Today, all hospitals in Israel conduct hospitalization satisfaction surveys, including in pediatric departments, but the respondents to the survey are the parents and not the patients themselves – the girls and boys. "Children have a voice, have an opinion, and have a right to be heard," says Prof. Efrat Bron-Harlev, CEO of Schneider Children's Medical Center. "The healthcare system is used to measuring satisfaction with hospitalization in pediatric departments through the parents, but we are a children's hospital, and therefore it is important to us to hear the children, at eye level, without mediation."
From this concept, a first-of-its-kind patient satisfaction survey in Israel was born at Schneider, which addresses the hospitalized children aged 8–18 directly, without the mediation of the parents, but of which course with their prior consent. Since its launch, about 130 children have participated in it, and the results were interesting and significant.
Two-thirds of the children reported that they experienced fear or stress during the hospitalization, a figure that is not surprising in itself. But precisely the children who feared the hospitalization more were also the most satisfied with the care experience in the hospital. Those same children gave the hospital higher scores in metrics of personal and courteous treatment, clear and adapted information, involvement in care, and assistance in coping with pain.
The meaning is profound: It is not the absence of fear that determines the hospitalization experience – but the way the staff copes with it together with the boys and girls.
Not Only What the Parents Think
One of the significant findings that emerged from the survey is the gap between the children's experience and that of the parents. While parents tend to report higher satisfaction with the hospitalization experience, the voice of the children themselves presents a more complex picture.
This gap, they explain at Schneider, is not accidental: For a parent, hospitalization is sometimes security – their children are under supervision. For the children themselves, however, it is a departure from home, a loss of control, and sometimes also pain and fear.
"It is important for us to see this gap and not blur it," says Bron-Harlev. "Only if we truly listen to the children, will we be able to improve the experience for them."
Speaking in "Children's Language"
The survey itself was built out of that same concept: Not only to ask children, but to ask them in a way that suits them.
The survey was developed in the Service and Patient Experience Unit at Schneider, in collaboration with the Research and Planning Department in the Service Division of Clalit and the TECH company, as part of joint thinking on developing adapted tools for children in the healthcare system. It is performed via a tablet containing a digital satisfaction questionnaire. The service coordinators in the department approach the boy or girl close to their discharge, and offer them to answer the survey. A special animated character developed for the subject (named "Galu Li" [Reveal to Me]) accompanies the questionnaire. The language of the questionnaire is adapted to the age, accompanied by an option to read the questions aloud, and the children progress through answering the survey via a playful experience of collecting stars while progressing through the questions.
Here too, the children were partners: They took part in the phrasing and design of the questions, in choosing the character, and in the manner of presentation on the tablet. The result is not only a high response rate, but honest, direct, and sometimes surprising answers.
Alongside the complimentary data, the survey also surfaced areas requiring improvement. About 73% of the children gave the hospital a high overall score (8–10 on the scale), without a significant difference between a first and recurring hospitalization. However, it emerged that the parameter: "There is things to do in the hospital" is defined as having high importance for the children, but receives a relatively low rating. The gap is particularly prominent among those aged 12 and older, who reported higher levels of boredom compared to the younger children (8–11), who enjoy the existing activities more. The subject of food was also rated lower across all age groups, and especially among adolescents. In addition, children in recurring hospitalization emphasized a need for variety in activities and a clear daily schedule for leisure hours, while in a first hospitalization, the need for involvement in care and maintaining privacy was prominent.
"The beauty of the survey is that we do not choose what to hear," says Efrat Milner, Director of the Service and Patient Experience Unit at Schneider, "The children also surface what works less and that is exactly what allows us to improve. Children experience hospitalization differently from adults. We wanted to hear them directly and not through filters. When you speak to a child in their language, you get a cleaner truth. And this obligates us as a leading hospital for children."
The analysis of the data further showed that children who experienced fear or stress gave higher scores in metrics related to personal treatment and familiarity with the staff, and a significant difference was even found in the personal familiarity metric: "The staff members in the department know me and call me by my name."
"This figure moved us particularly," says Milner, "It teaches that when a child feels that they know him by his name, explain to him and involve him in the care, he does not remain alone inside the fear."
This is Not Just a Survey – It is a Concept
At Schneider, they emphasize that the survey is not a localized initiative, but part of a broad worldview led by the hospital management over years: To see the child as a whole person, with emotional, social, and experiential needs, and not just a patient.
Thus, for example, initiatives operate such as "Prescription for a Gift" (a prescription given by a doctor to a child after a painful treatment or a significant event in hospitalization to receive a gift from the gift room), a young patient council where children and youth share their experiences and needs with the hospital management.
And what next? As of today, the survey addresses children from the age of 8, but at Schneider they are already looking ahead. "A 3-year-old child also has an opinion," says Bron-Harlev. "We do not always know yet how to ask it, but it is our responsibility to listen and especially to learn."
The aspiration, according to her, is not only to continue and improve within the Schneider Center, but also to influence the healthcare system in the country, and in the world: "We hope that this model will be adopted in additional places as well. Children themselves need to be an essential part of their care. One simply needs to ask them, listen, and treat accordingly."