New satisfaction survey offers lessons to hospital
Response rate for patient surveys almost 100%
Perhaps you think that patient satisfaction data are the lightweights among your benchmarking data. Not so, according to a Chicago-area behavioral health hospital. The information that can be gleaned from patient perceptions is so important at Alexian Brothers Behavioral Health Hospital that last year the facility opted to change its surveys. The result has been a nearly 100% return of both in- and outpatient surveys. And more than just being a good way to gauge customer satisfaction, chief operating officer Francine McGouey thinks surveys offer her facility an opportunity to improve patient care and thus improve outcomes.
Until last year, the facility used an internal survey instrument developed by its staff psychiatrists and social workers. "We liked it because it was customized to our needs and could probe patients about their perceptions of our services," says McGouey. But it didn’t allow the facility to benchmark against other hospitals. "We had looked at an external survey several years ago, but we couldn’t find one that satisfied our needs as a psychiatric facility."
Hospital administrators looked at three different instruments, considering issues of cost and service as well as the issues investigated by the survey. They opted for one developed by Parkside Associates of Chicago, in part because its survey most closely mirrored what Alexian Brothers had already been asking, and in part because it offered training and quick responses to questions.
Finding something specific to psychiatric facilities was important, says McGouey, in part because patients often come in with a different mindset than patients going to a standard medical hospital. "They may not be coming to you voluntarily, and the circumstances may be very trying," she says. "The questions you have to ask must be geared specifically to their experience here, not to their general satisfaction with their health care."
Patrick McDowell, research consultant at Parkside Associates, admits that there is a tougher methodology in creating surveys that work for behavioral health. "Usually, we work with a mail-back methodology. But there are legal issues about that with psychiatric patients. So we have to have a method of handing the surveys out. That makes staff buy-in even more important."
Responses soar with new survey
Staff like the new survey, and that could be part of the reason for its success. The national average of inpatient satisfaction response rates is about 50%, and outpatient response rates normally are about 58%. The new survey has exceeded those averages. Currently, Lois Nicol, case manager and team leader for customer satisfaction, says 100% of outpatient surveys are being returned, and inpatient responses are in the high 90s.
McDowell says one sure element of the new survey’s success is the effort the hospital put into rolling it out to staff. "[Alexian Brothers] piloted it first to make sure that it was working correctly and made sure that [the survey] did what it [was supposed] to do," he says.
Simple things also helped, such as assuring patients don’t have to hand the survey back to a person, but can drop it off in a box that is conveniently placed and well-labeled.
Alexian’s staff understand the survey process is an important part of discharge, says McDowell. "It is a top-down initiative, and they understand it requires more than handing something to the patient and saying, fill this out if you want.’ Instead, they let the patient know that they are interested in providing the best service and would greatly appreciate any feedback the patient can give."
"We did a lot of preparation for this," McGouey explains. "One of our primary goals was to have a good response rate, and all of the units brainstormed on ways to make it happen. We have to arrange circumstances so patients have an opportunity to participate and ensure that their confidentiality is being protected. We have to assure them that we are doing this so we can improve services for future patients."
Nicol says another reason for the good response is that the same system for dissemination and collection is used throughout the hospital. Staff are trained and given scripts to help them know what to say. "That has been very helpful."
Staff also are motivated because each unit has chosen two or three questions for monthly feedback, Nicol says. Before the surveys are sent to Parkside, where results are tabulated quarterly, units have their specific questions tabulated. Those are presented monthly and discussed at unit meetings.
For example, on the geropsychiatric unit, delivering compassionate care at the last stages of life is important, says McGouey. So that unit tracks responses to questions about whether staff have explained treatment in a way that the patient can understand. On the adolescent unit, administrators track responses to questions about how available staff react when the patients want to talk. "It is important for [patients in] that age group to feel that we have time for them and listen to their responses," McGouey says.
There is a benefit to being able to compare satisfaction data at Alexian to other facilities that serve this field, says McGouey. "You always think you have a great program, but this allows you to verify that," she says. In addition, it allows the facility to verify that it is fulfilling its mission and adhering to the values of respect that are at the core of the religious order with which the hospital is affiliated. "The survey helps us to ascertain if we are respectful of our patients, if they are participating in their treatment, and if they understand it. Listening to them, being accessible — those are all elements of respect."
In addition, in behavioral health as in perhaps no other kind of health care, having patient buy-in with treatment plans and satisfaction with them is key to positive outcomes. "We have had a chemical dependency outpatient program for more than 25 years," McGouey says. "If our satisfaction rates are low, we know we have to change something because if they aren’t satisfied, treatment is more likely to fail."
Compliance in any treatment regimen is important, she continues. In a med/surg ward, patients who don’t finish their antibiotics or who don’t learn how to care for incisions may end up back in the hospital after discharge. "If you don’t get buy-in, you are less likely to succeed in treatment. If you ask the right questions, patient satisfaction can indicate if patients have enough confidence in the care you provide to follow through with their treatment."
That is a lesson that any facility can take from the Alexian experience with patient satisfaction surveys. Nicol says that the increasing amount of research showing the link between spiritual, mental, and physical health makes it important to ensure patients are happy with their care. "The more they feel their caregivers are providing the best care, the more likely they are to follow through with treatment, and the more likely you are to have good outcomes."
[For more information, contact: Patrick McDowell, Research Consultant, Parkside Associates, Chicago. Telephone: (847) 384-2682. Lois Nicol, LCPC, NCC, Team Leader for Customer Satisfaction and Case Manager, and Francine McGouey, COO, Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL. Telephone: (847) 755-8007.]
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