Patients’ experience with hospital care in New Brunswick

Introduction

Hospital stays can be a significant life event for patients, whether due to surgery, illness, treatment, or childbirth. During this time, patients interact with a variety of healthcare professionals. Considering the patients’ perspective in their care experience is important for quality improvement initiatives. By measuring patient experience and identifying areas for improvement, healthcare providers can better meet patients' needs and deliver more patient-centred care.

The observations highlighted in this article focus on hospital acute care patients, referred to as 'patients'.

Overall care experience is a global patient reported experience measure that reflects a patient's entire satisfaction during a recent hospital stay. It is an important measure as it can affect health outcomes, length of hospital stays, and readmissions¹

When every effort is made to provide patient-centred care during the patient’s stay, it leads to an overall very good experience:

“The nurses I had on the labour and delivery floor were two angels, they made me feel comfortable, like I was in control, they helped me through pain management …, they were compassionate, and they made me feel like a human and not a patient they had to “fix”. My doctors were forward and encouraging…. Your labour and delivery staff is phenomenal!!” (Patient responding to the 2023 Hospital Acute Care Survey)

On the other hand, when the patient feels less supported during his or her hospital stay, it can negatively affect their stay:

“It was one of the worst experiences I have ever had to endure. I was treated like a NUMBER, a nonhuman, a disease, a condition, but never as a PERSON. I was disrespected, humiliated, talked about very casually among the staff at the nursing station, and generally disregarded. I left the Hospital a day early by my own choice because of staff behavior and extremely bad food!” (Patient responding to the 2023 Hospital Acute Care Survey)

To understand how we can improve overall experience of patients, it is important to understand the factors that influence it.

Six key factors, or key drivers, largely influence the overall experience during a hospital stay in New Brunswick, according to the 2023 Hospital Acute Care Survey. These factors include:

• Emotional support: patients reporting that they always received the support they needed to help with any anxieties, fears or worries. 
• Internal coordination of care: patients reporting that they always felt there was good communication between hospital staff and how informed the staff were about the patient’s care.  
• Received information about condition and treatment: patients reporting they always received all the information about their condition and treatment. 
• Communication with nurses: patients reporting that when they interacted with the nurses, they reported always being treated with courtesy and respect, listened carefully to and that the nurses explained things in a way that they could understand. 
• Pain control: patients reporting that the hospital staff always did everything they could to help them with their pain. 
• Hospital takes their safety seriously: patients reporting that the hospital where they stayed definitely took their safety seriously. 
   

The 2023 Hospital Acute Care Survey highlights the need for improvement in all six factors influencing patient experience. Moreover, three areas, crucial to patient-centred care, require particular attention:

• Only 58% of patients reported that they had always benefitted from internal coordination of care

“During my stay, I was on the delivery floor and the nurses weren't too familiar with my case. Apart from following the doctors' instructions, they couldn't answer my concerns or questions about what had happened to me. the rest was fine!” (Translation - Patient responding to the 2023 Hospital Acute Care Survey)

• Only 61% of patients reported always receiving emotional support.

“…certain doctor hurries to tell me what he thought was wrong with me and scared me so much. I felt like I had left my body, 2 other doctors came and calm me by telling me it wasn't that bad” (Patient responding to the 2023 Hospital Acute Care Survey)

• Only 64% of patients reported that they always received information about their condition and treatment. 

“My only complaint is that I did not receive any post treatment information, i.e., how long before getting better etc. what to avoid, i.e., physical activities, what to eat/drink no eat/drink.” (Patient responding to the 2023 Hospital Acute Care Survey)

Focusing quality improvement efforts on these key drivers can help in prioritizing specific areas of patient-centred care and improve overall experience of patients in hospitals.

The Hospital Acute Care survey was conducted between June and November 2023 and focused on the experience of 4 719 patients during their hospital stay in a New Brunswick hospital.

When it comes to the six key factors that influence patient experience, Zone 4 seems to be showing better results than the provincial average and Zone 5 worse results.

Compared to the New Brunswick average: 

• Zone 4: A higher percentage of patients reported a good care experience on 3 key factors: internal coordination of care, information about condition and treatment, and hospital takes their safety seriously.  
• Zone 5: A lower percentage of patients reported a good experience on 4 key factors: internal coordination of care, emotional support, received information about condition and treatment, and hospital takes their safety seriously. 
   

Understanding the reasons for these disparities is crucial for identifying best practices and areas needing improvement.

In general, the overall experience of patients varies by type of care received: surgical, maternity, or medical care.

•    Medical care includes treatments for conditions like cardiovascular, respiratory issues or complications from medical conditions, etc.
•    Surgical care encompasses procedures such as orthopedic or gastrointestinal surgeries, etc.
•    Maternity care includes childbirth, C-sections, and treatments for conditions like preeclampsia, etc.
 

Compared to the provincial average, a smaller percentage of patients receiving maternity care reported a good or very good overall experience. This seems to have been influenced by perceived gaps in internal coordination of care and whether hospital takes their safety seriously.

“… (I was given) No info on how to take care of c-section incision. Miscommunication between pre-op nurse/nurses in OR and anesthesiologist about when to stop drinking H20 before surgery. Nurses said 12 hrs. Doctor said 3 hrs which resulted in me being very dehydrated. Nurses confused about COVID rules.” (Patient responding to the 2023 Hospital Acute Care Survey)

On the other hand, a larger percentage of patients receiving surgical care reported a good or very good overall experience, likely influenced by a higher percentage reporting a favorable experience across the six factors.

“The entire experience from surgical staff to post-op recovery team was handled with professionalism and utmost respect and concern for my well being. Any reservations I had prior to my arrival on day of surgery were put to rest by the excellent care I received.” (Patient responding to the 2023 Hospital Acute Care Survey)

Patient experience is an important indicator of the quality of care provided in New Brunswick hospitals. By understanding the factors that influence overall experience during the hospital stay, healthcare providers can prioritize improvement efforts to enhance patient-centred care. While all six key factors can be improved, particular focus should be on the factors that are lagging. When looking at the health zones, Zone 4 seems to be showing better results than the provincial average and Zone 5 worse results and overall care experience also varies by type of care received in a hospital setting. Stakeholders can focus on these factors as a starting point for prioritizing specific areas of patient-centred care to facilitate change, guide quality improvement efforts and improve overall experience.