How You Can Use Patient Satisfaction Surveys to Improve PerformanceMarch 19, 2014 by Jamie Smith
After conducting their 2013 benchmarking report, the Medical Group Management Association (MGMA) discovered that nearly 80 percent of the practices they identified as “better-performing” used patient satisfaction surveys. These high performers were more likely to survey their patients, and to do so more frequently compared to other practices.
Patient surveys don’t just improve performance and communication with patients—they may soon be mandatory. Over the past decade, health insurance companies and the government have increasingly relied on customer satisfaction measures to evaluate provider performance. Implementing patient surveys now can help practices prepare to meet future patient satisfaction requirements.
But using patient surveys effectively involves more than just asking your patients for feedback. We spoke to healthcare experts and successful practices to learn their tips, tricks and tactics for using patient surveys to improve performance.
Know How You Plan to Use the Results
Many practices survey patients without a clear idea of why they’re collecting feedback and how they plan to use the responses they collect. “It’s important to define what you’re going to do with the information,” says medical group operations consultant Elizabeth Woodcock. “Knowing how you’ll use the data also helps you determine what questions you’re going to ask.”
In order to craft the right questions, you’ll need to determine what topic area(s) you want to address with your survey. “General surveys are always a good first step,” says Nick Fabrizio, a principal consultant with MGMA.
“Meanwhile, other practices may know they have certain problem areas—e.g. access to providers scheduling appointments—so those groups might want to target one or two specific areas in a survey.”
For general surveys, Jean McLaughlin, the director of marketing with SullivanLuallin Group, says questions should be designed to gather patients’ feedback about every point of their interaction with the staff and physician.
For more focused surveys, Fabrizio recommends bringing the management team together to talk about which facets of patient satisfaction fit into the practice’s strategic goals or existing patient satisfaction improvement plans.
According to our experts, the most common topics covered in surveys are:
- Access to care;
- Quality of care;
- Coordination of care;
- Confidence in providers; and
- Appointment experience.
However, if a practice knows there are certain problem areas they’re simply unable (or unwilling) to change, such as available parking, then they should avoid asking for feedback on those aspects. “Unless you’re prepared to make those changes, don’t ask the patient questions and waste their time,” says Fabrizio. “I always tell practices to ask themselves, ‘If we get negative responses, are we prepared to make operational and workforce changes based on these survey results?’”
Regardless of the survey’s focus, our experts say there are two questions in particular that should be included to provide valuable feedback:
“Would you recommend our practice to a family member or friend?”
Woodcock says this question gets to a patient’s essential feelings of trust and satisfaction in the practice. “I’ve had practices tell me, ‘We got a 4.27 in satisfaction last month!’ Well, what does that really mean? A patient’s willingness to recommend the practice to others is a concrete way to measure their satisfaction,” she explains.
“What could we have done better?”
Concluding the survey with an open-ended question allows patients to provide feedback on topics you may not have considered. The answers can offer deeper insight into patient experience and their relationship with the practice.
Utilize the CG-CAHPS Survey
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey has become the industry standard for measuring patient satisfaction. Created by the Agency for Healthcare Research and Quality, this survey was developed with the help of experts across many healthcare fields and has been tested extensively with patient focus groups.
There are several different versions of the CAHPS survey for different types of medical providers. CG-CAHPS (Clinician and Group Consumer Assessment of Healthcare Providers and Systems) is the version used to measure patient perceptions of care delivered in an office setting.
“I always encourage physicians to begin the survey process by looking at CG-CAHPS,” Woodcock says. “It’s lengthy, but it’s available for free and has some really good elements.” Rather than reinventing the wheel, practices can use the CG-CAHPS survey in its entirety, customize it or use selected questions.
According to Press Ganey, a leading provider of tools for improving patient experience, five questions from CG-CAHPS are key determinants of patient satisfaction and loyalty:
- Confidence in Provider: “Rate your confidence in this care provider.”
- Coordination of Care: “Rate how well the staff worked together to care for you.”
- Concern for Worries: “How much concern did the care provider show for your questions or worries?”
- Listening: “During your most recent visit, did this provider listen carefully to you?”
- Courtesy: “Rate the friendliness/courtesy of the care provider.”
These five questions are a great place to start when developing your own patient satisfaction survey.
Another reason to become familiar with CG-CAHPS is that it’s likely to become mandatory in the next few years. Hospitals are already required to use a version of CAHPS, and Woodcock says experts believe a similar mandate is coming soon for private practices.
Use Multiple Methods to Distribute Your Survey
How do you get your survey into the hands of your patients? Should you distribute using paper or digital means? According to our experts, the answer is both. “I recommend reaching out on multiple fronts,” says Owen Dahl, a consultant who focuses on medical practice management. “If you give patients a paper form at the time of the visit, reach out to them via direct mail and email as well.”
McLaughlin adds that paper surveys have higher response rates than web-based email surveys, but are more costly to administer. Finding the most effective survey method for your practice may take some experimentation, since it can be affected by a multitude of factors, e.g. the age of your patients, their Internet access and personal communication preference.
For example, Mona Reimers, the director of revenue at Ortho NorthEast in Ft. Wayne, IN, found that their practice’s geriatric patients respond more positively and at higher rates than other patients surveyed. To increase response rates among other age groups, OrthoNorthEast plans to test out other survey methods.
