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The Problem[s] With Patient Satisfaction Surveys

Measuring patient satisfaction and quality of care has become a much talked about topic lately. Due to changes in federal law, Medicare reimbursements paid to hospitals are now tied to patient satisfaction scores. These new laws give hospitals even more incentive to improve patient satisfaction and experience – which, in theory, is a good thing. Doctors (and hospitals) should be subject to feedback and held accountable for their work. There are, however, problems with patient satisfaction surveys.

Dr. Christopher Johnson writes in a recent article that patient satisfaction surveys – as currently used – are “riddled with problems.” Dr. Johnson goes on to say, “they [surveys] don’t measure what they are suppose to measure and they can easily drive physician behavior the wrong way.” Dr. Johnson refers to his survey tools as made and facilitated by Press Ganey. Press Ganey is a massive corporation that provides hospitals and health systems full service patient experience solutions, in which Press Ganey writes, distributes, and collects the surveys and data. As such, hospitals using Press Ganey’s services essentially outsource all of their patient satisfaction and survey measurement. Dr. Johnson writes, “I’ve read the Press Ganey forms and the questions they ask are all very reasonable.” This quote raises a red flag that perhaps Dr. Johnson misses: Dr. Johnson is not, nor is anyone at his organization, writing the questions on their patient satisfaction surveys. It makes the most sense for those who are trying to benefit from collecting their own patients’ data to write their own surveys. Those closest to the patients and those working in the hospital are better suited to understand the different context and circumstances surrounding the measurement of patient satisfaction. Instead of a Press Ganey employee 800 miles away writing survey questions and processing the data; the doctors, nurses, and administrators should be more involved in the process of measuring quality of care. There is no such thing as a one-size-fits-all survey.

Dr. Johnson also speaks of the poor sample sizes used to collect the data; “[a]lthough the forms are sent out to a random sample of patients, a very non-random distribution of them are returned. Perhaps only the patients who are happy, or those who are unhappy, send them back.” This very well could be true, but it is most likely an easy fix. Again, each hospital knows (or should know) the best way to collect data from their patients. Generally, for most hospitals, the best way is with in-person paper surveys. Surveying the patient while still on site raises response rates and ensures that the sample size is more random than the one Dr. Johnson describes. Along with higher response rates, a patient’s memory of her experience is fresher when surveyed on-site and therefore the data is more accurate.

Dr. Johnson is correct in saying that patient satisfaction surveys “as currently used are riddled with problems,” but there are solutions to these problems. Understanding the quality of care provided by a doctor or a hospital or a nurse is too important to ignore or be discouraged by those obstacles. The healthcare world has been talking about measuring patient satisfaction for decades yet still have a long way to go. Getting rid of patient satisfaction surveys is not the solution. Acknowledging constructive criticism about the process and fostering open debate about improving patient satisfaction is the solution.

Is Patient Satisfaction Overrated?

A recent article on Forbes.com asked an interesting question: is patient satisfaction overrated? The question is an important one and warrants more discussion. The article (found here) uses Dr. House, the rude but extremely effective fictional doctor from the Fox television series “House,” to analogize that perhaps patient satisfaction doesn’t always equal quality health care. The author – Steven Salzberg – attempts to make the point that while Dr. House is abrasive and his patients do not have the best experience, they do receive the best care. Salzberg writes that even though large scale reforms in healthcare are pushing the importance of patient satisfaction, better patient satisfaction scores are not necessarily correlated with better care. Essentially, instead of giving patients what they want, doctors should give them what they need. Salzberg doesn’t just use the “House” analogy; he cites a study that shows higher patient satisfaction rates being tied to higher costs and higher death rates.

AutoData agrees with some of the author’s points and disagrees with others. AutoData couldn’t agree more with the premise that doctors must give their patients what they need as opposed to simply what they want. And we are not disputing the study Salzberg cites (though we’re unsure of the context and specifics of the study). However, Salzberg asserts that measuring patient satisfaction in general is the overall problem; AutoData believes the problem is in how patient satisfaction is measured.

