Acknowledgement
Client Focused Evaluation Program (CFEP) Surveys is committed to supporting reconciliation among Indigenous, Aboriginal and Torres Strait Islander peoples and non-Indigenous Australian people.
We acknowledge the Aboriginal and Torres Strait Islander peoples as the Traditional Custodians of the lands and waters. We pay respect to Elders – past, present and emerging – and acknowledge the important role Aboriginal and Torres Strait Islander peoples continue to play within our community.
Disclaimer
CFEP Surveys' training, presentations, slides and documentation, including this guide, Making patients, carers and consumers your partners in practice improvement: a guide for harnessing feedback in your practice using the Practice Accreditation Survey (PAIS) tool, are copyrighted to CFEP Surveys. All rights reserved worldwide under international and Australian copyright law, except as permitted by the Commonwealth Copyright Act 1968 and amendments (unless given specific written permission by an authorised representative of CFEP Surveys). No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means (electronic, mechanical, photocopy, recording or otherwise), without the express, prior written permission of the copyright owner.
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Welcome
Your guide to consumer engagement and using Practice Accreditation Survey.
This is a comprehensive guide to patient and carers participation and consumer engagement. The guide is for staff at practices that want to use CFEP Surveys’ Practice Accreditation Survey (PAIS).
You will notice that patient and consumer are used interchangeably throughout the guide. In some practice settings it is understood that patients receive care, whereas consumers tend to be more involved in their care and decision making. No one term is right or wrong and it should be a practice decision on how they refer to people that access their service.
The guide explains:
Why patient and carer participation and consumer engagement are important to general practice and the benefits they offer.
What is Practice Accreditation Surveys (PAIS), and how CFEP Surveys can help you collate meaningful and validated patient and carer feedback on the patient experience of care to help identify practice strengths and opportunities for personal development, practice improvement and growth.
How to conduct effective patient and carer participation and consumer engagement, including how to undertake patient surveys, how to analyse data and present results, and how to act on those results.
For more information about Practice Accreditation Survey (PAIS) and other resources from CFEP Surveys, visit our website, www.cfepsurveys.com.au.
What
Let’s start by getting to know Practice Accreditation Survey (PAIS), and how CFEP Surveys can help you collate meaningful and validated patient and carers feedback on the patient experience of care.
The Practice Accreditation Survey (PAIS) is an evidence-informed and internationally validated survey tool,1 approved by the Royal Australian College of General Practitioners (RACGP) for use in:
• patient and carer feedback
• consumer engagement
• data collection
• the identification and prioritisation of opportunities for improvement and action planning.
Practice Accreditation Survey (PAIS) provides valuable feedback on the consumer experience of care, benchmarked against peer practices. This historical benchmark data enables deeper reflection and greater insight into practice performance relative to peers. Most importantly, it helps you identify and prioritise opportunities for quality improvement at a practice level and personal development at a practitioner level.
Practice Accreditation Survey (PAIS) comprises 40 questions that capture qualitative and quantitative data, and associated patient demographics. See Appendix 2 for a sample copy of Practice Accreditation Survey (PAIS) questionnaire.
Practice Accreditation Survey (PAIS) is designed to collect data to identify what works well and should be celebrated, and where opportunities for personal development or practice improvement lie. Results from the survey help you, your patient and carer participants, and your practice team identify what patients’ value and where to best put your resources to achieve higher performing primary healthcare.
CFEP Surveys provides you with all the necessary tools to help you successfully administer Practice Accreditation Survey (PAIS). CFEP Surveys has an international reputation for helping healthcare organisations to gather evidence on the quality of service provided and relationships with patients.
Data collection processes and governance arrangements comply with best practice and legislative requirements2-4 for the collection, storage and management of data.
CFEP Surveys and Practice Accreditation Survey (PAIS) take the administrative burden out of data collection, analysis and reporting, allowing your practice staff to get on with running your practice.
Benefits of using Practice Accreditation Survey (PAIS)
• Practice Accreditation Survey (PAIS) is an internationally validated survey specific to healthcare.
• Practice Accreditation Survey (PAIS) reduces the administrative burden of a patient survey on your practice staff, allowing them to get on with business as usual.
• Practice Accreditation Survey (PAIS) is cost effective.
• Repeatedly using Practice Accreditation Survey (PAIS) can result in:
° easier monitoring of performance over time in a world with rising expectations of all service providers
° greater trust with patients because you’re meeting their expectations, which is directly linked to patient outcomes
° repeat attendance, which means the practice can provide more comprehensive care with less stress for the team, attract and retain a great practice team, and achieve better financial results and sustainability
° a mature approach to patient and carer participation and consumer engagement prompting consideration of Practice Accreditation Survey (PAIS) results, allowing you to prioritise what your patients really value and opportunities for change
° fine-tuned focus on where you should direct your efforts to enhance the value you provide, which is vital in a resource-constrained environment and in a healthcare system that is increasingly prioritising person-centred and comprehensive team-based care. Person-centred and more integrated healthcare are what every healthcare consumer, health practitioner and health funder really want.5
Further, the Practice Accreditation Survey (PAIS) process and results give evidence of your commitment to:
• your patients and carers, consumers and community, through active engagement and a focus on a quality experience of care
• your staff and their professional development, collaboration and quality service provision
• your practice performance and business sustainability through continuous quality improvement (CQI).
