Patient experience surveys are vital in the twenty-first century: let's put some myths to rest.

Patient-reported data derived from surveys places patient feedback at the heart of quality improvement and health system responsiveness. Such surveys are not without critics, however, who contend that there are better ways to collect feedback. Criticisms assert that response rates are too low and measures are not robust, valid or reliable, that patient experience surveys are neither valid nor reliable for Maori and Pacific peoples and that such surveys do not contribute to improved outcomes for patients. We debunk these myths in the context of the Te Tahu Hauora Health Quality & Safety Commission (Te Tahu Hauora) patient experience survey programme. We explain the centrality of a strong consumer and whanau voice in a twenty-first century health system, and that listening to and acting on this voice-including use of patient-reported data-is now a statutory requirement for health entities under the Pae Ora (Healthy Futures) Act 2022. We describe the different surveys in the programme and explain the differences between patient satisfaction and patient experience. We address sample size and response rates, including representativeness in the surveys of Maori and Pacific peoples' experience. We look at how survey data can be used for quality improvement and to guide us toward providing equitable, culturally safe care. We assert that, contrary to criticisms, the programme delivers valid, reliable, relevant, systematic and practical patient experience surveys and resulting data, with guides for improvement, and that we are both legally and ethically bound to listen to and use these results to improve the healthcare we deliver.

Clinical governance in New Zealand: perceptions from registered health professionals in health care delivery compared with social insurance.

Objective Effective clinical governance can improve delivery of health outcomes. This exploratory study compared perceptions of clinical governance development held by registered health professionals employed by two different but interrelated health organisations in the broader New Zealand (NZ) health system. Most staff in public sector healthcare service delivery organisations (i.e. District Health Boards (DHBs)) are registered health professionals, whereas these clinical staff represent a small minority (5%) in social insurance organisations (i.e. the Accident Compensation Corporation (ACC)). Given these different contexts, comparison of results from three surveys of clinical governance perceptions identified key learnings for the development of clinical governance. Methods The Clinical Governance Development Index (CGDI) was administered to registered health professional staff in NZ DHBs and ACC, at different time points. The data were explored, compared and reported. Results Responses to survey items completed by NZ DHB staff and registered health professionals employed by ACC were compared. For each administration, there was a similar profile of positive responses across the seven CGDI items. The 2020 ACC survey results for one item were clearly different. This item asked about perceptions of full and active involvement in organisational processes and decision making (i.e. clinical engagement). Conclusions Perceptions of registered health professionals working in the NZ public sector delivering health services were compared with those held by staff employed by a NZ social insurer predominantly commissioning and influencing care. The results indicated similar levels of clinical governance development. Clinical governance development in the ACC context can benefit from clear communication, building strong supporting structures and greater management-clinical provider partnerships. Clinical governance development drives health outcomes and regular measurement of developmental progress can provide momentum. There is room across the NZ health system to raise awareness and leverage clinical governance to deliver improved health outcomes. What is known about the topic? Little is known about the perceptions held by registered health professionals employed by social insurance organisations. There are no published comparative studies exploring differences in perceptions between registered health professionals across two different organisational contexts, both with a goal of improving health outcomes. What does this paper add? Effective clinical governance drives coordinated, quality systems that promote optimal health outcomes. Social insurance organisations predominantly commission healthcare providers to deliver health outcomes. Although registered health professionals employed by social insurance organisations represent a small total number of staff, their perspective on clinical governance, as reported via survey, indicated there is most to be gained in the development of partnerships between management and clinical providers. This exploratory study fills a gap in the existing clinical governance development literature and evidence base. What are the implications for practitioners? Any health organisation can leverage clinical governance to deliver improved health outcomes. Effective clinical governance interventions are targeted to specific organisational context and culture. For ACC, a clear definition, enhanced management-clinical provider partnerships and strong supporting structures or organisational arrangements can be further developed. The survey results indicated that a focus on management-clinical provider partnerships is a clear priority for ACC clinical governance development. Partnerships based in empowered collaboration require greater clinical engagement, as well as increased capability for aligning with organisational priorities. Effective clinical governance development requires attention to context and culture. It can improve delivery of health outcomes.

Wide-ranging impacts reported by NZ cancer survivors: is supporting cancer survivor resilience a health sector role?

PURPOSE: Cancer survivor numbers are on the rise but little is known about New Zealand (NZ) survivors' experiences with management of cancer-related impacts and vulnerability. This study explored the experiences and resilience of NZ cancer survivors and the experiences of healthcare practitioners who work with cancer survivors. There is a focus on indigenous Maori survivors. METHODS: This study used qualitative methods to explore survivors and healthcare practitioners' views on cancer-related impact and management strategies. Two focus groups were conducted with mainly colorectal cancer survivors residing in the central regions of NZ. There was one Maori-only group (n = 6 participants) and one multicultural group (n = 18 participants). The Maori-only focus group was purposefully organised to provide a culturally safe setting for the research. In addition, 12 in-depth interviews were conducted with healthcare practitioners between October 2011 and March 2012. RESULTS: Wide-ranging survivorship impacts were described by survivors across physical, emotional, spiritual and social domains. Shame resilience and relationships, particularly with healthcare practitioners, were indicated as useful supports. Healthcare practitioners' time constraints and role priorities were identified as barriers to their ability to provide survivorship support. CONCLUSIONS: This study generated qualitative data on survivorship impacts and components of survivor resilience in NZ. It also provided insights into the need for better strategies and pathways to help the NZ health system be more responsive to both Maori and non-Maori survivors. IMPLICATIONS FOR CANCER SURVIVORS: Survivor impacts create vulnerabilities that are experienced and described differently by individuals and groups in NZ. Tailored survivor support that can enhance resilience and support relationships is needed in NZ.

