When Kevin Watson joined Colorado Otolaryngology Associates, PC, as administrator nearly two years ago, the Colorado Springs practice wasn’t asking patients about their care experience in a systematic fashion. “They had done some patient surveys, but it was all hard copy and they hadn’t received a great response,” he said.
Watson worked with an outside vendor on a trial basis to develop a patient satisfaction survey that he posted on the practice’s website. The response has been so strong that Watson plans to adapt the format using an online tool such as SurveyMonkey.
Other otolaryngology practices may soon find themselves doing the same. The American Board of Otolaryngology (ABOto), in collaboration with the American Board of Medical Specialties (ABMS), is updating its Maintenance of Certification (MOC) program to include a section addressing “performance in practice.” Although details of Part IV will not be available for several months, the section will include, among other items, a patient satisfaction survey such as those produced by the Consumer Assessment of Healthcare Providers and Systems (CAHPS).
“We don’t do a good job in the health care industry of relating to our patients,” said Owen J. Dahl, MBA, FACHE, CHBC, a health care consultant and author based in The Woodlands, Texas. “We’re moving to an era that requires us to spend more time looking at the kinds of questions we should be asking our customers and responding to their concerns.”
Part IV measures will allow physicians to evaluate their clinical practices according to specialty-specific standards for patient care. Every two to five years, otolaryngologists will be required to perform a practice improvement exercise to demonstrate that they assess the quality of care they provide, measured against peers and national benchmarks, and that they apply best practice recommendations for quality improvement. Patient satisfaction surveys represent one of three key mechanisms used to achieve that goal, along with a peer survey and a surgical and/or ambulatory outcomes assessment tool with a performance improvement module.
“No one quite knows at this stage how to evaluate quality of practice,” said Jack Gluckman, MD, chair of the ABOto’s MOC committee and professor emeritus of otolaryngology at the University of Cincinnati. “The easiest, most obvious way that has been validated to some degree is to conduct patient satisfaction surveys.”
Important Feedback
Patient satisfaction represents a window into clinical care, experts agree.
“The patient satisfaction survey is the voice of the customer,” said Elizabeth W. Woodcock, MBA, FACMPE, CPC, an Atlanta-based health care consultant and trainer. “Getting that feedback is so powerful, particularly today, when service and access are at the top of American’s minds because they have to pay more and more for their health care. Patients want more input into the process, and practices have to be willing to give that.”
“The patient satisfaction survey is the voice of the customer.”
—Elizabeth W. Woodcock, MBA, FACMPE, CPC
Watson’s survey focuses on customer service from the check-in process through the clinical visit to the checkout desk. Questions explore not only physician care but also the efficiency of services provided by medical assistants and office staff, especially respect for the patient’s time. “Many patients take time off from work and they want to be seen as quickly as possible,” Watson said. “They’re our customers, and we need to treat them right if we want them to come back.”
Karen Boyd, COPM, CMM, practice manager at Ashland ENT, Allergy & Hearing Aid Center in Ohio, has surveyed patients across the practice, which includes allergy and general otolaryngology, and also conducted a survey focused exclusively on hearing aid patients. Boyd used a paper-based tool offered through the Association of Otolaryngology Administrators but wants to develop an in-house tool that is economical for a solo practice. She welcomes the ABOto initiative.
“This may be the time for associations like the Association of Otolaryngology Administrators (AOA) and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) to work together and develop something that’s easily accessible and cost-effective for practices,” Boyd said. “It’s important that patients know we care enough to request their feedback.”
Through Part IV of MOC, the ABOto plans to conduct patient satisfaction surveys both for outpatient visits and surgical procedures. The ABMS has developed seven “core” questions for use across all patient satisfaction surveys, both in surgical and nonsurgical settings, according to Dr. Gluckman. (See “12 Patient Satisfaction Questions,” p. 19.) These are derived from the Clinician and Group Survey in the Agency for Healthcare Research and Quality’s CAHPS survey and reporting kits, which can be downloaded at cahps.ahrq.gov/cahpskit.
“Exactly when we’re going to implement them, and in what form, nobody knows just yet, but this is going to be the start of our technique to evaluate quality of care,” Dr. Gluckman said.
The correlation between patient satisfaction and surgical outcomes is spurious at best, Dr. Gluckman added, acknowledging that some physicians are skeptical about the value of patient satisfaction surveys in improving the delivery of clinical care. Nevertheless, he and others insist that the surveys can provide useful feedback to help physicians improve clinical practice.
“Patient satisfaction surveys, in their most simplistic manner, are all about communication between patients and physicians,” Dr. Gluckman said.