When used effectively, Practice Accreditation Survey (PAIS) helps you meet:
• the Medical Board of Australia (MBA) and the requirements for continuing professional development (CPD)6 for medical practitioners that have opted into participate individually
• your obligations as an accredited general practice7
• conditions for eligibility to the Practice Incentive Program – Quality Improvement (PIP QI).8
Practice Managers report that the administration process for Practice Accreditation Survey (PAIS) is minimally disruptive to practice operations.
Used by over 5,000 practices across Australia, Practice Accreditation Survey (PAIS) can be conducted at two levels:
• practice-level where the practice receives one overall practice report
• practitioner-level where each practitioner receives their own patient feedback report and the practice receives one overall practice report.
The RACGP has approved Practice Accreditation Survey (PAIS) for use in relation to the General Practice Standards (5th edition)9 complying with:
• Patient feedback – Criterion QI1. 2 Indicator A
• Action plan – Criterion QI1. 2 Indicator B
• Practice improvement plan template – Criterion QI 1. 2 Indicator C
• Certificate of completion – Criterion QI1. 2 Indicator C.
Your practice may use the resulting data and reports from Practice Accreditation Survey (PAIS) to:
• develop practice-focused improvement plans and, when repeated, demonstrate whether change has led to improvement as per the intent of the RACGP Standards and the PIP QI, which requires practices to demonstrate change activity and quality improvement over time.
• develop personal development action plans that identify opportunities for personal development and CQI, as outlined in the MBA’s requirements6 and, when repeated, confirm whether changes made at a personal level have led to improvement in behaviours and practice.
Practice Accreditation Survey (PAIS) is used by over 5,000 practices across Australia.
CFEP Surveys supports you in administering Practice Accreditation Survey (PAIS) for your practice, and analyses and reports on your Practice Accreditation Survey (PAIS) results. This includes:
Supporting your practice by being available to answer any queries or concerns you have about patient participation and the RACGP Standards for general practice (5th edition). We work together as a team to meet your accreditation needs
Informing practice leaders to simply determine the survey goals, target population, sample size, and distribution period
Supplying all necessary materials, including printed surveys and envelopes, guidelines for staff, patient awareness counter stand, ballot box and large self-addressed envelopes for returning surveys
Generating a comprehensive and statistically significant report. We pride ourselves on our efficient and accurate reporting methods
Holding and organising the data to provide the practice with future comparative results
Processing your application form in a timely manner
Ensuring you have met the RACGP Standards for general practice (5th edition) by supplying the required number of patient surveys and providing clear staff guidelines about the number of surveys the practice must return
Collating and data processing the completed surveys promptly, mindful of your accreditation date
Analysing all data and providing benchmarks against similar general practitioner full-time equivalent (FTE) using data from approximately 5,000 practices across Australia
Emailing your report to your practice in an efficient timeframe.
CFEP Surveys wants to reduce your stress and free up your valuable time by offering a quality product backed by exceptional service to assist in the patient survey component of the accreditation process.
Frequently asked questions
See Appendix 3 for common questions from patients
See Appendix 4 for common questions from practice staff and consumer representatives, about applying Practice Accreditation Survey (PAIS)
When using Practice Accreditation Survey (PAIS), it helps to have all practice staff review both sets of FAQs. You may wish to tailor them to your practice by adding or deleting relevant questions. Once your practice has an agreed list of FAQs, share them again with all staff so they can better understand Practice Accreditation Survey (PAIS) and respond appropriately and consistently to patient questions about it.
Let’s now look at why patient and carer participation and consumer engagement are important to general practice and the benefits they offer.
Aligned with the Alma-Ata Declaration on primary health care,10 the Hippocratic Oath,11 and the Declaration of Geneva guiding principles of a medical practitioner,12 most health professionals’ core motivation is to use their skills to improve the health and wellbeing of the patients and populations they serve. Similarly, most practice teams’ core motivation is to use their combined skills and resources to improve the health and wellbeing of the patients and populations they serve while sustaining the organisation to continue its work over time.
The key questions around ‘the why’ of consumer engagement and patient surveys are:
Does your practice team share a commitment to the common cause of providing services that improve patient health outcomes?
Are they appropriately skilled and supported to do what is required in your community, which may have different needs from other regions in your vicinity?
Do they work together to produce more than they could for patients working alone?
Is the patient, their carer, and family part of this group effort to deliver what is needed?
Does the healthcare you provide evolve to meet new needs, harness different blends of skills and emerging priorities for patients and the community?
Are you offering meaningful employment where everyone’s talents are fully engaged and appropriately recognised and remunerated?
