Focus groups help doctors understand patient needs

Survey ratings may not reveal dissatisfaction

From hundreds of surveys, your doctors found that 90% of patients rated their care as excellent or good. That may seem like an overwhelming endorsement, but doctors shouldn’t be misled. Their patients may still be dissatisfied. And dissatisfied patients can take their business elsewhere, eroding practice revenues and leading to dissatisfied doctors.

A patient focus group can help your doctors find out directly from their "customers" how they view the care they are receiving.

Overall ratings of care tend to be skewed toward the positive, says Margaret Gerteis, PhD, director of communications and education at The Picker Institute, a Boston-based firm that specializes in designing surveys of patient-centered care.

While questions can be tailored to receive more targeted information from surveys, focus groups with patients offer a unique way to learn the values and experiences of your patients, Gerteis says. "That physical piece of paper is literally a barrier," says George Miaoulis Jr., PhD, president of Marketing Strategy & Research in Camden, ME, a health care consulting firm. "If you were to say, Tell me what we could have done to improve our satisfaction today,’ you’re taking responsibility for the interaction that happened between the patient and the practice."

Getting to the bottom of complaints

When Family Health Associates in York, PA, decided to begin using focus groups, the six-physician practice faced a dilemma. The practice was growing rapidly, but two unhappy physicians had decided to leave. At the same time, patient complaints were growing.

When Dave Schlager, MBA, president of Family Health Associates, would present the complaints at staff meetings, someone always had an excuse, such as noting that the patient was upset about his or her insurance company’s handling of claims. "Instead of getting to problem-solving, we would rationalize that we weren’t as bad as people thought we were," he recalls.

Family Health’s first focus group included eight women who had either come in for an appointment or had brought a child to the doctor during the past month. Schlager and his staff identified potential focus group participants from the past month’s medical records and called them. Those who agreed to attend received a thank-you, a reminder note two days before the meeting, and a reminder phone call. They were promised a "gift" in exchange for their time, which was a $25 gift certificate to a local department store.

The focus group meeting began with one critical question: "Describe your most recent experience with the practice in detail."

Each focus group can deal with a specific issue of concern to the practice, says Schlager. At the first meeting, Miaoulis asked, "What would you suggest Family Health Associates do differently to make it a better place to receive your health care?"

"You have to ask questions that really get into the issues relative to people’s experience and the flow within the practice," says Miaoulis.

Patient transfers decline after groups

At Family Health, the focus groups had an immediate impact. Requests from patients to transfer their medical records to another practice dropped from 290 to 240 within one quarter.

Staff and physicians watched videotapes of patients explaining what they didn’t like about the practice — and instead of making excuses, they suggested ways to change the system. For example, patients revealed that they were most bothered by the uncertainty of the wait in the exam room.

"People understood this was not a cookbook approach where everybody gets 15 minutes," says Schlager. "They would not want to be the one who needed 25 minutes but only got 15."

But after 20 minutes passed, a nurse would tell the patient the status of the doctor’s schedule and ask if the patient needed anything, such as a glass of water or to phone a sitter. The practice also placed information binders in the exam rooms so patients can learn more about the services available while they wait.

Although physicians are "data-driven," patients speak louder than the cold statistics of a survey, notes Gerteis. "Physicians listen to patients more than anybody else," she says. "If you can get them to hear from patients themselves, that can be persuasive."