“For patients who think a nice doctor is a good doctor, this might come as very disappointing news,” writes Salzberg. If surveys are asking patients questions like, “Was your doctor nice?” or “Did they communicate well with you?” or “Did you have a nice time?”, of course these metrics are hollow and should not be correlated with better care. But that doesn’t mean patient satisfaction doesn’t work, it means the provider of care must change how and what to measure. In other words, identify the data that will lead to better care and measure for that. Collecting data which shows that the care administered was superior will not always be the same as the data that shows the patient had a good time (AutoData discusses this in a post about the differences between patient experience and patient satisfaction here).

Salzberg also touched on the infamous standardized hospital survey, HCAHPS. He writes that Dr. House would fail this survey with flying colors, which is probably true. A one-size-fits-all, nationally standardized survey doesn’t make sense to us either. Hospitals and health clinics operate under different circumstances and contexts serving different demographics; measuring them against each other under one standardized survey is asinine. Hospitals have different objectives, goals, and ideas about delivering quality care, so why limit the ways they measure satisfaction and experience? Let the hospitals be in charge of the data they collect, ultimately it will lead to their success or their demise. The most encouraging trend AutoData has seen over the last 4 years is the consumeraztion of health care (AutoData wrote about it here). Due to advances in technology and the internet, healthcare consumers have been given a more powerful voice and as a consequence will continue to have more choices in care providers, ultimately forcing health systems to provide higher quality care. Therefore, it’s arguably more important than ever for health systems to measure patient satisfaction and experience. If the health system effectively listens to their patients through patient experience measurements, they can improve their service, advertise their superior service, and ultimately grow.

Salzberg’s article narrowly misses the point. It isn’t that patient satisfaction is overrated or unnecessary, but health systems must adapt to measure and collect the right kind of data. The right kind of data is data that will improve their care, not data that assesses whether a doctor is nice. When the right kind of data is measured and collected they can use it to persuade potential consumers to choose them as their provider of care. In that case, measuring the right kind of patient satisfaction is grossly underrated.

Form Scanning Software Will Help Hospital Scribes (and generate more revenue)

The efficient use of a simple solution to a big problem helped make Allina Health an extra $205,000 last year.

As technology advances in health care seek to drive down costs and improve overall efficiency, many doctors have felt frustration in the learning of new technological processes and systems. One such technological change causing issues is the process of converting to electronic-medical-record systems. Katharine Grayson of the Minneapolis/St. Paul Business Journal recently wrote an article about how Allina dealt with doctors frustrated with the amount of time spent in front of computers as opposed to patients.

The article (found here) follows Allina Health cardiologist Dr. Alan Bank and his simple solution to the problem of spending too much time in front of a computer. “I didn’t feel like I could focus on the patient. I felt like I was duplicating things. It just seemed like a lot of excessive data entry,” Dr. Bank told Grayson. Dr. Bank’s answer was simple: scribes. After Dr. Bank saw emergency room doctors using scribes, he thought he should do the same for cardiologists. The scribes – trained medical personnel who specialize in charting physician-patient encounters during medical exams – joined the doctors during patient visits to take notes and enter data.

Dr. Bank studied the results and noted that over the course of 65 clinic hours, doctors with scribes saw 210 patients while doctors without scribes saw 129. The difference in additional number of patients visited translated into a significant difference in additional revenue for Allina – roughly $205,000. One very important detail of the study is that the patients with scribes were at least as satisfied with their experience as those who didn’t have scribes. Although Dr. Bank’s solution was extremely simple, it proved extremely successful. He now sees 30% more patients then he used to yet feels less overwhelmed.

However, we can’t help but think about the scribes, who are most likely in charge of manually entering all of that data now. If only there was a way in which they could collect patient data and scan it into a computer that automatically enters it into a database. That would improve efficiency and allow scribes to see more patients with their doctors, which in turn, creates more revenue for (enter your hospital name here). Now, imagine if  you could find software that could do that . . . (hint: www.autodata.com).

Is there a difference between patient satisfaction and patient experience?

If so, how should both be measured?

