Why good’ isn’t good enough on patient surveys

Excellent’ ratings are the key to success

Imagine 82% of your patients rate their overall satisfaction with your practice as excellent or very good. Just 56% are that happy with their waiting time, but 77.8% gave the thoroughness of their exam those top ratings. Are you doing a good job?

You may think so. But consider another practice where 87% of patients rate their waiting time in the reception area as excellent, and 93.2% call their overall satisfaction excellent. Now how good do you feel?

Patients may be delivering a subtle message in their satisfaction ratings, and if you don’t get it, you may eventually lose their loyalty to someone who does, cautions Meryl Luallin, partner of Sullivan/Luallin, a health care marketing and management consulting firm in San Diego.

"If you’re rated just good, and your competition is very good or excellent, then you’re not good. You’re mediocre," she says. "In a competitive environment you can’t be mediocre. You have to be head and shoulders above everyone else."

In fact, Luallin says group practices should achieve at least 85% satisfaction in the "excellent" and "very good" categories.

"If you’re really trying to stand out and generate more patient word-of-mouth referrals, then aim for excellent," she says. "That’s the key to success, to be excellent. Difficult though it is, 90% excellent is what would set one practice apart from another."

Expecting the best scores

Rick White, MBA, FACMPE, administrator of the 30-physician Heritage Medical Associates in Nashville, TN, takes an exacting view of patient satisfaction scores.

"I look at things on a relative basis rather than as an empirical number," he says. "Suppose I’m getting scores of 95%, 96% satisfaction with everything else, and something like satisfaction with parking is 82%. Eighty-two percent may sound pretty good — but it’s not really. I’m a little concerned about it because it’s a 15-point difference with their satisfaction with the friendliness of our staff. There must be a problem here."

While White compares his scores on his annual survey with the database of Sullivan/Luallin, and he looks for yearly shifts, he also expects the scores to be consistently high.

For example, a couple of years ago he noticed problems with patient waiting time and telephone access. He set up quality teams to recommend changes in office systems.

In a survey of telephone traffic, the team found that Monday was far busier than any other day, with the majority of calls coming in between 9 a.m. and 11 a.m. "The number of busy signals delivered any other time was three to four an hour," says White. "On Mondays from 9 a.m. to 11 a.m., they jumped to about 300."

The practice added a recording for those who received a busy signal, which tells the 9 am. to 11 a.m. callers that they may want to try back at a less busy time. Callers can also leave a voice mail message if they just need a prescription refill. And patients now can request refills or referrals, schedule appointments, and fill out patient satisfaction surveys through the practice’s World Wide Web site.

The efforts worked. In 1995, 73.5% of patients said they were very satisfied that their telephone calls were answered promptly, and 76.8% said they were very satisfied with the availability of medical information and advice by telephone. The next year, those scores jumped to 86.2% and 85.0%, respectively. (For excerpts from two surveys, see box, above.)

Sometimes just paying attention to patients’ concerns makes them feel more valued — and more satisfied.

A quality team studying patient waiting times put stickers on patient charts and recorded the times when patients arrived, when they entered the exam room, and when they saw a physician.

"We worked on that project for about eight months," he says. "We were surprised at the [subsequent] improvement in the scores because we were baffled about what to do. We couldn’t see many ways that we could streamline and change the waiting time we were experiencing."

Much of the waiting occurred due to urgent or emergency care required for other patients. But, notes White, "when you start measuring the waiting times, employees sense that’s an important issue."

Patients must have sensed that, too. In 1995, just 57% of patients were very satisfied with their waiting time in the reception area, and 59% were very satisfied with their wait in the exam room. In 1996, those scores rose to 74.3% and 70.8%.

Making patients feel valued lies at the core of satisfaction, says Luallin. Practices with high satisfaction scores have "a commitment on the part of practice leadership to be superior to their competition, and support in terms of resources and recognition of the efforts of physician and staff to achieve excellence. They go the extra step for patients," she says.

[Editor’s note: For more information about evaluating patient satisfaction, contact Meryl Luallin, Sullivan/Luallin, 10623 Caminito Cascara, San Diego, CA 92108. Telephone: (619) 283-8988. Fax: (619) 283-2993.]