Connect satisfaction surveys with QI efforts

Phrase questions in a way that fosters objectivity

Question: "What can be learned from patient satisfaction data? Are patient satisfaction surveys a good way to measure the effectiveness of a program or teaching? If the patient was satisfied, does that mean he or she learned the information? How do you use patient satisfaction to evaluate programs or instructors?"

Answer: In recent years, patient satisfaction surveys have been used at St. Francis Hospital & Health Center in Blue Island, IL, to evaluate patients’ opinions of the nursing staff’s efforts to educate them about their condition and care. Survey questions were designed to measure both dimensions of care and specific educational content, says Juanita Gryfinski, RN, MS, clinical nurse specialist at the hospital.

Surveys are conducted with an interview at the patient’s bedside or with a telephone follow-up interview. During these interviews, patients are asked such questions as:

• How well did nursing staff educate you about your care, including treatment and equipment?

• Are you currently receiving teaching information to care for yourself after discharge?

• Were you instructed on things you could do to help decrease your pain?

• Did the nurse explain why you are in the hospital?

• Did you learn about the medication you are taking after you were discharged?

• Did your nurse explain your daily care?

• Did someone talk to you about going-home plans?

"Questions such as these not only give the surveyor information about a patient’s satisfaction with care — the assumption being an informed patient is a satisfied patient — but also elicit information about patient education content," says Gryfinski.

Patients discharged from Grant/Riverside Methodist Hospital in Columbus, OH, are mailed a satisfaction survey from Press, Ganey Associates, a South Bend, IN-based satisfaction measurement firm.

Although the survey doesn’t have specific questions pertaining to patient education, BJ Hansen, patient education coordinator at the hospital system, looks at statistics from six questions that could have relevance to the quality of teaching. Questions she reviews on each quarterly report include:

• Did nurses inform you about your tests and treatments?

• Did someone explain what was happening during tests and treatments?

• Did the physician inform you about your treatment?

• Did your family receive information regarding your test and treatment?

• Did you receive instructions for your special diet?

• Did you receive instructions for your care at home?

If the survey results identify low scores in any of these six areas, this provides an opportunity for improvement, says Hansen. For example, when scores indicated that nurses needed to do a better job informing patients about tests and treatments, focus groups were organized to determine ways to improve.

Use satisfaction measures with care

Patient satisfaction with a program or class doesn’t mean it is meeting its goals and objectives, says Kate Lorig, RN, DrPH, director of the Stanford Patient Education Research Center in Palo Alto, CA. To discover a program’s strengths and weaknesses, ask specific questions about content, not whether they liked the course, she advises. For example, ask participants such questions as:

• If you could only keep three things in this course, what would you keep?

• If you were forced to shorten this course, what would be the three things you would get rid of?

"If you ask people what they like best and what they like least about a course, they will tell you everything and nothing," says Lorig.

Questions must be worded with care, agrees Gryfinski. "Patient objectivity is only as good as the questions you ask," she explains. If the questions asked in surveys are framed well, patient’s answers will be objective. For example, asking a patient if he or she received information regarding plans for going home can only be answered either "yes" or "no." There is no room for subjectivity.

Also, a patient will be able to be more objective if he or she understands hospital procedures and what to expect, says Hansen. For example, a patient who expects to be pain-free after surgery won’t report high satisfaction with pain management teaching. Therefore, patient education should include information on hospital procedure and on what patients and families should expect, such as visiting hours and meal service. "We try to address all the areas that influence attitude and expectations as part of education," explains Hansen.

Satisfaction with teaching doesn’t equal learning, says Hansen. Patients might be satisfied because a fear or concern they had about surgery was addressed, not because they completely understand their post-op instructions.

Yet a surveyor can investigate learning by his or her line of questioning if the satisfaction survey is completed by an interviewer, says Gryfinski. For example, when measuring issues surrounding patient satisfaction with efficiency in answering the call light, surveyors will ask patients if they used the call light to alert a nurse to their need for pain medication. If they did, the line of questioning can segue into pain management. For example, the surveyor can find out what the patient was taught about pain control strategies preoperatively, or if the patient worried about the side effects of pain medication.

By including such questions in patient satisfaction surveys,patients realize there is a relationship between their knowledge and understanding of their visit and their overall happiness with the hospital itself, says Gryfinski.


For more information on patient satisfaction and its impact on education, contact:

Juanita Gryfinski, RN, MS, Clinical Nurse Specialist, St. Francis Hospital & Health Center, Nursing Administration, 12935 S. Gregory St., Blue Island, IL 60406. Telephone: (708) 824-4661. Fax: (708) 824-4664.

BJ Hansen, Patient Education Coordinator, Grant/ Riverside Methodist Hospitals, 111 South Grant Ave., Columbus, OH 43215. Telephone: (614) 566-5613. Fax: (614) 566-8067. E-mail: bhansen@ohiohealth. com.

Kate Lorig, RN, DrPH, Director of the Stanford University Patient Education Research Center, School of Medicine, Stanford University. Contact by e-mail through the university’s Web site: