​​​​​Image of Milijana Buzanin  and Ginger Biesbrock
Peter Munk Cardiac Centre Ambulatory Clinics Nurse Manager, Milijana Buzanin (L) and Ginger Biesbrock, VP, MedAxiom Consulting partner to Boston Scientific Advantics, display one of the temporary iPad kiosks being used to glean patient feedback on their clinic experience. (Photo: UHN/PMCC)​

Answers to 19 questions from 500 patients to help navigate nearly 50,000 people a year.

That's the thrust of a new initiative in the Ambulatory and Vascular Clinics on the fifth and sixth floors of the Peter Munk Cardiac Centre (PMCC). A patient survey endorsed by Health Quality Ontario (HQO), it employs temporary kiosks furnished with iPads, printed pamphlets and volunteers to help solicit critical feedback in an attempt to enhance patient care and staff workflows.

"Ambulatory clinics are the window on a healthcare organization. Often, this is the first experience a patient has with an institution and it is where the direction for the care is established and refined," says John Wilson, Boston Scientific Advantics, a medical solutions company that is currently collaborating with PMCC on a first-in-Canada initiative aimed at ensuring simpler, smarter, streamlined processes to enhance patient care and staff workflows.

"This survey tool will let PMCC understand the patient experience in near real-time, providing the information it needs to improve patient interactions and processes," John says. "Patient experience is more than just their comfort. 

"A patient who can easily obtain appointments, doesn't need to wait long, and feels listened to will be more at ease and less distracted during their consultations and testing.​ ​This is value-added care," he says.

The goal is to hear from 500 patients through the survey within one month. The survey questions themselves have been endorsed by HQO. The engagement of staff and volunteers are key components of the initiative.

Image of Team from the Ambulatory Cardiac and Vascular Clinics
The entire team from the Ambulatory Cardiac and Vascular Clinics at the Peter Munk Cardiac Centre, and volunteers, have been engaged to support patient survey feedback. (Photo: UHN/PMCC)​

"I delegate the volunteers, keep track of the iPads, and remind the patients of the importance of doing the survey," says OR nurse, Darlene Barnes.  "Patient-centered care is the priority and therefore directs the flow of these clinics."

UHN Volunteer Kowchiga Ratnasingam adds: "Patients are very cooperative in terms of providing feedback and appreciate a chance to voice their opinions.

"A lot of the patients had voiced incredibly positive things to me even following the completion of the survey which speaks to the culture at UHN and the quality of care provided at the cardiac ambulatory clinics."

Kowchiga also learned that although an iPad-mediated response system can seem very simple to facilitators, there are individuals who struggle with interpreting and answering questions.

"This may be due to a language barrier, challenges related to their own literacy or lack of familiarity with the technology as a lot of the patients are older adults," Kowchiga says. "Subsequently, volunteers had to be responsive to those concerns."

Ginger Biesbrock, VP, MedAxiom Consulting partner to Boston Scientific Advantics, notes "there is always room for improvement.

"Therefore it is necessary to survey patients on an ongoing basis," Ginger says. "Initially, we will benchmark to department, specialty clinic and at the individual physician level."

PMCC is the first Canadian site undertaking this type of collaboration with Boston Scientific Advantics, which has experience in implementing similar process improvement initiatives in 30 hospitals across eight countries, using a blend of international best practices and proven tools.


Ambulatory Cardiac and Vascular Clinics average:

  • 200 patients per day              
  • 4,000 patients a month
  • Appointments in more than 90 different clinics
  • 50 cardiologists and more than 15 surgeons
  • 30 nursing and admin staff  ​

Underpinned by the implementation of Lean continuous improvement tools, the two-year-long PMCC-Boston Scientific Advantics collaboration, which is now into its sixth month, is also examining:  Workflow Optimization (Cath Lab & Cardiac Short Stay), Supply Chain Optimization (Cath Lab), and Care Pathways (Cardiovascular and Vascular Surgery), in addition to Patient Experience (Ambulatory Clinics) and the development of a Staff Recognition Program.

The entirety of the initiative also aims to help PMCC achieve the broader organizational goal of becoming a High-Reliability Organization, by reducing preventable harm to patients, to zero.

"Our team's excitement around the survey is palpable in the clinics," says Milijana Buzanin, PMCC Nurse Manager, Ambulatory Clinics. "We look forward to reviewing the initial results and setting a plan for further growth."​

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