GP Satisfaction Survey by liaoqinmei

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									Eastern Health GP Liaison Program




GP Satisfaction
Survey




                                    2010
EXECUTIVE SUMMARY:

        The 2010 Eastern Health (EH)GP Satisfaction Survey was a collaborative survey of GPs from the
three divisions of general practice to the East of Melbourne which assessed GP satisfaction with:
communication from EH hospitals (Maroondah, Angliss, Box Hill, Wantirna, Peter James Centre, Healesville
and Yarra Ranges), GP education events, and the EH website’s GP portal. It also provided GPs the
opportunity to voice concerns with EH services and suggest potential improvements. The survey was
mailed to 1003 GPs within the catchment, and had a 16% return rate, a significant improvement on 2008.

        The 2010 survey layout was restructured from the 2008 version, with more questions relating to
the quality and timeliness of EH communication processes and a section for the new HealthSMART
discharge summary.

        GPs indicated satisfaction with EH outpatient communication and the quality of discharge
summaries, as well as satisfaction with the timeliness of the electronically transmitted HealthSMART
discharge summaries.

        GP comments also highlighted a number of areas for ongoing attention. This included
improvements to the quality of HealthSMART discharge summaries, attention to the lack of results
included in outpatient letters, and difficulty reading these letters due to illegible acronyms, abbreviations
and handwriting.

        Opportunity for promotion of the EH website GP portal as a resource for GPs was also highlighted,
as was scope for more GP credentialing and education events into 2011.

        Recommendations have been made for future EHGPL priorities and direction for future planning.




                                                                                                           1
Table of Contents
Background ........................................................................................................................................................ 3
Division Overview .............................................................................................................................................. 3
   Locations of GP divisions: .............................................................................................................................. 4
Distribution and Return Rates 2010 .................................................................................................................. 4
Method for Surveying GP satisfaction with Eastern Health .............................................................................. 5
Results ............................................................................................................................................................... 6
   Quantitative Data .......................................................................................................................................... 6
   Qualitative Data ............................................................................................................................................. 9
Recommendations ........................................................................................................................................... 10
   Audit process, evaluation and reporting ..................................................................................................... 10
   Improving communication from EH: ........................................................................................................... 10
   Education events for GPs:............................................................................................................................ 10
Appendix 2: 2010 GP Satisfaction Survey: Quantitative Summary of Results................................................ 13
   SECTION 1: Contact with Eastern Health ..................................................................................................... 13
   SECTION 2: Outpatients ............................................................................................................................... 13
   SECTION 3: Emergency ................................................................................................................................ 15
   SECTION 4: Discharge Summaries ............................................................................................................... 16
   SECTION 5: HealthSMART ............................................................................................................................ 17
   SECTION 6: Death Notification .................................................................................................................... 18
   SECTION 7: Education: ................................................................................................................................. 19
   SECTION 8: Percentage of respondents who would be interested in attending Eastern Health education
   events .......................................................................................................................................................... 19
   SECTION 9: Shared Care and Credentialing ................................................................................................. 20
   9.3 Percentage of respondents that would be interested in shared care programs for Eastern Health .... 20
   SECTION 10: Maternity ................................................................................................................................ 21
   SECTION 11: Website ................................................................................................................................... 22
Appendix 3: 2010 GP Satisfaction Survey: Qualitative Summary of Results .................................................. 24
   Common themes from free text areas: ....................................................................................................... 24




                                                                                                                                                                       2
Background

         The Eastern Health GP Liaison Program (EH GPL) is the joint work between the three Divisions of
General Practice to the east of Melbourne and the Eastern Health (EH) hospital network. Part of this work
centres on strengthening the interface between General Practitioners and Eastern Health in order to
promote the care of patients and prevent readmissions. One of the aims of the EH GPL program is to
facilitate the transmission of information and improve communication between General Practitioners and
EH hospital sites.

         EH GPL conducts a GP satisfaction survey bi-annually, which is distributed to GPs within the three
Divisions that make up the Eastern Health catchment including Greater Eastern Primary Health (GEPH),
Melbourne East GP Network (MEGPN) and Eastern Ranges GP Association (ERGPA). The survey places
emphasis on the quality and timeliness of discharge summaries and referral letters from EH, as well as GP
satisfaction with education and credentialing events and with the EH website GP portal; though the latter
are recent additions to the survey and have produced novel data for 2010 (see appendix 1). It also provides
an opportunity for GPs to inform the EH GPL team and EH of any concerns with processes and services, as
well as suggested improvements. The information provided is then used to guide future direction and
priorities for the EH GPL program.



Division Overview

        ERGPA has 196 GP members serving a population of over 225,000 people. ERGPA covers a large
area ranging from urban Croydon and Lilydale in the west, where the division has its office, to rural
Marysville in the East and Koo Wee Rup and Bunyip in the south, encompassing the Dandenong Ranges,
Yarra Valley (which is RRMA 5 rated) and the areas surrounding Pakenham.

        GEPH is located in the Eastern Outer-metropolitan area of Melbourne, at the base of the
Dandenong Ranges, and covers an area from Croydon in the North to Rowville in the South and roughly
follows the municipality of Knox’s boundaries. The 200 member GPs work across 47 practices, and provide
services to a population of 198,747 people.

        Located in Nunawading and Balwyn, the MEGPN was formed through the amalgamation of the
Inner Eastern Melbourne Division of General Practice and the Whitehorse Division of General Practice in
2008. The division covers the municipalities of Boroondara, Whitehorse, Manningham, and 50% of
Maroondah. MEGPN has a population of 548,543 who are serviced by 607 GPs working in 144 practices.

        All three divisions are affected by GP workforce shortages.

      ERGPA, GEPH and MEGPN GP liaison teams work cooperatively with all EH sites including
Maroondah, Healesville, Box Hill, Angliss, Peter James Centre, Wantirna and Yarra Ranges.




