Almost no one complains about the food. It’s not that the food at the University of Ottawa Heart Institute is better than at other hospitals. But, said Sharon Ann Kearns, the Manager of Quality and Performance Measurement, when people are satisfied with their care and feel they have been well treated, they don’t really focus on the food.
And that’s definitely how patients at the Heart Institute feel. In fact, the Heart Institute is among the best in Ontario when it comes to patient satisfaction. A recent survey of Ontario hospitals conducted by NRC Picker, a national provider of health care performance measurement, found that the Heart Institute ranked first among Ontario acute care hospitals that patients would recommend to their families and friends. The survey also found that the Heart Institute scored 98 per cent in terms of overall patient satisfaction, placing it in a small group of just seven hospitals in the province that scored in the 90th percentile or higher.
But in this era, when all hospitals are required to develop a quality improvement plan each year and when every health care organization is focused on increasing patient satisfaction, what makes the Heart Institute stand out?
It Is All About the People
One answer is its people. Another recent survey, this time of staff engagement, gave the Heart Institute a score of 70 per cent—the highest in the Canadian health care sector and well above the average score of 55 per cent.
“We’re never happy with the average. We set targets that are well above those of other hospitals.”
– Dr. Lloyd Duchesne, Cardiologist and Quality Committee Member, UOHI
Kearns ties this pride and commitment back to the earliest days of the Heart Institute. The motto of its founder, Dr. Wilbert Keon, was “Patients come first” and, said Kearns, “He lived that, every minute of the day. It has continued with our Vice President of Clinical Services, Heather Sherrard, who puts patients at the centre of everything we do.”
Carolyn Cooper sees this staff commitment every day as Clinical Manager of ward H4, which cares for cardiology and surgery inpatients.
“It’s more than a team. We work as a family,” she explained. “We understand that each of us has a key role to play. We help each other, are respectful of each other. And that translates directly to better patient care.”
“It’s partly a factor of size,” she added. In a hospital the size of the Heart Institute, everyone knows one another, whether they are physicians, nurses, social workers, physiotherapists or any of the myriad other professionals who play a role in patient care. No one works in isolation.
Nurses participate in rounds with physicians, which builds a collaborative relationship. There is a lot of discussion among the various groups, and in a relaxed fashion. This, Cooper said, has made a big difference in areas such as pain control. So has involving spiritual care workers in staff meetings, something that has helped nurses better understand how patients feel. While this level of collaboration is desirable, it’s still unusual to see in health care.
Cooper also credited the educational opportunities that exist on a regular basis and encourages her nurses to take full advantage of them. Alison Evans agreed. The physiotherapist has nothing but praise for the way physicians, in particular, share their knowledge with the students who come through the Heart Institute, broadcasting surgeries over live video feeds so that others can watch. Physicians even go so far as to track down interested students to encourage them to observe a procedure at the bedside.
Ultimately, said Cooper, it’s all about what is best for the patient. Every day, she takes time to talk to patients, to sit and listen to what they have to say. She encourages family members to bring in pictures, a comforter—small touches to help patients feel at home. “They’re small things, but they’re actually huge.”
Providing Care along the Continuum
Another reason patients are so satisfied with the Heart Institute lies in the way care begins long before patients are actually admitted and continues long after they’re discharged.
As soon as a patient is referred to the Heart Institute, for instance, he or she has access to a nursing coordinator who, at any time of the day or night, can answer questions about the patient’s condition and care. The Wait List Management Office keeps in close touch with patients at home or at their local hospital, monitoring their situations and adjusting their positions on the wait list if their conditions or symptoms change.
If a patient is in a local hospital, he or she knows that the Heart Institute works closely with all hospitals in the region (the Champlain Local Health Integration Network) to ensure that those institutions have access to the same programs and tools as the Heart Institute itself. “This gives patients a sense of connection,” said Kearns.
Erika MacPhee is the Regional Cardiac Care Coordinator, heading up the Wait List Management team. Fall is a particularly busy time for her unit, as snowbirds prepare to go south for the winter. MacPhee is the liaison dealing with insurers if something happens while patients are away, and she’s frequently told that the first thing patients say is that they want to be transported home as quickly as possible. And the Heart Institute does whatever it takes to make that happen.
One patient, she recalled, had a major heart attack while vacationing in the Turks and Caicos. The Heart Institute was able to arrange a bed right away—something that might take up to several weeks in Toronto, according to the insurer. The patient, however, wouldn’t return home without her dog. The Heart Institute agreed to have the dog brought with her and be picked up on arrival by family members.
