Measuring patient satisfaction is important in all aspects of healthcare, but anesthesia can pose a particular challenge. There is a lack of standardized tools and anesthesia does not fall easily into the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) categories.
That means hospitals usually do not provide HCAHPS to anesthesiologists the way they do with other physicians, notes Emily Richardson, MD, an anesthesiologist and chief quality officer with Encompass Medical Partners in Fort Collins, CO. Hospital quality leaders may have to find other ways to assess quality in this specialty, she says.
“With the financial implications with reimbursement and quality, hospitals are seeing anesthesiologists coming to them and asking for quality data, but the hospitals are saying they don’t have anything for them,” Richardson says. “Hospitals will start to see even more interest as physicians realize the impact on their Medicare reimbursement.”
Hospitals will need to start assessing patient satisfaction in anesthesia on an individual level because it will be tied to the hospital’s reimbursement. Under the Physician Quality Reporting System (PQRS), patient satisfaction counts as an outcome measure when reporting to the registry, Richardson notes. The move toward more shared accountability and concepts like perioperative surgical homes will make anesthesia satisfaction more important, she says.
Also, postoperative pain control is highly correlated with overall patient satisfaction, she notes. That is more incentive for hospitals to work with anesthesiologists to measure satisfaction, she says.
“Post-op nausea and vomiting are very strong dissatisfiers for patients, so those are very important,” Richardson says. “There also are benefits like patients adhering better to post-op instructions when they are satisfied, which in turn leads to better outcomes.”
Measurement Tools are Scarce
The Anesthesia Quality Institute (AQI) in Schaumburg, IL, noted in a recent white paper that, despite the implementation of CAHPS and HCAHPS, “there is a persistent gap in the ability to adequately measure patient experience, as identified by the Measure Applications Partnership (MAP),” which provides input to HHS on the selection of performance measures for performance-based payment programs. There is a “significant lack of validated satisfaction tools” for anesthesiologists, the report states. (The report is available online at http://bit.ly/292VONY.)
“Many practices are currently using proprietary vendor products or are being assessed by surveys implemented by the institutions to which they provide anesthesia services,” the AQI report says. “For example, the majority of free-standing surgical facilities assess patient satisfaction, and many of these assessment instruments include questions that pertain to the patient’s perception of anesthetic care. At this time, no standard for anesthesia-related questions exist, and this makes comparison of satisfaction results across facilities or practices very difficult.”
Hospitals can develop their own patient satisfaction measurement tools, but the usefulness of the data will be limited because the lack of standardization means it is difficult to compare anesthesia patient satisfaction from one facility to another, Richardson says. (See the story later in this issue for suggested questions.)
Anesthesia satisfaction can be improved through better education of patients, Richardson says. They often do not understand anesthesia well, and their anxiety is a major influence on their post-op satisfaction, she says. Patients also often are confused about the role of their anesthesia providers, a common problem when using a care team model with a physician and nurse anesthetist, Richardson notes.
“There is an opportunity at the preoperative clinic, with handouts and other information, but at the point of care the provider needs to explain and answer questions,” Richardson says. “Communication skills are important, and anesthesia providers need to be compassionate in their education.”
Privacy is a Major Concern for Patients
Setting appropriate expectations also is important and can improve patient satisfaction scores, and privacy is a particular concern. Privacy and respect for patients are important throughout the hospitals, but Richardson notes how patients are especially concerned with regard to anesthesia. Patients may already be anxious about being anesthetized, and worries about how the clinical team will treat them when they are vulnerable can make that worse. Those fears are increased after recent high-profile cases in which patients secretly recorded their anesthesia providers and other surgical team members insulting them and otherwise being disrespectful during the procedure.
The timing of surveys is important. The longer you wait to ask about patient satisfaction with anesthesia, the more likely the patient is to correlate it with the outcome of the procedure, skewing the results, Richardson says. Two weeks is often cited as the optimal time to survey anesthesia patients, she says.
The anesthesia group that Richardson previously was part of contracted with a third-party vendor to measure patient satisfaction, and she says a hospital could do the same for its anesthesia providers. That comes with considerable expense, of course, so a hospital would not be able to use a third-party vendor to study the patient satisfaction of every specialty. But it could be worthwhile for a specialty like anesthesia that is particularly difficult to measure with more common and less costly methods, she says.
Assessing patient satisfaction by specialty also runs the risk of patients suffering survey fatigue. When Richardson’s anesthesia group sought to contact patients, some of the ambulatory surgery centers the group worked with balked at providing access to the patients because they conducted their own surveys and did not want patients to feel overwhelmed and stop responding.
“I’m sympathetic to that, but I would want that facility to understand that anesthesia providers are at a real disadvantage when it comes to feedback, so it’s not like we are repeating what you’ve already asked them,” Richardson says. “We need that information if we are going to improve, so if it is not being gathered by the usual methods we might have to go out on our own to gather it.”
Patient satisfaction tends to be high with anesthesia, Richardson notes, but that can make it difficult to show improvement. Providers sometimes are frustrated when they employ quality initiatives but see little movement on their quality scores, she says.
When working with anesthesia providers to measure patient satisfaction, Richardson suggests keeping the tone positive and supportive. Many anesthesia providers do not like participating in patient satisfaction measurement because they see it as an audit to find their mistakes and weaknesses, she says. A hospital seeking to address patient satisfaction in anesthesia should strive to present the effort in a positive way, making it an opportunity for the anesthesiologists to confirm their quality rather than a witch hunt.
“Approach it from a global perspective, stressing that we’re all in this together and we’re not trying to single out bad providers,” Richardson says. “The anesthesia group will be interested in what works and how they can improve their satisfaction scores, but they will want to know that the hospital is supporting that goal and that everyone benefits in the end.”
Additional resources on measuring patient satisfaction are available from Somnia Anesthesia in New Rochelle, NY, at http://bit.ly/295CEFJ.
- Emily Richardson, MD, Chief Quality Officer, Encompass Medical Partners, Fort Collins, CO. Telephone: (970) 488-1649. Email: firstname.lastname@example.org.