                                                                                                         3
Locations of GP divisions:




                                                       310 and 303 – Melbourne East GP
                                                       Network
                                                       314 – Greater Eastern Primary
                                                       Health
                                                       320 – Eastern Ranges GP Association




Table 1: Distribution and Return Rates 2010

Division         of   Surveys received          Total Number of             Return Rate
General Practice                                GPs

ERGPA                 35                        196                         18%
GEPH                  30                        200                         15%
MEGPN                 98                        607                         16%
TOTAL:                163                       1003                        16%



 100%
  90%
  80%
  70%
                                                            Unreturned
  60%         161            170         509
  50%                                                       Returned
  40%
  30%
  20%
  10%         35             30           98
   0%
             ERGPA          GEPH         MEGN




                                                                                             4
Method for Surveying GP satisfaction with Eastern Health

  1. The EHGPL team consults and reviews the approach, survey process, evaluation spreadsheet and
     learning’s from the previous survey

  2. Specifications are confirmed drawing from previous GP satisfaction surveys and the Southern
     Health GPL survey template including what questions to include, how to word them, and how best
     to distribute the surveys for maximum return rates

  3.    GP Liaison Officers (GPLOs) print and distribute the surveys to all GPs in their Division, and put
       reminders in weekly faxes and email publications

  4. GPLOs receive completed surveys from GPs and enter responses in the evaluation spreadsheet

  5. The MEGPN and ERGPA GPLOs email the completed spreadsheets to the GEPH GPLO, who is the
     project lead, for collation and graphing

  6. Report is written by project lead including outcomes and recommendations and sent to GPL
     Coordinator, other GPLOs and GP Consultants for comments and approval

  7. Final report is presented to key stakeholders including the EHGPL Steering Committee and to key
     personnel at each of the hospital sites.

  8. An article is written for Division newsletters based on the written report and includes outcomes
     and recommendations. The article will also appear in Eastern Health newsletters and will be
     submitted to the EHGPL coordinator for inclusion.

  9. The EHGPL Program staff meet to review the process, make recommendations for future audits,
     and implement recommendations from the report




                                                                                                        5
Results
        The 2010 GP satisfaction survey had an average return rate of 16% across the catchment, which
was a 65.8% increase on the return rate from 2008 (see appendix two/table 1. for full breakdown of results
and comparison). This is a valuable increase in information as it validates the survey’s results, and could be
attributed to the incentive added to this year’s survey encouraging GPs to return their surveys as soon as
possible.



Quantitative Data
See appendix two


Section 1: Contact with Eastern Health (EH)
        As seen in previous years, almost all GPs from the catchment (98%) reported referring patients to
EH sites, and most GPs (48%) referred on a weekly basis – a rise of 33% since 2008.
Survey data also showed the greatest number of referrals were to Box Hill Hospital (as in 2008), with 99%
of MEGPN’s GPs referring to this site. And consistent with 2008 data, GEPH’s GPs primarily referred to the
Angliss and the majority of ERGPA GPs referred to Maroondah Hospital.



Section 2: Outpatients
         GPs were asked to reflect on their satisfaction with outpatient communication both before and
after their patients had attended the clinic.
         GPs responses for both questions were similar (see table 2. below), with 55% reporting being very
satisfied/satisfied, and 41% being not sure/unsatisfied/very unsatisfied with EH communication before
their patient had attended the clinic, and 53% reporting being very satisfied/satisfied, and 44% being not
sure/unsatisfied/very unsatisfied with EH communication after their patient had attended the clinic.

         This was a slightly different method to that used in the 2008 survey, where GPs were asked to
reflect on their satisfaction with overall EH communication. In 2008, 47% of GPs reported being satisfied
with overall EH communication, and when compared with 2010 results, indicate that communication has
remained fairly static over the 4-year period, but with room for improvement.



                Table 2. GP satisfaction with EH communication:


   60%           55%                            53%
   50%                    41%                            44%
   40%                                                                        Very Satisfied/Satisfied
   30%
   20%
                                                                              Not Sure/Unsatisfied/Very
   10%
                                                                              Unsatisfied
    0%
           EH communication BEFORE       EH communication AFTER
           patient has attended clinic patient has attended the clinic


                                                                                                            6
Section 3: Emergency
         GPs were also asked to assess their communication with EH emergency departments (ED) in terms
of their own referrals to EH, and EH communication back to GPs.
         The majority of GPs (75%) in the catchment reported always providing a written referral for
patients to ED.
          In response to whether or not GPs phoned ED before referring a patient, 24.6% of GPs reported
always doing so, 43% reported usually doing so, and 32.3% reported rarely or never doing so; highlighting
room for improvement in this area.
         In terms of communication from EH to GPs following a patient’s admission to ED, the majority
(63.7%) of catchment GPs reported feeling ‘very satisfied’ or ‘satisfied’ with this correspondence.

Section 4: Discharge Summaries
        The 2010 survey focussed on assessing the quality and timeliness of EH discharge summaries. In
terms of the quality, most GPs (52%) felt satisfied with EH discharge summaries regarding the information
given for medication changes and details for further management of patients post discharge. In regards to
the timeliness however, the majority of GPs (62%) reported being ‘unsatisfied’, ‘very unsatisfied’ or ‘not
sure’ with the wait for EH discharge summaries.

Section 5: HealthSMART
        The HealthSMART program was implemented at EH’s Box Hill Hospital in 2009 as an upgraded
computer system that would enable GPs to electronically receive discharge summaries for their patients
when discharged from the EH hospital.
        As this system was only implemented at Box Hill Hospital, only 26.7% of GPs reported having
received a HealthSMART discharge summary. Of those that had, 68% of GPs felt that HealthSMART was an
improvement on the timeliness of previous discharge summaries, with the electronic method of delivery
perceived as an improvement on fax and letter systems previously used.
        The quality of the HealthSMART discharge summary however was reported to be poorer than
previous discharge summaries by the majority of catchment GPs, with 55% of GPs reporting being ‘very
unsatisfied’, ‘unsatisfied’ or ‘not sure’ with its quality, and 59.7% agreeing this summary is ‘not’ an
improvement, or ‘not sure’ on the quality of previous discharge summaries.

Section 6: Death Notification
        This was a new section in the 2010 survey. 40% of GPs reported usually receiving notification if
their patient died whilst at an EH hospital.

