Use survey data to zero in on what patients want
Give them what they want, they'll return
(Editor's note: In the August issue of Hospital Peer Review, we suggested methods of collecting patient information for the greatest impact. This month we offer ideas on developing, analyzing, and applying patient satisfaction data.)
If you can ferret out the factors that most influence patients' decisions to return to your hospital, you've uncovered the gold buried in patient satisfaction survey data. Find it, and you will be able to dramatically improve not only your patient satisfaction scores, but ultimately your hospital's bottom line, experts say.
What drives satisfaction
Patient satisfaction experts refer to those factors as drivers because they essentially "drive" patient satisfaction. Knowing these drivers will enable a hospital's quality improvement staff to focus improvement efforts on areas where they can reap the biggest pay back, says Allyson Ross Davies, PhD, an independent health care consultant in Newton, MA.
Here is her advice and that of other patient satisfaction experts on how to identify drivers and initiate changes based on them:
1. Identify satisfaction drivers.
Usually, there are three or four drivers within the care process. In the inpatient setting, the single biggest driver for overall quality ratings usually relates to nursing care, especially responsiveness, Davies says. "If the systems in the hospital weren't set up so the nurse could respond promptly when their attention was needed, you get lower quality ratings," she says.
Drivers often relate to communication, says Duke Rohe, senior management engineer at St. Luke's Episcopal Hospital in Houston, TX. At St. Luke's, communicating information to patients regarding upcoming tests or procedures tops the list of drivers. How well staff relates to a patient's needs is also a significant driver. For example, if the patient was anxious, patient satisfaction may boil down to how well staff recognized it and how well they handled it, he says.
Survey responses point to common drivers, Rohe says. Look for questions to which groups of patients assign the same score as they give for overall satisfaction, he says.
For example, a satisfaction survey is usually based on a scale of one through five, with one being poor and five being excellent. One group of patients may score overall satisfaction as three, response to call bell as three, and food services one. Another group may score overall satisfaction as five, response to call bell as five, and food services as three. Response to call bell becomes the driver, because both groups gave that question the same score as they gave overall satisfaction, Rohe says.
2. Look beyond survey results to find drivers.
Surveys are just one tool to identify customer satisfaction, says David Sand, MBA, a quality consultant for Hewlett-Packard Company in Andover, MA, who also advises health care quality managers. "You have to be awash in customer data to develop an intuition of what the customer wants," he says.
Sand's company uses four sources including verbatim comments, focus groups, customer visits, and satisfaction surveys. A classification code system keeps track of the type of data collected, he says. "For example, we take the verbatim data and code it. We have 400-500 different codes for different issues and we can compare [how different customers address the same issues]," Sand says. A hospital could code complaints about slow response to room bells, or lack of communication regarding tests, he says.
Collect verbatim comments by just listening to customers or having a blank space on your written survey for patients to write in. At St. Luke's, volunteers collect verbatim comments by visiting patients to ask how things are going. They then pass the information on to the nurse manager, says Rohe.
"Many hospitals maintain very good complaint registries, and the information in those registries will tell the users of the survey data if patients are complaining about the same kinds of things the survey is getting low ratings on or if they're complaining about things the survey hasn't turned up," Davies adds.
3. Monitor data frequently.
Tabulate results frequently. Tallying data on a monthly or quarterly basis will show trends or potential problems that can be acted upon before they become overwhelming, Rohe says. For example, frequent tallying of survey data alerted administrators at St. Luke's when complaints about noise began growing in frequency. Signs were subsequently placed on the wards reminding staff to be quiet before noise complaints became a serious problem, he says.
At the 12-hospital, not-for-profit Sisters of Charity of the Incarnate Word Health Care Systems (SCH) in Houston, TX, staff compile monthly data on the system's ongoing patient satisfaction surveys, says Gayle Capozzalo, MHA, SCH, senior vice president of organizational development. Samples are statistically validated and correlated to define what the most important issue is to patients in any given month. This information is handed on to individual hospital directors or quality improvement teams. Results go monthly to the SHC corporate office which tracks trends over time, and quarterly meetings of SHC chief executive officers provide a free flow of information on how each SHC hospital is faring on patient satisfaction, Capozzalo says. "We believe if you watch patient satisfaction, the scores will fall before the bottom line looks bad or the market share decreases," Capozzalo says.
A Pareto chart is a useful tool for identifying improvement opportunities over time, Rohe says. "Take the various survey questions out and categorize them, or take the verbatim comments and group them," he says. Develop four or five categories such as communication, facilities, skill or competency of staff, and ancillary support. List each category on the graph and track over time whether scores go up or down, he says.
4. Put data to work.
Once the data is in hand, it's time to make changes, experts say. Each hospital usually has its own method of using data for change, Capozzalo says. Sand recommends a sequential approach to data analysis and application such as plan, do, check, act (PDCA), or Deming's Improvement Cycle.
Pick the low-hanging fruit, or the most obvious opportunities, first, Sand says. "Find things that are easy to do," he says.
One tip for making fast improvements is to let poor performers learn from strong performers within the same organization, Capozzalo says. When a problem is identified in a particular area at an SHC hospital, the corporate office will match that institution with one in the system that is doing well in that area. "We have them go through a learning process together," she says.
Keep staff apprised of how patients perceive their care, says Cindy Burns, RN, director of quality at the 106-bed Herrick Memorial Hospital in Tecumseh, MI. At Herrick Memorial, a multidisciplinary team of physicians, nurses, radiologists, ambulatory services staff, social workers, and ancillary services tabulate survey results quarterly and share them with staff hospitalwide, she says.
Staff takes corrective action when negative responses appear. "For example, a major complaint is that we don't have cable television in the organization, so we're getting cable. Also, patients complained that one service in the ambulatory area was ugly and drab, so we painted and wallpapered," Burns says.
Change probably won't happen without middle management buy-in, so they must be convinced that the survey data is accurate, Sand says. "If they don't believe the data, they won't let you make changes," he says. Obtain management buy-in by letting them hear complaints or praise straight from the customer's mouth.
"Management typically won't have daily interaction with customers so they only see a small portion of reality," he says. Give them verbatim data and let them make follow-up phone calls to patients.
5. 'Advertise' changes to patients.
Communicate to the customers when improvements are made based on their comments, which lets customers know a hospital cares enough to respond to their concerns, Sand says. Use the patient newsletter as a forum for articles about changes staff made in response to customer comments, he says. *
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