Discharged patients, like those awaiting admission, are never left to their own devices and their own anxieties. After discharge, the Heart Institute continues to provide care through a telehome monitoring program. Patients call in each day to report their vital statistics and symptoms to an interactive voice response system. If something is not as it should be, a nurse responds immediately to help the patient address the issue, whether through medication changes or even returning to the hospital when necessary.
The Heart Institute also offers outpatient rehabilitation programs. So on a January afternoon, several elderly patients circle the Heart Institute’s track, independently or with the help of walkers. A physiotherapist supervises the physical aspects of their recovery, but the patients are taking care of the social aspects themselves, with their animated conversation providing as much of a benefit as the exercise they’re getting.
For those who can’t travel to the Heart Institute, physiotherapists and rehabilitation specialists provide telephone support to help patients set goals and overcome the obstacles to their achieving their goals. The Heart Institute’s Heart Wise Exercise program also helps patients identify approved exercise programs in their local communities across Eastern Ontario and the Greater Toronto Area.
Responding to Concerns
Yet another answer lies in the structures the hospital has established to deal with patient complaints when they do occur.
When a patient concern arises, Kearns investigates and brings a multidisciplinary committee together to discuss the concern and work with the staff involved to resolve the issue and reduce any obstacles to optimal care by changing process. A Quality Committee, chaired by Board member David Scott, oversees quality of care issues more generally.
Patient surveys are an important part of the process. About two-thirds of all patients fill out a survey about their experiences. Each quarter, the results are posted on patient satisfaction boards featured prominently on every ward in the Heart Institute. Results are specific to the ward, and the boards highlight three areas where the ward excelled in the past quarter, three areas where it did well, and three areas where it needs to improve, all according to patients.
Care begins long before patients are actually admitted and continues long after they’re discharged.
Historically, said cardiologist Dr. Lloyd Duchesne, a member of the Quality Committee, quality of care has been an intangible, something very subjective and hard to measure. Over the years, however, hospitals have developed indicators that make it possible to measure quality. And once you can measure quality, he explained, you can act to improve it.
It’s not an easy process. It can take a lot of meetings, a lot of people, a lot of time to improve processes and ensure that changes in one area don’t negatively impact another. But there is no resistance from staff. On the contrary, said Kearns, “Staff is really anxious to make things better.”
“Quality and patient satisfaction are the responsibility of each and every employee here,” said Dr. Duchesne. “We’re never happy with the average. We set targets that are well above those of other hospitals.”
All patients know that they can go directly to Kearns if they have a problem. Often, patients or family members want to know the details of what happened to them and what kind of treatment they or their loved one received, especially when it’s a sudden event, like a young person experiencing cardiac arrest. If patients are unhappy with their care, Kearns will investigate and find a solution—for instance, by helping a staff member understand how to better manage a certain situation.
Kearns has two overarching principles: First, always apologize for the patient’s experience and understand the patient’s expectations for a resolution; and second, let the patient or family know the results of her investigation into their concern.
“We spend a lot of time on some concerns, but in the end, patients and families feel good about things,” she said. “Whatever people bring to us, it never gets ignored. We can’t treat patients paternalistically. They need to be the centre of their own care.”
The bottom line, according to MacPhee? Patients who are happy with their care recover better, and that makes everyone at the Heart Institute feel good about their work.
At any given time, there are some 400 people waiting for angiograms or other procedures at the Heart Institute. And chances are, Erika MacPhee and her team in the Wait List Management Office have talked with each and every one of them—often multiple times.
MacPhee’s official title is Regional Cardiac Care Coordinator, but she likens herself more to an air traffic controller. She and her team are engaged in a constant juggling act, balancing the beds available in the hospital with the changing conditions and needs of those waiting to be admitted, whether for catheter procedures or surgery.
Every patient referred to the Heart Institute immediately receives a letter explaining the process and giving them contact information for a nurse coordinator. The contact point is available around the clock, seven days a week, in case a patient experiences new symptoms or is concerned about something.
Those referred from other hospitals are monitored on a daily basis, with MacPhee and her team talking to the hospitals about the condition of patients and whether their needs are changing.
The most important thing, said MacPhee, is that “patients always have access to us. There is no answering machine. Every phone call has to be answered by a human.” She estimates that she and her team probably spend half their day talking to patients.
As a result, those patients feel cared for, not abandoned, while waiting for their procedures. And, when they do arrive at the Heart Institute, they know what to expect. But more important, MacPhee and her team have set the tone for the care patients will receive throughout their time at the Heart Institute.
“Everybody has a story,” she said. “It”s really important to listen to all the stories. “It’s so important to be there to talk to them.”
Beyond the emotional support, she and her team have access to patients’ charts and information, which allows them to provide targeted advice. And they, MacPhee emphasizes, are a much better source than Google. “Get off the Internet,” she said. “Just call me!”