Measuring satisfaction? Use the right techniques

How to create an actionable survey

To quantify the effects of a new customer service emphasis in your hospital’s emergency department (ED), it is important to select the right survey to measure patient satisfaction.

"Start by determining what your objective is. Is it to enhance the bottom line? To please an administrator? Then, your survey has to be designed around that basic element," says Richard F. Salluzzo, MD, FACEP, former chairman of the department of emergency medicine and current associate dean and president of faculty practice at Albany (NY) Medical Center.

Design a survey that measures loyalty

"What we tend to do is ask, How much do you love us?’ type of questions," he says. Salluzzo compares the technique with being in a restaurant where the waitress comes by, smiles, and asks if everything was OK.

"You always wind up saying Yes,’ no matter how bad the food was. How many times a day do they ask that question, from the lowliest diner to five-star restaurants, and how many times do they get a No’?" Asking meaningless questions won’t accomplish anything, he says. "It’s a very common problem," he adds. "We’re asking, asking, asking, and I think we’re wearing our customers out."

Patients could get up to five surveys in a week if they were in five different hospital departments, he points out. "The surveys may not be coordinated or integrated, and the language used may not be consistent," he says. Getting patients to return should be at the heart of the survey. "You need to design a tool that gets at the idea of loyalty: Will they ever come back?" Instead of using terms such as "excellent/very good," he recommends "very satisfied/somewhat satisfied" and so on. "That kind of scale might get more of an actionable type of survey," Salluzzo says. "With the other one, you tend to always get an OK score, which is meaningless."

Results are more valuable with surveys designed by experts, he says. "If you’re using a homegrown survey that’s just thrown together without a database or expertise in designing questions, it’s basically useless," says Salluzzo. "I don’t know how valid they are or how valid administrators think they are, so that’s one area I’d get a little expert help."

Comparative data gleaned from surveys linked to a national database is a valuable resource. "We’re with a [survey] company that has 400 EDs, so it’s a great management tool," says Salluzzo. "If you start out in the 50th percentile of all EDs, and you put that up in front of your staff, that will motivate them to get up to 60 or 70 all by itself."

Structure the survey to focus on the area the complaints are coming from. "Is it the physician interaction with the patient, the way the place looks, the ancillaries?" says Salluzzo. "You can really hone in on where your customers are scoring you quite low, and then put quality improvement teams together to work on specific processes, and try a different approach."

At Fairfax, complaints are classified by topic, including clinical, billing, communication skills, and problems with technicians or nurses. "That’s helpful because you can put it on a graph and determine what your primary sources of complaints are," says Mayer.

Connect improved patient satisfaction with the bottom line. "You have to have regular surveys, know what the data means, and link it to changes in revenue," says Thom A. Mayer, MD, FACEP, chairman of the department of emergency medicine at Fairfax Hospital in Falls Church, VA.

Satisfy all of your customers

Realize that managed care organizations and primary care providers are customers as well. "You need to look at all customers that affect the bottom line," says Salluzzo. "If you’re in a community hospital, and there are two in town, and a group of medical staff go to either one, and you send out a survey and you find out they’re much happier with the other one, you’ve got a problem."

If you’re trying to get a managed care plan or primary care organization to send patients to your ED, consider surveying them to find out what you need to do to get their loyalty, says Mayer. "Even if they contracted with you, they won’t stay long if the service isn’t good."

Create a tool that gets to the heart of relevant issues for primary care providers. Are physicians and nurses receptive when you come to the ED? Do they perceive that their patients are getting good care? "The bottom line is that private physicians have a definite set of expectations," says Salluzzo. "You need to find out if you are meeting them, exceeding them, or delighting them."

MCOs also should be surveyed regularly about the timeliness of reports and use of services, he says. "If you have a contract with an MCO and have regular satisfaction surveys of your service, you can relate that to how well you do with the contract. That’s where you can link it very clearly to your bottom line."