Section 7: Education
         31% of GPs reported attending EH education events, and of those who attended, 96% were either
very satisfied or satisfied with the quality of these events. GPs were also asked to show their interest in
specific topics for future GP education events, with 30% showing an interest in education for emergencies,
24% an interest in aged care education, and 22% an interest in maternity and fracture management events.

Section 9: Shared care and credentialing
        Only 11% of respondents recorded being credentialed to refer patients to Angliss ‘Hospital in The
Home’ (HITH) service, however 56% of respondents reported an interest in referring patients to an EH-wide
HITH program; suggesting scope for increased GP credentialing. Interest was also shown for shared care
programs with EH, with 23% of GPs interested in Aged Care programs, 18% interested in Mental Health
programs, and 17% interested in Fractures programs.
                                                                                                         7
Section 10: Maternity
         6% of respondents reported being credentialed as a GP obstetrician to the Angliss Hospital.
         A quarter of respondents reported their credentials as a shared-care affiliate with EH (Birralee at
Box Hill), the majority of whom reported being ‘very satisfied’ or ‘satisfied’ with the referral process for
obstetric patients (92.7%), the communication from EH of clinical information (58.4%), with the reporting
of birth notifications (80.3%), and 77% reported being very satisfied or satisfied with maternity discharge
summaries.

Section 11: Website
         The final section of the survey was concerned with usability and comprehensiveness of the GP
portal on the EH website.
         The majority of GPs reported not using the EH website (68%), however of those who did report
using it, the majority found it easy to navigate (59%) and reported being either ‘very satisfied’ or ‘satisfied’
with ‘outpatient clinic details’ and ‘how to refer’ details provided by the website (57.7%).
         There was a mixed response from GPs however in terms of maternity information available on the
EH website, with 41% of GPs ‘very satisfied’ or ‘satisfied’, and 48% ‘not sure’, ‘unsatisfied’ or ‘very
unsatisfied’ with this information, suggesting that this be an area improved on the website, or made more
accessible.




                                                                                                              8
Qualitative Data:
 See appendix 3

        Free text areas allowed respondents to comment/reflect on their satisfaction/dissatisfaction with
EH services and communication (see appendix three for full breakdown of 2010 results).

Discharge summaries/HealthSMART
         GPs reported discharge summaries arriving too late – if at all – and often seeing a patient before
their discharge summary arrived from EH. The quality of discharge summaries was also an issue, with GPs
reporting a lack of information, confusing abbreviations, illegibility in specialist reports and a deficit in
patient results attached.
         The electronic transmission of HealthSMART discharge summaries was the overall preferred
method of delivery – being timely and more thorough than previous discharge summaries. Faxes and
letters were perceived as too slow, and often were not received. Some GPs noted that their computer
software was incompatible with the HealthSMART summaries, and some even reported not using
computers at all, which are major issues for the electronic transmission of HealthSMART summaries.

Outpatient letters
        The lengthy wait for outpatient (OP) appointments and the lack of correspondence from EH OPs
both before and after OP admissions were issues raised by GPs in the free text areas of the survey.
        The slow receipt of OP letters – particularly where a patient required a follow up test or a GP
appointment within 7 days – was frustrating for GPs, as was the lack of medical staff at EH to arrange
follow-up appointments for patients post OP, and both issues often resulted in the slow delivery of
services.
        Poor communication from obstetrics was also reported by several GPs.

Shared care
        There was a generic consensus that communication between EH and GPs in shared care needs to
be improved, and in terms of improving shared care credentialing, methods to educate GPs that would not
interfere with large patient loads – such as online education – were suggested.

Website
        GPs noted difficulty finding the exact information they needed on the GP portal, and suggested
that getting to know the portal better would increase its usefulness.




                                                                                                           9
Recommendations

Audit process, evaluation and reporting
  1. The continuation of Bi-Annual GP Satisfaction Surveys, with regular improvements made to the
     survey tool.

  2. The continued development of a Victorian state standardised GP satisfaction survey to compare
     and contrast member GPL divisions with EH GPL divisions, and adopt new approaches to discharge
     summaries and education for Hospital and divisional GPs.

  3. The continuation of the development and circulation of GP satisfaction survey results to EH GPL
     member divisions, and GPL hospital committee members to ensure full disclosure of results.


Improving communication from EH:
  1. EH GPLOs work with EH hospital executives to improve timeliness and the quality of information
     provided in discharge summaries that are non-HealthSMART. Hospital doctors should be trained as
     to
            the minimisation of indecipherable abbreviations and acronyms,
            providing a full rundown of medication changes/patient management,
            using computers for discharge summaries to eliminate handwritten faxes
            the importance of prompt discharge summaries and outpatient letters for all patients and
            particularly those requiring follow-up treatment
            the importance of notifying a patient’s GP of serious complications or death whilst at an EH
            hospital within one working day

  2. EH GPLOs push for improvements to HealthSMART quality via discharge summary working groups
     and relevant IT bodies

  3. Further development of the GP portal, and potentially renaming this area


Education events for GPs:
  1. Roll out of an annual general information seminar for divisional GPs, including reminders that ED
     should be phoned before patients are referred, as well as navigating the EH GP portal, and the
     benefits and information provided by the portal.

Shared Care and Credentialing:
  1. Clarification of what the GPL role is in terms of GP credentialing

  2. Promotion of GP credentialing opportunities to all divisional GPs, including the development of a
     model for aged care

  3. The creation of an EH-wide Eastern@Home service by EH, and the promotion of this service to GPs
     in ERGPA, MEGPN and GEPH catchments.



                                                                                                     10
            .   Appendix 1: 2010 GP Satisfaction Survey


            Eastern Health GP Liaison - 2010 GP survey
            ~ Please provide us with feedback on your interaction with Eastern Health Hospital sites ~
            1.   Your main practice postcode: __ __ __ __
            2.   Which of Eastern Health’s sites do you refer to?
                 (If you refer to more than one site, place a 1, 2, 3... against the sites in order of most refer to least refer, leave sites you don’t
                 refer to blank

             Box Hill           Maroondah  Angliss                      Wantirna            Peter James Centre                Healesville 
                      Yarra Ranges

~ Outpatients ~
1.        Do you refer to outpatient services at Eastern Health?                   Yes            No       Not sure         If NO, please proceed to next section
2.        If yes, how often do you refer?                                          Weekly         Fortnightly  Monthly  Other........
                                                                                                              Very                                  Un-         Very un-
3.        How satisfied are you with: (please select one)                                                     satisfied
                                                                                                                             Satisfied   Not sure
                                                                                                                                                    satisfied   satisfied
     a.     Communication before the patient has attended the clinic (i.e. receipt of referral,
            appointment notifications, fail to attend)?
     b.     Communication after the patient has attended the clinic (i.e. outpatient letters)?

