Understanding the client and family experience is crucial in healthcare¹, leading to safer care², better health outcomes³ and improved staff wellness⁴. It matters greatly to the clients we serve. For home care organizations that provide care in the intimacy of a client’s home, client experience must be more than a side project. Measuring it effectively is essential.  

VHA Home HealthCare (VHA), a large not-for-profit provider of publicly-funded home care based in Ontario, has a volunteer board that cares deeply and is committed to supporting VHA’s vulnerable client population. In 2023, it decided to sharpen its attention on the best indicators of a positive client experience. An ad hoc working group reviewed VHA’s metrics, worked to understand leading practices and current literature and recommended a short set of Key Performance Indicators (KPIs) to form a client experience dashboard to be monitored regularly.

The first step was a comprehensive literature review. It revealed 10 factors that consistently influence client experience in home care: safety, relational care, care continuity, service quality, information sharing, participation, responsiveness, accountability, scheduling and connection across the health care spectrum.

Based on this, VHA analyzed their client experience survey data to identify which aspects of care most strongly influence overall client experience and which factors have the greatest independent impact. These directional insights and independent correlations would point to the most important drivers of client experience. 

The team analyzed two sets of survey data. The first analysis was of approximately 3,000 survey responses from clients discharged between 2021 and 2024. The analysis found that questions about respectful communication, receiving the right care, safety and preparation for discharge were most strongly related to client experience. More than half the respondents from this data set were rehab clients who had shorter lengths of stay. To capture a more complete picture of the home care experience, recognizing that many clients receive services for many months and sometimes years, a second analysis of active client survey results was conducted. This survey was focused on active clients who had been receiving personal support services for 12 months or more. The analysis found that questions related to the care schedule, whether services met the client’s needs, whether the services in the care plan were provided and whether the reason for a client’s call to the office was addressed were most strongly related to client experience.

In other words, surveys conducted during care and after discharge reveal different client priorities. 

A careful analysis comparing the responses of discharged clients with those of active clients found that their responses differed in material ways. For example, the consistency of the care team is a strong driver of experience for active clients but plays a lesser role after discharge. Once services end, people appear to be less focused on the day-to-day factors that mattered intensely while care was ongoing. What sticks with them is relational care, i.e. the quality of the relationship they had with their care provider and the respectful communication they received. 

VHA undertook to streamline and redesign its active- and discharged-client surveys to ensure it was obtaining the most relevant and reliable data. The goal was to develop a comprehensive set of survey questions that address the experiences of both active and discharged clients, including some questions unique to each group and a set of values-based questions aligned with key drivers that are core to both. This was done in collaboration with VHA’s Client and Carer Advisory Council to ensure that the streamlined survey felt meaningful and appropriate to clients.

The resulting survey was deployed in 2025. The results revealed which factors were most closely correlated to overall client satisfaction. An intercorrelation analysis of these items showed the extent to which the questions addressed similar underlying ideas. By considering both the strength of the association and the overlap between survey items, a few well-chosen questions could be kept and the rest consolidated or removed to respect clients’ time.

VHA again brought the findings and proposed survey changes to client partners to check whether the streamlined survey captured what was most important to them. This input shaped which questions stayed and which were combined or reworded. 

The results were distilled into five client-centred ‘Key Performance Indicators’ or KPIs that will be reported to the board quarterly. Listed below, they ladder up to an overarching strategic measure of success: overall client satisfaction with services received. These became the board’s client experience dashboard, which serves as an organizing framework for interpreting survey results, with multiple drivers of client experience informing each indicator.

There are two factors that matter most to both active and discharged clients. They are: “treated me with courtesy and respect” and “provided the services in my care plan”. Consequently, VHA retained questions related to these key factors in both surveys. These and many of VHA’s other findings about what matters most to clients align closely with the Ontario Patient Declaration of Values⁵. 

Why careful survey design matters

When clients say they feel respected, listened to and safe, they are not just describing a pleasant interaction. They are describing conditions that make it easier to speak up when something is wrong and ultimately to live safely and independently at home. In home care, where relationships can last for years or even decades, the quality and continuity of care relationships shape how people cope with illness, disability and aging 

Guided by the insights from the dual surveys, VHA has made scheduling improvements, added self-serve options for clients, and is making adjustments to care planning. 

For any home care organization, client experience is both a moral imperative and a practical necessity. By asking the right questions at the right time, providers can ensure care remains not just technically high quality, but truly people-centred as well. 

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