Patient Satisfaction Surveys: Using the Data
Each year, O&P patients around the nation fill out thousands of patient satisfaction surveys. Patient care facilities accredited by the Centers for Medicare & Medicaid Services (CMS) are required to offer the surveys, but the way the facilities treat the responses varies widely from practice to practice, experts say.
Many of these surveys, they fear, are being ignored.
Randy Schmitke, CPA, MBA, chief financial officer of O&P Digital Technologies, Gainesville, Florida, and general manager of Prosthetic & Orthotic Associates (POA), headquartered in Middletown, New York, estimates that about 80 percent of O&P practices are not seriously looking at the patient satisfaction surveys they gather. Mark Ford, director of business development at POA, thinks that number might be closer to 90 percent.
"Most practices still think of it as an accreditation standard issue and don't look at it as a tool for customer performance improvements," Schmitke says.
However, Schmitke and Ford say the surveys cannot be ignored for long.
When the Affordable Care Act (ACA) went into effect in October 2012, it began tying some hospital reimbursements from Medicare to patient satisfaction surveys. Schmitke and Ford speculate that Medicare and probably other insurance payers will soon be making the same kind of demands on O&P practices. "It's not going to go away," Ford says. "In fact, at some point, it might be a part of how we get paid. The sooner we embrace it, the better off we will be."
The good news, both experts agree, is that patient satisfaction surveys do not have to be daunting or cumbersome. Best of all, practices that use the surveys regularly find them to be important tools to know what's going on in the business and to help them continually improve.
Surveys in Use
Michael Oros, CPO, FAAOP, president of Scheck & Siress, headquartered in Oakbrook Terrace, Illinois, says his practice has made many positive changes for patients since the practice developed its survey about ten years ago. In response to recommendations made by patients in the surveys, Scheck & Siress has included more evening hours, recognized employees with outstanding job performance, and reached out quickly to patients who had negative experiences.
"It's probably the best way we have to get feedback from our patients in a way that they have the opportunity to be completely objective," he says.
Jeffrey Brandt, CPO, CEO and founder of Ability Prosthetics & Orthotics, headquartered in Exton, Pennsylvania, says Ability has used self-generated patient satisfaction surveys since its founding in 2004. The company now uses patient satisfaction survey software developed by Quality Outcomes, Fredericksburg, Virginia, which integrates seamlessly with the OPIE Software his practice uses.
Brandt says that among other things, he uses the survey data to compare how his practitioners rank on scores both nationally and within the company. He says this helps him to recognize areas where some practitioners may need help and identify practitioners who are doing well and can share their knowledge with their colleagues.
Brandt credits the consistent use of the surveys with positive changes in the office culture.
"The practitioners know and understand [that] the responses to questions being posed to patients are being used to critique them to create a better patient experience," he says. "I'm not saying our practitioners are perfect, but because that expectation is put out there, they know that patient satisfaction results are being looked at. That in and of itself is a behavior modifier."
D. Scott Williamson, MBA, CAE, president, Quality Outcomes, says that he's seen similar results in other O&P practices. In one case, patients in a client's office consistently scored one practitioner about 20 percent lower than others in the office. Upon further investigation, the practice manager found out that the practitioner had a poor bedside manner and gave him a month of coaching to improve. Williamson says after the coaching period, the practitioner started scoring higher than the rest of his colleagues.
"He wasn't a mean person," Williamson says of the practitioner. "When he realized how he was coming off, he changed because he wanted to help the patients."
Results like these, however, come from practices that use surveys in their day-to-day operations, Williamson says. That can sometimes be tough for practices that are not used to handling the surveys or that have surveys that are hard to measure. Williamson and other experts have these suggestions for practices that want to take patient satisfaction surveys seriously:
- Make the surveys part of the practitioners' normal work routines.
- Have a survey that can be measured and compared to others; for example, a survey that includes a rating scale as opposed to only a comment card.
- Respond as quickly as possible to negative surveys.
- Use the data gained from the surveys to improve.
A Survey Routine
First off, Williamson says, providing patient surveys should be part of the normal workflow of any O&P practice. He says Quality Outcomes achieves this by working with companies like OPIE Software, Gainesville, Florida, and Futura International, Clearwater, Florida. These software programs automatically generate a customized survey based on the patient's health needs and can e-mail it to the patient.
Even offices that do not use Quality Outcomes' software should still find a way to work patient satisfaction surveys into their schedules, Williamson says. Medicare likes to see 33 percent of patients responding to surveys, and that response rate can only happen if every patient receives one, he says. Williamson maintains that it also makes a difference who asks the patient to fill out the survey. His research indicates that if a survey is just available in a patient room, it will typically get filled out by 5-10 percent of patients. If patients receive the survey from the front desk, 15-20 percent of them will fill it out. If practitioners encourage patients to fill them out, 40-50 percent of patients will respond.
"There's a tremendous amount of trust between patients and practitioners," Williamson says. "If the front desk asks you to do it, it's just another piece of paper to fill out. If the practitioner asks, it can feel more important to the patient."