“Patient experience and satisfaction is the No. 1 priority for healthcare executives, according to the HealthLeaders Media Industry Survey 2013—above clinical quality, cost reduction, and many other burning issues.”

In the constantly evolving healthcare landscape, one thing is clear: delivering quality care is paramount. As the above quote suggests, patient experience and patient satisfaction are coveted key indicators of delivering quality care. The quote – from an article in HealthLeaders magazine, found here – goes on to explain why patient satisfaction and experience is the number one priority for healthcare execs:

“With the emergence and acceleration of both Medicare-approved and commercial accountable care organizations, there is a new sense of urgency for some health systems to improve their patient experience, particularly because it is one of 33 benchmarks Medicare-approved ACOs have to meet in order to qualify for the incentive payment.”

The quotes provoke a few interesting thoughts. The obvious one is that patient satisfaction and experience have never been more important. Yet, another thought begs the question: is there a difference between patient satisfaction and patient experience? Although closely related, there are certainly a few nuances differentiating the two.

Hospitals have the well-known HCAHPS – a core set of pre-determined survey questions – that they rely on to measure patient satisfaction. HCAHPS has proved successful at measuring patient satisfaction but it doesn’t necessarily get to the heart of patient experience. “Patient satisfaction and experience are closely tied together, but they are not the same,” says Press Ganey CEO, Patrick Ryan. Ryan goes on to explain:

“‘It [patient experience] is much more than just patient satisfaction,’ he says. ‘The confusion that some folks come into the industry with is that patient satisfaction is about keeping people happy, but it couldn’t be further from that because when people enter the health system, they’re coming in at one of the most complex and stressful times in their life. And what they want most from the experience is communication and understanding of what their condition is, the path to the best possible health they can achieve, and a way in which to coordinate that with their clinicians and staff to ensure that they get there.”

While HCAHPS’s standardized questions work for measuring patient satisfaction, measuring patient experience doesn’t work with one uniform set of questions. It requires multiple surveys with a variety of questions attempting to measure a variety of different topics and experiences – something that HCAHPS doesn’t do. The best way to find out if a patient is experiencing good communication from nurses and doctors or whether the patient fully understands her condition is not with a standardized 32 question survey. Those types of experiences are best measured with specific, detailed questions in the context of each situation.  “Real change begins to happen when physicians, nurses, and staff hear the voice of the customer, the voice of the patient,” Kevin Gwin – VP of communications for Ardent Health Services – is quoted saying in the article, “and you’ll have incremental improvement that turns into transformational change.”

In order for a hospital to take incremental improvement and turn it into transformational change, they must understand the difference between patient satisfaction and patient experience. Perhaps more importantly, they must understand the difference in measuring the two. In the end,  greater patient experience will translate into greater patient satisfaction which in turn will lead to a higher HCAHPS score.

How To Improve Survey Response Rates In Healthcare

Combining Web-Based and Mail Surveys Improves Response Rates

A joint effort between three separate Practice Based Research Networks (PBRNs) conducted a study that found combining web-based and paper surveys improves the rate for total survey responses. Using surveys in healthcare – whether for research, patient satisfaction, measuring quality of care, etc. – is a common practice and in the internet age, conventional wisdom suggests that web-based survey tools provide a superior alternative to paper based surveys. The conventional wisdom is incorrect, however.

The study was premised upon the fact that, regardless of the method or technology used in conducting research or gathering data, an adequate response rate is critical to the validity of any and all survey findings. The study (which can be read in full here) analyzed response rates from a survey implemented across 3 PBRNs which initially utilized electronic surveys but followed-up with paper surveys. Despite multiple (5) solicitations to respondents to take the electronic survey, the study found that not only were paper responses nearly one quarter of all responses, but that many responded via paper survey who would not have responded otherwise.

“Our results suggest there is still an important role for the use of paper-based methods in PBRN survey research. Both hard copy and electronic survey collection methods may be required to enhance clinician response rates.”

The study’s results make clear that the most effective way to conduct survey based research is by combining both paper and web based survey tools.

