As low-cost, high-quality healthcare providers, ASCs must continue to demonstrate excellence to avoid or minimize reimbursement cuts as aggregate healthcare dollars are reduced. In addition, publicly reported data will provide the impetus for other healthcare verticals to narrow the gap in patient safety as they will be forced to confront deficiencies. As competition increases, timely insight from patients, employees and physicians becomes increasingly more critical to ASC market superiority.
Editor’s Note: This article is an excerpt of a more comprehensive article on satisfaction survey trends and best practices written by Mr. Faraclas, which is available in its entirety here.
As low-cost, high-quality healthcare providers, ASCs must continue to demonstrate excellence to avoid or minimize reimbursement cuts as aggregate healthcare dollars are reduced. In addition, publicly reported data will provide the impetus for other healthcare verticals to narrow the gap in patient safety as they will be forced to confront deficiencies. As competition increases, timely insight from patients, employees and physicians becomes increasingly more critical to ASC market superiority.
Presently this insight is either lacking or underutilized in the ASC industry. This is partially due to facilities being slow to adopt new and more effective sources of patient data collection, assimilation and response. Numerous advances in technology and data collection within this decade provide facilities the opportunity to gather at least 2-3 times the data points collected in legacy approaches in a fraction of the time.
The opportunity to improve operational performance and financial health requires small investments in properly collecting patient data and transforming it to actionable decision-making information. The upside for the ASC community is huge. Global improvements across the ASC sector will allow ASCs to continue to be positioned as a market leader in healthcare. Future programs (e.g. value-based purchasing) will be tied to both process adherence and absence of negative outcomes. While some reimbursement will be tied to scoring, the greater reward for ASCs will be through publicly reported statistics.
Facilities must shift time from reviewing scores to adopting better capture processes and focus more energy in patient issue resolution. The latter provides a wealth of operational effectiveness feedback. An inefficient survey method is counter-productive in terms of effective use of staff time, internal cost and patient loyalty opportunity cost.
If executed properly, your patient, employee and physician feedback serves as input to quality- and process-improvement monitoring. The opportunity to maintain a fluid feedback model is at the industry’s fingertips. This insight will no longer be a luxury but a necessity as the rules within healthcare reimbursement and competition continue to evolve.
Survey effectiveness
There are four components that must all be effective for the entire survey process to be deemed successful: (1) survey content and rationale; (2) the mode of survey administration; (3) leadership access; and (4) patient issue resolution and management.
1. Content and rationale. Many legacy surveys that exist for multi and single-specialty ASCs have not evolved with organization and industry change. A critical success factor is to ensure the final survey deployed reflects facility uniqueness. Each evaluation statement must provide some magnitude of value when responded to. Over time the questionnaire needs to evolve to remove statements providing little or no value. To maintain optimal effectiveness, statements are added to reflect new processes, facility specialty or quality assurance oversight. The survey must contain enough statements to evaluate the entire experience. The facility needs to be able to discern whether individual components of the care continuum are effective and reflect excellence.
Even-scale survey models create a forced response. The patient either agrees, disagrees or has no opinion (not applicable). A middle response of neutral provides no evaluation value and skews both individual and overall scoring. Verbs and adjectives must be consistent. A statement should not attempt to evaluate two different measures. The category responses need to be limited to four options, plus the not applicable choice. Finally, the language needs to be easy to understand and statement with unmistakable clarity.
Two indicators encompass all measures, but do not supersede them. The two patient loyalty indicators measure: (1) if the patient will recommend the facility to others; and (2) if the patient is confident in the care provided. From a clinical standpoint the encounter may have been successful, yet patient loyalty is based on how immediate patient needs were attended to. One negative experience may negate 10 or more positive experiences.
2. Mode of survey administration. The mode of administration may negate feedback value. The chance to capitalize on feedback is highly predicated on (1) timing; (2) percent of response; (3) comments provided; and (4) leadership access. The two critical success factors having the greatest impact on effectiveness are timing and percent of response.