~ Emergency ~
1.        Do you provide a written referral when sending a patient to the Emergency Department?               Always          Usually       Rarely  Never
2.        Do you telephone the Emergency Department before referring a patient?                               Always           Usually      Rarely  Never
                                                                                                              Very                                  Un-         Very un-
3.        How satisfied are you with: (please select one)                                                     satisfied
                                                                                                                             Satisfied   Not sure
                                                                                                                                                    satisfied   satisfied

     a.     Communication after your patient has attended the Emergency department?

~ Discharge Summaries ~
                                                                                                              Very                                  Un-         Very un-
1.        How satisfied are you with: (please select one)                                                     satisfied
                                                                                                                             Satisfied   Not sure
                                                                                                                                                    satisfied   satisfied

     a.     The overall quality of Eastern Health discharge summaries?
     b.     Information about medication changes?
     c.     Information regarding further management?
     d.     The timeliness of the discharge summary (i.e. within 48 hours)?
2.        Have you received a HealthSMART discharge summary?                                      Yes       No           Not sure If NO, please proceed to question 8
                                                                                                              Very                                  Un-         Very un-
3.        If yes, how satisfied are you with: (please select one)                                             satisfied
                                                                                                                             Satisfied   Not sure
                                                                                                                                                    satisfied   satisfied

     a.     The overall quality of the HealthSMART discharge summary?
4.        Is the HealthSMART summary an improvement on the QUALITY of previous discharge summaries?                        Yes       No       Not sure
5.        Is the HealthSMART summary an improvement on the TIMELINESS of previous discharge summaries?                     Yes       No       Not sure
6.        Did you receive the HealthSMART summary electronically?                                                          Yes       No       Not sure
7.        If yes, is this an improvement on previous transmission methods (i.e. post, fax, patient)                        Yes       No       Not sure
8.        Are you notified if your patient dies while at an Eastern Health hospital?                          Always           Usually      Rarely      Never




                                                                                                                                                        11
~ Education ~
1.        Do you attend Eastern Health GP Liaison Education events?                                                              Yes            No             Not sure If NO, please proceed to next section
                                                                                                                                                                    Very                                                 Un-               Very un-
2.        If yes, how satisfied are you with: (please select one)                                                                                                   satisfied
                                                                                                                                                                                      Satisfied        Not sure
                                                                                                                                                                                                                         satisfied         satisfied

     a.      The overall quality of these education events?

3.        Which of the following education events would you be interested in attending:
           Emergencies  Maternity           Aged Care (inc medication management)                                                            Fracture management
4.        Are there other topics you would be interested in attending: ..........................................................................................................................................
          ............................................................................................................................................................................................................................................
          ............................................................................................................................................................................................................................................

~ Shared Care and Credentialing ~
4.        Are you credentialed to refer patients to Hospital in the Home (HITH) at the Angliss?                                                                Yes            No             Not sure
5.        Would you be interested in referring patients to an Eastern Health wide HITH program?                                                                 Yes           No             Not sure
6.        Would you be interested in shared care programs with Eastern Health for:                                                        Aged Care               Mental Health                    Fractures               Not sure

~ Maternity ~
1.        Are you a GP Obstetrician (Angliss) or                                                                          Yes            No            Not sure
2.        Shared Care Affiliate (Birralee at Box Hill) with Eastern Health?                                               Yes            No            Not sure If NO, please proceed to next section
                                                                                                                                                                    Very                                                 Un-               Very un-
3.        If yes, how satisfied are you with: (please select one)                                                                                                   satisfied
                                                                                                                                                                                      Satisfied        Not sure
                                                                                                                                                                                                                         satisfied         satisfied

     a.      The referral process for Obstetric patients?
     b.      Communication of clinical information (i.e. from clinics, delivery suite)?
     c.      Birth notifications?
     d.      Maternity discharge summaries?

~ Website ~
Do you access the GP Portal on the Eastern Health website?                                                                Yes            No            Not sure If NO, please proceed to next session
If yes, do you find the GP Portal easy to navigate?                                                                       Yes            No            Not sure
                                                                                                                                                                    Very                                                 Un-               Very un-
If yes, how satisfied are you with: (please select one)                                                                                                             satisfied
                                                                                                                                                                                      Satisfied        Not sure
                                                                                                                                                                                                                         satisfied         satisfied

     Outpatient clinic details and how to refer information available on the website?
     Maternity information available on the website?
     The overall usefulness of the GP Portal on the Eastern Health website?
              Please provide comments:

              ...................................................................................................................................................................................................................

              ...................................................................................................................................................................................................................

              ........................................................................................................ for further comments, feel free to attach a separate sheet


              The first 20 GPs to return this survey will receive a $20 Coles Myer gift card.

              To be eligible GPs must fill in their details below.

