Patient Satisfaction Planner
From interview to instrument: How to develop a PS survey
A satisfied patient will recommend your facility
Managers at a mid-sized southwestern community hospital decided they were dissatisfied with the patient satisfaction survey they were using. The survey didn't give the information necessary to improve services. So, a core team set about developing a new survey.
The team — the nursing administrator, the head of the quality management department, and the head of nutrition services — first wanted to find out what patients liked and disliked about the institution. The team knew that, from any patient's perspective, quality is doing the right things right. The team ran a set of interviews to find out:
• Is there a difference between quality and customer satisfaction?
• What do patients consider to be the "right things" in hospital care?
• How do patients' quality judgments affect their overall satisfaction?
The team was determined to learn from recent inpatients their impressions of their hospital stay. Were patients satisfied enough to be willing to utilize the provider's services in the future, and to recommend its services to family and friends? The interviews, they hoped, would provide information on what patients remembered about their stay, both good and bad. The data would be used to construct a new survey instrument to be administered to patients within 72 hours of discharge.
Four interviewers — all management-level hospital employees — participated in data collection. They conducted 21 interviews, and 93 critical incidents emerged in the following five dimensions of service quality:
• accommodations;
• quality of physician;
• quality of staff care;
• food;
• discharge process.
The critical incidents that emerged from the interview process contradicted any notion that patients are naive, such as the following comments:
• My doctor decided on the type of anesthesia to be used without informing me.
• How can the physician wait until the last minute to decide the treatment plan?
• When my pain recurred, I was unable to contact my doctor.
• When I went to the bathroom, they didn't measure my urine. I had to ask them each time to bring the container.
• My husband was going through alcohol withdrawal — he should have been watched.
Those incidents suggest that, in many instances, patients are capable of evaluating some aspects of the quality of their care. The incidents also challenge the concept that patient satisfaction is less a function of the doctor's competence than of the peripheral service, such as ease of the admissions process and the food service. Of 82 valid critical incidents reported, 11 referred to core processes. The team concluded that while good core service might not increase the likelihood of a positive evaluation, poor core service would increase the likelihood of a negative evaluation.
Many meetings were called for
Development of the survey items involved an average of three meetings per item, with each meeting lasting approximately two hours. The resulting instrument contained 50 items on a five-point Likert scale and three open-ended questions. (See survey excerpt, p. 44.)
The preliminary survey was pilot-tested on 100 discharged patients, and each test was accompanied by a cover letter. Follow-up mailings were done at one, three, and seven weeks after the initial mailing. The three- and seven-week follow-up mailings were made up of another survey and another cover letter. No bulk processing was allowed, such as the use of computer-generated letters or mailing labels. A $1 incentive was included with half the mailings. Of the 100 surveys mailed, 92 were delivered and 45 were returned.
The resulting tested survey, titled "How Did We Do?" is reliable, valid, and has a significant impact on intent to return. The service process managers report the results have been useful to them in planning process improvements.
Source: Thomas Pyzdek, MS, FASQ, a quality consultant with Pyzdek Management in Tucson, AZ. Pyzdek is the author of The End of Management (Tucson, AZ: Quality Publishing; 1998). Tele phone: (800) 628-0432. Web site: http://personal.riverusers.com/~pyzdek. E-mail: [email protected].
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