Assessing performance using PREMs data

Understanding a patient’s experience during a hospital stay is central to understanding overall health system performance. Patient-reported experience measures (PREMs) can amplify the voice of patients to support quality improvement. Using these measures can help care providers, hospitals and regions improve the overall patient experience and be more responsive to patient preferences and needs.

Patient experience measurement can help address information gaps to improve patient-centred care and facilitate peer-to-peer learning and sharing of best practices. In addition, self-reported data from patients can provide context to other sources of data about the patient’s hospital stay, treatments and health concerns.

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Using patient experience data, we can answer a few questions:

What can we learn about the patients we serve?
What can we learn about the experience of patients who report the best care?
Where are opportunities to improve quality of care?
Where should our facility focus efforts to improve patient experience?
Which facility can I look to for best practices?

Overall Hospital Experience and why it matters

Overall Hospital Experience is a global PREM that provides information on a patient’s entire experience during their most recent hospital stay. It’s a frequently used and important measure because we know that patients who have a better experience of care generally have better health outcomes. Conversely, a poor experience generally leads to higher care costs as patients may have poorer outcomes, require longer stays and/or be readmitted for further treatment.

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65% of patients said that their overall hospital experience was very good.

Province	Poor	Good	Very good	Number of respondents
Nova Scotia	13%	22%	65%	2,750
New Brunswick	15%	25%	60%	5,821
Ontario	12%	24%	64%	44,848
Manitoba	14%	23%	62%	10,640
Alberta	9%	23%	67%	22,242

Note
Data is shown for the most recent year of data submission (Ontario, Manitoba and Alberta, 2020–2021; New Brunswick, 2018–2019; Nova Scotia, 2017–2018).

You can explore the Overall Hospital Experience measure further in the Your Health System interactive web tool (In Brief and In Depth) and on CIHI’s Indicators web page.

Digging deeper: Assessing performance using PREMs data

To understand how to improve results for the Overall Hospital Experience measure, it can help to understand what other measures are strongly associated with it. These key drivers can be a great starting point for prioritizing specific areas of patient experience for quality improvement efforts, and for enhancing the quality of care for patients.

“Our health system is going through a bit of a transformation, like other provinces. There’s a performance measurement dashboard that we use on a monthly basis, and [CIHI’s CPES-IC] survey is reported within that,” says Ales Morga with Southern Health — Santé Sud in Manitoba. “The focus indicator that’s used is Overall Hospital Experience, and organizations are able to choose enablers that measure up to that.”

In our region, we use the enablers that were most highly correlated [with overall experience], such as Communication With Nurses and Doctors, [which we] monitor very closely. — Ales Morga, Director, Performance and Planning, Southern Health — Santé Sud, Manitoba

The following 3 key drivers have been identified for the Overall Hospital Experience measure. A key driver is a patient experience measure that is strongly associated with or that influences results for this measure. Key drivers can potentially be used as areas of focus when planning quality improvement initiatives.

For more information on the methodology used in the key drivers analysis, please see Acute Care Patient-Reported Experience Measures — Methodology Notes. To learn more about CIHI’s other PREMs, see the Canadian Patient Experiences Survey — Inpatient Care: Patient-Reported Experience Measures.

Key drivers: Overall Hospital Experience

Internal Coordination of Care

Whether patients felt there was good communication between doctors, nurses and other hospital staff. This measure also looks at whether patients felt that hospital staff seemed informed about and up to date on their hospital care.

Emotional Support

Whether patients felt they were supported and helped with any anxieties, fears or worries during their hospital stay.

Communication With Nurses

Whether patients felt that nurses treated them with courtesy and respect, listened carefully to them and explained things in a way they could understand.

Once an area of focus has been identified, you can compare your result with the peer group or national average, or look at trends to see whether the result has changed over time. The Your Health System interactive tool allows you to explore your data through comparative results and trends.

To enable comparisons and benchmarking year over year, all results have been

Sample weighted
Non-response adjusted
Age–sex standardized
Adjusted for mode (mail, telephone, online)
Adjusted for service line (medical, surgical, maternity)

Where does CIHI’s PREMs data come from?

The patient-reported experience measures (PREMs) are calculated using data reported by patients through CIHI’s Canadian Patient Experiences Survey — Inpatient Care (CPES-IC), an accredited and validated survey tool customized to the Canadian context and endorsed by the Health Standards Organization and Accreditation Canada.

CIHI supports hospitals and jurisdictions that administer the survey with standards and supporting documentation, and those who participate are able to include their data in CIHI’s Canadian Patient Experiences Reporting System (CPERS).

Using data from CPERS, CIHI has reported privately on 23 PREMs since 2017 via our CPES: Comparative Results tool. The ongoing and standardized nature of CIHI’s CPES-IC survey has enabled hospitals and jurisdictions to track changes in patient perspectives on their care over time.