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Standards for general practices (4th edition)

including Interpretive guide for Aboriginal and Torres Strait Islander health services

Standard 2.1 Collaborating with patients

Our practice respects the rights and needs of patients.

Criterion 2.1.2

Patient feedback

Our practice seeks and responds to patients’ feedback on their experience of our practice to support our quality improvement activities.

Indicators

► A. Our practice has a process for seeking and responding to feedback from patients and other people and our practice team can describe this process.

► B. Our practice has a complaints resolution process and makes contact information for the state/territory health complaints agencies readily available to patients if we are unable to resolve their concerns ourselves.

► C. At least once every 3 years, our practice actively seeks feedback about patients’ experiences of our practice by:

  • using a validated patient experience questionnaire that has been approved by the RACGP, or
  • developing and using our own individual practice specific method that adheres to the requirements outlined in the RACGP Patient feedback guide: learning from our patients (questionnaire or focus group or patient interviews).

► D. Our practice can demonstrate improvements we have made in response to analysis of patient feedback.

E. Our practice provides information to patients about practice improvements made as a result of their input.

Explanation

Key points

  • Patient experience is an outcome of healthcare
  • Good patient experiences are positively related to other aspects of healthcare
  • Collection of feedback about patient experience needs to be rigorous so that actions based on patient feedback can lead to meaningful quality improvement
  • This criterion cross references to Crtierion 1.2.1 Practice information.

Must-have resource

Practices are advised to refer to the RACGP Patient feedback guide: learning from our patients to understand the rationale for collecting and using patient experience feedback and suitable methods for collecting feedback, which can then be used to drive quality improvement.

Patient experience

Internationally and in Australia there is growing emphasis on the robust and meaningful collection of information about patient experiences in both primary and tertiary care settings. In Australia there is a range of patient ‘charters’ or ‘principles’ of patient centred care and consumer involvement. These relate to the provision of healthcare that involves, engages and prioritises the role of the consumer/patient in their care – sometimes referred to as a ‘partnership approach’ to healthcare. Critical to this type of healthcare, although only one element of it, is a process for patients to provide feedback (both positive and negative) to individual members of the clinical team and the wider practice team on their healthcare experience.

Issues critical to the patient experience

There is strong evidence in the published literature that there are six broad categories of issues that are critical to patients’ experience of primary healthcare. Practices will need to seek feedback on all six of these categories:

  • access and availability
  • information provision
  • privacy and confidentiality
  • continuity of care
  • communication skills of clinical staff
  • interpersonal skills of clinical staff.

Collecting patient feedback on a day-to-day basis

The practice needs to have day-to-day mechanisms for gaining feedback from patients (such as a ‘suggestion box’ at reception) to allow for the timely consideration of comments, concerns or complaints. Where possible, patients should be encouraged to raise any concerns with the practice team directly and attempts should be made to resolve such concerns within the practice.

Managing complaints

Practices should attempt to resolve patient complaints themselves. If the matter can not be resolved, the relevant Health Complaints Commissioner can be contacted by the practice or by the patient for advice and possible mediation. Section 3 of the MBA Code of Conduct contains advice about managing complaints at the practice level (available at www.medicalboard.gov.au/Codes-and-Guidelines.aspx).

Basic steps include:

  • acknowledging the patient’s right to complain
  • working with the patient to resolve the issue, where possible
  • providing a prompt, open and constructive response, including an explanation and if appropriate an apology
  • ensuring the complaint does not adversely affect the patient’s care. In some cases, it may be advisable to refer the patient to another doctor
  • complying with relevant complaints law, policies and procedures.

The practice should make a habit of contacting the relevant insurer when a patient makes a complaint about a member of the clinical team, in order to seek advice on resolving the complaint before any action is taken.