AutoData offers one of the very few solutions on the market that combines both paper and web surveys. In most cases, if an organization wants to combine paper and web-based surveys, they have to rely on separate products from separate companies, which can create more problems than it solves. From survey creation to storing and reporting on the data, AutoData’s software provides a streamlined, easy-to-use process that seamlessly combines all data collected from both paper and web into one database.

If improving survey response rates is your organization’s goal, then AutoData is your solution.

Scannable Forms and Employee Engagement

There is no “one size fits all” survey

When a new superintendent for a Florida school district wanted to improve the culture in his district he turned to surveys. Kurt Browning wanted to implement employee engagement surveys to measure teachers’ engagement and create a “baseline” engagement benchmark from which to measure against. Browning, interviewed by the Tampa Bay Times, explained that “when teachers feel good about themselves and about coming to work, they will deliver.” Browning obviously understands the importance of employee engagement. However, I’m willing to bet that there was an easier way Browning could have surveyed his district’s employees.

The district used Gallup (of “Gallup poll” infamy) to ask faculty and staff “a dozen questions aimed at determining how they feel about their jobs.” The survey’s results varied greatly between the many different schools throughout the district. Not only were the results all over the board (see link to article below) but by contracting out the work to Gallup, the school district lost autonomy over its surveys. As the article wrote, “Gallup uses the same questions for businesses and schools across the country.” What happens if the school district wants to ask different questions at different schools? Shouldn’t a survey for kindergarten teachers be different for high school teachers? What if the school district wants to make changes to a survey? Who keeps all the data that is collected?

It’s no surprise that the results were all over the board. The reality is that there is no “one size fits all” survey when measuring employee engagement (or any dataset, for that matter). There are different questions, different ways to ask questions, and different people to ask. Who is in the best position to determine what questions to ask? A giant, third-party Corporation or the school district? We think the answer is simple.

By taking control of their own surveys, the school district would have the freedom to write their own survey questions, edit the surveys on the fly, custom tailor their surveys, and keep all of the data they collect on their own computers. A company like Gallup doesn’t provide those types of solutions. But AutoData does. AutoData’s software provides the flexibility for any organization to create custom tailored surveys specifically targeted to certain demographics ensuring results are as accurate as possible. Thus giving school district’s like Browning’s better, more accurate data and bringing them closer to their goal of improving their culture. And an improved culture in this case means the real winners are the students.

 

(Tampa Bay Times article cited in post: http://www.tampabay.com/news/education/k12/pasco-school-district-absorbing-results-of-employee-satisfaction-survey/216409)

Health System Finds Success With ‘Ad hoc’ Surveys

In a reoccurring segment on our blog,  we’d like to highlight another customer’s success with our software. The customer we’d like to highlight is a unified health system of physicians, hospitals, and communities located in and serving a large metro area in the Midwest. This health system has state of the art neo-natal, obstetrics, and perinatal care centers which offer a variety of different services for pregnant women, newborns, and families. Year after year, this health system consistently delivers the most babies in their respective state.

They have used AutoData’s survey scanning software for nine years and counting.

“We use the software for all of our ‘ad hoc’ surveys,” says a planning manager for the health system’s Corporate Planning and Business Development group. Whether it’s a one-time survey or a monthly survey, they use Scannable Office to gather and measure important information for many different projects within the health system.

“As an example,” he says, “our Primary Stroke Center is a ‘Joint Commission Certified Center for Excellence’ in treating stroke patients, which requires abiding by a certain set of standards.” One standard set forth by the Joint Commission is to provide patient feedback. “We use Scannable Office to create the survey and mail them to discharged stroke patients.” They receive the evaluations back from the patients, scan the surveys using Scannable Office, tabulate and create reports on the data, and then send that information to the Primary Stroke Center. The information is then analyzed and studied by the stroke center which assists in providing education to patients and focuses on secondary prevention.

On top of being a Certified Center for Excellence, and as mentioned above, the health system is a leader in neo-natal, obstetrics, and perinatal care. A key part of the system’s high quality care in those specialized areas is the wide array of maternity classes they offer. “We also use Scannable Office to evaluate all of our maternity care classes,” says the planning manager, “the data we collect is turned into trend charts for analysis and to communicate how to improve our classes.” Consistently striving to improve their programs and classes contributes to the great success their hospitals have experienced.

