When the patient experience ends in disappointment

Learning valuable lessons from complaints and errors

It seemed almost like a scene out of a suspense film—except that for Shirley Freedman Rapoport, her feelings of insecurity, isolation and vulnerability were frighteningly real.

After finishing a hemodialysis session late one night this past spring, Ms. Rapoport was told to wait by the front door of the old JGH Emergency Department in Pavilion D, where she would be picked up by the STM’s Paratransit bus (for individuals with reduced mobility). Since the Emergency Department had vacated Pavilion E and moved into Pavilion K, Ms. Rapoport found herself alone amid shadowy rooms and deserted corridors.

Then, to her dismay, a stranger came to the front door and asked for money. Glancing around, she saw no security guard. No telephone. No one to turn to. In the end, no harm was done and Ms. Rapoport caught her bus without incident. But, she notes with annoyance, she was placed in a similar position more than once while waiting at night for the Paratransit bus in the main lobby of Pavilion H after hemodialysis last year.

Clearly, this is far from what the Jewish General Hospital considers a satisfactory patient experience. Even though Ms. Rapoport believes her medical needs (the hemodialysis) were met with professionalism and efficiency, the hospital fell short in other areas.

It’s situations like this one that have prompted the JGH to launch the Office of Patient Experience. On an individual basis, these incidents—regrettable though they may be—give the hospital an opportunity to learn from its mistakes and follow through with improvements, says Rosemary Steinberg, the Local Commissioner of Complaints and Quality of Service (Ombudsman).

Ms. Steinberg says the goal of the complaints process is not to be critical or find fault, but to improve the quality of care. For this reason, whenever a complaint is registered, three key questions are asked: Could or should anything else have been done? Could something have been handled better? What can be learned from this incident?

As a result of Ms. Rapoport’s complaint, Ms. Steinberg worked with Security, Technical Services and the head nurse in Dialysis to have patients wait for Paratransit in Pavilion G’s Atrium Café in a designated area that’s well lit, has a telephone and is more frequently patrolled by security staff.

Often, says Ms. Steinberg, the complaints revolve not around the medical treatment itself, but general elements of the patient experience—for instance, the tone of voice or facial expression of a member of staff when communicating with a patient. “When they meet with patients, healthcare professionals also need to introduce themselves and explain what they’re there to do,” she adds. “It’s an easy step that lessens anxiety and leads to a collaborative relationship with the patient. Unfortunately, when staff are rushed, it’s something they might forget.”

Improving the patient experience by learning from mistakes is also intrinsic to the hospital’s Quality Program (jgh.ca/qualityindicators), which is on a continuous quest to upgrade all facets of the JGH’s activities. As the web page demonstrates, members of the Quality Program not only perform tasks related to the investigation of accidents and errors, but they actively look for ways of boosting the quality of care in various areas, even if no complaint has been filed.

“It may sound a little odd, but we always need to be thinking in terms of the hospitality of health care,” says Markirit Armutlu, Coordinator of the Quality Program. “We’re obviously very different from a restaurant or hotel, but it’s still our responsibility to make sure our patients are properly served—for example, by having staff acknowledge them, introduce themselves and anticipate patients’ needs.”

Similarly, Ms. Armutlu says, a hospital needs to follow the example of the retail industry. “In whatever we do, it’s essential that we approach it from the customer’s—in other words, the patient’s—perspective. That’s what we mean by patient-centred care: doing what is of greatest benefit to the patient, rather than what is easiest for the staff.”

Ms. Armutlu recognizes that the JGH is already solidly on the right track, given its history and tradition of compassionate care. “However, when we talk about the patient experience, we’re looking at more than just the care. We’re asking ourselves, ‘What do patients want? What matters to them?’ and then we gear ourselves to that. This can only be done by actively involving patients (or their family members) in their care, and by including advisors, who are patients or relatives of patients, in all of our Quality and Safety Improvement Teams and hospital committees.”

Despite the complaints and the occasional lapses in the quality of care and the patient experience, Ms. Armutlu and Ms. Steinberg say they’re heartened by the sincerity and enthusiasm of JGH staff—clinical and non-clinical alike—in making a wide array of improvements on an ongoing basis.

“When I arrived here five years ago, I immediately felt the values of family that had been imbued in staff,” recalls Ms. Steinberg. “They feel a visceral connection to this hospital, which is why I always meet staff who want to do the best they can. Not only do they feel they belong, they want the patients to experience that same family feeling.”