Although patient satisfaction may not accurately reflect the delivery of clinical care, it does reveal patients’ perception of that care and serves as a leading indicator of a group’s overall performance. Poor or declining patient satisfaction metrics indicate an operational problem.
Patient satisfaction surveys can also capture a baseline in performance before practices adopt a major change, such as an electronic health record, according to Cynthia L. Dunn, RN, FACMPE, a principal consultant with the MGMA Health Care Consulting Group, based in Cocoa Beach, Fla. “When you look six months later, you can see whether that process changed patient perceptions about how much time the physician spent with them,” she explained.
Otolaryngology practices with a patient satisfaction survey should continue to use that instrument for the time being, Dr. Gluckman said. Because the ABOto is still working with the ABMS to finalize questions and format, paper-based or electronic, he doesn’t recommend that other practices rush to implement their own patient satisfaction surveys. Otolaryngologists who participate in MOC will be required to use the instrument developed by the ABOto or an acceptable, nationally validated survey approved by the ABOto.
How to Do It
That being said, it doesn’t hurt to develop some experience with patient satisfaction surveys, sources agree. Here are some strategies to consider:
- Decide whether your patient population is better suited to a paper-based or electronic format. A paper instrument can range from a postcard handed to patients at the checkout desk to a professional survey managed by an outside firm. Practices with diverse populations, including non-English-speaking and older adults, might need to adopt multiple tools.
- Seek a statistically significant response. In a controlled approach, you could target all new patients or 100 to 150 patients seen in a given month, with a goal of capturing a response rate of 25 percent or higher. Capturing immediate feedback through a freestanding kiosk in the office is ideal, “but if people have been waiting a long time, they won’t want to complete a patient satisfaction survey at the end of the visit,” Woodcock pointed out.
- Structure the survey properly. You can place a starburst on your website for patients to click and submit a comment, but responses will be random. One-page survey instruments with 10 to 12 questions that include a numbered rating scale produce the best results, according to experts. Survey instruments may also include an option for open-ended comments. “Most [administrators] believe that the only people who respond to patient satisfaction surveys are the ones who’ve had a bad experience, but I have not found that to be the case,” Boyd said. “We have received positive, constructive suggestions and criticism, and the results helped us to grow as a practice.”
- Promote the survey. At Watson’s practice, the checkout staff hand each patient a card with the website’s address and invite their participation. The practice has begun collecting e-mail addresses and will eventually send the survey electronically.
- Provide a feedback mechanism to share the information with physicians, and develop an action plan to address patient concerns. “You can’t just develop a survey, put it out there and get it back,” Dunn said. “You have to take time to discuss how you plan to use the results.” Garner the commitment of a physician champion to support the process and pledge the appropriate resources.
- Involve staff in planning, execution and follow-up. Incorporate staff suggestions and change optional questions once or twice a year to reflect practice initiatives, such as scheduling or telephone triage. Discuss both positive and negative feedback at staff meetings and strategic planning sessions. Consider adopting incentives for staff who receive exceptional feedback.
- Publish the results. “People are happy to fill out a patient satisfaction survey, but they want to see the results posted in the reception area or on a website,” Dunn said. Summarize survey responses at least twice a year, and tell patients how you’re responding to their concerns.
- Maintain the momentum. Whether you partner with an outside firm or develop your own instrument, make the effort consistent. “We want to be ahead of the government and other payers in tracking what we do for our patients,” Watson said. “The more data about customer service we collect within our practices, the better position we’re in to negotiate rates and promote our services to patients.”
Patient Satisfaction Questions
The ABOto is working with the ABMS to develop a patient satisfaction tool that will include core questions that are common across specialties and items that are specific to the practice of otolaryngology. Following are seven core questions required by ABMS for patient satisfaction surveys used by member boards and five additional questions that experts suggest using to gather valid feedback about the patient care experience.
ABMS Core Questions:
- Did the doctor explain things in a way that was easy to understand?
- Did the doctor listen carefully to you?
- Did you talk with the doctor about any health problems or concerns?
- Did the doctor give you instructions about taking care of your health problems or concerns that were easy to understand?
- Did the doctor seem to know the important information about your medical history?
- Did the doctor show respect for what you had to say?
- Did the doctor spend enough time with you?
Additional Questions:
- Are you satisfied with your visit today?
- Would you refer a friend or family member to our practice?
- Were you able to schedule your appointment in a timely manner?
- Were you greeted courteously when you arrived at the office?
- Did our business office handle your insurance and billing promptly and accurately?
Sources: Jack Gluckman, MD; Elizabeth W. Woodcock, MBA, FACMPE, CPC; Owen J. Dahl, MBA, FACHE, CHBC.