The Australian Commission on Safety and Quality in Health Care (ACSQHC) publication Better practice guidelines on complaints management for health care services provides guidance on effective complaints management in the Australian healthcare setting and is available at www.safetyandquality.gov.au/internet/safety/publishing.nsf/ Content/F3D3F3274D393DFCCA257483000D8461/$file/guidecomplnts.pdf.

Systematic methods for collecting patient experience feedback

Practices have four options for collecting patient experience feedback:

  • use an RACGP approved questionnaire, or
  • develop an individual practice specific questionnaire, or
  • conduct a series of focus groups with patients, or
  • conduct a series of interviews with patients.

Each option has advantages and disadvantages and practices will need to decide which method best suits their practice and patients. Detailed guidance is available in the RACGP Patient feedback guide: learning from our patients. Structured/ systematic patient experience feedback needs to be collected at least once every 3 years. There is good evidence to suggest that the most meaningful changes to practice can occur from collecting and using patient experience feedback on a more regular basis. Practices are therefore encouraged to consider collecting structured patient experience feedback more frequently than the required minimum. Where practices choose to collect patient feedback using methods other than an RACGP approved questionnaire, these methods need to meet the requirements outlined in the RACGP Patient feedback guide.

Using patient experience information to improve quality

Once patient feedback data has been collected and analysed, it is recommended the practice convene a dedicated staff meeting to reflect on the results and map out a plan of action for quality improvement. The plan needs to consider other information about the practice such as safety and cost issues. It is recommended the action plan focus on a few key issues. Not every suggestion made by patients will be practical, feasible or desired and it is up to the practice to determine a set of priorities for action.

Telling patients about quality improvement initiatives

Patients value knowing that their feedback has been useful to the practice. It is therefore recommended that practices communicate the findings of the feedback process in suitable ways (eg. a practice poster, newsletter or website, or at an individual level as appropriate).

Services providing care outside normal opening hours

For services that provide care outside normal opening hours, Indicator A includes responding to feedback from the practices for which they deputise and providing practices for which they deputise with any patient feedback directed at the patient’s regular practice.

Standard 2.1 Collaborating with patients

Our practice respects the rights and needs of patients.

Criterion 2.1.2

Patient feedback

Our practice seeks and responds to patients’ feedback on their experience of our practice to support our quality improvement activities.

In a nutshell

A recognised outcome of healthcare is a health service’s ability to both seek and respond to patients’ experiences of their healthcare, whether good or bad. Your health service can achieve this by having a mechanism for patient feedback, analysis of that feedback and a plan to improve health service delivery in direct response to that feedback.

Key team members

  • Health service manager
  • All health service staff

Key organisational functions

  • Patient feedback policy and processes
  • Service planning and evaluation meetings
  • Patient complaints policy and process
  • Legal and regulatory compliance (health service delivery, complaints and professional indemnity insurance)
  • Patient communication policy
  • Practice information sheet
  • Service delivery charters or principles
  • Risk management and control
  • Health service and professional indemnity insurance policy and procedures

Indicators and what they mean

Table 2.2 explains each of the indicators for this criterion. Refer to Criterion 2.1.2 Patient feedback of the Standards for general practices for more information and explanations of some of the concepts referred to in this criterion. Further essential reading for this criterion is a patient feedback guide and FAQ section on patient feedback requirements.

Table 2.2 Criterion 2.1.2 Patient feedback
IndicatorWhat this means and handy hints
▶ A. Our practice has a process for seeking and responding to feedback from patients and other people and our practice team can describe the process. Your health service should have in place a mechanism that allows for:
  • patients to provide feedback when they want to (for example, a feedback/suggestion box)
  • analysis of that feedback (for example, regularly emptying the box and analysing feedback to create reports for staff to consider and discuss at meetings)
  • the development of a plan of action in direct response to that feedback (for example, an agenda item for the regular health staff meeting).
It is important that this mechanism is easy for patients to use. It is equally important that all staff have an understanding of how the process works.
▶ B. Our practice has a complaints resolution process and makes contact information for the state/territory health complaints agencies readily available to patients if we are unable to resolve their concerns ourselves. Your health service should have a system for patients to make complaints. This can be set out in a patient complaints policy and procedures document, which is made known to all staff members. Information about the complaints process needs to be made known to patients. This can be done via a notice on the board or a take-home leaflet; alternatively, staff need to be able to describe that process when asked by patients.

