Are you satisfied with your patient surveys?
Ask questions that patients want to answer
To meet the Joint Commission on Accreditation of Healthcare Organizations' standards on patient complaints, many hospitals use patient satisfaction surveys as a tool for receiving and acting on the complaints. But these surveys can be useless to the hospital if patients do not complete them.
At Olympic Memorial Hospital in Port Angeles, WA, only 8% of the patients were returning the surveys. After revising the form, content, and distribution method, the hospital saw the response rate climb to 32% in one year.
By revamping your patient satisfaction surveys like Olympic Memorial did, you can not only improve patient satisfaction, but also have an effective risk management tool.
Following are six steps Olympic Memorial took to improve the response rate to its patient satisfaction survey program:
1. Distribute after discharge.
Before the hospital revamped its survey program, patients were given patient satisfaction surveys at discharge. This practice was a mistake, says Donna Davison, director of support services at Olympic Memorial, who has responsibility for risk management as well as patient relations, communications, and volunteers. At discharge, patients often were uncomfortable and too eager to leave the hospital to take the time to complete a survey.
Respondents prefer mailed surveys
Instead, the hospital began mailing its survey to the patients at home within a week of discharge. "We learned that by mailing them home and giving [patients] time to complete the surveys, the surveys were completed," Davison says.
Research on survey response also shows that patients are more apt to be truthful when responding if they take a written survey, rather than a telephone survey, says Richard Scalenghe, RMT, associate director for the department of standards of the Joint Commission.
2. Limit and simplify your questions.
Olympic Memorial's first patient satisfaction survey was too long. The survey had 19 questions, one of which had 15 potential responses!
"For example, we asked them to rate each professional who saw them at the hospital," Davison says, which could include anybody from a doctor to an X-ray technician to a physical therapist.
In addition, many of the questions required the patient to write out an answer, which also dissuaded them from responding.
The new survey pared down the number of questions to 10. All but one of the questions are phrased as statements to which the patient can respond using a numeric rating system. Space also was provided on the survey form for written comments following each question. The last question asks for suggestions about improving the quality of service at the hospital.
3. Ask relevant questions.
More important than limiting the number of questions was asking the right kind, Davison says.
The hospital's old survey was based on quality measurements that the staff thought were important but that patients did not. For example, patients were asked to comment on the exped-iency of their admission, including whether their chart contained accurate information. Patients were also asked to comment on the taste and appeal of the food.
The patients could not answer some of these questions, like the ones about the chart, Davison says. Other questions were simply not relevant to a certain patient population. Patients who were on liquid diets, for example, would not find the food question relevant to them.
"We wanted to change the information we were getting to find out what matters to the patient," she explains.
To pinpoint more patient-relevant questions, Davison and her team researched areas of patients' concerns, including but not limited to risk management. Their research revealed that patients are more concerned with their treatment than having the most up-to-date equipment or better tasting food.
One significant finding Davison used was a survey of plaintiffs' attorneys conducted by MMI Companies of Deerfield, IL. The survey indicated that the biggest reason patients sue hospitals is a lack of communication, she says.
"We found out that patients are more concerned with the intangible human elements like whether the staff was friendly and whether the staff treated them with respect."
On the hospital's new survey form, all the questions are meant to elicit information about the human aspects of the patient's care. For example, a question about whether the patient's privacy was respected is intended to show that the hospital cares about such issues.
Another question, which asks whether the patient was informed about his or her condition throughout the stay, is intended to find out whether patients feel as though they are being treated as humans and not numbers, Davison says.
4. Use what you have, rather than duplicating information gathering.
Another way Davison was able to pare the survey form was by removing questions to which the hospital already had the answers. Hospitals take in a significant amount of demographic information from patients on admission.
Davison removed all demographic questions from the survey. While the current form does not ask for any such information, she can obtain patient demographics by accessing admission records.
5. Pay for the stamp.
When patients were given the satisfaction surveys at discharge, they also were expected to return them to the hospital. Another innovation Davison made was to enclose the survey in a self-addressed, postage-paid envelope.
The envelope is actually the reverse side of the survey. Patients just need to fold the form into thirds and seal it to mail it back to the hospital. The hospital's printing shop created and printed the survey form.
Davison has not calculated the cost of the printing or the postage, but says it is minimal. She adds that the increased response rate is well worth whatever costs the hospital is incurring.
In addition to revising the survey form, Davison created a simple chart to compile the results. As director of support services for the hospital, Davison also is in charge of the hospital's volunteer program. She has trained several of the volunteers to tabulate the survey information.
6. Use the data.
Using the data gathered from the surveys is equally as important as getting responses. Often, hospital officials do not aggregate the information they have acquired through the patient satisfaction surveys, says Scalenghe. This makes it difficult to answer Joint Commission surveyors' questions about the meaning of survey results.
"The Joint Commission wants to see how you are doing compared to the [previous] year," says Scalenghe says. "If you've gone down in certain areas, is that a problem? If you've gone down in a number of areas, how are you going to prioritize which ones to improve?"
Olympic Memorial created a simple chart to tabulate the responses to each question. The tabulation is done monthly. The monthly reports are compiled into quarterly summaries for analysis.
Because compiling the data can be a time-consuming process, Davison has enlisted volunteers from the hospital volunteer program that she also administers to do the tabulation.
Starting from the bottom
The hospital's goal is to receive the highest ranking from patients for each of the questions asked on the survey. To reach this goal, Davison is starting from the bottom and working her way up to the top.
In the first year of the new survey, the hospital received consistently low marks from patients about receiving care in a timely manner. Since the survey also has a place for the patients to comment, Davison abstracted all of the comments to this question. She learned that the hospital was receiving low marks for their timeliness of care because the patients felt that they were not receiving their medication quickly. This sentiment was especially true when it came to pain medication.
As a result of the responses to this question, Davison has taken the patients' concerns to the nursing and pharmacy departments to help craft a solution to a speedier delivery of medication.
Davison plans to continue focusing on this element of patient care until 80% of the survey results consistently give the hospital the highest rating in this category. After this goal is accomplished, she will focus on the next-lowest rated category and continue the process until the patients rank the hospital in the highest category response for each area explored on the survey.
Risk management benefits
While the survey will help to improve the quality of care at Olympic Memorial, it also serves as an important risk management tool.
Patients who feel they have been mistreated, regardless of the outcome of the care, are the likeliest to sue. By reviewing the surveys, Davison can discern potential plaintiffs and call them to discuss their concerns. Her theory is working so far.
The wife of a recent stroke patient returned a survey that indicated that she was very upset about her husband's treatment at the hospital. Although the patient's medical outcome was a positive one, Davison still called the man's wife to hear out her complaints.
The call was a win-win situation for everyone. Davison was able to pacify an angry patient and ward off a possible lawsuit. *
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