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Measuring Patient Satisfaction, Part 1 of 3

August 17, 2011 Leave a comment

“There must be a mechanism in place to measure a patient’s satisfaction.  The patient has  the right to express his satisfaction or otherwise.”  

These are the regulations and the standards imposed upon surgery centers by regulatory agencies such as CMS and the different state licensing agencies as well as by the various accreditation organizations.

In the early days of ambulatory surgery we took that to mean that every patient was to be given a copy of our standardized patient satisfaction questionnaire upon his discharge from the center with a request to mail it back at his earliest convenience.  This form was frequently a list of questions put together by the Medical Director, the Administrative Director and the OR Supervisor/QI Coordinator.  We dutifully distributed these forms to our patients and implemented numerous tactics trying to get back more than the usual 20-30%.  We tried giving them a self-addressed, stamped envelope at no small expense.  That helped, and sometimes got us up to a 40% return.  We tried telling our Medicare patients that the form was required to be given to them by Medicare in the hopes they would think that they had to send it in if they wanted Medicare to pay the ASC fees.

These tactics worked to the extent that they worked.  There were centers who reported returns as high as 80-90%.

Research into these reports, however, sometimes uncovered some interesting processes in place to reach those percentages.

In one center that reported nearly a 100% return rate, we found the surgeon was bringing the form into the exam room during the patient’s post-operative visit.  He would ask the patients the questions and duly complete the questionnaire with their responses.  After that, he would have the patients sign and date the form.  He was very proud of his response rate, but one wonders whether his patients felt free to respond openly with any criticisms.

In another center the staff went over the questionnaire with the patients during the post-operative phone call and completed the form.  Again, concerns are raised regarding how free the patients felt in giving their response. Nevertheless the organization was reporting exceptionally high percentage of returns on their surveys.

The passing out of the questionnaires, or the completion of them by the staff, met the absolute requirement that the patient be queried, or be given the opportunity to express his satisfaction or otherwise; however, within three-four months of a center’s opening, it became blaringly obvious that certain questions were problematic.  These questions always resulted in poor ratings; e.g.,

  • Waited too long.
  • Surgery didn’t start on time.
  • The room was too cold.
  • The fees weren’t discussed adequately.

The QI Committee reviewed the comments and implemented everything they could to try to increase satisfaction in these areas.  We did time studies and tried to work with the patients to ensure they didn’t arrive too early at the center on the morning of their procedure.  We met with the medical staff, especially those who were chronically late.  We altered our schedules, but still those complaints persisted.  We let patients wear their street clothes where possible.  We got them socks to wear on their feet.  We bought blanket warmers and wrapped them in toasty blankets.  We bought warming units of various kinds.  We met with surgeons and, where possible, increased the OR temperature as much as allowable.  We developed proposed fee schedules to give to the patients identifying the various fees for which they would be billed along with those of the ASC.  But…in spite of all these efforts these areas continued to be the ones with the ongoing complaints. So….we set up critical thresholds and declared that we would not address those issues unless we got a percentage of complaints greater than our threshold.  We continued, though, to get the complaints even though we had done everything we could think of to remedy those issues.  We even altered the survey forms taking off the offending questions, but what we, again, found was that we were not learning anything new from the questionnaires.  They truly were just an exercise to meet the regulations and standards, as we struggled to get an acceptable return rate.

But wait!  What if there was a better way the results of which could impact the way we deliver our care in our surgery center? This would take the entire process out of being a painful exercise and turn it, instead, into a valuable tool.

In part 2, I’ll share how to make this process  simple, impactful and painless…

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