This process would include the delegation of a staff member as the person primarily responsible for communication with patients about complaints (such as the health service manager).

Patients need to know what to do if they are not satisfied with the response to their complaint, and the service should provide patients with contact information for the state/territory health complaints agencies (such as Health Complaints Commissioner).

Section 3.11 of the MBA’s Good medical practice: a code of conduct for doctors in Australia (www.medicalboard.gov.au/Codes-Guidelines-Policies.aspx) provides advice about managing complaints. Basic steps include:
  • acknowledging the patient’s right to complain
  • working with the patient to resolve the issue
  • providing a prompt, open and constructive response (such as explanation, or apology or both)
  • ensuring that the patient is still able to utilise your health service during the complaints handling process (such as referring them to another doctor or AHW)
  • complying with relevant laws, policies and procedures that deal with health complaints.
If your health service has a policy of allowing patients access to your board members for complaints, explain to patients the process involved and provide the relevant contact details.

It is advisable that your health service also contacts the relevant insurer when the complaint involves a clinical team member. Advice should be sought from the insurer before taking action.
▶ C. At least once every 3 years, our practice actively seeks feedback about patients’ experience of our practice by:
  • using a validated patient experience questionnaire that has been approved by the RACGP or
  • developing and using our own individual practice-specific method that adheres to the requirements outlined in the RACGP Patient feedback guide: learning from our patients (questionnaire or focus group or patient interviews).
The RACGP Patient feedback guide: learning from our patients is essential reading for this criterion.

In addition to having processes to encourage patients to provide feedback and to make complaints if they wish, it is important your health service actively and systematically seeks feedback from its patients.

The information gained from this more formal process is more likely to capture all aspects of the patient experience, and from a wider range of patients. It will provide a more reliable basis for developing and implementing quality improvements based on patient feedback. This process provides important information to your service about where it is doing well and where it could improve. It also allows your service to compare one group of patients with another (for example, from services delivered at different locations) and to monitor its service quality over time (for example, to measure the effect of a new service or improvements to an existing service).

The RACGP Patient feedback guide: learning from your patientsoutlines six dimensions of the patient experience that need to be covered:
  • access and availability
  • information provision
  • privacy and confidentiality
  • continuity of care
  • communication skills of clinical staff
  • interpersonal skills of clinical staff.
There are two options for the collection of patient feedback, explained more fully in the Patient feedback guide:
  • a validated patient experience questionnaire, which has been approved by the RACGP
  • a practice-specific method of collecting patient experience feedback (questionnaire, focus groups or patient interviews), also approved by the RACGP.*
There are advantages and disadvantages to each of the methods described above. Many are outlined in the Patient feedback guide, and we recommend that you understand these and choose the method most appropriate for your health service. Health services with patients from culturally diverse backgrounds need to also consider issues such as language, cultural safety and cultural protocols when choosing methods for feedback collection. This will reduce the possible barriers to patients’ participation in feedback processes.
▶ D. Our practice can demonstrate improvements we have made in response to analysis of patient feedback. An important part of patient feedback is your health service’s capacity to put in place changes in response to that feedback, and to demonstrate that you have done this. Depending on the type of feedback – how significant or urgent it is – you service’s response to the feedback can be immediate (at regular staff meetings), annually (at planning day) or every 2 to 3 years (part of the strategic plan).

Improvements made need to be incorporated into relevant policies and procedures, where appropriate, and communicated to all staff.
E. Our practice provides information to patients about practice improvements made as a result of their input. Patients value being heard. It is recommended that when you have analysed feedback findings and instigate change as a result, you communicate this back to patients. This communication may be with an individual patient where appropriate – for example, about actions taken if the patient has made a complaint or suggestion. If actions from informal or individual patient feedback affect all patients, then information regarding that improvement would be given to all patients.

