Getting it right: A guide to patient satisfaction
Advice on hiring a consultant or doing it yourself
What's the best way to conduct a patient satisfaction survey? The answer will depend on your practice's needs and resources. To provide guideposts in the measurement dilemma, Patient Satisfaction and Outcomes Management asked several outcomes experts for their responses to some frequently asked questions:
1. What benefits do outside consultants provide to medical groups?
If you want to know how satisfied your patients are compared to those in other medical groups, you may want to hire an outside vendor to conduct your surveys. Your scores will only be comparable to others if you used the same questionnaires, data collection methods, and reporting requirements, explains John E. Ware Jr., PhD, director of the Health Assessment Lab at the New England Medical Center in Boston.
Using an outside consultant clearly places less burden on your staff. In some cases, the receptionist simply hands patients a questionnaire when they check in, and the practice provides an envelope and a drop box. The surveys are mailed to the consulting firm, where they are scanned, tallied, and analyzed.
Other firms may take a computer-generated list of patients who had a recent office visit and either mail them surveys or conduct phone interviews. Cost varies widely according to the method and number of patients surveyed.
2. Can you measure patient satisfaction effectively with an in-house survey?
Yes, if you use one of the psychometrically tested, widely used surveys that are available for modest fees. (See list of available surveys, p. 57.) For example, the Visit Satisfaction Questionnaire (VSQ-9), developed in the 1980s by Ware and colleagues, is one of the most frequently used surveys to measure satisfaction with specific office visits. It asks just one question for each dimension of care, such as communication or perceived technical competency. (For a copy of the VSQ-9, see p. 55. For excerpts from another physician-specific survey also published by the Health Assessment Lab, see p. 56 and above.)
Conducting in-house surveys means involving your staff in both the measurement and analysis of patient satisfaction. "There's an advantage to bringing this into a part of the way you do your business," says David Radosevich, PhD, RN, director of the Center for Applied Research and Analysis at the Health Outcomes Institute, which is part of Stratis Health in Bloomington, MN. Medical groups may be able to detect and correct problems through periodic surveys rather than waiting for the once-a-year analysis from a survey firm.
In-house surveys also can be useful if a group wants to ask more specific questions for quality improvement purposes, adds Laurie Gavoni, project director for the quality and outcomes measurement department at Harvard Pilgrim Health Care in Brookline, MA. "You may find from some of your routine surveys that your appointment access was low," she says. "You may want to develop another instrument to probe and find out why these results are so low."
3. What should you look for in a consultant?
First, check the science of the survey tool and the data collection methods. Are they using a standardized questionnaire that has been a part of the medical literature? If the survey tool is proprietary, was it subjected to rigorous testing? Does the database compare medical groups using like data collection methods? Do they report variations in response rate or factor those into the analysis?
"If you're going to go with a commercial company, you need to have it show to you the reliability and validity tracking it has done," says Darlene M. Trandel-Korenchuk, RN, PhD, grant and community outreach director for Nalle Clinic in Charlotte, NC. "If it can't supply it to you, I would say 'No, thank you' and go to the next."
Make sure the surveys meet your information needs, both in terms of focused questions and timely reporting, Radosevich says. Some vendors may provide a core questionnaire that can be used for comparisons with other medical groups and add questions that are targeted to the needs of the practice.
4. What should your response rate be? How many patients should you survey?
While some outcomes experts recommend response rates of 50% or greater, Ware says that lower response rates may yield valid results if the sample is representative of your overall practice.
Because medical groups rarely have the resources to conduct a statistical analysis of respondents and nonrespondents, you should strive for the highest response rate you can achieve.
However, regardless of your overall rate, Ware has a caveat. "We should limit comparisons to a standardized response cohort, such as the first 30% to 40% who respond, regardless of whether more surveys are returned by some plans [or providers]. If this is not possible, and plans [or providers] differ a lot in terms of response rate, satisfaction results should be reported along with response rates and a cautionary note that plans with much higher rates may be at a disadvantage."
Be sure that your sampling is random. If you're going to compare results among physicians, you should get 40 to 50 patient responses from each, Ware says.
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