QUALITY of CARE SURVEY WORKSHOP April 23-25, 2003.

QUALITY of

CARE SURVEYWORKSHOP

April 23-25, 2003

Background

Secondary health care

services are currently

delivered from a

renovated Primary

School building with a

capacity of 30 beds.

Background (cont’d)

Services offered on-site include – Emergency– Pharmacy – Laboratory– X-ray– Dental – Nutrition – Housekeeping – and Maintenance

Background (cont’d)

The Operating theatre is located about one mile away from the hospital.

Four district clinics are located at – Salem,

– St. Peters,

– Cudjoe Head

– St. John’s.

Why Did We Do This Survey

This initiative arose out of:

A concern that the public

had no input in the provision

of health services,

The constant difficulty in

accurately assessing the

quality of services given to

the public.

Why Did We Do This Survey(cont’d)

The lack of information on the needs of

the population made it very difficult for

projects like the Operating Theatre to be

approved by DfID.

The dwindling finances of the Ministry of

Health meant that focus had to be placed

on the efficient use of resources in key

areas.

Why Did We Do This Survey(cont’d)

No survey on this subject or on this scale

had ever been conducted on Montserrat.

Other surveys conducted were targeted to

specific areas of health and were generally

used as tools for problem-solving

Health staff wanted to know what the public

thought of the services they provided

Problem Statement The quality of care offered

to the people of Montserrat has never been measured and documented.

The needs of the people could not be effectively and completely addressed for improvement and continuation and also for effective use of resources.

Definition

“Quality of Care” refers to the

value, grade or class of the hands-

on care, or any other service

received by a person, that

contributes to the health care of

that person.

Survey Objectives

Main Objectives

1. To determine levels of satisfaction of

services, both primary and secondary,

provided to the general public.

2. To assist in determining the future direction

of health services to include;

• Development of Health Policies

Main Objectives (cont’d)

• Establishment of Quality Assurance and Quality Control Programmes

• Development of Cost Recovery Strategies

• Development of adequate Health Information and Management Information System

Categories of Users

Age Gender Disabled Exempt & Fee Paying Insured & Uninsured Unemployed Low Income

National & Non-national Secondary Care Users – In-

patient & Out-Patients Primary Care Users – Public

& Private Overseas Users Private Care & Public Care National Care & Public Care

Users were categorized by the following

Categories of Services

• Laboratory

• Housekeeping

• Diagnostic (X-ray,

ECG, Ultrasound)

• Pharmacy

• Emergency/Casualty

• Ambulance

• Maintenance

• Dietary• Nursing/Ward• Mortuary• Orderly• Clinical (Surgical,

Medical, Paediatric)• Administration• Reception (Telephone,

Medical Records)

Hospital Services

Target Areas/Groups

Private Clinics Public Clinics Users at Lab, Pharmacy, and other Out-Patient

Departments Geriatric Homes Students Government Departments (civil servants) Statutory Body Groups In- Patients

Approach A small group of senior health officials met in May 2001.

A Steering Committee and a Sub- Committee was formed in June 2001 to plan and undertake this initiative.

The committees met on at least seven occasions.

The categories of services, users, target areas and focus groups were decided by these committees.

Focus Groups

Elderly Groups Social Welfare

Recipients Anglican Group Lookout Comm.Group Manjack Com. Group Drummunds Group Womens SG10 Group

Davy Hill Groups Non-Nationals Hill View Home Red Cross First Aiders Brades Pentecost Grp Rotaract & Rotarians

Methodology

The following represents the tools developed to carry out the survey;

1. Main questionnaire

2. Individually customized questionnaires for Outpatient and Inpatient Departments and Clinics

3. Focus Groups

What kind of Information Did We Collected

Waiting Times Frequency of Visits Reason for Visits Opening Hours Serving Methods Helpfulness of staff Rating of staff Quality of staff

Effectiveness of– Instructions– Treatment

Facility Physical Access to

services Parking Confidentiality Satisfaction


Awareness of types of services

Availability of services Choice of services Use of services on and off

island Suggestions for a range of

services to be offered Familiarity with

regulations

Referral System Affordability of Fees Criteria for quality

health care Perceptions of health

service Physical facilities


Care of the Elderly

Mentally Ill

Exclusion and Access

to Health Care

Views on

Exemption

Suggestions for

Improvement

Criticisms

Key health problems

on Montserrat

Financing Health

Limitations of the Survey

It is recognized that the total hands-on quality of care cannot be assessed by this survey.

Further tools such as clinical audits will have to be used in conjunction with these tools.