Actions from your systematic 3-yearly patient feedback process need to be communicated to all patients. You could provide this information in many ways, such as:
  • at annual general meetings and in annual reports
  • in an electronic bulletin
  • via health service posters or notice boards
  • via newsletters
  • on your website
  • to the relevant individual patient.

Case study

Below is a description of the ways in which an Aboriginal community controlled health service can obtain and respond to patient feedback. Not all of these good practices are required by the Standards, but they illustrate the many practical and creative things that ACCHSs can do to ensure they deliver services of high safety and quality to their community.

The health service’s patient information sheet tells how a patient can discuss issues with the service directly. It emphasises that the service values critical as well as positive feedback, and that there will be no negative consequences for a patient resulting from a complaint. The service has a designated staff member with whom patients can lodge complaints or discuss issues, either verbally or in writing. This staff member keeps a record of complaints and how the complaints were resolved or, if a complaint could not be resolved, the reason why not.

The service provides the contact details for the state/territory health complaints agency if the patient is unwilling to complain to the service directly, or if the patient feels that the service hasn’t addressed their complaint properly.

The service has a suggestion box in the waiting room. Reception staff empty it weekly and give the suggestions to the designated staff member. Suggestions are discussed at team meetings and action taken if agreed. The service keeps a logbook of any changes or improvements made as a result of a patient complaint or feedback. Staff speak directly to individual patients who have made suggestions that result in a change or improvement about the change made as a result of their suggestions.

Program staff members get feedback from their clients at the end of any program that is run, either in the form of a written questionnaire or by conducting interviews or focus groups. The feedback is provided in a report to management for review. Improvements that are agreed are planned and implemented in the next program.

An RACGP-approved patient feedback survey is completed at least once every 3 years. The results of the survey are distributed to all staff for review. All staff members are asked to offer suggestions regarding the feedback issues that are appropriate for improvement and action, and then prioritise areas for action. The priorities are based on key areas that show clear potential for achievable improvement. A record of improvements or changes is documented in a quality improvement record book.

Changes that are implemented are included in the service’s newsletter and on the waiting room notice board. The service’s website also includes information on changes that have been made as a result of client feedback or suggestions. The service also uses local media to promote or announce major changes in service delivery and highlights that the changes are as a result of client feedback and suggestions.

* 
Note that ‘If a practice decides to develop its own practice-specific method, then after the initial development, pre-testing and refinement (but prior to collecting information from patients), the practice needs to apply to the RACGP to have its method approved as suitably rigorous to meet the requirements of the Standards. (The RACGP Patient feedback guide: learning from our patients, p2).

Showing how you meet Criterion 2.1.2

Below are some of the ways in which an Aboriginal community controlled health service might choose to demonstrate how it meets the requirements of this criterion for accreditation against the Standards. Please use the following as examples only, because your service may choose other, better-suited, forms of evidence to show how it meets the criterion.

  • Maintain a complaints policy and procedures.
  • Show that you have designated a person to receive and handle complaints or suggestions.
  • Maintain a complaints register.
  • Keep a suggestion box in the reception area.
  • Show that you run community forums and information days.
  • Make available a service information sheet.
  • Make available a patient information sheet documenting the contact details for state/territory health complaints agencies.
  • Include patient feedback/complaints information in the board manual.
  • Maintain an RACGP-approved patient experience questionnaire.
  • Provide patient feedback reports.
  • Show that you address issues at team meetings, annual planning days and/or strategic planning agendas.
  • Address patient feedback/complaint issues in the newsletter.
  • Provide patient feedback information on the notice board.
  • Provide patient feedback information on the website.
  • Provide patient feedback information in the local media, where appropriate. 

Related RACGP Criteria

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