              Name, Practice, Phone, Email



                                                                                                                                                                                                                             12
Appendix 2: 2010 GP Satisfaction Survey
Quantitative Summary of Results

Table 1 : Comparison of GP satisfaction surveys distributed versus those
returned 2008 to 2010

                          2008                                                 2010
                          ERGPA      GEPH      MEGPN              Total        ERGPA         GEPH          MEGPN            Total
Number Distributed        190        187       610                987          196           200           607              1003
Number Returned           8          15        72                 95           35            30            98               163

% Return Rate             4.21       8.02      11.80              9.63         17.86         15.00         16.14            16.25




SECTION 1: Contact with Eastern Health
   1. Eastern Health sites GPs refer to – 2008 compared with 2010
        (number of mentions by respondents - not ranked)
            Angliss               Box Hill              Healesville           Maroondah              Peter         James    Wantirna
                                                                                                     Centre
            2008          2010    2008       2010       2008        2010      2008     2010          2008         2010      2008       2010
GEPH        28            14      26         14         1           0         23       13            15           10        7          5
            96%           93%     90%        93%        3%          0%        79%      87%           52%          67%       24%        33%

MEGPN       22            6       97         72         1           1         47       29            61           39        22         4
            22%           8%      99%        100%       1%          1%        48%      40%           62%          54%       22%        6%

ERGPA       25            7       28         7          12          4         31       7             16           7         7          2
            71%           88%     80%        88%        34%         50%       89%      88%           46%          88%       20%        25%




Section 1 Chart: Eastern Health sites GPs refer to – 2008 compared with 2010
100%
  90%
  80%
  70%                                                                                                                               GEPH 2008
  60%
                                                                                                                                    GEPH 2010
  50%
                                                                                                                                    MEGPN 2008
  40%
  30%                                                                                                                               MEGPN 2010
  20%                                                                                                                               ERGPA 2008
  10%                                                                                                                               ERGPA 2010
   0%
                Angliss           Box Hill          Healesville          Maroondah     Peter James               Wantirna
SECTION 2: Outpatients                                                                   Centre



                                                                                                                                    13
     2.1 Do you refer to services at Eastern Health? 2010
                            Yes                           No
GEPH                        28                            1
                            97%                           3%
MEGPN                       95                            2
                            98%                           2%
ERGPA                       35                            0
                            100%

Total:                      98.3%                         1.7%




     2.2     How often do you refer to services at Eastern Health? 2010
                      Weekly                Fortnightly              Monthly                 Other                      No Response
GEPH                  11                    4                        7                       7                          0
                      38%                   14%                      24%                     24%
MEGPN                 43                    16                       19                      16                         4
                      44%                   16%                      19%                     16%                        4%
ERGPA                 22                    8                        4                       1                          0
                      63%                   23%                      11%                     3%

Total:                48.3%                 17.7%                    18%                     14.3%                      1.3%



     2.2     How often do you refer to services at Eastern Health? 2008
                      Weekly                Fortnightly              Monthly                 Other                      No Response

GEPH                  4                     1                        2                       0                          0
                      27%                   7%                       13%
MEGPN                 22                    6                        10                      0                          1
                      31%                   8%                       14%                                                1%
ERGPA                 4                     0                        0                       0                          0
                      50%

Total:                36%                   5%                       9%                      0%                         0.3%



     2.3     How satisfied are you with communication before the patient has attended the clinic? 2010
                 Very Satisfied     Satisfied             Not Sure             Unsatisfied           Very Unsatisfied        No Response
GEPH             4                  15                    3                    5                     0                       2
                 14%                52%                   10%                  17%                                           7%
MEGPN            13                 37                    16                   27                    2                       3
                 13%                38%                   16%                  28%                   2%                      3%
ERGPA            2                  15                    3                    11                    4                       0
                 6%                 43%                   9%                   31%                   11%

Total:           11%                44.3%                 11.7%                25.3%                 4.3%                    3.3%



     2.4     How satisfied are you with communication after the patient has attended the clinic? 2010
                 Very Satisfied     Satisfied             Not Sure             Unsatisfied           Very Unsatisfied        No Response
GEPH             2                  16                    4                    5                     0                       2
                 7%                 55%                   14%                  17%                                           7%
MEGPN            4                  48                    14                   25                    4                       0
                 4%                 49%                   14%                  26%                   4%
ERGPA            2                  13                    4                    10                    6                       0
                 6%                 37%                   11%                  29%                   17%

Total:           5.7%               47%                   13%                  24%                   7%                      2.3%




                                                                                                                                           14
SECTION 3: Emergency
         3.1 Do you provide a written referral when sending patients to the emergency department? 2010
                        Always                Usually             Rarely                   Never
GEPH                    21                    8                   0                        0
                        72%                   28%
MEGPN                   69                    29                  0                        0
                        70%                   30%
ERGPA                   29                    6                   0                        0
                        83%                   17%

Total:                  75%                   25%




         3.2 Do you telephone the emergency department before referring a patient? 2010
                         Always                Usually                Rarely                   Never
GEPH                     7                     10                     11                       1
                         24%                   34%                    38%                      3%
MEGPN                    21                    45                     31                       1
                         21%                   46%                    32%                      1%
ERGPA                    10                    17                     7                        1
                         29%                   49%                    20%                      3%

Total:                   24.6%                 43%                    30%                      2.3%


How satisfied are you with...

         3.3 Communication after your patient has attended the emergency department? 2010
                Very Satisfied    Satisfied      Not Sure   Unsatisfied        Very Unsatisfied        No Response
GEPH            8                 15             0          4                  2                       0
                28%               52%                       14%                7%
MEGPN           3                 59             13         20                 2                       1
                3%                60%            13%        20%                2%                      1%
ERGPA           4                 13             4          9                  4                       1
                11%               37%            11%        26%                11%                     3%

Total:          14%               49.7%          8%         20%                6.7%                    1.3%




                                                                                                                     15
SECTION 4: Discharge Summaries
How satisfied are you with...


         4.1 The overall quality of Eastern Health discharge summaries? 2010

                Very Satisfied   Satisfied        Not Sure      Unsatisfied       Very Unsatisfied       No Response
GEPH            3                18               1             6                 0                      2
                10%              62%              3%            20%                                      7%
MEGPN           2                58               12            18                8                      1
                2%               58%              12%           18%               8%                     1%
ERGPA           6                13               1             12                3                      0
                17%              37%              3%            34%               9%

Total:          9.7%             52.3%            6%            24%               5.7%                   2.7%



         4.2 Information about medication changes? 2010

                Very Satisfied   Satisfied        Not Sure        Unsatisfied         Very Unsatisfied   No Response
GEPH            3                14               5               6                   0                  1
                10%              48%              17              20%                                    3%
MEGPN           2                52               18              17                  8                  1
                2%               53%              18%             17%                 8%                 1%
ERGPA           5                12               3               11                  4                  0
                14%              34%              9%              31%                 11%

