Accessible Digital Tool to Improve Patient Engagement: Bringing the Patient's Voice to Quality Improvement 



Black Creek Community Health Centre (BCCHC) provides holistic care and program services to a diverse client population in Toronto, Ontario Canada. The social-determinants model of care delivery is integral to BCCHC’s commitment for informed development and service delivery. 

Every year they ask their population to complete a paper-based HQO (Health Quality Ontario) Client Experience Survey with specific BCCHC questions to evaluate and implement quality improvement initiatives. 

 Traditional Paper-Based Survey

Traditional Paper-Based Survey


Paper forms are cumbersome:

  • Require manual data entry. 
  • Chance for human error. 
  • Low completion rate. 

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Presented at: IHI National Forum Orlando Florida Dec 13th 2017, Quality Forum Vancouver B.C. Feb 24th-26th 2018, eHealth Conference May 27th-31st Vancouver B.C.



1. Quadruple patient experience response rates.

2. Improve equitable representation of organization's population in collected data set.

3. Use live data for continuous quality improvement.

"We’re really happy with the data we collect and have received so much positive feedback about Tickit from everyone that uses it from doctors to patients and caregivers. We’ve been able to implement a lot of positive change in the clinic too based on the results of the survey. Black Creek"
Community Health
Centre Toronto, ON


 Digital Data Collection with Tickit

Digital Data Collection with Tickit

Clients who indicated that they come to Black Creek to visit with their doctor or nurse practitioner (i.e. Primary Care Providers), were given HQO questions related to dimensions of Access to primary care and client-centeredness.

Staff were empowered to improve data collection by automating processes to collect the patient’s voice in a responsive and value-added approach. Clients completed the survey before or after a clinic appointment and in group programs.


92% of Patients felt the questions were easy to understand 

94% of Patients found Tickit easy to use

95% of Patients thought the information is helpful to BCCHC

Evaluation Quality Improvement Intervention

Advance access intervention success was demonstrated in improved client and provider satisfaction. Tickit live data validated the Access Quality Improvement initiative. 49% of clients were able to always see their healthcare provider the same day or next day. Reduction of the 3rd next appointment by 27 days.

Meet quadruple aims through efficient client-centred care

• Increased response rate improved data quality for better outcomes.

• Validated patient satisfaction.

• Reduced cost: average time to complete the survey was 3 minutes and eliminated need for manual data.

• Reduce clinician burnout.


Outcomes & Lessons Learned

429 % increase in survey response

Tickit n=713  vs  Paper  n=167

  • Tickit technology was easy to implement and integrated seamlessly into BCCHC’s normal workflow.
  • Clinic staff were motivated by the value of the tool & encouraged clients to participate which increased response rate.
  • Digital versions of the survey fostered a higher volume of quality data that enabled faster continuous improvement Plan-Do-Study-Act (PDSA) cycles, and created a model for success and sustainability.
  • Increase efficiencies: BCCHC were able to collect 4x the number of surveys and eliminated the need for manual data entry.
  • Number of tablets available limits the amount of surveys that can be completed at the same time (vs paper-based surveys).


Black Creek Quality Improvement Committee: Erin Barnes, Hannah Bontogon, Melissa Galeano, Amika Gupta, Farha Khan, Daniel Monroy, Yolanda Mendoza, Judy Murray, Beryl Pilkington, Michelle Westin, Samentia Wilson, Erin Zindoga. Tickit Health: Dr. Sandy Whitehouse