They also use our paper scanning software within their residency programs. Providing patient feedback on the residents is an integral part of how the health system teaches, and subsequently produces, great doctors. The data collected from the patients is used to give each resident a scorecard reflecting their work, giving the future doctors the opportunity to examine their strengths and weaknesses.

Further, the health system uses Scannable Office for at least a half dozen other surveys. The planning manager has found that Scannable Office serves a great niche function in his hospitals. “While we outsource all of our health system’s patient satisfaction surveys due to sheer volume, we have found Scannable Office gives us the flexibility and autonomy needed for successfully administering the dozens of ‘ad hoc’ surveys across our hospitals.”

AutoData’s software’s ability to allow its user to have full control over the creation, distribution, and reporting of surveys has helped numerous customers improve organizational processes, cut costs, and most importantly, provide higher quality care.

Employee Engagement: 70% of workers in the U.S. are unengaged

AutoData tries to write posts on many different worthwhile topics that our users and potential users find valuable. One topic we haven’t written about is the importance of employee engagement.

An “engaged employee” is one who is fully involved in and enthusiastic about their work. This allows them to act in a way that furthers their organization’s interests. In other words, an organization with high employee engagement will be a successful organization. Achieving high employee engagement is no easy task, however.

In fact, according to a State of the American Workplace report, 70% of American workers don’t like their job. A whopping 70%!

A recent article in Forbes wrote about the importance of engaged employees:

“Employees engaged in their work are likely to be motivated, to remain committed to their employer and to stay focused on achieving business goals and driving the organizations future. Disengaged employees can drag down others and impact everything from customer service to sales, quality, productivity, retention and other critical areas.”

It’s clear that employee engagement is an integral part of maximizing the value an organization provides. Thus, organizations should ask themselves two questions about employee engagement: what engages employees? How do I know they’re engaged?

The Forbes article discusses a number of great ways to answer the first question (full article found here: http://www.forbes.com/sites/sylviavorhausersmith/2013/08/14/how-the-best-places-to-work-are-nailing-employee-engagement/) I’ll simply outline them in our post:

–        Understand what employees are thinking

–        Create an intentional culture

–        Demonstrate appreciation for contributions, big and small

–        Commit to open, honest communication

–        Support career path development

–        Engage in social interaction outside work

–        Know how to communicate the organizations stories

The second question is equally as important – how do I know if my employees are engaged? The most obvious way is through surveys. Many organizations use online surveys to measure their employee’s engagement. However, more and more organizations are finding out that online surveys don’t yield great participation results. In fact, studies have shown that paper surveys yield higher participation rates than online surveys. Because our software allows users to create, distribute, and report on thousands of paper surveys, many organizations have had success using our software to measure employee engagement.

Knowing whether or not your employees are engaged is a top priority in organizations across all types of industry. How do you measure employee engagement?

Using surveys at assisted living facilities to increase quality of care

There are currently 735,000 men and women residing in assisted living housing in America.[1] Over the next 20 years, as baby boomers continue to age and leave the workforce in droves, the number of assisted living residents will spike. Recent questions surrounding patient safety and the quality of care administered at these facilities have been raised in the media, most recently highlighted by an investigative series done by PBS’s Frontline.

A large concern surrounding the problem of patient safety at these facilities is “[t]oo often, families don’t have the information they need to protect their loved ones residing in assisted living facilities,”[2] says National Association of Professional Geriatric Care Managers’ President, Julie Gray.  One of the best ways for facilities to get that information into the hands of those families is through measuring their own quality of care and resident satisfaction. The best way to measure care and patient satisfaction is by surveying residents, employees, and families.

