knowing
more about your patients

Influence and relevance
The questions in the survey 1
26
One question for
Hospital management
Two local questions
Five questions total
• Generic vs. local concrete questions
• Interpretation of strategy into local questions
• Quality improvement/action oriented
• Follow up on local initiatives
• Few questions
• one screenshot
• Large font
• Improvement meeting
• Mediation between operational and political level
• Follow up on large scale initiatives

Influence and relevance
The questions in the survey 2
27
• Different professions – different scientific ideals
• Nurses
• Qualitative rather than quantitative data
• What and why rather than how many
• Qualitative data gives ideas
A screen shot
for comments on the
stay/consultation

Minimizing technical know how (Easy acces)
28
• Web-Interface on hospital level gives acces to
• other levels interface
• standardreports on results from all clinics plus agregated
results
• Database with questions
• Acces to raw data
• Web-Interface on clinic level gives acces to
• Two types of standard reports (click or email)
• Database with 130 questions to choose from by clicking (continuously growing)
• Standard letters for printing
• Tablets and kiosk stands showing questionaire

Building capacity (Teaching how)
29
• Teaching sessions with a representative from each ward/clinic on
• How to use interface
• Choice of questions
• Data collections methods
• Nudging methods (and materials)
• How to read/interpret the reports/results
• Information material on the above and
• Cases on how other clinics do
• Network meeting with representatives

30
Did we go to far in meeting user needs and giving away control?

31
THANK YOU!

Patient Satisfaction Monitoring Denmark

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