Abstract
Introduction
While MSF aims for healthcare that is free, adapted to the context, and appropriate to patients’ needs, systematic quality monitoring of activities has proven to be challenging in many contexts. In 2018 we designed a set of hospital-based quality of care indicators for use within MSF projects. These indicators included measures of patient satisfaction. We piloted a process to compile, analyze and propose improvements in the delivery of care based on patient satisfaction measures. Digital patient satisfaction surveys (PSS), using KoBo software, were conducted by our field staff. The same software was used by field teams to analyze results, and propose concrete actions to improve service delivery.
Methods
The PSS were piloted in 2018 in MSF’s Al-Salamah Hospital, Syria in a Ministry of Health facility, Gambela Regional Hospital, Ethiopia, and in the Public National Hospital in Bissau, Guinea Bissau. Questions to gather data on four different dimensions of patient care were reviewed by the MSF health promotion and community engagement referent, and checked with field teams to ensure context-related adaptations. Data was collected from patients on discharge in two of the hospitals, and during their stay in the case of Guinea Bissau. Surveys will be applied between three-month intervals. A process for constant improvement is being piloted in Al-Salamah Hospital, where the first round of data collection has finished. Key steps are the analysis of results and proposal for actions by health teams. It was designed with the support of a service designer using human-centered design tools.
Ethics
This description and evaluation of an innovation project involved human participants or their data, and has had ethics oversight from the medical director, Jean-François Saint-Sauveur, Medical Director of Operational Centre Barcelona, MSF.
Results
In Syria, 96 surveys have been conducted between Jan and Feb 2019. In Guinea Bissau and Niger, use of PSS is ongoing. In Ethiopia, ethnic violence, staff turnover and difficulties in communication with the project team have delayed completion of the first survey. We have been offering field teams options of design-thinking tools to address the cycle of analysis, including tools to prioritize topics and organise ideation sessions, prior to piloting of improvement ideas. The teams in Syria will be piloting those tools in order to improve the services offered in Al-Salamah Hospital.
Conclusion
Initial results show that collecting relevant data on patient satisfaction in MSF settings is possible. The strategy we used, involving PSS, achieved a positive impact on the quality of data and the speed of data collection. Challenges within this project included the potential for increased workload for field teams, difficulties in operationalizing the process, due to staff turnover and a remote location, and ensuring technical support from headquarters and engagement of key stakeholders at field level. Our data will provide baseline statistics which can be used to help evaluate the impact of corrective actions to improve overall perceived quality of care. Use of PSS is planned for four more projects in 2019.
Conflicts of interest
None declared.
Silvia Moriana
Silvia has experience in both the humanitarian sectors and in global health. Alongside working with MSF since 1998, Silvia has headed up, or acted as emergency coordinator, for several MSF projects including in Ethiopia, Central African Republic, Yemen, Sri Lanka, Bolivia and Ecuador. At headquarters, she was Human Resources Director between 2008-2013 and currently is the innovation and transformation Lead for Barcelona Operational Centre. Silvia also worked at the Institute for Global Health, Barcelona, as coordinator of the Chagas Disease initiative, and the Chagas Global Coalition.
