Situation
A caregiver contacted Patient Ombudsman to complain about a hospital’s response to her concerns about her late husband's care in the emergency department.
She reported that she and her husband were unaware that her husband's care was being managed by a resident or that they had the option to consult with the resident’s supervising physician. There was no signage or information available identifying the organization as a teaching hospital, nor were staff name badges designed to ensure that a resident's status is obvious. The caregiver made a number of practical suggestions that would have helped the couple understand who was providing care and their ability to escalate their concerns to an attending physician.
What we did
Patient Ombudsman reviewed the complainant’s concerns about communication and the hospital’s response to her suggestions for improving the information available to patients in the emergency department. The hospital revised clinical trainee badges so that they are double-sided and large font identifying clinical trainee's student status. Additionally, the hospital's "Welcome Handbook" will clearly describe the hospital’s affiliation with various universities and what areas of care within the hospital the medical residents are being trained. The handbook ensures that patients and families are aware of their right to speak with the supervising physician if they have questions or concerns about a treatment plan. As Patient Ombudsman suggested, the information will be translated into the languages that are representative of the diversity of the community the hospital serves.
At Patient Ombudsman’s request, the hospital has also created a large poster that has been placed throughout the hospital indicating that it is a teaching hospital and the universities that it is affiliated with. The same information will be made available on the hospital's website. The hospital is working on sharing a scrolling photo and name for each staff and resident physician on shift in the emergency department on the waiting room television so that patients are further informed of who they are receiving treatment from and who is responsible for their care.
The hospital also asked for the complainant’s consent to use her story for teaching purposes. Patient Ombudsman suggested that the complainant be invited to share her story personally and the hospital agreed that this would be more impactful. The hospital contacted the complainant to arrange the telling of her story, given her fierce commitment to ensuring something positive and meaningful arises from the tragedy of her husband's death.
Situation
A patient living with a serious chronic illness contacted Patient Ombudsman to complain that she had not been advised that she was eligible for coverage under the Ontario Drug Benefits Program (ODBP) while she was receiving professional home care services coordinated by the Local Health Integration Network (LHIN).
Her care coordinator only asked if she had drug coverage under her private supplemental health insurance. Since her private insurance only partially covered drug costs, the patient had spent thousands of dollars on co-payments during a time when her drug costs should have been fully covered under the ODBP.
What we did
Patient Ombudsman contacted the LHIN and discussed the actions the LHIN had taken in response to the patient’s concerns. The LHIN acknowledged that it had failed to discuss eligibility for drug coverage under the ODBP with the patient and had not inquired about the nature of her coverage through her private insurer.
The LHIN followed up with the Ministry of Health and as a result the patient received reimbursement for the majority of her out-of-pocket costs. To ensure that other patients do not have a similar experience, the LHIN reviewed and updated its policies to reflect a comprehensive procedure for ODBP communication, approval and renewal. The LHIN provided a communique to all its care coordinators and other patient care staff to inform them of revised policy and procedure. The LHIN has also implemented new policies and procedures to support patients transitioning from professional home care to self-care who are no longer eligible for coverage under the ODBP but continue to require high-cost drugs.
Miscommunication, lack of communication and communication breakdowns continue to be significant factors underlying the vast majority of complaints received by Patient Ombudsman. Specific complaints about communication and information make the top ten lists of complaints about all three sectors within the Patient Ombudsman’s mandate and are a contributing factor in many more. Patients and families are often at a disadvantage in their encounters with the healthcare system. They don’t know what their providers know about how the system works. They may not know what questions to ask and may find it hard to absorb complex information at a time of stress. At the same time, they have important information to offer about their own conditions and circumstances. Active listening, patience and empathy are important factors in effective patient care and good patient experiences.
In many cases, health sector organizations have responded positively when Patient Ombudsman has raised these concerns and have made significant positive changes in their policies and practices to ensure that future patients have better experiences with their care. The above are two examples when the health sector organizations acted to introduce changes to benefit their patients. We encourage public hospitals, LHINs and long-term care homes to be proactive in seeking opportunities to improve communication with patients and families, and to ensure that patients know who to contact if they have concerns.
Tips for patients and caregivers
- Consider developing a list of questions to ask your care provider. It can be helpful to ensure you get the information that is important to you.
- If it is easier for you, ask for information in writing so you can review it later.
- Some patients may find it helpful to have a support person (family member, good friend) available during appointments or meetings with care teams. They might be able to remember different parts of conversations related to care or administrative processes.
- Health sector organizations in Ontario are required to accommodate a person living with a disability. If you need a special accommodation to communicate with your healthcare provider or team, please ask.
Suggestions for HSOs
- Encourage patients and families to share what matters most to them.
- The healthcare system is difficult to navigate for many patients and their families, and healthcare settings can be unfamiliar and stressful environments. Be clear when you communicate important pieces of information. Make sure messages are consistent and avoid acronyms and medical jargon.
- Focus on the main points that patients and their caregivers need to know to make decisions and participate in managing their care.
- Many patients and families may struggle with communicating in English or French. Translate important documents into priority languages and use interpreter services for important conversations. Family members who can help interpret should be encouraged to attend appointments and meetings when appropriate.
- Check for understanding. Teach-back is a great strategy to ensure patients and their loved ones understand what you are trying to communicate. An example of using ‘teach-back’ in conversation can be “we just went over a lot of information. Please share with me in your own words the steps we just reviewed.”
- Appropriate signage in wait-areas, clinical rooms and on badges worn by staff can be impactful in communicating important messages.