What is the system challenge?

In the mental health and addictions system, a client’s perception of care is widely recognized as a key indicator of the quality of the care received. Though many organizations were gathering feedback from clients using a variety of tools, there was no consistent way that this information was collected and reported. Due to the lack of standardization in the surveys used across the system, the information gathered could not be adequately compared or used to guide quality improvement efforts at the regional or system levels.

Evidence:

Measuring client satisfaction in mental health and addiction treatment is recognized as an important indicator of the quality of care as it is a direct measure of whether a client received services that met their expectations and needs (McLellan & Hunkeler, 1998; McLellan et al., 2007).

As an approach to evaluation and performance monitoring, measuring client satisfaction ensures that service providers have explored their clients’ perception of the various aspects of quality of care received. Such information may be collected with other quality-related information, (e.g., indicators of program engagement, retention and treatment participation, and outcome) and integrated into a larger performance measurement system (Rush et al., 2012).

Several key studies demonstrate the connection between client perception of care or satisfaction surveys and changes to the way services were delivered, creating a link from client feedback to quality improvement.

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Development of a Client Perception of Care Tool for Mental Health and Addictions - Final Report for the Ministry of Health and Long-Term Care

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Background and psychometric validation of the OPOC-MHA

Find more evidence

The Provincial System Support Program (PSSP) at CAMH developed and validated the Ontario Perception of Care Tool for Mental Health and Addictions (OPOC-MHA).

This evidence-based tool standardizes how substance use, mental health, and concurrent disorder services obtain client perception of care feedback, which can be used to make valuable service improvements. The survey also captures extensive demographic information about clients that can inform the creation of a general client profile or identify inequities in service delivery. The OPOC-MHA survey meets the need for a standardized perception of care tool for informing, monitoring, and evaluating quality improvements and provides a consistent way to gather client feedback in both community and hospital settings. This brings the client voice forward as a source of evidence to support program, agency, and system quality improvement efforts.

About the tool

There are currently five versions of the OPOC-MHA:

OPOC-MHA for Registered Clients is for people registered in a program for treatment or support. This includes family members (or other supporters) who are registered to receive services, such as in a family support group.
OPOC-MHA for Non-Registered Clients is for people who are receiving service but not registered in a program (such as a drop-in peer support program). This includes family members or supporters who are receiving service but not registered in a program.
OPOC-MHA for Caregivers is for people who have a family member receiving services. This version enables family members and supporters to comment on the services received by their loved one.
OPOC-MHA for Supportive Housing is for residents or tenants of organizations providing permanent supportive housing or long-term transitional housing.
OPOC-MHA for Crisis is for clients of organizations providing crisis services or brief interventions.

Perceptions of care are gathered across several quality domains, with an opportunity for written comments following each domain. Demographic information is also collected to help organize the information and identify potential inequities in service. Each version is available in English and French.

A central provincial database and reporting portal gives organizations access to OPOC-MHA results, which can be filtered and analyzed in a customized manner. For example, organizations can select specific indicators they wish to track over time, examine data through a health equity lens, and then look at specific programs to support quality improvement efforts. Organizations also have access to aggregated, comparable provincial data.

Evaluating perception of care data is an important way to measure client experience within the healthcare system. Actionable items from the OPOC-MHA can be used to bring about necessary service change in areas such as access, quality of care, and safety. More broadly, system planners and funders can utilize results of providers to identify system-level quality improvement opportunities.

Who is involved?

All publicly-funded addiction, mental health, and concurrent disorder service providers in Ontario are in scope of OPOC-MHA, including both hospital and community-based programs.

Current status

OPOC-MHA implementation continues across the province. In 2022, after six years of implementation experience, PSSP engaged the mental health and addiction sector in a comprehensive evaluation to explore what has been the experience of those implementing the OPOC-MHA across the sector. The evaluation identified several feasible opportunities for ongoing improvement.

Below is a summary outlining the report's key findings, recommendations, and limitations.

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OPOC Evaluation Summary 2023

How the OPOC is helping advance equity

The OPOC-MHA can support your agency to action Ontario Health’s Equity, Inclusion, Diversity and Anti-Racism Framework. The OPOC-MHA captures extensive demographic information and the reporting platform helps to establish a system for collecting, reporting and using equity data to inform decisions and service improvements. Filtering the question responses through sociodemographic filters can help your agency assess for potential disparities in service delivery in relation to population groups. In addition, OPOC-MHA centers the client voice as a source of evidence, engaging key voices in service feedback and quality improvement initiatives.

Areas of action:

Collect, Report, and Use Equity Data
Include and Engage Key Voices
Reduce Disparities
Report and Evaluate to Drive Improvement

Moving Knowledge to Action: OPOC Equity Improvement Modules

This is a free, self-directed course designed for staff at organizations that use the OPOC.

The course consists of five modules and takes approximately three hours to to complete. It aims to build agency capacity to collect, understand, and use client experience data with an equity lens, regardless of where an agency is at with their OPOC implementation.

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Moving Knowledge to Action: OPOC Equity Improvement Modules