Actively listening to patients, families, and care partners is foundational to delivering high-quality, compassionate health care. Across Ontario, health care organizations are increasingly seeking feedback approaches that move beyond satisfaction scores to capture lived experience, equity, and opportunities for improvement. 

The REFLECT (Realtime Experience Feedback for Listening, Engagement and Care Transformation) program was developed to strengthen equity-focused listening and learning. It was created in partnership with qualitative researchers from the Centre for Quality Improvement and Patient Safety (CQuIPS), a collaboration between the University of Toronto’s Temerty Faculty of Medicine and four of its major teaching hospitals: The Hospital for Sick Children (SickKids), Sunnybrook Health Sciences Centre, Women’s College Hospital and Michael Garron Hospital.​

As part of this program, the REFLECT survey serves as an additional source of real-time patient experience feedback, working alongside our existing digital patient experience survey. 

While our digital patient experience surveys achieve a strong response rate of approximately 40%, demographic response data indicate that ~60% of respondents identify as white, and 94% report English as the language they are most comfortable using when speaking with their health care provider. Recognizing these gaps, the REFLECT program was intentionally designed to make a more active effort to hear from patients whose voices may be underrepresented, including individuals for whom English is not a preferred language, older adults, and others who may experience barriers to providing feedback. Through meaningful listening, reflection, and action, REFLECT supports the use of patient experience insights to inform more equitable, inclusive, and responsive care. 

The REFLECT survey is conducted by our Patient Experience Ambassadors. They identify one inpatient ward at a time and spend ~4 weeks surveying patients admitted to that ward. When preferred, the Ambassadors use interpretation services to conduct the interview. After reviewing and consolidating the feedback, it is provided back to the team. 

The REFLECT survey centers on understanding how individuals experience care across key touchpoints. Rather than focusing solely on outcomes, the survey emphasizes communication, respect, emotional support and inclusion, which are elements that strongly influence trust and engagement within the health care system. By inviting respondents to reflect on their experiences in their own words, REFLECT provides richer, more actionable insights than traditional survey instruments.

A core strength of the REFLECT survey is its alignment with patient-centred and equity-informed care principles. The survey is intentionally designed to be accessible and inclusive, using plain language and flexible response options. This approach helps reduce barriers to participation and supports engagement from diverse patient populations, including those whose voices may be underrepresented in conventional feedback processes.

Implementation of the REFLECT survey has supported teams in shifting from passive data collection to active learning. Results are shared with Patient Care Managers and frontline staff to encourage collective reflection and shared accountability. Qualitative comments are often the most powerful component of the survey, and they highlight moments of excellence as well as gaps in communication, coordination, or emotional support. These insights have informed quality improvement initiatives and staff education.

For example, during feedback review sessions with two inpatient units, REFLECT responses revealed that staff were not consistently aware of how to access interpreter services to support patients with language barriers. In response, the Patient Experience team partnered with the Equity and Social Accountability team to address this gap. This collaboration resulted in the delivery of a targeted microlearning session for unit staff, focused on when and how to appropriately use interpreter services in clinical care. 

Through this process, an additional system issue was identified: the interpreter service code was missing from the list available on the corporate website, making it difficult for staff to locate and use the service. This gap was escalated and corrected, improving access to interpreter services across the organization. This example illustrates how REFLECT feedback can lead to both education and system-level improvements that directly support equitable, patient-centred care. 

The REFLECT survey also reinforces a culture of psychological safety and learning. By framing feedback as an opportunity for reflection rather than evaluation, teams are better positioned to engage with results constructively. Staff report that hearing patient perspectives firsthand strengthens empathy, reinforces purpose and supports meaningful conversations about what compassionate care looks like in practice. 

As health care systems continue to navigate complexity and change, tools like REFLECT play a critical role in keeping patient experience at the centre of decision-making. Listening with intention and acting on what is heard, signals to patients and families that their voices matter. The REFLECT survey offers a practical, values-driven approach to understanding experience and advancing care that is not only clinically effective, but also respectful, inclusive and responsive. ​