Table Of ContentSatisfaction with Health Care
Services
A S urvey of Albertans
2003
Health Services Utilization and Outcomes
Commission
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Conducted By: Ipsos-Reid Corporation
September 2003
HSUOC Survey Working Group
Dr. Peter Norton, Commissioner
Mr. Doug Tupper, P. Eng., Commissioner
Dr. John Cowell, Chief Executive Officer
Dr. Michael Plumb, Director and Project Manager
Ms. Barbara Wilkinson, MBA, Director
©2003
Health Services and Utilization Commission
Government of Alberta
ISBN 0-9734213-0-8
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Table of Contents
EXECUTIVE SUMMARY 1
Provincial Overview 1
Regional Overview 6
BACKGROUND AND METHODOLOGY 9
INTERACTION WITH HEALTH CARE SERVICES 15
Recency of Interaction with Health Care Services 15
Incidence of Interaction with Health Care Service Areas .. 16
QUALITY OF ALBERTA'S HEALTH CARE SERVICES 18
General Perceptions of the Quality of Alberta's Health Care Services 18
Quality of Health Care Services: General Perceptions vs. Actual Experiences 21
Factors Associated with Ratings of the Quality of Health Care 24
ACCESS TO ALBERTA'S HEALTH CARE SERVICES 37
General Perceptions of Access to Alberta's Health Care Services 37
Access to Health Care Services: General Perceptions vs. Actual Experiences 40
Access to Health Care Services Across the Continuum of Care 43
Factors Associated with Accessibility 45
SATISFACTION ACROSS THE CONTINUUM OF CARE 57
Overall Satisfaction Across the Continuum of Care 57
GENERAL PRACTITIONERS/ PERSONAL FAMILY DOCTORS 70
Incidence of Having a G P 70
Length of Time with GP 73
Ease of Finding Present GP 74
Reasons Behind Difficulties in Finding Present GP 76
Accessing Health Care Without a P ersonal Family Doctor 77
Reasons for Not Having a P ersonal Family Doctor 78
Frequency of Interaction with GPs 79
Overall Satisfaction with GPs 81
Satisfaction with Specific Aspects of GP Services 85
Factors Associated with Satisfaction with GP Services 88
SPECIAL THERAPY SERVICES 90
Interaction with Special Therapy Services 90
Access to Physical Therapy Services 92
Overall Satisfaction with Special Therapy Services 93
Health Care Coverage to Pay for Special Therapy Services 94
COMMUNITY WALK-IN CLINICS 96
Interaction with Community Walk-In Clinics 96
Access to Community Walk-In Clinics 98
Overall Satisfaction with Community Walk-In Clinics 100
Satisfaction with Specific Aspects of Community Walk-in Clinic Services 104
Satisfaction With Personal Family Doctors And Community Walk-In Clinics 107
Factors Associated with Satisfaction with Walk-In Clinics 109
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Personal GP at Walk-In Clinic Ill
Reasons for Visiting a W alk-In Clinic vs. Personal GP Office 112
GP Involvement Related to Walk-In Clinic Visits 113
EMERGENCY ROOM SERVICES 114
Interaction with Emergency Room Services 114
Frequency of Interaction with ER Services 115
Access to Emergency Room Services 116
Overall Satisfaction with Emergency Room Services 119
Satisfaction with Specific Aspects of ER Services 122
Factors Associated with Satisfaction with ER Services 125
Reasons for Visiting Emergency Room vs. GP 127
GP Involvement Related to Emergency Room Services 128
GP Informed of Emergency Room Services 131
SPECIALISTS 134
Total Interaction with Specialists 134
Incidence of Seeing Specialists 136
Incidence of Waiting to See Specialists After Referrals 138
Access to Specialists 140
Obtaining Referrals to Specialists 142
Satisfaction with Specialists 144
Satisfaction with Specific Aspects of Specialist Services 147
Factors Associated with Satisfaction with Specialists 150
GP Involvement Related to Specialist Services 152
GP Informed of Specialist Services 153
DIAGNOSTIC IMAGING AND LAB TESTS 155