The Quality of Care survey results are expected to provide pointers to areas

needing attention.

RESULTS

Response Level

The response level for was 100% for

all departments, with the exception

of the In-patient Section which

recorded a 90% response level.

Distribution by Gender(of respondents)

Respondents by Gender

41%

59%

Male Female

Fifty-nine percent

(59%) of the

respondents were

females.

Respondents By Age Group

AGE GROUP DEPARTMENT

15-24 Dental

25-39 Dr. Buffonge; In-Patient

40-59 Salem Clinic; Medical Records; Pharmacy, Lab, Casualty; Out-

Patient Clinic; X-Ray

60+ Cudjoe Head Clinic; St. Peter’s Clinic; St. John’s Clinic;

Residency Status

Respondents by Nationality

80%

6%

10%

3%

1%

M/ratian Non-Cari Caricom No Resp Visitor

The majority of

respondents were

Montserrat nationals

Occupational StatusRespondents by Occupational Status

Part Time7%

Unemployed38%

Home4%

Disabled1%

Retired8%

Social Welfare1%

Full Time35%

Student6%

Forty two

percent (42%)

of the

respondents

were persons

in the labour

force.

Income Levels

0%

10%

20%

30%

40%

%

Income Level

Repondents by Income Level Forty-seven percent (47%) of the respondents were either unemployed or had minimal income.

Source of Referrals (Clinics)

0%

10%

20%

30%

40%

Source of Referrals

Our Opening Hours -How satisfactory are they?

100%

Cudjoe Head Clinic, Salem Clinic

Dr Buffonge,X-Ray

98% St. Peter’s Clinic, St John’s Clinic

95% Dental

85% Lab

80% Medical Records

60% Out-Patient

46% Pharmacy

Physical Access

Satisfaction Levels

0%

25%

50%

75%

100%

CH

C

SPC

SAL

SJC

Med

Rec

Lab

Phar

O.P

.C.

X-r

ay

Departments

13% of the respondents said they could not see the Casualty Department from the main road.

Parking

0%

25%

50%

75%

Departments

Satisfaction Levels • Salem: Respondents said • “they can’t do any better.”• “they can’t do anything about it, no land.”

• St. John’s: Respondents said

• “Here is just temporary.”

• “When they go to the new one there may be enough.”

• “For a clinic it should not be directly on the highway.”

Physical FacilitiesPhysical Facilities(focus groups)

Positive

13 groups commented very highly on the cleanliness of medical facilities generally

Negatives12 groups commented on the inadequacy of waiting areas especially when it rains particularly for Lab, Casualty and Pharmacy.

Physical Facilities(focus groups cont’d)

Lack of proper waiting rooms with protection from the elements (6)Lack of comfort especially for the elderly (10)Not enough seating

Highest Frequency ofWaiting Time

<10 mins Dental, X-Ray

10 - 30 mins Cudjoe Head Clinic, St. Peter’s Clinic, Salem Clinic, Pharmacy, Casualty

11-30 mins Laboratory

30-1hr St. John’s Clinic,

<10mins, 10-30mins, 30 min- 1hr

Medical Records

30mins – 1hr

2hrs+

Outpatient Clinic

Dissatisfaction withWaiting Time

Dep

art

men

ts

Levels of dissatisfaction ranged between 0% – 50%. The lowest levels were in the X-ray Department and the highest levels at the Pharmacy.

Doctor’s Waiting Time(How much time did most persons wait)

AREA %of respondents

WAITING TIME

Casualty 52% More than 30 minutes

In-Patient 26% Less than10 minutes

Seating

0%

25%

50%

75%

100%

Sat

isfa

ctio

n L

evel

Departments

Privacy

Cudjoe Head Clinic– Could close the door

– Facility is too open

St. John’s Clinic– Nurses section is not so

private

Pharmacy– Persons sitting on the bench

can see and hear what is taking place.

0%

25%

50%

75%

100%

Satis

fact

ion

Leve

l

Departments

Privacy

Pharmacy cont’d– Everyone waiting can see what medication one

received and hear instructions.

– Seating is to close. Casualty

– Persons can hear or see patients being dealt with.

– Screen should be closed at all times. Dental

– There should be a door instead of a curtain.

PrivacyPrivacy (Focus Groups)

12 groups talked about the privacy of the physical facilities provided.

Positives

Some groups (6) felt there was (some) privacy at the various facilities (Casualty, Pharmacy, Wards, Clinics)

Xray was considered private, as well as the private doctors.

