Follow Us:

Follow AutoData Systems on TwitterFollow AutoData Systems on LinkedInFollow AutoData Systems on FacebookFollow AutoData Systems on YouTube
AutoData Systems > Scannable forms

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).

Patients or consumers?

“The health care landscape is changing.”

That phrase – or some variation of that phrase – has been used ad-nauseam in recent years (we’re guilty of using it). The phrase has become cliché, as most people are aware that massive change in healthcare is underway through government reform referred to as ObamaCare. Although a large portion of the general population understands that change is happening, I don’t think they are sure – present company included – what the change means or where it is headed. Further complicating things is the change happening unrelated to ObamaCare, due to advances in technology and changes in consumer sentiment. You read that correctly, consumer, not patient.

In basically every industry outside of health care, when change is needed, the consumers drive the change whether individual businesses are ready or not. The customer knows best, after all. With the advent of Yelp!, Google reviews, Angie’s List, and countless social media sites, consumers have been given a much larger voice – and businesses have been listening. But until recently, health care hasn’t listened. In 2014 and beyond, the hospitals and health systems that don’t start listening to their consumers will be left behind – quickly.

“Despite controlling nearly 20% of the economy, traditional healthcare is years if not decades behind other industries when it comes to adopting a business model and technologies that assess and meet consumer needs.”

The quote comes from a recent HealthLeadersMedia interview (found here) with Chris Wasden, a global healthcare innovation leader and SVP at PwC. The interview discusses recent empowerment of health care consumers who are now willing (and eager) to “dump the doctor’s office for cheaper and more convenient retail and remote alternatives that could amount to tens of billions of dollars of lost revenues if they fail to adapt.”

In short, if health systems want to survive they need to adapt. Step 1: Treat patients as consumers:

“Whether it’s the pharmaceutical companies, device makers, payers, or providers, nobody considers the patient as their customer so they’ve never tried to come up with solutions that were consumer-friendly or consumer-centric.”

Treating them as consumers forces a hospital to frame the experience they provide differently. If they frame it correctly, they will improve the consumer’s experience for the better. Framing it correctly depends on Step 2.

Step 2: listen to the consumers. Ask them. Survey them. Gather the data and use it to make consumer-friendly choices that enhance the experience and the care. Framing patients as consumers means asking different questions than ones found in typical patient satisfaction surveys or HCAPHS surveys. Ask about every conceivable positive or negative experience and then implement the proper changes. This will improve the experience and when you improve the experience and the care, the consumer will follow. The health systems that do this will flourish, the health systems that don’t will flounder. It is painfully simple.

Customer Profile: The Baltimore Multiple Sclerosis Center of Excellence

The U.S. Department of Veterans Affairs (VA) operates the largest integrated health care system in the nation, with more than 1,700 hospitals, clinics, community living centers, and other facilities. Included in the varied types of care the VA provides are many specialized clinical and research centers. Baltimore’s Multiple Sclerosis Center of Excellence is one such place and has used AutoData’s Scannable Office since 2008.

The Associate Director of Epidemiology and Outcomes for the MS Center, Dr. William Culpepper, explained how the Center has had success using Scannable Office in collecting pertinent data from veterans from all over the country. Over the past five years, the Center used Scannable Office with help conducting two nation-wide surveys. Dr. Culpepper and the Center sought to collect specific, detailed clinical data on veterans with MS. They found that one of the best ways to do so was through representative surveys and asking the patients themselves. Dr. Culpepper wanted something simple to use and something that could be managed by his assistants yet still retain its high functionality; they ultimately settled on Scannable Office. Before mailing the surveys out, the Center was able to pre-print the surveys with ID numbers linking the form back to the respondent, a feature Dr. Culpepper appreciated. The Center then mailed out the paper surveys to thousands of veterans.

The Center collected data from over 3,000 veterans nationwide and Dr. Culpepper was able to use that data to draft multiple manuscripts describing the epidemiology of MS. One of the important findings Dr. Culpepper was able to show was that the veteran population with MS is not that different than the non-veteran population with MS. Evidence was also gathered to show that within the VA system, MS patients’ care costs twice as much as other patients’ care. Dr. Culpepper and the MS Center of Excellence are doing extremely important work by conducting cutting edge research and clinical work on our nation’s heroes diagnosed with MS. AutoData is proud to learn that Scannable Office has played a small part in aiding the Center to further its research. Most importantly, the Center continues to plan more survey based research in the future in an effort to learn more about veterans with MS.

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.

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?

Normandale Community College has success with ExpertScan

Customer Profile – Normandale Community College

“We use AutoData’s products every single day now,” says Anne Janzen, a performance improvement specialist at Normandale Community College (NCC) in Bloomington, MN. NCC is consistently ranked as one of the top 50 community colleges in the country and enrolls over 10,000 students.

“In the past, many of our departments were using comment cards and other experience surveys that they were entering in by hand or worse – filing them away and never doing anything with the information collected.” With ExpertScan’s form scanning technology, NCC can take full advantage of the valuable information and insight they collect from their students.

Not only does ExpertScan make it easier for NCC to collect and report important data, but Anne says “ExpertScan allows us to print the surveys through any printer on regular office paper which saves us a lot of money, as opposed to using scantron-type surveys. This also makes the survey creation process more user-friendly.”

Anne further discussed the importance of their process of using paper surveys, “[our] online response rates were horrible and resulted in invalid data. To be able to administer end-of-course surveys and satisfaction surveys in the classroom to get representative rates was wonderful. We really rely on these results to inform decision-making.”

ExpertScan’s automatic reporting features help NCC to communicate those results, “we create lots of standard reports – each faculty member gets reports on each class with their course evaluation results compared with everyone else for that semester.”

“For the price, AutoData’s products are superior to any other I’ve encountered. Without AutoData’s software, our ability to evaluate the effectiveness of our services and programs would be limited.”

Thank you to Anne Janzen and NCC for being this month’s customer profile!

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.