One option to explore is having a survey available for patients at check out using an iPad or similar digital device. According to Woodcock, this gives practices real-time business intelligence they can use right away. “You don’t have to wait for someone to put a stamp on it and mail it back,” she explains.
Fabrizio and McLaughlin confirm that in-office surveys, whether digital or paper, have the highest response rates.
Keep Surveys Short and Simple
Fabrizio recommends practices keep their surveys to ten questions or less and use a 75/25 ratio: 75 percent should be scale/rating questions, 25 percent open-ended questions.
When it comes to paper surveys, McLaughlin says the number of pages has a greater effect on completion rates than the number of questions. In her experience, most patients will complete a two-sided, one-page survey in a point-of-service setting. For a traditionally mailed survey, two-page surveys yield the highest response rate.
If you’re asking patients to rate service, keep the scale simple and clear. Sheila Grady, a marketing manager with popular online survey tool SurveyMonkey, says that a five-point rating scale typically gives patients a wide enough range to express their opinion while still being easily understood.
Grady adds that endpoints should be clearly and specifically labeled to avoid confusion. For example, if the question is about approachability, good labels for the high and low ends of the scale are “extremely approachable” and “not at all approachable,” respectively.
Specificity is also key to ensure useful data. For example, when asking about “wait times,” it’s crucial to clarify whether you’re referring to the waiting room or the exam room.
After developing a draft of your survey, Grady suggests reviewing it to make sure it doesn’t include any unclear language or leading questions that might confuse patients or lead to biased answers. As a final step, send the survey to colleagues and friends outside the practice to get their feedback on clarity and length before sending it to patients.
Set Response Rate Goals
The main reason for using multiple methods of delivery is that survey response rates are typically very low. The experts we spoke to said practices should strive to reach a 10-20 percent response rate across all distribution methods so the results will be statistically significant.
“I wouldn’t advise practices to make changes without an adequate response rate,” Fabrizio says. “Some changes, like adjusting your workforce or changing provider hours, are so significant that you have to make sure you get it right.”
For practices that see a smaller number of patients, the threshold for action may be lower than for larger practices. Debbie Downey manages the sleep lab at the Texas Neurology Center in Austin, TX, which sees around 60 patients per quarter.
When her staff receives three comments on the same issue in a single quarter, it raises a red flag and they begin looking into remediation. While three patients isn’t a huge number on its own, it is a significant percentage relative to the number of patients they see and who complete surveys.
While achieving a healthy response rate is important, Fabrizio adds that individual patients should be surveyed no more than once or twice a year to avoid bombarding them with requests for feedback. Reimers agrees. “Everyone from Kohl’s and Applebee’s to their credit card company are asking them to take a survey,” she says. “People are fatigued.”
Prioritize Improvements That Impact Patient Experience
Both Woodcock and Dahl recommend that reviewing survey results should become a standing part of practice management meetings and should happen at least once a quarter; ideally once a month.
It’s also critical to identify the staff members who will review the results and the process for acting on feedback. Dahl suggests that someone who isn’t the lead doctor or administrator review the results, because they’re likely to be more objective. “The goal is to select someone who would be receptive to the feedback and able to look at the practice critically,” he explains.
McLaughlin adds that staff involvement at all levels helps make improvements more effective. “Gathering the staff’s input to create action plans ensures that everyone is on board, cooperative and engaged for ongoing improvement,” she says.
To make changes most effectively, practices should focus on improving a few areas at a time, starting with the issues that have the greatest impact on the patient experience. Kenneth Hertz, a principal consultant with MGMA, says that patient access is one of the most critical issues to address in this area.
“Some patients are very loyal, but many patients probably think your practice is just okay and will go elsewhere if they face problems getting access,” he explains. Impactful changes that can be made quickly and easily and that will make a visible difference should be enacted immediately. However, some issues will need more time to address.
“For example, if you’re hearing from patients that the phone line is always busy, it’s going to require some investigation to figure out how to best handle that,” Hertz says.
“You’ll need to conduct a study to determine how many calls you get, what your peak call times are and how long the average hold time is before you decide whether you need more staff or another phone line or something else.”
To this end, Hertz recommends that practices separate their action items into short, mid and and long-term projects. These projects should be worked on simultaneously so patients see immediate improvement while more complex issues are being addressed.
Communicate Your Progress to Patients
All of our experts strongly recommend communicating with patients about how the practice has acted on the information from its surveys. “You can do more harm than good by asking someone about the problem and then having it still exist the next time they come back,” says Cindy Nyberg, chief financial officer with Raleigh Neurology Associates.
Woodcock recommends practices have a sign in their office or a page on their site that says, “You talked, and we listened.” This sign should detail the feedback you received and what you’ve done to address it. “It makes people feel listened to and appreciated, and that results in more feedback,” she says.
Hertz suggests practices also post updates on social media, provide literature in the waiting or exam room, and even update their hold messages with announcements about improvements.
Most importantly, our experts say, surveys should be part of an ongoing effort to improve patient satisfaction, which means practices must measure the success of improvements.
“Surveying only once or rarely is not going to supply a practice with the appropriate levels of information needed in order to benchmark, track changes, and monitor improvement,” McLaughlin says. “It’s important to survey on a regular basis, follow up and take action to monitor and measure a patient satisfaction action plan.”