Survey redesign boosts response rates
Survey redesign boosts response rates
Group practice wins recognition for changes
When UT-Med the physician practice of the Galveston-based University of Texas Medical Branch (UTMB) decided to change its patient satisfaction surveys last year, the primary goal was to improve patient response rates. What happened was more far-reaching, according to Cissy Yoes, UT-Med’s senior health programs analyst.
Along with improved response rates, Yoes found more teamwork from the 40 clinics, more buy-in from the 465 physicians, and a better understanding of the use of the surveys.
In years of surveying, "our outpatient visits had increased significantly, but responses had not," Yoes says. "Our physicians always said they didn’t buy into the results because our sample rates weren’t high enough."
With some 400,000 outpatient visits per year at the group practice, collecting patient satisfaction surveys presented a significant challenge for Yoes and her colleagues.
Tapping the expertise of Press, Ganey Associates, a patient satisfaction consulting firm based in South Bend, IN, and the input of UT-Med medical directors, Yoes recreated the surveying process as well as the survey itself.
In the first quarter of its new survey, UT-Med received 2,500 responses double the amount collected before the changes. Medical directors, physicians, nurses, and other staff also regularly receive information from surveys within a month, rather than the six to eight weeks it once took."They take it seriously now because the feedback is so much more timely," Yoes says of the physicians.
The UT-Med efforts also won the group practice some outside recognition. UT-Med was the one of two medical practices among the finalists in an annual "client success story" contest by Press, Ganey. The firm compiles and analyzes patient satisfaction for 95 group practices.
"It’s a big challenge to coordinate the whole process [of survey redesign] with that many physicians, clinics and patients," says Mary P. Malone, MS, JD, CHE, vice president, corporate development at Press, Ganey. UT-Med impressed Press, Ganey officials with their responsiveness to "the customers of the process the clinics, the employees and physicians," Malone says. "Step one of making improvements for your patients is to take input from your staff," she says.
Getting the medical staff involved in the redesign of the surveys was an important aspect of their success, Yoes says. She visited every clinic and met with the medical directors. It was the first time the medical directors were involved in the process, she recalls.
Previously, "the survey was perceived as something that happened to the people that worked in the clinics," says Malone. Yoes was able to change that mindset so that clinic staff and physicians realized the surveys could be an important part of quality improvement, Malone says.
Yoes reworded a couple of questions and took a couple out, based on comments from the physicians. She also addressed a major concern: timeliness of results.
Problems addressed immediately
Press, Ganey analyses include quarterly comparisons against a national database. But that also means the group practice may not receive responses to surveys conducted in the first two weeks out of every quarter for almost three months.
Yoes developed a shadow system. Each survey is immediately photocopied; the original is sent to the clinic in question and the copy to Press, Ganey for usual quarterly compilation.
"We screen the surveys when they come in" to allow for a quick response, says Yoes. For example, when a receptionist at one clinic received low scores, Yoes immediately called the manager to talk about the problem. She also gives timely accolades to those mentioned favorably by a patient. "We give [the staff] gold stars [on their name badges] if their names get mentioned," she says.
From her experience with the successful redesign of UT-Med’s survey process, Yoes offers the following advice:
• Make the survey process a shared responsibility.
At UT-Med, each clinic makes sure patients receive the surveys and have an opportunity to fill them out but the clinics have control over how that is done. "I told them, You can choose your methodology as long as you’re getting a decent response rate,’" she says.
Rather than calculating a response percentage, Yoes’ goal is a significant number of overall responses. Clinics are expected to receive at least 200 survey responses each quarter. Smaller clinics have a target of 100 responses.
Providers hand surveys out personally
Previously, UT-Med placed the patient satisfaction surveys on the reception desk when patients checked in. Some patients actually filled them out before they even saw the doctor, Yoes says. Now, the surveys are distributed in a more personal manner at the end of the patient visit, she says.
"The patients take the surveys much more seriously and provide better comments if a health staff person at the end of the visit hands it out," she says. "In many of our clinics, it’s the nurse. In some of the clinics, the physicians themselves hand it out. At those clinics, physician communication is rated very high."
Yoes also asks every clinic management team the medical director, the practice coordinator (an RN), and the practice manager to go over their quarterly survey results and predict their comparative Press, Ganey scores. "This will help us see if there are any blind spots," she explains. "If their estimates are more than 15% off in either direction [high or low], then it means management doesn’t understand something."
• Make the survey tool attractive and easy to read.
UT-Med’s original survey was an oversized sheet; Yoes reduced it to a standard, letter-sized page.
Yoes also increased the type size and used brightly colored paper, to make the survey seem easier to fill out. The original survey was printed on gray paper. Now, different paper colors correspond to specific teams. A family medicine clinic, for example, will have a different color from a specialty clinic. This makes tracking responses easier.
• Copying, rather than printing, can be a cost-saver.
Yoes was able to increase her volume of surveys and still decrease costs by switching from printing to copying. She was able to apply some $6,000 in savings to additional postage for patients who returned their surveys by mail.
Surveys now cost about three cents each. If a clinic runs out, Yoes just copies more.
• Make drop-off points interesting.
Because of the large number of patients UT-Med serves, Yoes can’t afford to mail personalized letters and surveys. Instead, patients receive their surveys on-site and can either place them in a drop-off box or return them with postage paid by the group practice.
To encourage clinics to design enticing boxes, Yoes organized a "Bright Ideas" contest. The clinic staff became both competitive and creative as they designed the survey receptacles.
When the contest was completed, UT-Med’s chief medical officer and chief operating officer went through each clinic and judged the entries. Since the senior management didn’t usually go to the clinics, that alone acted as a real morale booster for the staffs, Yoes said.
Yoes also created her own T-shirts for the winners, honoring the "UTMB All-Star Service" with iron-on transfers she made with a color printer.
The contest also brought attention to the improvements in the process and survey, she says. "We live in a society which surveys everyone about everything," Yoes says. "The patients feel surveyed to death. We have to think of new ways to keep them interested, and new ways to get the medical staff interested."
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