Find out how you’re doing by asking your patients

Patient satisfaction surveys are improvement tools

How effective is your patient satisfaction survey? You can point to it and tell your accreditation agency that you measure patient satisfaction as part of your quality improvement program, but are you really getting good information from it?

"We used to send our own homegrown surveys to our patients," says Rita Holley, RN, MS, BSN, director of Shore Home Care Services in Easton, MD. "The return rate was miserable, but every survey that we did receive was positive."

Holley and her staff experienced a shock the second quarter after they had changed to an outside research firm to handle their patient surveys and provide reports that compared Shore Home Care’s results against other home health agencies’ results.

"We dropped to the first percentile in overall satisfaction ratings when compared against other home care agencies," Holley admits.

The low ranking was a real wake-up call to her and all employees of the agency who had believed they were providing good service, she adds. "We realized that our homegrown survey was giving us a false sense of security."

While larger agencies may have the resources to develop a scientifically sound survey, distribute it, and produce reports, Holley suggests that most home health agencies benefit from outside companies that enable them to benchmark against other agencies.

"You must also have a method to identify the causes of your low scores and develop solutions to your problems," she says.

Teams address problems

A multidisciplinary committee that was set up to identify the areas in which the agency had opportunities to improve found several areas on which to focus, says Kay Satchell, RN, quality improvement specialist for the agency.

Scheduling was one area that received very negative scores, she adds. Smaller work groups were set up to address specific issues and make recommendations for changes, she explains.

"We just assumed that because our patients are homebound, we can schedule visits at our convenience, but our patients wanted us to show them more respect for their schedules," Satchell says.

The work group that focused on scheduling found that a major obstacle to meeting the patients’ needs was the exclusive use of the hospital’s rehabilitation therapy staff to provide services to home care patients, she says.

Because the hospital staff’s priority was their own patients, home care patients were just fit in when possible, she adds.

As a result of the work group’s recommendations, the home care agency hired six independent rehab contractors who work out of the agency’s office.

"Having our own therapists gives us more control over the scheduling and lets us work more easily with our patients’ schedules," Satchell explains.

After addressing areas that involved scheduling, the patients’ desire to be more aware of the plan of care, the method for handling emergencies, and other areas, Shore Home Care staff saw their rankings increase, Satchell says. From March 2000 to December 2001, the mean percentile rose from 76.8% to 93% for the scheduling issue, and the overall patient satisfaction rose from a percentile ranking of 1% to 95%, she adds.

While Shore Home Care contracted with additional staff to address one of their concerns, Sylvia Fournier, RN, MSN, director of Wentworth-Douglas Home Care & Hospice in Dover, NH, did not change her staff size, but did increase staff education to improve her agency’s patient satisfaction rankings.

"Our patients complained that they had trouble reaching us by telephone and were often transferred several times before they were able to speak with someone," Fournier says. "We learned that our employees needed additional training on the telephone system so they could use voicemail, paging, call forwarding, and other features appropriately."

Because her patients also were unhappy with explanations of billing procedures, more training was provided to help clinicians and office staff answer financial questions, Fournier says.

"After the prospective payment system was implemented, we not only present training sessions, but we also conduct a pre- and post-class test to make sure employees are getting the information they need," she adds.

The efforts at her agency to improve communication with patients have been successful, Fournier says. "We’ve improved from the 35th percentile in this area when compared to other agencies in early 2001 to the 92nd percentile at the end of 2002," she explains.

Let staff see results

You must share data from the patient survey with staff members if you want changes to occur, says Patrice A. Cruise, RN, PhD, corporate vice president for clinical development and research for the home care division of Adventist Health System in Port Charlotte, FL.

Although Adventist distributes the surveys and results are returned to the corporate office, the original, completed surveys are sent back to the individual agencies in addition to the quarterly reports, she says. "This enables the directors to share written patient comments with staff members and give kudos to the staff or identify areas in which they need to improve."

Benchmarking is a big benefit to choosing an outside, national, or regional firm to handle your satisfaction surveys, Fournier says.

"We collect a lot of data from different sources, but you don’t know how you are doing as compared to others if you only look at your results," she says.

Sometimes, the patient satisfaction results reinforce what you already may know, Cruise says. "One of our agencies had more than its share of complaints. We knew the agency suffered from staffing shortages, but the patient survey results pointed out that the shortages were affecting the patients’ perception of our service," she adds.

The survey results added impetus to an effort to look at the market rates for salaries, benefits, and other issues to increase the agency’s ability to attract and retain nurses, she adds.

Most importantly, pay attention to the results, Satchell says.

"Have a staff member designated to read and understand the reports, share the results with the staff, and oversee efforts to address performance improvement issues," she says.

Holley agrees. "If you see a downward trend in an area, don’t wait too long to react. Set up a team to address the problems before they affect other areas of your agency’s service."

[For information about the use of patient satisfaction survey results, contact:

  • Patrice A. Cruise, RN, PhD, Corporate Vice President for Clinical Development and Research, Adventist Health System, Home Care Division, 1600 Tamiama Trail, Suite 400, Port Charlotte, FL 33948. Telephone: (941) 255-9296. E-mail:
  • Sylvia Fournier, RN, MSN, Director of Wentworth-Douglass Home Care & Hospice, 113 New Rochester Road, Suite 4, Dover, NH 03820. Telephone: (603) 742-7921. E-mail:
  • Kay Satchell, RN, Quality Improvement Specialist, Shore Home Care, 29515 Canvasback Drive, Easton, MD 21601. Telephone: (410) 763-7282, ext. 8713. E-mail:

For information about patient satisfaction survey tools that are available for home care, contact:

  • Fazzi & Associates, 243 King St., Suite 246, Northampton, MA 01060. Telephone: (413) 584-5300. Fax: (413) 584-0220. E-mail: Web site:
  • Press, Ganey Associates, 404 Columbia Place, South Bend, IN 46601. Telephone: (800) 232-8032 or (574) 232-3387. Fax: (574) 232-3485. Web site:]