Benefits of Surveys
As the healthcare market becomes more consumer driven, practices that show they care about patient satisfaction will have a competitive advantage, experts say.
“Anyone who ignores patient-satisfaction surveys, I think, is not going to have a thriving practice for long,” says Eric S. Schned, MD, a clinical rheumatologist with Park Nicollet Clinic in Minneapolis.
If your rheumatology practice is not using patient-satisfaction surveys, consider the evidence supporting their use.
High ratings on patient-satisfaction surveys have been linked to benefits for medical practices ranging from reduced patient turnover to lower malpractice risk.1-2 More recently, a survey conducted by the Medical Group Management Association (MGMA) in Englewood, Colo., shows that formally evaluating patients’ experiences may relate to higher revenues. More than 60% of 549 “better-performing” medical practices use patient-satisfaction surveys to assess and improve operations, the 2011 MGMA survey finds.3
Many private healthcare organizations already are using patient-satisfaction scores for physician compensation such as bonuses. If you accept Medicare patients, evaluating your patients’ experiences may even become a requirement. Experts anticipate that the Centers for Medicare and Medicaid Services will tie measurement of patient experience to a pay formula for physicians within the next few years.4
Furthermore, the American Board of Internal Medicine (ABIM) is considering when to add a patient-survey requirement to its maintenance of certification (MOC) program, as it is a requirement of the American Board of Medical Specialties, says ABIM spokeswoman Lorie B. Slass. However, she notes that patient surveys are already a part of some of the ABIM’s Practice Improvement Modules for MOC.
Aside from possible future requirements, patient-satisfaction surveys give practitioners valuable information about the patient’s overall experience, including nontechnical dimensions of care.
It used to be that surveys were a pretty laborious effort, but the surveying process has gotten a lot easier.
—Elizabeth Woodcock, MBA
“Achieving a clinical benchmark, such as giving a DMARD [disease-modifying antirheumatic drug] to a patient with rheumatoid arthritis, doesn’t necessarily translate into a pleasant experience for the patient,” says Raymond S. Hong, MD, MBA, a rheumatologist with Kaiser Permanente Ohio Region in Parma, Ohio, and an ACR CORC member.
Because a patient-satisfaction questionnaire implies that the medical practice is interested in doing things better, patients will assume change will follow. Thus, before undertaking a patient satisfaction survey, you need to be motivated to change, says Kenneth T. Hertz, an Alexandria, La.-based principal with MGMA Health Care Consulting Group.
Do It Yourself?
A major decision in launching a patient-satisfaction survey is whether your practice will create and disseminate the survey or hire a consultant or company to handle it.
Advantages of an outside agency are experience, time savings for the medical practice, and guaranteed anonymity for respondents. In addition, many survey vendors provide clients with reports that track results over time and that benchmark their satisfaction scores against other providers.
“Unless your budget is constrained, I think it’s better to use an outside vendor that is experienced in doing surveys,” Dr. King says.
On the other hand, rheumatology practices considering developing their own patient survey should not be intimidated, says Elizabeth Woodcock, MBA, a healthcare consultant and trainer with Woodcock & Associates in Atlanta.
“It used to be that surveys were a pretty laborious effort, but the surveying process has gotten a lot easier,” says Woodcock, who also is the author of the book Front Office Success—How to Satisfy Patients and Boost the Bottom Line (MGMA, 2010).
Electronic surveys, she says, offer an easier option than mail-based surveys. Also, free survey templates are available online.
Distribution Decisions
Woodcock believes it is best to integrate measurement of patient satisfaction into the workflow. A stand-alone computer in the front office, or even a portable media device such as a tablet computer or iPad, can serve as the survey delivery system. Woodcock suggests stationing the device at the checkout point, with the touchscreen facing the patient.
Another option is a drop box located in the checkout area for completed print surveys. Surveys can be handed out after the physician visit to every patient or to a random number, such as every third patient.
E-mail is a popular choice for survey distribution because of its low cost and rapid feedback. Web-based survey tools such as SurveyMonkey allow free or inexpensive e-mail surveys, with costs depending on the number of questions, responses, and other features.
Some survey leaders still use postal surveys, because they believe they give the patient time to formulate an impression of the visit and they encourage greater honesty when done outside the office visit, Woodcock says.
The response rate, however, tends to be lower for mail-based surveys than in-office surveys. Although survey response rates vary widely depending on many factors, one estimate is approximately 75% for in-office surveys vs. 30% for mailed surveys (or 45% with a reminder).5 Dr. King says the response rates for mail surveys from his health system’s vendor range from 5% to 80% depending on the provider being rated.
To increase survey response rates, he recommends telling all new patients at their first visit to fill out the satisfaction survey if they get one.
“The most important thing is to create buy-in among patients and staff by demonstrating that patient satisfaction is very important,” Dr. King says. “We tell them we’re very interested in change and making our practice as good as possible.”
The most important thing is to create buy-in among patients and staff by demonstrating that patient satisfaction is very important. We tell them we’re very interested in change and making our practice as good as possible.
