Worst practices in patient satisfaction measurement

Measuring satisfaction is harder than it appears

By Patrice L. Spath, RHIT
Brown-Spath & Associates
Forest Grove, OR

There appears to be an endless search for the ideal measurement instruments and techniques for evaluating patient satisfaction. Researchers and practitioners now have more than a decade of know-how in determining whether a patient is satisfied with his or her health care experience. However, it is clear that measuring satisfaction correctly is far harder than it appears. Health care providers may not always know the right way to measure patient satisfaction, but it has become apparent that there are several wrong ways. For a more effective evaluation of patient satisfaction avoid the following "worst practices."

• Worst Practice #1: Survey only your most recent patients

Your current patients are most likely happy with your health care organization. That’s why they have recently received services at your facilities. If you only ask current patient about their satisfaction, you are likely to get an overly rosy picture of your organization. Unfortunately, in most health care facilities, surveying recent patients is the path of least resistance in measurement terms. But how about those potential patients who use other health care facilities; why aren’t they receiving services in your organization? Seek out samples of competitors’ patients and people who no longer use your facility. You often learn more from people who are angry than people who are happy.

• Worst Practice #2: Ask only about overall satisfaction

Health care organizations that focus on global patient satisfaction measures don’t learn how to improve those measures. Asking whether a patient is satisfied or dissatisfied overall is a useful first step because it gives a summary picture of satisfaction. However if the questioning stops there, you don’t know what is affecting overall satisfaction. In any patient satisfaction survey, include items regarding the specific benefits and attributes patients experience to gain deeper understanding of what drives overall satisfaction.

• Worst Practice #3: Ask only about your organization

Often patients choose among competing facilities. What drives their behavior is not their absolute satisfaction with your facility, but their satisfaction relative to the competitive options available. Always ask about satisfaction with other health care providers and report satisfaction with your offerings in terms of relative satisfaction. This also can be a useful exercise in segmentation, as you will find some people who are completely loyal, and some who have sampled services from many different providers.

• Worst Practice #4: Ask only about your health care services

Most health care services are acceptable to patients. This means that the basis of competition must shift from specific services to the "delight" factors. Evidence increasingly suggests that customer defection can be traced to intangible factors urelated to the technical quality of services. Survey customers about their entire experience with your organization; from initial contact to post-service billing. In Figure 1 is an example of a survey tool that can be used to question patients about the "delight" factors related to their health care encounter.

• Worst Practice #5: Let your caregivers administer the survey

An early lesson in the satisfaction movement was that while having caregivers administer the survey may be an easy way to do it — after all, they see the patient anyway — it is not the best way to do it. First, caregivers are more likely to give the survey to happy patients. Second, they are particularly unlikely to give the survey to patients who are unhappy with them. Even if they are forced to distribute to all patients, there is a tremendous incentive for caregivers to attempt to manipulate the process. Patient satisfaction research should be performed by administrative staff or an external agency to avoid these biases.

• Worst Practice #6: Don’t ask about price

Price increasingly is becoming an important factor influencing health care choices. Even many insured patients have out-of-pocket expenses when using health care services. Patients may like your services better than competitors’, but not if they have to pay 20% more. Patient satisfaction research shouldn’t focus only on areas of improvement without regard to the cost of the improvement to either the organization or the customer.

Follow up standard patient satisfaction research with a more detailed small sample study looking at how much more patients would be willing to pay for your services as compared to one that competes in relative quality. Similarly, examine how much patients would be willing to pay for improvements identified in the initial survey.

• Worst Practice #7: Don’t segment the market

A single gross satisfaction measure across all patients is as useful as a weather forecast for "North America." Segmenting your patients into small market share units usually provides far greater insights into your strengths and weaknesses.

Segmenting your patients by customer loyalty variables such as frequency of use, recency of visit, type of services used, and duration of relationship with your organization can lead to powerful knowledge about the strength of your organization’s actual and potential patient base.

• Worst Practice #8: Focus on the mean satisfaction score

Relying on a single mean satisfaction score masks a host of valuable variations. On the common five-point satisfaction scale anchored with "very dissatisfied" and "very satisfied," how many patients fall into each group? How do those patients look on the segmentation variables?

Be particularly wary of the popular practice of aggregating the "satisfied" and "very satisfied" numbers into a single "top two box" percentage. While this often produces a gratifyingly large number — percentages routinely exceed 80% — there is increasing evidence that "very satisfied" patients often differ substantially in both attitudes and behavior from the merely "satisfied." In particular, the former group appears to be much more inclined to continue to use your facility for health care services than the latter group.

Converting these worst practices into corresponding best practices make it more likely you will accurately measure patient satisfaction. Understanding satisfaction levels does not however lead to success. Satisfying patients involves committing to a satisfaction management system, taking accurate measures, learning about the strengths and weaknesses of your strategy, and responding appropriately. Only in this way does patient satisfaction lead to true sustainable competitive advantage.