Public reporting boosts patient satisfaction
Experts say internal changes behind improvement
Press Ganey Associates Inc., the South Bend, IN-based patient satisfaction and quality firm, reports that "patient satisfaction leaped" after the launch of public reporting. The company cites an "unprecedented" jump in hospital patient satisfaction since March 2008, when hospitals began publicly reporting data on patients' experience of care. The company analyzed its proprietary patient satisfaction data for hospitals that in March began reporting data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures.
These improvements were specifically cited in three areas:
- likelihood to recommend "definitely yes"
- coordination of care "very good"
- overall rating of hospital nine or 10.
The analysis included data representing more than 1.5 million patients and 1,158 hospitals from January 2007 through June 2008, and indicated year-to-year comparisons for each month. (The graphs of these Press Ganey data points are available at http://www.pressganey.com/galleries/default-file/HCAHPS_Graphs.pdf.)
"Our clients have seen slow and steady improvement over the years, but the comparison of one month this year over the same month last year is statistically significant — and we have not seen that before," notes Deirdre Mylod, PhD, vice president of acute services at Press Ganey.
What is the link?
The first question begged by this new data is this: Just what is the link between patient satisfaction and public reporting? "The link is mostly a push for transparency within the organizations," says Mylod. "Consumers don't use most of the public data yet, but even if they are not looking at them and make decisions about them, if hospital leadership and boards see they are being publicly reported, we see tremendous attention to and seriousness with which these [patient satisfaction processes] are taken."
In addition, she says, "What we have found in our clients is that those who have been modeling transparency within the organization and giving nurse managers access to their own data are those that are improving more on the patient satisfaction front."
Traditionally, she notes, hospitals were required to report on patient satisfaction quality measures, which had a lot to do with processes. "But now they also have to report how patients evaluate their care," says Mylod. "So much of being patient centered is the culture; it adds a piece to not just drive the numbers, but also getting people tapped into their mission."
"Researchers have shown there's a linkage between quality improvement and public reporting, so it does not surprise me that the same thing is going on with patient satisfaction rates," adds Patrice L. Spath, of Brown Spath Associates in Forest Grove, OR.
"These same researchers who identified the link between increased quality improvement and the reporting of quality outcome data found that when that same data were only reported internally there were still quality management activities that occurred, but not necessarily at the same rate as in those hospitals where they were reported publicly."
Hospitals participating in HCAHPS, she continues, know their data will be publicly reported and, therefore, are making a more concerted effort to raise their patient satisfaction scores. "Those things being publicly reported are those things hospitals focus on," she notes.
Most patients don't know that these data are being shared publicly, she continues, adding that recent studies confirm this. "So, it's not the fact that hospitals say they are being transparent, but there are different levels of transparency," Spath notes. "What increases satisfaction is one-on-one transparency, like disclosing adverse events when they occur. That's more important."
Nevertheless, she says, "Satisfaction is a subset of quality and it is probably a more meaningful measure of quality to consumers than some of the clinical measures. If consumers are looking at this data, it would seem they would be likely to use those hospitals [that score higher]."
One system's response
Paul Convery, MD, senior vice president and chief medical officer, Baylor Health Care System in Dallas, agrees that most consumers are not yet paying attention to the publicly reported data. He can also testify to how HCAHPS has impacted his system's patient satisfaction efforts.
"Public reporting has a bigger impact internally than externally at this time, and this has been true for a number of years," he notes. "Our internal managers, executives, board members, doctors, and nurses pay more attention to patient satisfaction because we circulate data internally and report them internally. When they know they're being made public they are more concerned about it than the public is."
Right now, says Convery, "the public is not paying a lot of attention to the public web sites, but the knowledge that it was going to be public in March caused us, and a lot of other systems, to begin working on satisfaction and understanding the drivers for the last couple of years. Once we knew the data were going to become public we talked about it internally, and the two years we have been working on it has really made a difference."
What exactly has Baylor learned? "We learned we have to be very focused on specific behaviors that must be done, and that it varies from department to department," says Convery. "So in the ED, for example, it may be greeting people and introducing who you are, telling the patient what you are going to do, and giving people information about how long they are going to wait. You may do regular rounds on inpatients and ED outpatients, and give that information back to the staff on a regular basis and work with them to let them know how important these things are."
He says that Baylor has undertaken "a whole series of activities in a systematic fashion," and that is what is driving its improvement. "We measure our satisfaction scores on a monthly basis, and we have broken the responses down by what the key satisfiers and dissatisfiers are," says Convery. "And we employ internal coaches who are trained to work with the staff on these line items that are dissatisfiers." Those dissatisfiers, he explains, "may be a nurse who is not communicating with the patient, or a doctor who is not explaining the medicine or the wait time."
In addition to the internal coaches, he says, "we communicate with the staff to help them understand how to perform important system activities."
Patient focus critical
Mylod says that patient-centered care is the key to improving satisfaction and, thus, looking good on those public reports. "The organizations that are listening to patients and sharing what patients say in a transparent way, those are the ones that are improving," she notes. "What improves patient satisfaction is that focus on the patient — how you communicate with them and build trust. This can be different than a process improvement, because it's both process and culture."
For quality managers, she continues, public reporting should be an impetus to galvanize and "move the needle." "They must ask themselves how they can improve," she advises. "Hospitals are less comfortable with driving behavior change and holding people accountable. What we say is you already hold them accountable on the clinical side."
Quality managers, she says, know that staff have to be accountable for behavior as well as clinical performance; they know what the staff need to do, and what will happen if it's not done.
"It's not any different when it comes to serving patients; there needs to be behavioral standards defined, they need to be noticed and tracked, and people need to know what will happen if they do not do it since it is part of the performance standards of working at the facility," she explains. "Patients need to know they can trust you, they need to share in their care, and this needs to be defined. You guys are already experts in this; you just need to define those quality standards to a different type of behavior."
[For more information, contact:
Paul Convery, MD, Senior Vice President and Chief Medical Officer, Baylor Health Care System, Dallas, TX.
Deirdre Mylod, PhD, Vice President of Acute Services, Press Ganey Associates Inc., South Bend , IN. Phone: (800) 232-8032, ext. 178.
Patrice L. Spath, Brown Spath Associates, P.O. Box 721, Forest Grove, OR 971116. Phone: (503) 357-9185. E-mail: email@example.com.]