Privacy (Focus Groups cont’d)

Negatives

A lack of privacy on the Wards (5)No privacy at the private pharmacy when prescriptions are left (3)Lack of privacy at the Homes

Level of Confidentiality

0%

25%

50%

75%

100%

Sati

sfac

tion

Lev

el

CHCSPC

SALSJC

Med

Rec Lab

PharCas

Denta

l

X-ray

Inpati

ent

Departments

POLITE & HELPFULNESS OF NURSES(Clinics, Casualty, Inpatients)

POLITENESS– Levels of

satisfaction ranged from 73% to 100%

QUESTIONS – Levels of

satisfaction ranged from 70% to 98%.

0%

25%

50%

75%

100%

Sati

sfac

tion

Lev

el

War

dCas SP Sal SJ

Polite

0%

25%

50%

75%

100%

Sati

sfac

tion

Lev

el

War

dCas SP Sal SJ

Questions


TOOK TIME– 100% levels of satisfaction

were recorded on the Wards and at Salem Clinic

EXPLAINED– 63% of the respondents

were satisfied with the explanations given at the Casualty Department.

0%

25%

50%

75%

100%

Sati

sfac

tion

Lev

el

War

dCas SP Sal SJ

Took Time

0%

25%

50%

75%

100%

Sati

sfac

tion

Lev

el

War

dCas SP Sal SJ

Explained


CARING– 100% levels of satisfaction

were recorded on the Wards and at Salem Clinic.

In all the categories the Casualty Department recorded the lowest levels of satisfaction.

0%

25%

50%

75%

100%

Sati

sfac

tion

Lev

el

War

dCas SP Sal SJ

Caring

Nurses Professional Service

0%

25%

50%

75%

100%

Departments

Very Good Good AverageNR Poor Very Poor

• Casualty was the only Department that had levels of poor and very poor.

• Many persons thought that the resources available affected the nurse’s ability to provide the best professional service.

• On the other hand, some persons commented that Nurses had resources but were unable to use it, e.g. ultrasound

Nurses Instructions

An average of 95% of respondents for clinics were satisfied that they could clearly understand and easily carry out the nurses’ instructions and advice.

Those falling into the 5% who were not satisfied made comments such as:-

Information is sometimes conflicting, all should say to do things the same way (Cas)

Most nurses always seem to be in a hurry as if they are not working. (Cas)

Nurses are sometimes too abrupt and uncaring. (Cas)

Nurses Medical Treatment or Advice

An average of 93% of respondents for Clinics and Casualty were satisfied that they nurse provided effective advice and treatment for their medical condition.

Those falling into the other 7% made comments such as:-

Whenever you ask them a question???

Nurses Medical Treatment or Advice (cont’d)

Sometimes it helps, sometimes it does not. They

can’t cure me, they can only help me.

In asking those 7% how they would deal with this

problem, most indicated that they would go to a doctor or return to the Clinic.

Nurses ServicesNurses Services(focus groups)

Positives

16/18 groups made 40 positive comments about the nurses. They found that the nurses on the whole were caring, friendly and provided a good service.20 Nurses were specifically praised either by name or clinic.

Nurses Services(focus groups cont’d)

Negatives

12/18 groups also made 32 negative commentsSome Nurses were seen as uncaring, unprofessional and impolite to patients (8)


Some Nurses were seen as not responding quickly enough, not putting the needs of the patients first, ignoring the patients (5 groups, 11 different comments)Nurses at Casualty were seen as less caring and not prompt/professional (7)Questions were raised about confidentiality (6).


Suggestions

A range of suggestions were made including:-Resident nurse at all clinics (4)Ongoing training for nurses (3)Patients may wish to speak to the Doctor alone without the nurse present (2)Nurse to accompany patient in ambulance.

POLITE & HELPFULNESS OF DOCTORS (Clinics, Casualty, Inpatients)

80%82%84%86%88%90%92%94%96%98%

100%

Satis

factio

n Lev

el

Explained

0%

25%

50%

75%

100%

Satis

factio

n Lev

el

Caring

80%82%84%86%88%90%92%94%96%98%

100%

Sati

sfac

tion

Lev

el

War

dCas SP SJ CJ

Advice

Doctors Professional Service

0%

25%

50%

75%

100%

Sati

sfac

tion

Lev

el

SJ CJW

ard SL SP

Departments

Very Good Good Average NR

QUALITY of CARE SURVEY WORKSHOP April 23-25, 2003.

Documents

Transcript of QUALITY of CARE SURVEY WORKSHOP April 23-25, 2003.