Same-day surgery has ew benchmarking option
Patient survey offers national comparisons
Looking for a good program against which to benchmark your same-day surgery (SDS) department? SDS managers now have the opportunity to benchmark with a prestigious national academic database, University HealthSystem Consortium (UHC) in Oak Brook, IL, a group of more than 70 academic and teaching hospitals, using a patient-centered care survey that identifies how well key patient needs are met.
The Picker Institute in Boston has developed a questionnaire that uses highly specific questions to target seven areas 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.
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 five, 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."
A new benchmarking resource
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 a problem existed. 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 probably were caused by time constraints. "There’s so much to do in so little time. But from a patient’s perspective, it’s very important."
Patients can rate overall care
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 a 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.
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."
Improving communications
When the score for patient education dropped by four points from 89 to 85, SDS managers focused on improving informational 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 now have set a higher goal of scoring at least 82 out of 100, Anton says.
A quality challenge
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.
[Editor’s note: For more information, contact: Joanne Leamey, client services associate, The Picker Institute, 1295 Boylston St., Suite 100, Boston, MA 02215. Telephone: (617) 667-2388. Fax: (617) 667-8488. E-mail: [email protected].; and Richard Anton, MHA, director, Market Research, Vanderbilt Health Services, 1801 West End Ave., Suite 1700, ashville, TN 37203. Telephone: (615) 936-3477. Fax: (615) 320-3175. E-mail: [email protected].]
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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