Total Interaction with Diagnostic Testing 155
Diagnostic Tests Received 157
Waiting for Diagnostic Testing 159
Access to Diagnostic Testing 161
Overall Satisfaction with Diagnostic Testing 164
Satisfaction with Specific Aspects of Diagnostic Testing Services 167
Factors Associated with Satisfaction with Diagnostic Imaging 170
Factors Associated with Satisfaction with Lab Tests 172
Doctors Having Test Results 174
HOSPITAL SERVICES 175
Interaction with Hospital Services 175
Access to Hospital Services 177
Overall Satisfaction with Hospital Care Personally Received 179
Satisfaction with Specific Aspects of Hospital Care Services (Personally Received) 181
Factors Associated with Satisfaction with Hospital Care Personally Received 184
GP Informed Following Hospital Care Personally Received 186
Overall Satisfaction with Hospital Care Provided to Family 187
Satisfaction with Specific Aspects of Hospital Care Services (Provided to Family) 189
Factors Associated with Satisfaction with Hospital Care Provided to Family 193
Location of Hospital Care Received 195
SURGICAL SERVICES
197
Interaction with Surgical Services
197
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Access to Surgical Services 197
199
Elective vs. Emergency Surgery
200
Overall Satisfaction with Surgical Services
202
Satisfaction with Specific Aspects of Surgical Services
205
Factors Associated with Satisfaction with Surgical Services
HOME CARE SERVICES 207
Interaction with Home Care Services 207
208
Access to Home Care Services
209
Overall Satisfaction with Home Care Services Personally Received
210
Overall Satisfaction with Home Care Services Provided to Family Members
Suggested Improvements to Home Care Services 211
LONG-TERM CARE SERVICES 212
212
Interaction with Long-Term Care
213
Access to Long-Term Care
214
Overall Satisfaction with Long-Term Care
216
Suggested Improvements to Long-Term Care
PATIENT SAFETY.....
217
Concern About Patient Safety 217
Albertans Concerned vs. Not Concerned About Patient Safety 220
Experiences with Medical Mistakes 221
223
COMPLAINTS ABOUT HEALTH CARE SERVICES RECEIVED
223
Incidence of Complaints
Actions Regarding Complaints 222254
Satisfaction with How Complaints Were Addressed
TIME TO TREATMENT.
227
230
Time to Treatment by Ease of Access and Satisfaction
COORDINATION OF HEALTH CARE SERVICES 231
233
HEALTH CARE INSURANCE COVERAGE
PERSONAL HEALTH ASSESSMENT
234
Personal Health Assessment by Health Region 235
236
COMMUNICATIONS BARRIERS
SUGGESTIONS TO IMPROVE HEALTH CARE SERVICES 237
APPENDIX A 240
Questionnaire . 2 40
APPENDIX B 266
Use of Shapley's Values in Penalty-Reward Analysis . 2 66
APPENDIX C 268
Pre-Test Report . 2 68
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APPENDIX D 274
Sampling Report ...
274
APPENDIX E. 276
276
Survey Limitations
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EXECUTIVE SUMMARY
The Health Services Utilization and Outcomes Commission (HSUOC) conducts
independent assessments of health services delivery, encourages continuous
improvement in Alberta's public health care system, and regularly reports on the quality
of care provided to Albertans. In 2003, the HSUOC commissioned Ipsos-Reid to conduct
a telephone survey that measured what Albertans say about health care quality, access
and service based on their actual experiences across a continuum of care. The survey
also identified factors associated with satisfaction and dissatisfaction.
Ipsos-Reid conducted a total of 4,004 interviews among a stratified random sample of
adult Albertans between April 4th and 23rd, 2003. The attached report details the
extensive feedback Albertans provided about public health care services in the province.
This executive summary provides a synopsis of the most salient issues that emerged.