Total:          8.7%             45%              14.7%           22.7%               6.3%               1.3%


         4.3 Information regarding further management? 2010

                Very Satisfied   Satisfied        Not Sure      Unsatisfied       Very Unsatisfied       No Response
GEPH            3                15               4             6                 0                      1
                10%              52%              14%           20%                                      3%
MEGPN           3                44               21            22                8                      1
                3%               43%              21%           22%               8%                     1%
ERGPA           5                11               4             13                2                      0
                14%              31%              11%           37%               6%


Total:          9%               42%              15.3%         26.3%             4.7%                   1.3%



         4.4 The timeliness of the discharge summary (ie/ within 48 hours) 2010

                Very Satisfied   Satisfied        Not Sure      Unsatisfied       Very Unsatisfied       No Response
GEPH            3                12               4             9                 0                      1
                10%              41%              14%           31%                                      3%
MEGPN           2                28               23            25                18                     0
                2%               29%              23%           26%               18%
ERGPA           4                5                5             12                9                      0
                11%              14%              14%           34%               26%

Total:          7.7%             28%              17%           30.3%             14.7%                  1%




                                                                                                                       16
SECTION 5: HealthSMART

     5.1 Have you received a HealthSMART discharge summary? 2010
                  Yes               No                Not Sure
GEPH              5                 12                12
                  17%               41%               41%
MEGPN             23                42                33
                  23%               43%               34%
ERGPA             14                19                2
                  40%               54%               6%

Total:            26.7%             46%               27%



If the respondent answered Yes to Question 5.1....

   5.2 The overall quality of the HealthSMART discharge summary... 2010

                   Very Satisfied      Satisfied            Not Sure      Unsatisfied   Very Unsatisfied
GEPH               0                   2                    1             2             0
                                       40%                  20%           40%
MEGPN              1                   6                    6             8             2
                   4%                  26%                  26%           35%           9%
ERGPA              5                   2                    2             2             1
                   36%                 14%                  14%           14%           7%

Total              13.3%               26.7%                20%           29.7%         5.3%


     5.3 Is the HealthSMART discharge summary an improvement on the
     Quality of previous discharge summaries? 2010

                  Yes                No                Not Sure
GEPH              1                  2                 2
                  20%                40%               40%
MEGPN             7                  13                3
                  30%                57%               13%
ERGPA             10                 4                 0
                  71%                29%

Total:            40.3%              42%               17.7%


     5.4 Is the HealthSMART discharge summary an improvement on the
     Timeliness of previous discharge summaries? 2010

                  Yes                No                Not Sure
GEPH              4                  1                 0
                  80%                20%
MEGPN             13                 7                 3
                  57%                30%               13%
ERGPA             8                  4                 2
                  57%                29%               14%

Total:            64.7%              26.3%             9%




                                                                                                           17
     5.5 Did you receive          the    HealthSMART        discharge       summary
     electronically? 2010

                     Yes                   No                    Not Sure
GEPH                 4                     1                     0
                     80%                   20%
MEGPN                13                    9                     1
                     57%                   39%                   4%
ERGPA                9                     4                     1
                     64%                   29%                   7%

Total:               67%                   29.3%                 3.7%

If the respondent answered Yes to Question 5.5....

     5.6 Is this an improvement on previous methods?
     2010

                     Yes                    No
GEPH                 4                      0
                     100%
MEGPN                11                     2
                     85%                    15%
ERGPA                7                      2
                     78%                    22%

Total:               87.7%                  12.3%




SECTION 6: Death Notification
         6.1 Are you notified if your patient dies whilst at an Eastern Health hospital? 2010

                    Always               Usually              Rarely              Never         Not Sure
GEPH                4                    12                   4                   4             5
                    14%                  41%                  14%                 14%           17%
MEGPN               14                   41                   11                  7             25
                    14%                  42%                  11%                 7%            26%
ERGPA               4                    13                   9                   3             6
                    11%                  37%                  36%                 9%            17%

Total:              13%                  40%                  20.3%               10%           20%




                                                                                                           18
SECTION 7: Education:

     7.1 Do you attend Eastern Health education events? 2010
                        Yes                    No                      Not Sure
GEPH                    8                      18                      3
                        28%                    62%                     10%
MEGPN                   35                     54                      9
                        36%                    55%                     9%
ERGPA                   10                     22                      3
                        29%                    63%                     9%

Total:                  31%                    60%                     9.3%



If the respondent answered Yes to Question 7.1....

   7.2 How satisfied are you with the quality of these education events? 2010
                    Very Satisfied     Satisfied           Not Sure                Unsatisfied           Very Unsatisfied
GEPH                3                  5                   0                       0                     0
                    38%                62%
MEGPN               8                  27                  0                       0                     0
                    23%                77%
ERGPA               3                  5                   1                       1                     0
                    30%                50%                 10%                     10%

Total:              30.3%              63%                 3.3%                    3.3%                  0




SECTION 8: Percentage of respondents who would be interested
in attending Eastern Health education events


   40%
              31%           32%
                    27%                                           29%                                  27%
   30%                                        25%                                 24%                        24%
                                                     21%                20%                                                 GEPH
                                       19%
   20%                                                                                           16%
                                                                                                                            MEGPN
   10%                                                                                                                      ERGPA
    0%
               Emergencies                Maternity                   Aged Care             Fracture Management




                                                                                                                            19
SECTION 9: Shared Care and Credentialing

     9.1 Are you credentialed to refer patients to HITH at Angliss? 2010

                        Yes                     No                         Not Sure

GEPH                    5                       14                         10
                        17%                     48%                        34%
MEGPN                   1                       65                         31
                        1%                      66%                        32%
ERGPA                   5                       15                         15
                        14%                     43%                        43%


Total:                  10.6%                   52.3%                      36.3%


     9.2 Would you be interested in referring patients to an Eastern Health wide HITH
     program? 2010
                        Yes                     No                         Not Sure

GEPH                    15                      8                          6
                        52%                     28%                        21%
MEGPN                   53                      14                         31
                        54%                     14%                        32%
ERGPA                   22                      5                          8
                        63%                     14%                        23%


