3.5.1 Questionnaires
Measures of staff and patient satisfaction were determined through three staff and two patient questionnaires. A specific objective of the model of care study was to improve the level of staff and patient satisfaction. Consequently, the questionnaires needed to reflect components that staff and patients consider to be relevant satisfaction measures and enable the organisation to draw comparisons with previous satisfaction survey results.
The questionnaires used for the staff surveys was adapted from the Employee Perspective Survey Tool produced by Parkside Associates (Australasia) which had been tested for reliability and validity in the Australian health care setting. Reliability coefficients in the 0.80-0.90 range and significant criterion-related validity (p = <0.05) between 10 of the 14 individual scales and employee satisfaction were reported (Grundy, Davis-Lenane, & Sibert, 2001). The significant reliability and validity results demonstrated the tool as an effective measurement of employee perceptions, job satisfaction, organisation, support and work environment (Grundy et al., 2001). Nursing Services had used components of the tool to measure staff satisfaction in 2004 and 2006.
The tool used for patients’ satisfaction was adapted from a tool developed specifically for Western Australian public hospitals by the Department of Health which has been validated by 30 focus groups across the state and reliability tested (Department of Health, 2007). No psychometric data are available.
3.5.2 Staff Satisfaction Questionnaire: Pre SCM
The staff questionnaire (Appendix K) was developed during the pilot study based on responses by 43 staff in facilitated reflective practice sessions. Four themes emerged from these sessions: nursing care, patient, environment and staff. Information from each of these themes was then used to select existing questions from the hospital’s Nursing Satisfaction Survey which in turn consists of questions from the Employee Perspective Survey Tool. Information from the reflective practice exercises during the pilot study to inform the selection of questions are detailed in Appendix L. In addition, specific questions relating to the model of care was added in order to evaluate changes associated with the SCM.
Staff names were obtained through the hospital’s roster system and checked with each participating ward’s CNS/CNM. Staff were invited to voluntarily and anonymously complete the questionnaires and place them in a sealed box on the ward over a 14 day period.
The staff questionnaire was distributed to staff during week one of the Orientation Phase.
3.5.3 Staff Satisfaction Questionnaire: 3 Months Post SCM
A second staff questionnaire was administered three months after implementation of the SCM (Appendix M). This questionnaire consisted of the same questions listed in the model of care section of the pre model of care implementation questionnaire and unique questions relating to specific components of each ward’s model of care. In addition, questions to assess staff views of the practice development approach were included.
3.5.4 Staff Satisfaction Questionnaire: 12 Months Post SCM
A third staff questionnaire was administered 12 months post implementation of the SCM. This consisted of a combination of all questions asked in the previous two staff questionnaires.
3.5.5 Patient Satisfaction Questionnaire
A patient survey to measure patient satisfaction with nursing care was developed by using information gathered from the patient interviews collected during the pilot study to select relevant questions from the Western Australia Department of Health 2006-07 Patient Evaluation of Health Service Questionnaire. Information from the patient interviews during the pilot study to inform the selection of questions are detailed in Appendix N.
Patient names were obtained through the hospital’s electronic tracking of patient names and unit number system. The patient satisfaction survey was administered up to three months prior to implementing the new model of care and 12 months post implementation (Appendix O). One month prior to commencing Phase I of the study all patients who were discharged two weeks previously, or in the case of rehabilitation patients who were discharged three months previously, were contacted by telephone and invited to participate in a telephone interview. The reason for the difference in time frame for rehabilitation patients is that there are fewer patients discharged from the rehabilitation wards thus the need to increase the number of patients responding.
3.5.6 Patient Incidents
The hospital maintains a clinical incident management process governed by the Western Australian Health Clinical Incident Management Policy using the advanced incident management system (AIMS) and sentinel event policy (Department of Health, 2011). The Advanced Incident Management system is used to record reported incidents. A clinical incident is defined by the Australian Council for Safety and Quality in Health Care as “an event or circumstance resulting from health care which could have, or did lead to unintended harm to a person, loss or damage, and or a
complaint” (Department of Health, 2006, p. 4). The information is coded and entered by staff in the Clinical Safety and Quality Unit.
Clinical incidents include “near misses - incidents that may have, but did not cause harm: and adverse events - an incident in which harm resulted to a person. Harm includes death, disease, injury, suffering and/or disability” (Department of Health, 2006, p. 4). Examples of clinical incidents reportable to AIMS include: medication errors, patient falls, intended self harm or suicidal behaviour, surgical operational complications, environmental hazards, problems with blood products, hospital acquired infection, incidents when a patient expresses concern with their treatment and inappropriate treatment (Department of Health, 2006).
The reporting of AIMS is voluntary and therefore does not reflect non reported incidents. Consequently there is a potential for under reporting of incidents. However, it is the only system used in all Western Australian government area health services that covers the reporting, investigation, analysis and monitoring of clinical incidents that occur as a result of provision of care. In addition, since the introduction of AIMS in the study hospital there has been an increased awareness of the need to report incidents in an effort to minimise risk by putting in place preventive measures. Patient incident data aggregated by month and by event type were extracted from AIMS for each ward for the two years prior to and 12 months post implementation of the shared care model.
3.5.7 Patient Complaints
Patient complaints were used as another measure to assist with assessing the impact of the SCM on patient care. The hospital maintains a complaints management process governed by the Western Australian Health Complaint Management Policy (Department of Health, 2009). One of the components of this process is the maintenance of a database to record reported patient complaints. Complaints are recorded into the following nine categories:
Access: refers to availability of services in terms of location, waiting times and other constraints that limit the service.
Communication: refers to the quality and quantity of information provided about treatment, risks and outcomes.
Decision making: refers to the consultation with the consumer in the decision making process.
Quality of clinical care: refers to the assessment, planning, implementation and evaluation of clinical care by any health care professional.
Costs: refers to issues about costs and fee structures.
Rights, respect and dignity: refers to the consumers’ mandated or legislated human and health care rights.
Grievance: refers to the individual’s rights to have a timely and fair management of the complaint.
Corporate services: refers to corporate issues resulting in complaint.
Professional conduct: refer to alleged unethical and alleged illegal practices.
Complaints are entered on to the system by members of the Customer Services Department. Data on the number and type of patient complaints related to the provision of nursing care in each participating ward, aggregated in three months periods, were obtained from the database for the 12 month period prior to and post implementation of the new model of care.
3.5.8 Workforce Data
Data on each ward’s workforce including number, skill mix, percentage of part and full time staff were extracted from the hospital’s workforce data system.