Do you know what a recent national poll found to be a ‘very believable’ source for information about quality health care? Family and friends ranked number one, followed by patient satisfaction surveys and individual doctors, respectively. Have you considered how much power a properly administered survey can wield in your own practice?
The ability to see ourselves as others do is a task not easily accomplished. But, if you could unearth out of your practice management tool box one tool that could serve as your personal looking glassyou’d want it, wouldn’t you? Well, don’t dig for it because you may already have it! I am referring to patient satisfaction surveys!
Most of us have heard of them, and many have probably used them to one extent or another, and perhaps a managed care organization (MCO) that you belong to has performed them on your practice. But, I don’t think anyone stops to consider how important such surveys are and how much “power” they can give us. We should for if we have the ability to objectively look at a faithful representation of our practice and a constructive look at our care, then we have the power to provide our patients with the highest quality care possible.
The goal of a patient survey is to assess the extent to which patients are content with the quality of a provider’s care. The goal of managed health care is to approach the highest quality and value for every dollar spent on such care. These two are thus merged and measured in the patient satisfaction survey. However, unless the surveys are designed and administered properly, the results can be skewed. To avoid such skewing, there are many details that must be taken into consideration, especially if you are designing your own. First, let’s examine why the feedback from a patient survey can be so valuable.
A recent AHCPR release1 regarding a national poll sponsored by AHCPR and the Kaiser Family Foundation noted that, “When selecting a physician, those surveyed said they are more concerned with how well a doctor communicates with patients, if he or she shows a caring attitude (94%), and whether the doctor is board certified (71%).” Further on the release states, “…patient satisfaction surveys were valued as quality sources of information for those polled. When asked to name a ‘very believable’ source about quality of care, family and friends were considered the most believable (50%), followed by patient surveys (34%) and individual doctors (29%).” Clearly, patients have strong opinions on what they feel are quality indicators of their care, regardless of what we may feel those indicators should be.
A properly designed and administered survey has the potential for providing invaluable information. However, the key words “properly designed and administered” are far more important than most realize. A poorly designed survey (or one that does not ask the ‘right’ questions) will equate to worthless results. (garbage in = garbage out!) Similarly, if the surveys are not distributed within a reasonable time frame (once per year vs. quarterly or more), the outcome will not be a representative overview.
Realistically, how many of us have really taken the time to look at our own practice from entrance to exit? While patient care admittedly is more than wallpaper and a pleasant voice on the phone, these can be subtle cues to a patient on the overall “quality” of your practice. Let me go into more detail and I think you’ll see what I’m getting at.
If you are planning to design your own survey, there are many details that you must take into consideration. First, you want it to be relatively short, yet concise. A one-sided page of questions is ideal. Given that, the questions asked have to be to the point and clear. Far and away one of the most critical elements is to equally weigh questions on the front office and other business aspects with those related directly to the patient encounter. The importance of a well-designed survey relies on separating the doctor-patient relationship from other potential annoyances such as billing, scheduling, and waiting time. Jerry Siebert, of Parkside Associates in Itasca, Illinois, is quoted in Medical Economics2 as saying, “Unsophisticated surveys overemphasize front-office factors, which affects physician ratings. As a result, they don’t give a ‘clean’ measure of the doctor-patient relationship. That’s a serious problem, particularly if the survey results are going to affect the doctor’s bonus.” As often happens, if the survey is being given by an MCO, the results can be tied to potential financial rewards, and a flawed survey could deny you that which you should receive!
So how do you design such an information tool? In essence, you want to see your practice from the patient’s point of view, as if you were entering your own practice for the first time. Therefore, the questions must be carefully worded to specifically gather this type of information. The example in Figure One is an excellent place to start. First, observe that this particular survey is divided into what happens to the patient before and during the office visit and visibly separates the questions. Note that the questions are clear and concise. Also note that the second half is devoted to the patient’s perception of the overall caliber of the encounter itself. This graphically examines what happened to the patient during the visit.
But don’t be shocked if the answers you get back surprise you. It’s not easy for any of us to peer into that “looking glass” and such a survey may give you frank, honest information. The true test is what we do with this information.
Personally, I have difficulty in accepting that there is a difference in the quality of care a chiropractor provides during a 10 versus 20 minute encounter. As Siebert says, “More important than how much time a doctor spends with patients is what occurs during that time. An effective doctor can establish good contact and communication with a patient in only a few minutes.” Admittedly, the more serious or complex the condition, the more time involved in resolving it, but that is not the issue here.
Also critical is the frequency with which the surveys are dispensed. Surveys given more frequently will result in patients from all risk categories being observed, instead of a one-time “snapshot” approach. Bette Waddington, A Medical Group Management Association consultant, also quoted in Medical Economics remarks, “If you really want to improve the quality of care, surveys should be done quarterly or even more often. Ideally, you should survey patients every day for a couple of months, then analyze the results and discuss them with the physicians to give them a chance to change their behavior. Then you should do the surveys again a few months later to measure any changes.”
Ms. Waddington stresses that the entire process can be a wasted opportunity if the results are not analyzed and acted upon. And this is an important issue both for you and for any MCO that might survey your practice. If you do not use the results gleaned from the surveys, why do them? This is a perfect opportunity to grade the “hills and valleys” of your practice’s performance.
If the MCO does not take the opportunity to present the data to you, especially in comparison to your peers, then they, too, have missed an opportunity to “stay on top of your game.” Further, if they don’t offer to communicate with you on ways you can improve, they are either not using the results to their full advantage or they may not care.
In the AHCPR funded Ambulatory Care Medical Audit Demonstration (ACMAD) Project,1 the impact quality improvement intercessions had on primary medical care was investigated. The factors affecting performance and steps that could be taken to not only improve such performance, but the quality of care as well, were analyzed. The analysis showed that care improved in five of eight patient-care guidelines after feedback was provided on the performance and corrective actions were taken by the involved physicians. Essentially, this article stated that providers don’t have an aversion to being told when they need to perform better, as long as they are told how.
Realize that both the design and the administration of a survey by an MCO is totally out of your control. Some MCO’s hire outside firms to administer the surveys and others do them “in-house.” Unless you garnered this information before you signed your contract, you won’t know what their strategies are regarding the surveys. Remember that flawed layout and distribution will only provide flawed facts.
Don’t shun patient satisfaction surveys. Realize that they can perform an invaluable function for you, at limited cost and effort. When assessing care, the definition of “quality” can become mired. However, use of patient satisfaction surveys can often allow a practitioner to measure how his or her patients are responding to the practice and to the care they provide, yielding a personalized definition of quality.
Jill Bjerke, B.S., D.C., is President of Health Care Choices, Inc., an Iowa corporation that provides primary source credential verification and on-site review services. She also directs a managed care consulting firm. A 1991 Palmer graduate, Dr. Bjerke is a Continuing Education faculty member of Palmer College and is a former member of the Board of Directors of the Iowa Chiropractic Society. She serves on Chiropractic Economics’ Editorial Advisory Board and is a regular contributor for the publication. Please contact Dr. Bjerke at 319-323-5580 or firstname.lastname@example.org.
1. Research Activities, Agency for Health Care Policy and Research, No. 199, December 1996.
2. Medical Economics, Vol. 73, No. 23, December 9, 1996.