Who is keeping your patients happy? Targeted surveys let you find out
Managers create goals for staff, benchmark against academic facilities
What if same-day surgery (SDS) managers could determine which staff or surgical specialty was best meeting patient needs? What if you knew which aspects of care pleased or bothered patients most?
That day is here. While everyone does patient satisfaction surveys, the time has come for patient comments to shape the delivery of care.
Managed care organizations want to know detailed information about patient satisfaction and how SDS programs compare and you should, too. SDS managers now have the opportunity to benchmark with a prestigious national academic database called University HealthSystem Consortium (UHC) in Oak Brook, IL, a consortium of academic facilities, using a patient-centered care survey that tells you how well you are meeting key patient needs. For example, patients are asked whether they felt their questions were answered in a way they could understand.
The Picker Measure of Patient-Centered Care, developed by The Picker Institute in Boston, differs from other patient satisfaction surveys because it uses highly specific questions to target seven dimensions of patient-centered care in SDS, such as respect for patients’ values and preferences and alleviation of fears and anxiety, says J. Lee Hargraves, PhD, survey scientist at The Picker Institute and a lecturer in medicine at Harvard Medical School, both in Boston. (See sample questions, p. 123.)
Rather than just asking patients to rate their experience as good, bad, or fair, the Picker survey provides numerical scores for the different aspects of patient-centered care, Hargraves says. The survey found that patients are most likely to rate your SDS program highly if they think you provided good patient education and respected their preferences. Conversely, same-day surgery programs most often fail to coordinate patient care properly and involve family and friends.1
"If you tell [your staff] that the average rating of nurse courtesy is 4.5 on a scale of 5, that gets shrugs," says David Drachman, PhD, director of marketing research for UHC, which helped develop the survey. "But if you tell them 20% of their patients felt the nurses were not available to answer their questions, that’s something concrete."
The Picker Institute survey provides another benefit as well: For the first time, surgery centers and hospitals can compare their performance with benchmarks from the academic institutions that are members of UHC. The UHC hospitals wanted to open their database so they could compare their performance with local competitors, Drachman says. Currently, biannual benchmark reports in same-day surgery contain only national comparisons, but as the database grows, The Picker Institute will include both regional and local comparisons, Hargraves says.
Picker typically charges $8,000 to $10,000 to conduct the patient survey and provide an analysis and comparison to the national database.
One clear message emerged from the Picker survey: Patients want to understand and have some control over their care.
"Did you have enough say in your treatment? Did someone answer your questions in a way you could understand?’ Those are very similar issues," says Hargraves, citing some questions from the survey. The survey asks patients, Are you involved enough, and are you getting what you need?’"
In a survey of 17 hospitals in 1994, 5.5% of ambulatory surgery patients reported problems with "attention to [their] values and preferences," and 6% reported problems with "involvement of family and friends."
The survey tool asked patients three to 11 questions in each dimension of care, and patients indicated whether there was a problem. For example, patients were asked: "Did someone talk to my family about what was needed when I left? When I was in the recovery area, did someone keep my family and friends informed about my care?"
Hargraves says the problems detected by those questions were "probably a time factor. There’s so much to do in so little time. But from a patient’s perspective, it’s very important."
The Picker survey also gives patients an opportunity to rate their overall care. When Hargraves compared those ratings to specific problem areas, he determined that not everything affects patient satisfaction equally. For example, patients reported the most problems in "coordination of care," such as delays in the procedure’s start time. But patients didn’t necessarily rate their overall experience more poorly even if they experienced delays, Hargraves says.
On the other hand, few patients reported problems with pain control. But that is the third most important predictor of whether they rate their SDS experience favorably, Hargraves says. So SDS managers must pay close attention to even small changes in patient satisfaction in that area, he says. (For more information on conducting patient surveys, see related story, p. 124.)
Survey detects problems
Such results from the Picker survey allow SDS managers to monitor and improve their delivery of care. At Vanderbilt University Medical Center in Nashville, which surveys patients semiannually, quality improvement teams review Picker scores on the SDS dimensions of care.
For example, Vanderbilt usually scores 95 or 96 out of 100 on pain control. Still, the hospital’s pharmacy department investigated anesthetic agents and antiemetics that might further improve pain control and reduce nausea.
"We want to maintain that [pain control score] because it has a high degree of importance to patients," says Richard Anton, MHA, Vanderbilt’s director of market research. "You have to put a lot of energy into scoring very well."
When the score for patient education dropped by four points from 89 to 85, SDS managers focused on improving information materials. They created a "Learning Center" where different units of the hospital share patient education material. Nurses also received inservice training on how to communicate with patients, Anton says.
Picker scores are routinely reviewed by Vanderbilt’s same-day surgery quality council, which includes a physician, nurse manager, administrator, staff nurses, and risk managers.
At Vanderbilt, physicians receive survey results for their patients. Vanderbilt also sets up job descriptions and employee competencies based on the Picker patient-care dimensions, and the same-day surgery unit tries to achieve certain score-related goals. For example, the SDS program recently scored 79 out of 100 on "check-in occurred without delay." They set a higher goal to score at least 82 out of 100, Anton says.
Vanderbilt has surveyed patients with the Picker tool twice a year but plans to increase that frequency. "Our intent is to give this to all our patients," says Anton. "We’re challenging ourselves to improve in terms of how we provide patient care."
Achieving high goals in patient-centered care is the focus of the Picker survey, says Hargraves. "We’re trying to think about quality improvement from a patient perspective," he says.
Reference
1. Hargraves JL, Drachman DA, Cleary PD. Through the patient’s eyes: How do we measure satisfaction? Anesthesia and Analgesia 1996; July(supplement):43-47.
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