Total:                  56.3%                   18.7%                      15.7%




9.3 Percentage of respondents that would be interested in shared care programs
for Eastern Health

  50%                                                                            44% 46%
                                                                                            37%
  40%
                                                                                                  GEPH
  30%        22% 23% 23%                      21%
                                  19%                   16% 16% 19%                               MEGPN
  20%                                   15%
                                                                                                  ERGPA
  10%
    0%
               Aged Care          Mental Health           Fractures                   Not Sure




                                                                                                          20
SECTION 10: Maternity
     10.1 Are you a GP obstetrician? 2010
                    Yes                 No                  Not Sure
GEPH                2                   25                  2
                    7%                  86%                 7%
MEGPN               1                   72                  25
                    1%                  73%                 26%
ERGPA               3                   32                  0
                    9%                  91%

Total:              5.7%                83.3%               11%



     10.2 Are you a shared-care affiliate (Birralee at Box Hill) with Eastern
     Health? 2010
                    Yes                 No                 Not Sure
GEPH                5                   22                 2
                    17%                 76%                7%
MEGPN               27                  50                 21
                    28%                 51%                21%
ERGPA               10                  21                 4
                    29%                 60%                11%

Total:              24.7%               62.3%              13%
If respondent answered yes to 10.2...

   10.3 How satisfied are you with the referral process for obstetric patients? 2010
                    Very Satisfied       Satisfied            Not Sure          Unsatisfied   Very Unsatisfied
GEPH                2                    3                    0                 0             0
                    40%                  60%
MEGPN               7                    18                   0                 1             1
                    26%                  67%                                    4%            4%
ERGPA               1                    10                   0                 2             0
                    8%                   77%                                    15%

Total:              24.7%                68%                                    6.3%          1.3%




   10.4 How satisfied are you with Communication of clinical information? 2010
                    Very Satisfied       Satisfied            Not Sure          Unsatisfied   Very Unsatisfied
GEPH                1                    1                    2                 1             0
                    20%                  20%                  40%               20%
MEGPN               4                    16                   3                 2             2
                    15%                  59%                  11%               7%            7%
ERGPA               2                    6                    1                 3             1
                    15%                  46%                  8%                23%           8%

Total:              16.7%                41.7%                19.7%             16.7%         5%




   10.5 How satisfied are you with Birth notifications? 2010
                    Very Satisfied       Satisfied            Not Sure          Unsatisfied   Very Unsatisfied
GEPH                1                    2                    2                 0             0
                    20%                  40%                  40%
MEGPN               7                    17                   0                 3             0
                    26%                  63%                                    11%
ERGPA               3                    9                    1                 3             1
                    23%                  69%                  8%                23%           8%

Total:              23%                  57.3%                16%               11.3%         2.7%


                                                                                                                 21
   10.6 How satisfied are you with Maternity discharge summaries? 2010

                     Very Satisfied          Satisfied               Not Sure                 Unsatisfied                 Very Unsatisfied
GEPH                 2                       1                       1                        1                           0
                     40%                     20%                     20%                      20%
MEGPN                4                       21                      1                        1                           0
                     15%                     78%                     4%                       4%
ERGPA                1                       9                       2                        1                           0
                     8%                      69%                     15%                      8%

Total:               21%                     55.7%                   13%                      10.7%



SECTION 11: Website

     11.1 Do you access the GP portal on the Eastern Health Website? 2010
                      Yes                         No                    Not Sure
GEPH                  8                           21                    0
                      28%                         72%
MEGPN                 34                          49                    15
                      35%                         50%                   15%
ERGPA                 6                           29                    0
                      17%                         83%

Total:                26.7%                       68.3%                 5%


If respondent answered Yes to 11.1...

     11.2 Do you find the GP portal easy to navigate? 2010
                      Yes                         No                    Not Sure
GEPH                  5                           3                     0
                      63%                         37%
MEGPN                 16                          14                    4
                      47%                         41%                   12%
ERGPA                 4                           2                     0
                      67%                         33%

Total:                59%                         37%                   4%

If respondent answered Yes to 11.2...

   11.3 How satisfied are you with outpatient clinic details and how to refer information available on website? 2010
                 Very Satisfied       Satisfied           Not Sure              Unsatisfied            Very Unsatisfied         Blank
GEPH             1                    2                   0                     2                      0                        0
                 20%                  40%                                       40%
MEGPN            0                    10                  2                     1                      0                        1
                                      63%                 25%                   6%                                              6%
                 0                    3                   1                     1                      1                        0
ERGPA                                 50%                 17%                   17%                    17%

Total:           6.7%                 51%                 14%                   21%                    5.7%                     2%




                                                                                                                                             22
   11.4 How satisfied are you with maternity information available on website? 2010
                 Very Satisfied   Satisfied        Not Sure          Unsatisfied      Very Unsatisfied   Blank
GEPH             1                1                0                 2                0                  1
                 20%              20%                                40%                                 20%
MEGPN            0                8                5                 1                0                  2
                                  50%              31%               6%                                  13%
ERGPA            0                2                2                 1                1                  0
                                  33%              33%               17%              17%

Total:           5.7%             34.3%            21.3%             21%              5.7%               11%




   11.5 How satisfied are you with the overall usefulness of the GP portal on the Eastern Health website? 2010
                Very Satisfied    Satisfied        Not Sure         Unsatisfied       Very Unsatisfied    Blank
GEPH            1                 2                0                2                 0                   0
                20%               40%                               40%
MEGPN           1                 9                4                0                 0                   2
                6%                56%              25%                                                    13%
ERGPA           0                 2                2                1                 1                   0
                                  33%              33%              17%               17%

Total:          8.7%              43%              19.3%            19%               5.7%                4.3%




                                                                                                                  23
Appendix 3: 2010 GP Satisfaction Survey
Qualitative Summary of Results
Common themes from free text areas:

Managerial Changes / General
MEGPN:
         Issues related to management changes
         Surgeons are arrogant
         Sometimes good service, sometimes bad, all under huge pressure
         Inpatient care is poor
         Phone communication is poor and often rings out
         Staff at BH ED should identify themselves and position


ERGPA:
         I am not satisfied with waiting times in casualty at Maroondah (related personal experience)
         Inexperienced junior doctors
         EH communication is at times VERY POOR, I write to Box Hill re induction of labour and ...?? and
         have spoken to others but no reply after 8 weeks?



