Fine-tune your patient satisfaction survey

Agency strives to make A’ grade an A+’

As most home care agency quality managers know, patients rarely give poor ratings on patient satisfaction surveys. Therefore, it’s common for agencies to receive scores of 95% or better in patient satisfaction.

If everything the agency does is so great, how will the staff know what to improve?

One answer is for the quality manager to target any areas that receive less than a "good" or "excellent" rating on the patient satisfaction form. Agencies that work to bring a 95% up to a 98% or a 98% up to 100% will continue to improve because they are making efforts to do so.

Ambassador Home Health in Downey, CA, makes excellence in patient care a top priority, says Gifty-Annette DuBois, RN, COHN, BS, administrator and chief executive officer for the freestanding agency that serves Orange County in California with about 1,800 visits a month.

"We look at every aspect of what is going on with the patient," she says.

This close attention to detail has paid off in high customer satisfaction ratings. "Our patient satisfaction is always high, a 97% or 98%," says Nerissa Hall, RN, RMN, SCM, MA, director of patient services.

Hall says the agency doesn’t coast on its ratings because there is still that 2% of patients who were not happy for whatever reason. The agency monitors all complaints to see if anything could have been done to satisfy those customers.

The surveys are sent to all clients after discharge or after their first recertification. The surveys of discharged patients are on blue paper and the surveys of patients who have been recertified are on pink paper.

Here are some of Hall’s tips to improving your patient satisfaction scores:

1. Make sure your form is easy to understand.

Ambassador Home Health’s patient satisfaction form is one sheet of paper, tri-folded. It notes at the top: "Thank-you for allowing us to provide care for you and your family members. In order to better serve our patients, we need your assistance. Please take a second to fill out this questionnaire and return to our office, postage paid."

The front page also includes the agency’s mission statement. The survey has 10 questions that can be answered by circling a number from one to four.

"Three is good and four is excellent; anything under three we say we’re not meeting our goals," Hall says.

However, the agency initially had a problem with the number system. Earlier surveys had the number one equal to excellent, and the number four equal to poor. Some surveys came back with all fours circled.

"We’d call the patients and say, We noticed you weren’t happy with your care; could you please tell us what we did wrong,’" Hall recalls. "They’d say, No honey, it was great. I just read the survey wrong.’"

Since it appeared that the agency’s elderly clients expected a rating system to have the number one equal to poor and the higher numbers equal to higher ratings, the agency changed the survey’s rating system. Hall says they haven’t had any confusion over the numbers since.

2. Select questions that will give you important feedback.

Ambassador Home Health supervisors wanted to look at both patients’ overall satisfaction with the agency and their satisfaction with staff.

The first question, which is, "How do you rate the overall performance of our staff?" is broken down by classification: nurse, home health aide, physical therapy, occupational therapy, master’s level social worker (MSW), and speech therapy.

"If the family was satisfied with the MSW but dissatisfied with the nurse, they each have their own line of rating," Hall says. "And if we have 10 complaints one month about aides, we can focus on the home health aides."

The agency’s other questions are:

How would you rate your involvement in decision-making regarding planning your home health services?

The agency typically has high ratings on this question, Hall says. "When we open a case we say to the patient, It’s very important that you be a part of the planning of care; you need to give us input, and if you’re not happy, you need to discuss it,’" she says.

How were your opinions considered in planning your discharge from home care?

Some patients misunderstand the purpose of home care and how the home care nurse will not be able to visit them indefinitely. The agency’s nurses explain to the patient upon admission that home care is temporary, and once patients reach the plan of care goals, the agency will discharge them, Hall explains.

The staff treated me, my family, my home, and my belongings with respect.

Hall says this question was written as a positive statement so it would be easier to understand.

Staff explained my condition, rights, and responsibilities, and other procedures related to the care I received.

Nurses give a copy of the patient’s rights to each patient. They also explain advanced directives and the procedures they will be doing. Then the nurses document that they explained all of these matters.

The staff generally arrived as scheduled.

How would you rate your ability to reach your nurse or therapist, or have your calls promptly returned?

How would you rate the courtesy and helpfulness of the office staff?

The agency’s policy is to never allow a telephone to ring more than three times. "If it’s not answered on the third ring, then I will answer it or any one of us in the office will," Hall says. "We say, Thank you for calling Ambassador Home Health. This is Nerissa. How may I help you?’"

How likely would you use this agency again or to recommend this agency to friends or relatives?

Overall, were you pleased with our services?

Underneath each question, there is space for comment or suggestion for improvement.

3. Look for trends of problem areas.

Hall reviews all surveys and looks for problem areas. When she sees a rating that’s lower than "good," she’ll call that patient directly, saying, "My name is Nerissa at Ambassador Home Health. We provided home health services for you. Thank you for filling out your questionnaire. I noticed a few areas where we didn’t meet your needs, so could we talk about it?"

Two survey questions had been returning with lower ratings, and the agency targeted these areas for improvement. The question whether the staff arrived as scheduled had received poor ratings. Hall investigated this problem by speaking with staff and patients who had made the complaint. She learned that nurses or therapists were telling patients they would arrive at a specific time. If they were a little late, the patients would be upset."They could have had bad traffic, or the last patient could have detained them," Hall explains.

The delays often were unavoidable, so the agency’s quality assurance group, consisting of aides, case managers, supervisors, and Hall, fixed the problem by changing how the staff would tell patients their expected arrival times. Instead of giving patients an exact time, the staff would tell them they’d arrive within an one hour time frame. For example, if the nurse intended to see the patient at 2 p.m., the nurse would say, "I’ll be at your home between 2 p.m. and 3 p.m." This way the patient would not become anxious if the nurse still has not arrived at 2:30 p.m.

The strategy appears to have worked. Patient satisfaction ratings for this question have improved since the agency switched to giving time frames.

Another problem area involved the question about patients’ ability to reach their nurse or therapist. Nurses always told patients that they could call the agency during its office hours of 9 a.m. to 5:30 p.m., or they could reach a home care professional through an answering service that is available nights and weekends.

The problem appeared to be that patients expected to speak with their nurses immediately when they called the office, even when someone else at the office was able to answer their questions, Hall says. "That was another area where we needed to give them some education."

Now nurses tell patients to call the office if they need the nurse or have a problem, and the office will call the nurse’s beeper number, if necessary, because the nurse most likely will be in the field.


Gifty-Annette DuBois, RN, COHN, BS, administrator, chief executive officer, Ambassador Home Health Inc., 8255 Firestone Blvd., Suite 205, Downey, CA 90241. Telephone: (562) 923-3990 or (800) 230-4242.

Nerissa Hall, RN, RMN, SCM, MA, director of Patient Services, Ambassador Home Health Inc., 8255 Firestone Blvd., Suite 205, Downey, CA 90241. Telephone: (562) 923-3990 or (800) 230-4242.