You may answer yes to many of these questions but still not be certain your practice teams are making a difference. How do you know whether your patients and the practice populations you serve value the professional and personal skills you have, the services and supports you provide, and the systems and processes you adopt?
Patient and carer feedback extracted using tools, such as Practice Accreditation Survey (PAIS), gives you some answers to these questions. It allows you to identify opportunities and establish priorities for personal and professional development, patient safety and quality, CQI, business continuity and growth. Feedback gives insight into the patient experience of the care you provide – what the people you serve value and find important.
Our health system is on a journey from ‘What is the matter with you?’ to ‘What matters to you?’5 . Addressing what matters delivers better value for everyone.
High-value healthcare organisations
Healthcare organisations that continuously strive to deliver high-value healthcare demonstrate four core habits:13
and planning
Figure 1: Four habits of high-value healthcare organisations.13
Source: Adapted by CFEP Surveys, 2023.
A culture of excellence, with these four features, enables the four core habits:
1. a robust quality management system (see below), including quality control, quality assurance, CQI processes and data-driven improvement
2. active engagement of patients and carers in co-designing priorities for change, associated change activities, and measures of success
3. demonstrated leadership and active engagement of all individuals, core practice teams and extended practice teams (e.g. co-located allied health or embedded specialty physicians and dentists) recognising that quality is everyone’s responsibility, with:
a. a shared vision – quality care to all patients, at all times
b. a shared mission – let’s take learnings from today to inform improvement so we provide better care tomorrow and the day after
4. integrated clinical and organisational governance and effective performance measurement and management, oversight and scrutiny.
How does your practice address each of the four core habits of a high-value healthcare organisation?
How do you engage with patients, carers and consumers to display each of these habits?
Quality management system
Four features of a robust quality management system in general practice are:14
Figure 2: Four features of a robust quality management system in general practice.14
Source: Adapted by CFEP Surveys, 2023
How does your practice engage with consumer representatives and patients in each component of the quality management system?
‘The goal of [quality management systems] is not to test a hypothesis but rather to gain insight into the workings of a system and improve that system.’15
Robust engagement mechanisms are critical to the success of consumer engagement. Mechanism must actively engage the patients and carers and practice staff, and include both qualitative and quantitative enquiry:
• involving consumers in quality planning ensures strategic and operational objectives, plans and resources targets what is important and valuable to them and engages them throughout related change processes
• consumer-focused and informed measures and interventions enhance quality control
• patient and carer feedback used regularly and appropriately provides a high-level view of practice performance and identifies any need for further enquiry or change
• change activity focuses on what consumers value and what matters to them. Patients and carers can identify small but effective adjustments in practice and the potential effects of change from their perspective, based on focused information the practice gives to them
When practice staff know what patients and carers want, they can introduce changes and new ways of doing things that are acceptable to patients. Conversely, patients and carers who feel informed and are actively involved in their general practice will be more open to new ways of doing things.
Together, input from consumers and team members provides a rounded picture of the quality of care provided. This picture:
• makes it easier to appreciate what patients and team members value
• makes the case for the need for change
• generates appropriate ideas
• prioritises those ideas that will make the most difference and monitor success
Benefits of consumer engagement and patient surveys
Consumers are often described as the most underused resources in the healthcare system,16 yet it’s the consumer experience of care and their health outcomes that are the true measures of the quality of care provided. Involving patients and practice populations in quality management systems is now a core indicator of higher-performing primary healthcare.
Those practices that have conducted robust and meaningful consumer engagement assert that healthcare consumers have great insight to offer and are often willing and active agents of change.
Can you identify any other benefits of consumer engagement and patient participation in general practice?
When implemented successfully, consumer engagement and patient feedback engenders a culture of excellence within general practice:
• demonstrating personal, professional and organisational commitment to excellence through a journey of enquiry, learning and evidence-informed improvement7
• complying with:
° RACGP Core Standard 1– Communication and patient participation
° RACGP Core Standard 3 – Practice governance and management7
° National Safety and Quality Health Service (NSQHS) Standard 1 – Clinical Governance Standard, and Standard 2 – Partnering with Consumers Standard.17
When used systematically, consumer engagement and patient feedback provide evidence for:
• CPD at a personal level (in line with Medical Board requirements)6
• CQI at a practice level (potentially building a case for change within any other service standards or general practice improvement measures)8
• health partnerships and closer service integration at a neighbourhood and regional level
• change within the health system that can address fragmentation between providers, quality of referral and processes, and improved operation of shared care systems.
When implemented consistently and integrated into business as usual, consumer feedback and Practice Accreditation Survey (PAIS) results strengthen relationships with the practice patient population and reinforce the culture of excellence within general practice. It spurs ongoing change activity and improvement that strengthens the practice approach so everyone gets closer to delivering the Quintuple Aim of health care (please see Figure 3).18,19
3: The Quintuple Aim of health care.18,19
Source: Adapted by CFEP Surveys, 2023
Figure
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