Provincial Overview
Interaction with the Health Care System
Eighty-three percent of Albertans have had contact with the provincial health care
system within the past year, three-quarters (76%) within the past six months, half
(51%) within the past two months. In the past year, Albertans interacted most with
personal family doctors (62%) and to a lesser extent with diagnostic testing (35%),
walk-in clinics (34%), specialists (26%), emergency room services (26%) and hospitals
(24%). Albertans interacted least with special therapy services (15%), surgery (7%),
long-term care (4%), and home care (4%) within the past year.
Quality of Health Care Services
When asked to think broadly about the health care system, 69% of Albertans describe it
as good, very good or excellent. Thirty percent say the health care system and the
quality of medical services it p rovides is fair or poor. More Albertans (74%) rate overall
health care quality as good, very good or excellent based on their actual service
experiences, compared to the 69% of Albertans who broadly perceive the quality of
medical services to be excellent, very good or good. Similar differences between
Albertans' ratings of the quality of health services based on actual experiences versus
general impressions exist in each health region.
Key Factors Associated with Overall Assessments of Quality
The most important factor related to Albertans' ratings of the quality of health care
services is reducing the difficulty of accessing health care services. Other key factors
that are most highly associated with improved assessments of the quality of health care
services are:
• alleviating concerns about medical mistakes occurring;
• reducing the incidence of patients having serious complaints about health care
services they receive;
• improving emergency room and community walk-in clinic services; and,
• maintaining the quality of services provided by personal family doctors.
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Key Factors Associated with Satisfaction Across the Continuum of Care
Key factors associated with Albertans' satisfaction and dissatisfaction with health care
service delivery across the continuum of care are specific to each area. Overall, the key
factors are:
• the health care professionals' approach;
• access and timing; and,
• outcomes and information.
The following are the top six factors most strongly associated with satisfaction across
the continuum of care:
Key Factors Associated with Satisfaction
Across the Continuum of Care
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Doctor listening
GPs docTthoorr’so u gehxanmeisnsa t ioofn yoIumrp a chte a lotfh c aarned olnif e eDnoocutogrh stpiemne d iwnitgh carheefaullltyh tcoa r yeo ur
concerns
Doctor spending
WCallikn-iIcns docTthoorr’so u gehxanmeisnsa t ioofn Quaclliitnyic ’ so f d coacrteo r t he enough time with yoIumrp a chte a lotfh c aarned olni fe
Staff listening
Time between being Staff epxrpolvaiindiendg your carefully to your Doctor spending
ER Services assessed by a nurse placement in the Impact of care on health care enough time with
and seeing a d octor wait to be treated your healytohu and life concerns
Specialists docTthoorr’so u gehxanmeisnsa t ioofn Beindge c iinsvioolnvse d in Spceacriheaeflauillstltyh ltcoia sr tyeeo nuirn g yoIumrp a chte a lotfh c aarned olnif e Speencoiaulgihs t t ismpee n wdiitnhg Sypoeuc ai nawdli ti hsr te cs optureercattte isnyg
conycoeur ns
DiaIgmnaogsitnigc daBtee i nogn kyeoputr uwpa-itt o -f or Time to schedule
tests testing
your tests
Lab Tests Time tor e rsuelctesi ve test Time to schedule daBtee i nogn tkyeeosputtrs uwpa-itt o -f or Thoroughness of you
your tests Understanding
(PReerHcsoeosinpvaCiealtdrla)eyl PcroPonrrvdeoiiigvdtnaiiifrdnoodignrin mng aga at dnif deoay qnmo u iuclaray rt ee caonudr t Scetooaumfsfp, a bs essieinnogsn iatitvee PHrasosvevtirainvfdfgii c n ep gcsr oo nvytsiooidu si ytn oweguin tth arEen s muraidneg fcoor n ftoalcltosw - serrwevhsiipccoSehtnsas fi f pyb vrol oobueuve ii dnfneogerr e dt ihesed aaEr n e rs e uparrsioonfvngria adb mesledee r vw iitctiehmisen
(ProvHiFodasempdCii alt ryate)lo regamriedanamifdnbnoedger q mr u ac acta otrinweeoid n ti ht ion aaEr n e r se uparrsioonfvngria adb mesledee r vw iitctiehmisen mienmfboeyraoramudn'aredst qi fuo canacam tori neelad ybi otuito n Encsaurrei nigs up pfr ocoalrveli odwe-du p caonudr tt oce o oymuomesupm,ra bs efssareimn oislniyat itvee Ifmahpmeaialclytt h mo efa mn cbda er erl i' fseo n
SSeurrvgiicceasl Kcnoomwpslueertdgegeneoc ne a nodf Iymopuarc t he oafl t shu r agnedr y l iofen Suyrogue r otenoc o d vepearlre yp awritihn g Scuarrhgeefceauoollnnltc yhe rltcinoass rt y eeon uinrg Beindge c iinsvioolnvse d in Follow-up care
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Access to Health Care Services
Forty-two percent of Albertans say it is easy to access health care services based on
their actual personal experiences while 22% rate access as easy based on their general
perceptions.
