Are your patients happy? Ask them in a focus group

Survey ratings may not reveal dissatisfaction

In hundreds, even thousands, of surveys, about 90% of your patients rated your care as excellent or good. That may seem like an overwhelming endorsement, but don’t be misled. Your patients may still be dissatisfied.

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 specialized in designing surveys of patient-centered care.

While you can tailor your questions 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 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 involved eight women who had either come in for an appointment or brought a child in 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 note, 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.

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 a 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 and ask if the patient needed anything, such as a glass of water or a phone call to a sitter or office. The practice also put information binders in the exam rooms so patients could learn more about the services available while they waited.

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."