—Charles M. King II, MD
Questions to Ask
Before you develop a survey, Dr. Hong recommends that you define your goal. Is it to confirm that you are providing good service or to improve service? Decide if the survey will assess the most recent visit or care over time. Also, get staff input in creating the survey.
“Patient satisfaction depends on a whole-practice approach,” Hertz says. “Engage the staff by talking with them before you send the survey.”
He recommends not only getting staff suggestions of questions to ask patients but also telling staff members what elements you plan to measure on the survey. “You will see change instantaneously because they want good feedback,” Hertz says.
Patient-satisfaction surveys typically address these areas:
- Convenience or access to care (such as how quickly the phone was answered, ease of getting an appointment, and waiting time at the office);
- Friendliness and helpfulness of staff; and
- The physician interaction (took adequate time with the patient, explained information clearly, and answered questions thoroughly).
An overall assessment should complete the survey. Woodcock recommends including “How satisfied were you with your visit?” and ending with “How likely are you to refer a friend or relative to us?”
To make the survey easier for patients, many experts advise using a consistent rating scale. A five-point scale is common, such as “poor, fair, good, very good, or excellent” or from “strongly agree” to “strongly disagree.”
At the end, provide blank space for the patient’s comments about the visit or suggestions for improvement, Dr. Hong suggests.
If you use a survey vendor, ask if you can customize the survey. That will allow you to ask questions specific to your practice.
As for survey length, Dr. Schned says the questionnaire should obtain enough information to be meaningful but not so long as to discourage the patient from responding. Mail surveys typically are one or two pages, but Woodcock says in-office surveys should be brief—no more than five questions.
Some experts recommend test marketing the survey with a small number of patients before using it on a larger scale. An improperly worded question, such as one that asks about two different measures, may result in unusable answers, according to Hertz.
What To Do With the Results
For an in-office survey, Woodcock suggests reviewing response data twice a month. Dr. Schned says the number of responses should be large to ensure validity and may require a longer survey period. He appreciates receiving a departmental quarterly report from their survey vendor showing a number of patients surveyed that he considers substantial—around 100 for six rheumatologists in a three-month period.
Achieving a clinical benchmark, such as giving a DMARD to a patient with rheumatoid arthritis, doesn’t necessarily translate into a pleasant experience for the patient.
—Raymond S. Hong, MD, MBA
Dr. Schned says the rheumatology department at Park Nicollet Clinic has implemented changes based on responses to one survey question. For example, results that showed lower satisfaction scores with the time it took staff to answer the telephone led the rheumatologists to take action. The department added another nurse to answer phones, as well as an automated system that told patients how long the estimated wait time was. Subsequent surveys found improved satisfaction scores on that point, he says.
Dr. King agrees that some specific survey questions can drive the provider to make changes, but adds, “The overall score is more important than an individual question.”
Both Dr. King and Dr. Hong post results of their patient satisfaction surveys for their staff to see. “It rewards success or points to the need to improve,” Dr. King says.
Patient-satisfaction surveys are not just about the need for change. According to Dr. Schned, “When you get positive feedback from patients, it gives you confidence that your style and philosophy are what patients want.”
Satisfaction vs. Quality
A recent study calls into question whether an overemphasis on patient satisfaction could have unintended adverse effects. Published in the Archives of Internal Medicine, the study found that higher patient satisfaction on surveys was associated with greater inpatient use, higher overall healthcare and prescription drug expenditures, and increased mortality, compared with patients reporting low satisfaction.6
These results show that patient satisfaction may not equate to quality, Dr. King says. “Patient-satisfaction surveys are important in understanding how our patients view the process of receiving healthcare, but should not be used as surrogate marker for quality healthcare,” he concludes.
Kathleen Louden is a medical writer based in the Chicago area.
References
- Rubin HR, Gandek B, Rogers WH, et al. Patients’ ratings of outpatient visits in different practice settings: Results from the Medical Outcomes Study. JAMA. 1993;270:835-840.
- Fullam F, Garman AN, Johnson TJ, Hedberg EC. The use of patient satisfaction surveys and alternative coding procedures to predict malpractice risk. Med Care. 2009;47:553-559.
- MGMA survey: Better-performing medical practices focus on cost management, productivity, and patient satisfaction [press release]. January 24, 2012. www.mgma.com/press/2011-MGMA-better-performing-practices-survey. Accessed March 5, 2012.
- Berry E. Sharpening your survey skills: How practices can measure patient satisfaction. American Medical News. April 18, 2011. www.ama-assn.org/amednews/2011/04/18/bisa0418.htm. Accessed March 9, 2012.
- Walpert B. Patient satisfaction surveys: How to do them right. ACP Internist. April 2000. www.acpinternist.org/archives/2000/04/surveys.htm.
- Fenton JJ, Jerant AF, Bertakis KD, Franks P. The cost of satisfaction: A national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med. 2012;172:405-411.