Patient feedback is as good as its opportunity to be actionable. A critical success factor for effective surveying is the ASC’s ability to follow up with patients in a timely manner. This obviously requires the survey to be returned as promptly as possible.
Mailing surveys poses timing and response challenges. It requires time to provide patient addresses to a third-party, and the survey has an outbound and inbound mail delay. It might take 4-8 weeks from the date of service for a return. Typical response rates for mailed surveys range from 15-30 percent.
Handing out surveys at time of discharge removes the outbound mail delay and timing can be reasonable (1-3 weeks). The response rate, however, ranges from 20-35 percent.
Electronic surveying yields the greatest response (45-65 percent) and from a timing perspective, greatly exceeds all other modes (2-5 days for completed return and view). Electronic surveying is the most cost effective as postage is not required, nor is data-entry upon return.
For most organizations, a combination of electronic surveying and handed- out paper surveying works best. A facility should target collecting e-mail addresses from at least 60 percent of their patients and dispel the myth that older people will not respond electronically. In fact, patients 65-and-older comprise the highest percentage responding age group for electronic surveys.
If current survey administration occurs at the end of the visit while the patient is onsite, discontinue this practice immediately. The patient is likely uncomfortable, still medicated and anxious to get home. The feedback includes survey bias and may exclude helpful information the patient may be reluctant to share given their lack of privacy.
3. Leadership access. The survey’s ease of use upon receipt varies from mode to mode. A paper survey is cumbersome when self-administered by a facility. Envelopes are opened and entries might not be tallied until the end of the month. More important, the survey with negative feedback might not reach the right person who should follow up with the patient for days, if at all. Organization leadership has challenged the veracity of results, citing that some negative surveys may be discarded upon return and never be addressed.
Electronic surveys and paper surveys administered by a third party provide leadership immediate feedback. Sophisticated survey providers alert facility leadership to a separate and distinct collection of surveys containing dissatisfaction as these may warrant immediate follow-up. A best practice affords the facility’s gatekeeper to assign the follow-up to the appropriate stakeholder.
4. Patient issue resolution and management. The value of the entire survey process lies in the facility’s effectiveness at following up with dissatisfied patients, as well as creating a knowledge repository of comments, feedback and follow-up.
First, leadership absolutely needs to be immediately alerted to surveys containing issues. Attending to, dealing with and learning from patient issues provides true actionable data. Disgruntled patients should be contacted by the facility associate that can relate to and address the issue, leaving the patient with the confidence that they were listened to and, if action is required, things will be addressed. Patients appreciate time and energy they believe is sincere. The initial goal is to remedy dissatisfaction as early as possible to protect patient loyalty.
Second, the facility must make patient issue data actionable and learn from issues shared. Salient details from the discussion with the patient, as well as staff accountable for explaining the issue must be documented. The patient’s insight gives the facility the chance to review processes to determine if any corrective action is warranted.
Patient issue tracking helps determine if issues are isolated or patterned. An isolated issue may be explainable, yet not be excusable. Patterned issue identification offers an early foray to a process- or quality-improvement initiative. The ability to learn of under-performance at the earliest stage arms the facility with an immediate risk mitigation tool to prevent failure points from perpetuating.
The aforementioned use of patient issue resolution data is transforming insight to “quality intelligence.” Leadership must have access to this data through simple and intuitive reporting that is easily shared at risk management and quality assurance meetings. Internal benchmarks are developed with measurable tracking to ensure the issues are corrected and do not resurface.
Benefits realization begins with leadership
To reach the highest level of benefits realization, leadership must not only buy in but be engaged in the surveying process. Leadership must be active in taking an introspective look at feedback and help define areas of opportunity along with measurable and attainable goals. Leadership must embrace the newer processes and share the importance of improved feedback mechanisms within the organization. A patient-centric model must become hard-wired into the organization’s culture.
Mr. Faraclas is president and CEO of CTQ Solutions. Learn more about CTQ solutions by visiting www.ctqsolutions.com.