Tips and Pointers

Tip One

An effective patient satisfaction program supports the provider in reaching for strategic success in the five critical outcomes important for today's market - 1) patient satisfaction that drives for patient loyalty, 2) patient retention; 3) patient profitability; 4) new patient acquisition; and 5) market domination. If managed properly, it is linked to the many provider systems that share common quality and service-oriented goals that feed these outcomes. When managed properly, patient satisfaction helps in creating a common thread for success across an organization.

Tip Two

Over the years, many providers have fallen victim to the data trap. Too often, the abundance of information only tends to overwhelm people and distract attention away from the smaller subset that actually has potential for value-adding benefit. Ten well selected questions that lead to ten value-adding improvements that strengthen one or more of the five critical outcomes are actually more beneficial than one hundred questions that lead to nothing more than fostering status quo.

Tip Three

A good satisfaction tool should never overwhelm a patient. The goal is the quality of information in creating strategic knowledge - not quantity. An effective inpatient survey should generally contains no more than 25 questions while an outpatient survey contains no more than ten. The shorter the patient encounter, the shorter the tool. When providers focus on the volume of information rather than the quality, everyone generally loses. Remember that when patients become frustrated with the length of the process they tend to provide marginal information at best, if any at all.

Tip Four

Every question should have a purpose. The information solicited in a satisfaction survey generally works to: a. establish baseline data and knowledge about performance on which to base future measurement and action; b. identify those organizational characteristics and attributes that patients and community members view as strengths, weaknesses, threats and opportunities; c. monitor the impact of current quality and performance improvement initiatives to know that efforts are adding value; or d. monitor patient perception and satisfaction over time as variables in the patient/provider relationships continue to change.

Tip Five

Some of the best information about patient perception and what would help in creating stronger patient relationships is found in the narrative and verbal information that patients shares. Radio button-type questions that require a patient to rate an experience should be appropriately balanced with narrative-type questions. While radio button-type questions provide a general sense of patient perceptions, they frequently offer limited information that generates new knowledge or identifies value-adding opportunities for improvement from the patient's point of view. They frequently force providers to guess what can make a difference and often waste valuable resources in a game of trial and error.

Tip Six

Questions designed to evaluate the impact of change should remain in surveys long enough to monitor for sustainability. It takes the average person about six months to take a new behavior and hard wire it as a habit. Until new behavior is indoctrinated into day-to-day life as a habit, it is easy for people to revert back to old behaviors that undermine the goals for a stronger future. The length of time that questions remain in the satisfaction tool should be determined by the monitoring inside the quality program for habit conversion. Sustainability of an improvement is critical once the patients experience it. Reversion back to a lesser standard once a patient experiences something better generally promotes nothing more than new dissatisfaction.

Tip Seven

Patient satisfaction information can be collected through written feedback tools, in-person interviews, telephone interviews and electronic tools. While some questions work well in all three settings, there are many where the best feedback can be achieved by asking it in a particular way. For example, probing questions lend themselves best to interviews. Interviews work best in situations where the knowledge needed can best be acquired through a series of questions with each building on the answers of the previous question. If the question is a sensitive one where patient comfort is important to the quality of the information solicited, a provider might want to choose a face-to-face interview approach where body language can communicate commitment and sincerity. Pulse questions lend themselves to written tools and the measurement of general perceptions. Questions about post-discharge experiences, such as billing, are best managed through telephone interviews. Certain approaches work better for different patients. For example, patients in the 80-100 year old generation are generally more forthcoming with value-adding information during discussion-type interviews. Younger generations don't tend to like written tools that they view as busy-work or are too long in length. They do best with very direct and short tools.

Tip Eight

The greatest potential for value-adding information often comes from questions that a provider might find tough to ask. Over the last several decades, many characteristics found in traditional quality programs have prompted the development of a number of defensive behaviors. One of those defensive behaviors involves a tendency to select quality activities that make the present look the best it can rather than digging for the more value-adding information that may not look so good today but contains the real information about tomorrow's opportunities for improvement. Many patient satisfaction activities have fallen victim to this behavior. Rather than being powerful tools that dig for the truth and identify opportunities to improve the patient experience from the patient perspective, they ask soft questions to make everyone feel good about what currently exists. In the emerging environment, the only people to be fooled by this behavior will be the leaders who struggle to be a patient's preferred choice.

Tip Nine

Sample sizes generally need to be larger when the goal is patient loyalty. Sampling has always been a challenging question in health care. Quality programs have commonly worked with 10% sample sizes. While smaller sample sizes may work well in gaining a sense of comfort with what is, they may not do the trick when the goal is loyalty. The goal when striving for patient loyalty is to better understand those details in the patient/provider relationship that create a special place for the provider in the hearts and minds of its constituents. An effective patient satisfaction system strives to identify and understand those details that a significant percentage of patients value. Larger sample sizes tend to increase the potential for identifying those details.

Tip Ten

Consistency and reliability will be two critical pseudo-measures of the patient experience in the emerging market. Pseudo-measures are those aspects of the patient experience that patients can judge because they do not require special knowledge and expertise. As patients can rarely measure the actual clinical decisions a provider makes, they have come to rely on pseudo-measures to help them establish a sense of trust in their providers. If a provider seems to take the pseudo-measures seriously, patients have historically taken a leap in faith that providers put the same level of commitment into the clinical care. The three oldest pseudo-measures for health care are cleanliness of the building, friendliness of the staff and the quality of the food. Last decade, the perception of teamwork and the accuracy of the bill joined the list. In this new decade of value-based purchasing, consistency and reliability have joined the ranks.