The voice of experience: results from Cancer Control New Zealand's first national cancer care survey.

AIMS: The 2009 Cancer Care Survey aimed to gather information from patients about their experiences receiving outpatient cancer care. METHODS: In mid-2009, Cancer Control New Zealand sent an NRC+Picker postal survey to a stratified sample of 3251 eligible adults, who had received outpatient cancer care between October 2008 and March 2009. Eight cancer treatment facilities across New Zealand provided patient lists from which potential respondents were selected. RESULTS: The final response rate to the survey was 68%. Most of the patients surveyed responded very positively to questions related to specialist care coordination (91% positive response; 95%CI: 90-93), the level of privacy (87% positive response; 95%CI: 85-89), and the dignity and respect provided by healthcare professionals (86% positive response; 95%CI: 85-88). However, patients tended to be much less positive about the level of information they received on the effects of cancer treatment on their day-to-day life (responses ranging between 30% and 40% positive) and the level of emotional support provided (36% positive response; 95%CI: 33-39). Responses from different cancer services tended to follow similar patterns, although for twelve questions there was at least a 20% difference in response between services. CONCLUSIONS: Overall, patients rated their outpatient cancer care experiences as positive, but important gaps exist in the provision of information, emotional support, and treating patients within the context of their living situation. Cancer patient experience surveys can achieve high response rates and generate useful information on patient perceptions of their care. This data can be used to inform quality improvement efforts at both national and cancer treatment service levels.

Is quality cancer information available for consumers in New Zealand? A national stocktake and review of written consumer cancer information.

AIM: To review the quality of written consumer cancer information resources in New Zealand and to test a selection of quality tools. METHODS: A national stocktake of consumer cancer information resources available in New Zealand through health services and non-government organisations was completed. Using set criteria a selection of these resources was reviewed using three quality tools: DISCERN, EQIP and a cultural sensitivity tool. RESULTS: A total of 1445 cancer information resources were returned from 119 (23%) of the 521 organisations contacted for the stocktake in early 2006. The highest rates of return were from cancer-related non-governmental organisations and district health boards. Of the 1445 resources returned, 93 resources were identified for quality review using selected criteria. The resources were evaluated by teams of cancer information experts using three quality tools. The review teams were able to well utilise all three quality tools and to assess the applicability of each tool. The information resources reviewed were mainly of acceptable quality but lacked cross-cultural relevance and sensitivity. CONCLUSION: Quality tools are useful for reviewing the accessibility, usability and reliability of written cancer-related information resources. There is a need to develop or adapt a quality tool to include components of cultural sensitivity. A national, systematic approach to developing and reviewing the quality of consumer cancer information is recommended.

What ring size should be used in association with vertical gastric bypass?

BACKGROUND: The placement of a ring circumferentially around the gastric pouch of a vertical gastric bypass has the advantage of permanently fixing the size of the gastric outlet and slowing the passage of food into the jejunum. Opinion remains divided about the use of rings, and the optimal size. METHODS: Since 1990, we have consistently placed a ring at the time of gastric bypass surgery and have an experience with three ring sizes (circumference); 5.5 cm, 6.0 cm and 6.5 cm. Patient data has been recorded prospectively in a computerized database. We have reviewed the outcomes of all patients with at least 12 months follow-up with respect to quality of eating, the need for subsequent ring removal and weight loss. RESULTS: Quality of eating was better in those with the larger rings. Ring removal was undertaken in 7 (14%) of those with a 5.5-cm ring, in 11 (5.1%) with a 6.0 cm ring and in 3 (2%) with a 6.5-cm ring (P<0.05). Ring removal led to a median recorded weight gain of 6.8 kg (-4.13 kg to 32.2 kg). When only those 415 patients in whom the ring was still in situ and there was no known staple-line disruption were considered (5.5 cm - 50, 6 cm - 215, 6.5 cm -150), there was no difference in the weight loss achieved and maintained out to 5 years, although there was a trend for this to be better in those with the larger rings. CONCLUSION: We conclude that the inclusion of a ring placed around the gastric pouch of a vertical gastric bypass is beneficial for maintenance of weight loss, and a ring size of 6.5-cm circumference should be recommended.

Selective internal radiation therapy with 90Y microspheres for colorectal liver metastases: single-centre experience with 100 patients.

BACKGROUND: Many patients with colorectal liver metastases die from liver-only disease. Selective internal radiation therapy (SIRT) is an evolving method suitable for treating patients with non-resectable metastatic liver disease. METHODS: One hundred patients with advanced colorectal liver metastases were treated with SIRT. A single dose of between 2.0 and 3.0 GBq of (90)Y microspheres was given into the hepatic artery either by a surgically implanted portacath or a percutaneous femoral catheter. When a port was used (n = 87), SIRT was followed by hepatic arterial chemotherapy with 5-fluorouracil. RESULTS: Treatment-related morbidity occurred in 11 patients. Responses to SIRT were assessed by serial computed tomography scans and carcinoembryonic antigen (CEA) measurement. Median CEA level 3 months after SIRT (expressed as percentage of initial CEA) was 18%. Only 5 of 80 patients (6.25%) scanned at 3 months showed disease progression. Survival was significantly more in those who experienced a good tumour marker response and in those who were slow to develop extrahepatic disease. Survival was independently influenced by the use of ongoing hepatic arterial chemotherapy, the extent of liver involvement and the lymph node status of the original primary tumour. CONCLUSION: Selective internal radiation therapy is a very effective and well-tolerated regional treatment for colorectal liver metastases, which should be considered for those with liver-only metastatic disease.