Impact of COVID-19 on patient experience in acute care hospitals

In 2020–2021, 65% of patients said that they had a positive experience during their hospital stay, which is similar to the previous year. One of the main drivers of overall patient experience is communication between health care providers and patients, an important component of which is being treated with dignity and respect. During the pandemic and in preceding years, most patients rated their experience communicating with doctors and nurses positively.

67% of males and 63% of females reported that they had a positive overall experience during their hospital stay. This was similar to patients who had hospital stays before the pandemic.

68% of patients who had elective hospital stays reported that they had a positive experience — slightly higher than patients who had urgent stays (63%).

Even in the pandemic, I felt I was treated well. I knew I was going to get better and I was going to go home. What was different was that I felt more vulnerable and relied more on staff. I needed to make decisions more on my own, without my family. None of us had been through a pandemic, so we didn’t realize what we stood to lose. I kept realizing that I was missing having family supports and so on. I had to be more careful.— Anne O’Riordan, Ontario

Patient and family/friend involvement, 2019–2020 to 2020–2021

 

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The percentage of patients that reported they were involved as much as they wanted to be in decisions about their care and treatment remained relatively the same: 56% in 2019–2020 and 55% in 2020–2021.

The percentage of patients that reported their family or friends were involved as much as they wanted them to be in decisions about their care and treatment dropped from 69% in 2019–2020 to 49% in 2020–2021.

Only 49% of patients reported that their family or friends were involved as much as they wanted them to be in decisions about their care and treatment — 46% for younger patients. This was a large drop from 69% the previous year. This decrease may be related to visitor restrictions, which impacted the involvement of family and friends of patients admitted to hospital. Beyond the patient and provider relationship, caregivers and family or friends serve a vital role as patient advocates, providing physical and emotional support and helping patients navigate their care journey.

For me, it was more about being the navigator for my family while they were in the hospital, not about making the care decisions. It’s hard for the patient to know how to navigate the system when they don’t have experience. I get a little worked up about the fact that I couldn’t be there to support my family the way I wanted to during the pandemic. I felt helpless to know that they were just inside the hospital and really were not prepared. They were prepared to have the surgery and the pain, but I don’t know that people really understand how a surgery can impact you. And it really was horrible. I couldn’t go into the hospital. I had to sit outside the hospital in the truck and wait — 4 hours away from our home.— Brenda Andreas, Saskatchewan

Patient and family/friend involvement, by age, 2020–2021

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58% of patients age 18 to 64 reported that they were involved as much as they wanted to be in decisions about their care and treatment, 5 percentage points higher than patients age 65 and older (53%).

52% of patients age 65 and older reported that their family or friends were involved as much as they wanted them to be in decisions about their care and treatment, 6 percentage points higher than patients age 18 to 64 (46%).

In contrast, 55% of patients reported that they themselves were involved as much as they wanted to be in decisions about their care and treatment, similar to the previous year (56%). Effectively engaging patients in their care can improve health outcomes, reduce costs and improve overall satisfaction with their care experience.Reference3

“The best care occurs when a patient is involved as an equal partner in the decision-making process. As a patient, it means that I’m engaged, I know what’s going on and I can discuss pros and cons or share differing opinions with medical experts. I’m the expert in how I feel and it’s so important to have time and the willingness to have a two-way conversation with the health care professionals involved in your care. These discussions allow me to learn about unfamiliar topics and provide more information to make the right decisions for myself.” — Anne O’Riordan, Ontario

As a nurse, you often seek connection through the family and their reactions to the patient situation, and collaborate around care decisions. We really can’t do our job 100% if we don’t have family involved. And that’s really what patient- and family-centred care is about. — Maria-Lena Brix, RN, ICU Unit Manager, Alberta

During the pandemic, hospitals and health systems have had to balance treating patients with COVID-19 with treating patients who are in hospital for other reasons. Patient experience survey results from 2020–2021, the first year of the pandemic, reveal that both groups had a positive overall experience (65%). However, while their overall experience was similar, patients with COVID-19 who were discharged from hospital reported that they were less involved in their decision-making than patients without COVID-19.

Throughout the pandemic, hospitals have continually adapted their response to COVID-19, operating at different levels as needed. Delivering effective care that involves family and friends in decision-making has been an important aspect of the pandemic response of many hospitals. Most patients reported that their family or friends were not as involved as they would have liked them to be in their care, which may be a direct reflection of visitor restrictions during the pandemic. Despite the challenges introduced by the pandemic, many hospitals have adapted and introduced new approaches to ensure involvement.

“I think the biggest challenge was the physical barriers. With masks, you are not seeing a smiling face, you’re barely seeing eyes. Everyone looks the same, so that personal contact, like holding someone’s hand, isn’t the same. There’s a big difference when you’re wearing gloves, mask, a gown and goggles — this impacts how you communicate with the patient. We have a great group of volunteers, and they facilitated patient-to-family communication using iPads. They would bring the iPad to the bedside, so the patients could see their family member, and I think that’s hugely impactful. I hope that the communication with families is one of those things that we carry forward.” — Maria-Lena Brix, RN, ICU Unit Manager, Alberta

“It is very challenging to balance the safety of the health care workers and family needs. There was significant advocacy work to get families back to the bedside. We formulated a plan that involved appointments for family members to visit. We also implemented scheduled Zoom calls to facilitate communication between health care workers and families, as well as families and patients. We have a patient-centred philosophy, which involves patients and families in the decision-making. I do believe this approach facilitates an open and honest conversation where all the questions are answered, and we can have a much better understanding, consensus and informed decision-making process.” — Dr. Juan Posadas, Intensivist, Alberta

Patients’ feedback on their experiences during their hospital stay is crucial for highlighting best practices and areas for improvement. During the COVID-19 pandemic, the way that care is provided has changed; however, patient experience survey results show that despite radical transformation of the health care system, patients’ own assessment of their experience remained relatively positive overall.

Health care providers face numerous challenges while having to maintain a high standard of care. Understanding patient experiences during the pandemic is crucial for informing decision-making and adjusting hospital services to deliver patient-centred and timely care moving forward.

• What were the experiences of people who had their planned hospital care delayed or cancelled altogether?
• What were the experiences and consequences for people who delayed seeking care or were unable to access care?
• How did negative experiences associated with delayed or cancelled procedures impact people’s health outcomes?
• Were certain groups affected more than others by negative experiences associated with delayed or cancelled procedures?

CIHI, in collaboration with health system stakeholders, developed the Canadian Patient Experiences Survey on Inpatient Care (CPES-IC) to provide standardized reporting of inpatient experiences of care from Canadian acute care hospitals. The CPES-IC is a post-discharge survey. Data is submitted by hospitals or jurisdictions that administer the survey, and CIHI collaborates with participating jurisdictions to support CPES-IC implementation and data submission.

This report features 2020–2021 data from 57,883 survey respondents (1,053 COVID-19 patients) from 227 acute care hospitals in 3 provinces: Ontario, Manitoba and Alberta. All results are age- and sex-standardized and take into account the type of service a patient received and the mode in which they responded to the survey.Footnote i For more details about the methodology, please email prems@cihi.ca.

• COVID-19 resources
• Learn about the CPES-IC survey
• Learn more about patient experience in Canadian hospitals

• Overview: COVID-19’s impact on health care systems
• COVID-19’s impact on emergency departments
• COVID-19’s impact on physician services
• COVID-19’s impact on hospital services
• COVID-19’s impact on home care