Use a survey to find out what your patients think

Practice Management. By Julie A. Jacob, amednews staff. July 30, 2001.

PRACTICE MANAGEMENT

A column about keeping your practice in good health

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It's important to know what your patients think -- about the quality of care they receive, the courteousness of your office staff, the amount of time they have to wait to get an appointment, how hard or easy it was to find your office and the ambience of the waiting room.

After all, satisfied patients will keep coming back to you and will recommend you to their friends and family, while dissatisfied patients will seek out another physician the next time they need medical care. Plus, Blue Cross of California may be only the first of many plans to link your bonus payment to how satisfied your patients are.

Patient survey tips
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The tried-and-true method of getting feedback is the patient survey, say the experts.

Asking patients to fill out a patient satisfaction survey shows them that you care about what they think and "will identify problem areas that you weren't even aware existed," said Crystal S. Reeves, a principal with the Coker Group, a health care consulting firm in Atlanta.

"Physicians need to know this information and take it very seriously," said Todd Welter, a Denver-based consultant for the Medical Group Management Assn.

Many factors other than the quality of medical care affect patients' opinions about their experience at their physician's office, Welter said. No matter how good the physician is, patients may stop going to that physician if the staff is unfriendly, the billing department constantly makes mistakes on their insurance forms or if it's difficult to find parking.

"The objective [of gathering information] is to improve your operations," said Kay Stanley, an associate partner with the Coker Group and co-author of the AMA Press book Assessing and Improving Patient Encounters.

A medical practice should do a survey at least once a year, Welter said.

The Palo Alto Medical Foundation, a 200-physician group in Palo Alto, Calif., conducts random telephone surveys of six patients of each physician every month, said Tomas Moran, the group's director of quality. It also conducts periodic mail surveys in conjunction with its affiliate, Sutter Health Care.

"When you have limited resources to make improvements, the only way to really target the things that are most bothersome to patients is to ask them," Moran said.

You can either hire an outside health care consulting firm to design and conduct your survey or have your staff write and administer it. While hiring an outside consulting firm will cost more money, a health care consulting firm can provide data on how your practice measures up on patient satisfaction compared with others, said Kevin Sullivan, a consultant with Sullivan/Luallin of San Diego.

Either way, it's important that the survey is short and easy to fill out, yet covers all main areas of the patient's experience at your office, experts say. Areas that need to be covered in your survey are access, facilities, staff, communication and medical care, Sullivan said.

The section on access, for instance, should include questions such as: Were you satisfied with how quickly you were able to get in to see your doctor? Was it easy to find parking?

The section on facilities should include questions such as: Is the office clearly marked? Is the waiting room well-lit and comfortable?

Staff questions should include questions such as: Did the receptionist greet you by name when you arrived? Was the staff courteous?

The section on communication should include questions such as: Does the office return phone calls? Can you reach your physician by telephone or e-mail?

The section on medical care should include questions such as: Did your doctor answer your questions? Did he or she clearly explain what you need to do to treat your condition?

The experts have different suggestions on what sort of scale patients should use to answer the questions.

Sullivan favors a 5-point scale -- ranging from 1 ("strongly disagree" or "strongly unfavorable") to 5 ("strongly agree" or "strongly favorable"). But Stanley recommends using questions that patients can answer with a simple yes or no. Reeves suggests a 4-point scale so that patients can't rate anything as just average.

Once the survey is written, you need to decide whether to mail the survey or to ask patients to fill it out when they come to the office for an appointment.

There are several advantages to asking patients to fill out a survey while they are in the waiting room or as they are leaving the office, Stanley said. It gives them something to do while they are waiting, and their impressions of the office and the staff are fresh in their minds.

The downside, Welter said, is that they are usually not feeling well, which may influence their responses.

If you mail the survey, include a brief cover letter explaining that responses will help your office serve patients better, Welter suggested.

Once you've tabulated the survey results, you need to decide how you will respond to patients' concerns.

For example, if patients say the magazines in the waiting room are out of date, you can ask the receptionist to throw out old magazines and set new ones out every month. If patients indicate that they have a lot of mistakes on their insurance forms, talk to the billing staff to find out how they are handling claims.

The administrators at the Palo Alto Clinic, for example, streamlined the clinic's procedure for informing patients about laboratory results after patients indicated on surveys that they were frustrated with waiting for results, Moran said.

Let your patients know when you've made changes in response to surveys, Reeves suggested. For instance, if you add more reading material in the waiting room, open the office earlier in the morning or make changes to your claims processing procedures, put out a sign or send a letter to patients telling them you've made changes to improve service and make things easier for them.

Jacob served as a staff writer for AMNews from 1996 to 2002.

ADDITIONAL INFORMATION:

Patient survey tips

Keep surveys short and simple.
Ask questions about access, facilities, staff, communication and the patient's encounter with the physician.
Use either a simple rating scale or questions that elicit yes/no responses.
Take action to improve things that patients are unhappy with.
Let your patients know that you've taken steps to address their concerns.