Pioneer Network – a non-profit organization which advocates for positive change in eldercare – released a helpful guide outlining what families should look for when searching for the right assisted living facility.[3] The guide is not only extremely helpful to families looking for the right facility, but it is also helpful for the facilities themselves. It serves as a reminder of the importance of constantly evaluating the care an assisted living facility provides. The guide suggests families ask specific questions about “person-directed care and what the assisted living community is doing, if anything, with person-directed care.” The guide lists specific questions to ask: how do you welcome a new resident?; do you measure resident satisfaction each year?; do you provide training for your staff on how to provide person-directed care?; etc. As obvious as it may seem, care facilities should be asking themselves the same questions about the care they provide. Further, the guide suggests that facilities survey family members of the individual residing at the facility.

Assisted living facilities will increase their quality of care and patient satisfaction by asking their residents, employees, families, and themselves, the right questions. The best way to ask and answer the important and specific questions put forth above is through custom tailored surveys. Facilities are in the best position to know which questions to ask. When facilities have the ability to custom tailor their own surveys to ask those specific questions and to freely edit those surveys, they put themselves in a position to gather more accurate and valuable data.

Feel free to contact AutoData to find out how we can help assisted living facilities create custom tailored paper and web surveys to  improve your care, and most importantly, improve the overall quality of life for your residents.



[1] “New Survey from National Association of Professional Geriatric Care Managers Offers a Roadmap to Protect Growing Number of Seniors http://www.prweb.com/releases/2013/9/prweb11083496.htm

[2] See id.

Businesses are using employee wellness to address rising healthcare costs

The unsustainable costs associated with healthcare have been part of an ongoing conversation in our country for the past decade or so. Although the discussion about our country’s healthcare has been well documented and debated it feels that little progress has been made. The U.S. spends $2.8 trillion on healthcare annually – more than any other country – yet rank 37th in world health systems, according to the World Health Organization. Further, as Dr. Nick Baird of U.S. Healthiest states, “unhealthy behaviors drive 70% of preventable healthcare spending.” As healthcare costs rise at alarming rates, individuals and the businesses that provide their health insurance are feeling the pain, for lack of a better term.  How do we as a nation address the unhealthy behaviors and the decisions behind those behaviors contributing to unsustainable costs?

This is where organizations such as U.S. Healthiest come into play. U.S. healthiest is a non-profit, public-private partnership formed to address these market pressures by recognizing the value of healthy employees through workplace engagement and well-being. U.S. Healthiest has created an accreditation system –comparable to LEED accreditation for green buildings – to address worksite health and wellness. The accreditation system uses standardized scores and benchmarking to encourage businesses to embrace continuous workplace health improvement. When businesses commit to their employees’ health through wellness programs, they begin to see an increase in productivity and work ethic, ultimately translating into increased revenue. A focus on employee wellness also leads to lower healthcare costs for the company. The incentives for businesses to encourage their employees’ health are clear. So far, companies such as Target, Intel, and ING have all signed up for the accreditation process.

U.S. Healthiest and organizations like U.S. Healthiest are hoping to change individual employee’s behaviors by leveraging business incentives and in turn, taking our nation’s healthcare problem head-on. So far, the numbers don’t lie:

“A 2010 analysis of 36 studies that looked at corporate wellness programs suggested they can be effective. Researchers calculated that employers saved $6 for every $1 spent: $3.27 saved in medical costs and an additional $2.73 gained due to reduced absenteeism. An earlier analysis had found that such programs reduced sick leave, health plan costs, worker compensation and disability costs by about 25%.” (see link below)

Whether it’s a massive corporation such as Target or a local small business, companies benefit from investing in employee wellness, and in turn, hopefully our country will benefit as well.

An important element of adhering to workplace health improvement and U.S. Healthiest’s accreditation process is measuring employee’s health, most commonly through an HA (health assessment). AutoData’s software simplifies the process of measuring employee wellness with its survey creation software. By offering a combination of paper and web surveys, using our software will increase a company’s response rates and employee engagement. AutoData embraces the opportunity to assist companies in improving their top and bottom lines, but most importantly, the opportunity to help businesses improve our nation’s healthcare.

http://articles.latimes.com/2013/sep/15/opinion/la-oe-parikh-employee-wellness-programs-20130912