Health services can be grouped into three clusters according to ease of access. The
largest percentages (65% or greater) of Albertans say it was easy to access the
following health care services:
• Lab tests: 81% easy; 6% difficult;
• Special therapy services: 72% easy; 12% difficult;
• Finding a G P: 69% easy; 15% difficult; and,
• Obtaining referrals to specialists: 65% easy; 16% difficult.
A smaller majority (50% to <65%) say it was easy to access the following health care
services:
• Diagnostic imaging: 62% easy; 16% difficult;
• Home care services for a close family member or for them personally: 61%
easy; 17% difficult;
• Surgical services: 58% easy; 24% difficult;
• Community walk-in clinic services: 54% easy; 19% difficult; and,
• Hospital services: 52% easy; 22% difficult.
A smaller percentage (between 34% and 45%) say it was easy to access the following
health care services:
• Emergency room services: 46% easy; 31% difficult;
• Specialist services: 42% easy; 36% difficult; and,
• Long-term care for a close family member: 34% easy; 39% difficult.
Key Factors Associated with Assessments of Accessibility
Having a personal family doctor is the most important and positive factor associated
with Albertans' assessment of the accessibility of health care services. Improving access
to specialist services, emergency medical services and walk-in clinics are also key factors
associated with improved assessments of accessibility to health care services.
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Satisfaction with Health Care Services
The largest proportion of Albertans say they are satisfied with the following services
based on actual personal experiences:
• General practitioners: 81% satisfied; 5% dissatisfied;
• Lab tests: 81% satisfied; 6% dissatisfied;
• Surgical services: 79% satisfied; 9% dissatisfied;
• Special therapy services: 75% satisfied; 8% dissatisfied; and,
• Diagnostic imaging services: 74% satisfied; 9% dissatisfied.
A s maller majority (between 60% and 68%) reports they are satisfied with the following
services based on their actual personal experiences:
• Specialist services: 68% satisfied; 14% dissatisfied;
• Hospital care they personally received: 66% satisfied; 14% dissatisfied;
• aHnodm,e care services for a close family member: 60% satisfied; 14% dissatisfied;
• Hospital care provided to family members: 59% satisfied; 19% dissatisfied.
The smallest proportion of Albertans report being satisfied with the following services
based on actual personal experiences:
• Community walk-in clinic services: 55% satisfied; 21% dissatisfied;
• Emergency room services: 50% satisfied; 27% dissatisfied;
• Long-term care provided to close family members: 49% satisfied; 20%
dissatisfied; and,
• How complaints were handled: 19% satisfied; 60% dissatisfied.
Coordination of Services
Forty-eight percent of Albertans say service coordination among health care
professionals was either very good or excellent. Sixteen percent say service
coordination was fair or poor.
Perceived Impact on Personal Health
Albertans were asked about the ultimate impact various health care services they
received had upon their health and life. Seventy-six percent are satisfied with the
impact from surgical services, 75% from general practitioners' care, 68% from
diagnostic testing, 68% from hospital care they personally received, 63% with hospital
care their close family member received, and 61% from specialist services. Smaller
proportions are satisfied with the impact from emergency room services (54%) and
walk-in clinic services (48%).
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