That said, it can be difficult to incorporate a survey into the normal workflow of a practice, says Jon Shinn, chief operating officer at OPIE Software. Most practitioners will say they care about the surveys and the data but putting that care into practice can be difficult. Shinn explains, "The question is if they will shift their workflow around it. It is a cultural shift. It's about becoming a patient-centric practice." To make that shift easier on the practitioner, giving the patients the surveys needs to be as easy as possible, he says.
A Measureable Survey
Before Brandt started using Quality Outcomes, he says it was difficult to use the patient satisfaction data to find out how his practice was doing. The number-crunching could be tedious and was only done twice annually. These days, he can get a daily or weekly report on the surveys and has the data to track trends to compare his multiple patient care facilities.
"If I can't measure it, I can't manage it right," Brandt says. "It's pretty nice when I sit down at an annual and quarterly review to have quantitative data that says 'here's where you rank in your patient satisfaction scores,' and set new goals accordingly."
In this new age of data analysis, a good survey is one where practices can dive into the data and see real trends about how they are doing, Williamson says. While surveys that just ask for comments can be nice, they can't be measured and compared over time periods, he says.
Quality Outcomes is collecting the data it gathers from clients' patient satisfaction surveys to normalize national benchmarks so practices can compare how they're doing against others across the nation. At the very least, Williamson says, practices should have surveys that they can measure and compare from one time period to the next. To do that, surveys should be based on number rankings rather than comments. The rankings should range from total dissatisfaction to total contentment with an equal number of good and bad options and also a neutral option, he says. Surveys should also ask just one question at a time, he says.
"Don't ask 'Were you pleased with our service and our people?'" he says. "Ask a separate question for each."
The most measurable data comes from a lot of patients, and that can take time to compile, Ford says. Right now, POA is working to compile as many surveys as possible to ensure the data is as accurate as possible.
"We think the bigger the data pool the more relevant it will be," he says. "If you are just getting back two to three responses, then the data can be skewed."
In time, Williamson says, the positive and negative surveys tend to balance out and practices can get an accurate overall picture of their true strengths and weaknesses.
A Quick Response to Negative Surveys
When surveys are particularly negative, they need to be dealt with immediately, Williamson urges. Patients who respond to surveys with negative responses and are not contacted assume that the practice doesn't care about them, he says. "Patients who provide negative responses or request a follow up and do not hear from you in short order will assume that the practice does not really care about their thoughts."
Oros says all Scheck & Siress patient care facilities have a goal to respond to any negative surveys as quickly as possible.
"Almost universally, they are surprised that we even called," he says. "Most of the time the issue can be amicably satisfied. I find that very few people are unrealistic of their expectations of what we can do for them."
This policy has helped them fend off possible public relations problems, he continues. In one case, a woman was dissatisfied, said so on a survey, and then posted her complaint on her page on Facebook. The practitioner reached out to her, and the issue was quickly resolved. She then posted on Facebook how impressed she was with the practice.
Oros says, "Not only did she change her Facebook post but she turned it into a positive for us."
Ability also has a quick response policy to negative surveys, Brandt reports. By the time patients complain in the form of a survey, it means their discontentment is pretty high and needs to be addressed. "If a patient doesn't complain until they're presented an opportunity to do so on a survey, it usually means a practitioner was missing vital clues and comments from the patient throughout the process," he says. When practitioners call patients to address their complaints, they are trained to start off by fully listening. That listening approach, he says, ends up solving most issues.
To respond best to negative complaints, Williamson recommends that practices do not hand out anonymous surveys. Statistics show that patients are just as likely to hand in a survey whether it's anonymous or not. Since it doesn't make a difference, he says, the surveys should be open so the practices can best reach out to their patients.
An Improvement Tool
The ultimate goal of patient satisfaction surveys is to be able to give patients a better experience, Williamson says.
To do that, O&P practices need to take an honest look at what the data says and act on it. That can sometimes be tough, he says. He's lost clients before because they were not scoring 100 percent on patient satisfaction. If patients are ranking a practice perfectly, then it's probably a faulty survey, he says. "If everything you are doing is perfect, then you aren't asking the right questions because none of us is perfect," Williamson maintains. "So let's be honest about it and find out ways to improve."
Those patients who are not entirely happy often have the most to teach practices about their patient care, Schmitke says. "Certainly you want to hear positive feedback, and it's great to have high scores, but I also want to hear from those patients who aren't happy because I want to find out what we can do to improve patient care."
Using the surveys to really listen to patients is what gives them their true power, he says. "They have a greater value than a task on a list," Schmitke says. "You have to look at it as a tool to improve your business."
Brandt says that he was alerted to an area for patient experience improvement from Quality Outcomes survey data. The data indicated that 81 percent of patients with new orthoses said they had been trained to inspect their skin for signs of possible trouble. That number displeases him. "That's about one in five patients who said they weren't told to look at their skin for irritation," he says. Even though Ability is ahead of the national benchmark of 80 percent in that category, Brandt says that is still not enough. He plans to use this data to bring it up to his practitioners and make sure that it's a topic on their minds.
That kind of frank appraisal is just what these surveys are supposed to accomplish, Williamson says.
"It's all about just being honest," Williamson says. "If you don't want to improve, then just go through the motions and be accredited. But if you are going to go through the motions, you may as well really do it so you can learn from it. It's about learning from everything that you do."
Maria St. Louis-Sanchez can be reached at