Discharge Summaries / HealthSMART
GEPH:
         Unsure what HealthSMART is
         HealthSMART timely and thorough
         Pathology results via fax are unnecessary and wasteful, email is preferred method of delivery
         Emailed pathology results are rare, despite GP being registered for process
         GPs not receiving A/E discharge summary, causing confusion as to whether patient is to bring it
         themselves? Or if it is just not given? A fax directly to the clinic is therefore a better option
         HealthSMART is too tick a box and not laid out well
         GPs not receiving all or any HealthSMART discharge summaries via email, and are still receiving
         faxes
         Discharge summaries are incompatible with software at clinics, and therefore cannot be read. If EH
         provided the referring GPs provider number, this could be partially resolved
         Minimal information is given on discharge summaries and rarely results are attached




                                                                                                        24
MEPGN:
         No discharge summaries received or sent
         Poor follow-up at Maroondah
         Want summaries electronically
         Extended timeframes to receive summaries despite multiple calls, and once received, difficult to
         comprehend, or often results are not included
         Don’t receive ED discharge letters, please fax or send through electronically not with patient
         Often see patient before summary arrives
         Formatting issues, poorly executed, non user friendly, abbreviations confusing, too much
         repetition, dates of admission aren’t clear
         Sometimes GP information incorrect
         Electronic referral must be way to go because fax often takes 5-6 hours and 2-3 times before it is
         received
         Can be quite good but need to ensure they happen and are not missed – this should be a rarity
         Variable quality, sometimes non-existent though
         Useful discharges often take weeks to receive
         If HealthSMART is discharge summary then happy with report


ERGPA:
         HealthSMART is destructive, costly and has poor outcomes for GPs
         Critical discharge summaries rarely arrive in a timely manner
         The GP Liaison service does not assist with improvements to discharge summaries
         Difficulty reading summaries, (most) illegible
         More effort needed by hospital GPs when managing complicated patients, especially re/medication
         changes being contemplated, or if it unclear why a medication is being used
         I prefer to receive all my discharge summaries by post as I do not use a computer, nor do I know
         how to use a computer
         Difficulty getting patients a timely OPD appointment
         Fax referral request does not work
         Patients report 4-5 hour wait in ED
         Poor quality of consultants
         Inaccurate diagnosis and treatment
         Poor follow up
         Language difficulties with OTD’s
         Discharge summaries on average take over a month to arrive, if at all; even when the patient has
         been asked to see their GP in a week for follow-up
         Quality of DS variable - depends on individual. We spend hours attempting to find results
         Overall service from Maroondah is appalling. The service from Angliss is reasonable. The service
         from Box Hill is ok but variable.
         Discharge summaries usually too late
         Often not enough info, never includes results
         Often get several copies of discharge summaries (but often very delayed). Often unable to read
         specialist writing on endoscopy reports from Healesville




                                                                                                        25
Outpatient Letters
GEPH:
         Angliss general surgery and response outpatients give prompt feedback. Other hospitals very poor
         and delayed
         Patients are referred to outpatients at Angliss following admissions without any correspondence
         with their GPs, and with no notification of their admissions, which is unnecessary doubling up of
         services
         Rarely receive feedback from casualty for referred patients


MEGPN:
         Long waits for appointments and don’t receive any correspondence
         Difficulty getting appointments and then do not receive receipt of referral
         Never received a letter from orthopaedics, plastics, OPD even though referred and surgery
         completed
         Typed letters must be posted within 2 weeks as usually has request for follow-up tests
         OPD letter should include what Ward / Unit Medical / Surgical / Obstetrics and provide the name of
         the Registrar / Consultant
         Letters arrive 4-6 weeks later and patients are often unclear of information such as surgery date, or
         they usually have requests for follow up tests
         Clinical staff do their best, however appointment timeframes are poor and medical staff contact
         post appointment is nonexistent
         ED staff do very well considering how busy the department is
         OPD waiting time so poor refer to private clinics with public hospital admitting rights


ERGPA:
         OP letters arrive 2-3 months after a patient has been seen – POOR. Follow up arrangements after
         discharge should be made by hospital if OP appointments required. Quite often patients fail to get
         follow up OP appointments
         Re communication from delivery suites – I have never received any letter of notifications about
         patients’ ante-natal visits. Likewise, patients rarely bring cards, so the hospital does not receive my
         information
         Rare to get info back from hospital after OPD attendance




Shared Care
GEPH:
         Protocol and procedures change without the GP obstetricians being aware or consulted
         Poor communication from Birralee
         If my obstetric patients are referred for an emergency Caesar the surgeon gets the obstetric
         summary and the GP does not. Difficult to discuss a delivery if I do not get one.




                                                                                                             26
MEGPN:
         Didn’t have enough referrals to remain actively involved
         Reconsidering status because don’t receive correspondence post-birth, why take medico legal
         responsibility when there is not hospital follow up?
         Nonexistent correspondence
         Better communication from maternity than other parts of the hospital (ED/OPD)
         Poor communication – generic letter even when results have been provided to the test they are
         asking for
         Likely to let status lapse because can’t attend enough professional development due to patient
         load


ERGPA:
         Online education events would be useful
         GP shared care at Angliss does not exist unless you become a GP obstetrician\


Website
GEPH:
         (GP) is getting better at using website. Will be a more useful resource once better at using it


MEPGN:
         Hard to navigate so don’t use it
         Don’t access it but would like to know the benefits
         Harder to negotiate than before, tend to go around and round and can’t find the information
         required

ERGPA:
         Don’t know about the GP portal?
         Access to (hospital?) clinical guidelines would be useful. Still very difficult to arrange mental health
         placements, despite this year’s educational event
         There are a lot of criteria to fulfil before a patient is accepted – but there is no comprehensive list /
         guidelines as to what these criteria are?
         I do not use a computer, nor do I know how to




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