Brian S. Kern. Medscape. Dec 30, 2015.


"What else can we do for you?"

It's a simple question, but it's remarkable how many doctors, nurses, and other members of a practice's staff don't ask it before the patient leaves the office or is discharged from the hospital.

Managing patient "satisfaction" is more important than ever, and—like practicing medicine—is an art as much as a science. The patient experience begins with the very first encounter, and literally continues for a lifetime. Given the ever-increasing benefits associated with satisfied patients, and the detriments that unsatisfied ones can bring, it's imperative for physicians to incorporate a comprehensive patient satisfaction survey process into their practice.

Ask and Ye Shall Receive

The best way to find out how patients feel about their care is to ask them. Yet asking them at the point of care or upon discharge can be misleading. Patients might be too intimidated or flustered to give honest and thoughtful responses. Sending out surveys several days after care can be more valuable, and creates the opportunity to ask a wide range of questions: from how patients were treated by the staff, to whether they understood their care plan and whether they would be comfortable recommending your practice to others.

A clear, simple, and straightforward process of questioning patients and soliciting their feedback can produce tremendous benefits in five key areas.

1. Communication

Physician who communicate effectively with their patients can accomplish two fundamental healthcare goals related to patient satisfaction and delivering effective care: informed consent and patient engagement.

Signed consent forms are effective tools in defending against medical liability lawsuits, but they don't necessarily reflect a patient's true comprehension of the recommended treatment and alternatives. The survey process not only helps ensure a patient's understanding of their care plan, but adds another layer of protection if you're sued for a bad outcome.

Ensuring that patients are "engaged" in their own care is an old concept, but with new ramifications. That's because appropriate patient engagement is required as a condition to participate in many shared-savings programs, such as accountable care organizations and patient-centered medical homes. Simply by asking the right questions and having them properly documented, practices can achieve these goals.

Important Benefits of Patient Surveys

2. Reduced Risk

It's frequently argued that patients who like their physicians don't sue them. Even if true, having a great relationship with your patient isn't a foolproof way to avoid a lawsuit. Not only do we live in a litigious society, but spouses and family members who experience the loss of a loved one may not have any knowledge of the strength of a patient's previous relationship with his or her provider. Over time, a series of positive responses to patient satisfaction surveys can demonstrate precisely how great a relationship was—both to family members and to jurors.

Negative responses, instead of being ignored, can provide information needed to improve relationships. Perhaps a patient was treated rudely upon arrival, waited too long without being told why, or was never called with important lab test results. These factors are entirely outside the direct physician/patient relationship, but they're all relevant to the welfare of the practice and can be uncovered through surveying.

Of course, a patient may simply not like his or her physician, for any number of reasons. Isn't it better to find this out early and address any issues up front, rather than wait for a plaintiff's attorney to address them in court?

3. Practice Management

By nature, physicians are competitive people who are accustomed to receiving high marks whenever assessed. Accordingly, the initial results of patient satisfaction surveys can be emotional (they rarely, if ever, reveal 100% satisfaction). In the long run, though, effective surveying can be a road map for providers to improve their relationships with patients, enhance the overall care experience, and produce better outcomes.

Armed with real-time patient satisfaction scores, practice leaders no longer have to play the role of judge or referee; they can simply report findings. The results of patient satisfaction surveys speak for themselves, and can be powerful tools to drive change.

4. Your Online Reputation

How a patient chooses a physician may come down to what he or she finds on the first page of an Internet search engine. Many sophisticated physician-rating programs publish scores without any clear explanation of their algorithms or limitations. For example, a physician with hundreds of responses and a four-star rating may provide far better care than one with just a single five-star response. But after only a cursory glance, a patient may make an appointment with the "five-star" physician.

What's worse is that physicians with low online patient satisfaction scores rarely receive any guidance on how to improve them. By controlling the process, physicians can learn and master the game, not just accept the score.

Individual patients wield tremendous online power. Just one unhappy patient who can navigate rating sites or even social media can do significant harm to a practice, particularly by including a damning testimonial.

Practices often feel helpless when they receive bad ratings or in responding publicly to angry patients. To fight back, practices can publish their own (third-party verified) patient satisfaction data and their straightforward criteria, while simultaneously bringing greater transparency to their operations.

You Can Even Do Better on Revenue

5. Reimbursement

An increasing number of payer compensation programs—both government and private—incorporate patient satisfaction scores into their metrics. If physicians don't achieve minimum satisfaction scores, they'll lose valuable dollars.

Unfortunately, physicians often are kept in the dark about how payers gather patient satisfaction information, causing them to struggle over how to improve the results.

These realities have led some physicians to gather data on patient satisfaction by conducting their own surveys. Once they become familiar with the program and questions, physicians are generally able to improve their scores quickly. To align with external compensation structures, groups can adjust their internal compensation formulas and include patient satisfaction scores as a component.

If the patient satisfaction system is sophisticated and comprehensive enough, there's no reason why it can't, and shouldn't, be used as the shared-savings program metric in lieu of the ones used by payers.

Some Important Next Steps

There are various ways to conduct patient satisfaction surveys. Many small groups elect to use an internal and simple surveying process, and may ask just a few questions. More sophisticated healthcare systems, by contrast, will usually outsource the process. Although some companies are still primarily using paper, electronic formats that can display results in a dashboard setting can prove beneficial in many ways, including:

  • Easier for practice leaders to navigate the results and present them to physicians;

  • More effective when using the data to negotiate with payers;

  • Can satisfy the requirements of other reimbursement/government programs; and

  • More organized in the event that results are posted online, to combat incomplete or underrepresented surveys shown at other web sites.

When reviewing patient satisfaction programs, physicians should focus on the questions being asked to ensure that the answers can provide insight and guidance on the topics and issues most meaningful to them. As important, of course, are the results, though you shouldn't expect everyone to jump at the opportunity to provide you with feedback—surveying programs commonly generate less than a 10% response rate, with some of the better ones getting closer to 30%.

Own the Data

Regardless of which approach you or your group chooses, always conduct proper due diligence before commencing a comprehensive surveying campaign. Healthcare will continue to change rapidly, and the winners won't necessarily be the ones with the most data, but the ones with the best data.

It's time for physicians to stop relying on data created by the very parties with whom they must negotiate, and start collecting their own. Implementing a comprehensive patient satisfaction program is a critical first step.


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