Assessing Patient Experience
Assessing patient experience means measuring that experience, and fostering an environment that encourages and sustains improvements. The increasing importance for organizations to formally obtain patient feedback has become evident as more and more government agencies and regulators require implementation of patient satisfaction surveys, and in some cases tie reimbursement to scores. The Health Resources and Services Administration (HRSA), for example, requires federally funded health centers to conduct a patient satisfaction survey. Health centers with patient-centered medical home designation have met strict criteria on how to implement surveys and use the resulting data. As a result of the Affordable Care Act’s Hospital Value-Based Purchasing program, Medicare is rewarding or penalizing hospitals financially based on their patient experience scores.
Why is measuring patient experience so important?
Because patient data can be used to guide improvements in services and increase an organization’s ability to compete in the marketplace. Feedback can (source: Community Health Association of Mountain/Plain States):
- Improve patients’ health, compliance, and confidence in treatment
- Inform quality improvement efforts
- Show patients that their physicians care about their input
- Reduce malpractice suits
- Inform contract negotiations
- Contradict negative ratings/profiles
Patient satisfaction vs. patient experience
Although the terms sound similar, there is a difference between measuring patient satisfaction and measuring patient experience. Patient satisfaction questions subjectively measure how well a patient’s expectations were met. If a person has low expectations, then their satisfaction might be higher, and vice versa. The following are examples of patient satisfaction questions for which patients are asked to respond by checking a box corresponding with great, good, OK, fair or poor.
- Please rate your ability to get an appointment when you need it.
- How well do you think your provider did in listening to you?
- How would you rate the friendliness of your nurses and medical assistants?
Patient experience questions, on the other hand, ask about objective experiences with the health care provider that can be quantified in some way. Examples of patient experience questions are:
- In the last 6 months, how often did you see your provider within 15 minutes of your appointment time?
- In the last 12 months, did anyone in your provider’s office talk with you about specific health goals?
- In the last 6 months, did someone in your provider’s office talk to you about things in your life that worry you or cause you stress?
Patient satisfaction/experience survey tools
The most widely used and validated patient experience survey is the Consumer Assessment of Healthcare Providers and Systems (CAHPS), developed by the Agency for Healthcare Research and Quality (AHRQ). The surveys are free and provide standardized measures of patient experiences in a variety of settings. Organizations that use a CAHPS survey can compare their results with other organizations. Multiple question sets are available, such as:
- The CAHPS Clinician and Group Survey. This survey was endorsed by the National Quality Forum in 2007, and is comprised of over 50 questions that measure the experiences of adults and children in primary and specialty settings. The practice or a certified vendor mails the survey to the patient, who completes it and returns it by mail. The survey can be completed in about 15 minutes.
- The CAHPS PCMH survey. This question set was developed to assess performance related to the National Committee for Quality Assurance (NCQA) standards for the Physician Practice Connections-PCMH.
Patient satisfaction/experience data can be collected in a variety of ways, whether by a mailed survey, an online survey, or a response card after a visit. A clinic may use a validated survey, such as CAHPS, or use a hybrid or original survey. It might use a third-party administrator, or conduct the survey and collate the data themselves.
An example of another survey tool, in contrast to the longer CAHPS survey, asks patients only two questions. The goal of the Pulse One-Minute Survey (POMS) is to have more patients give more immediate feedback before they leave the health center. The questions are:
- On a scale of 1-10, how would you rate your experience today?
- Thinking about your overall experience during today’s visit at this health center, including your provider, care team, clerks and receptionists, what worked well and what can be improved?
The patients answer the questions on a card and place it into a box in the clinic’s waiting room. The clinic then sends the cards to a third-party vendor, which analyzes the responses and sends a report back to the clinic with their findings and possible areas of improvement.
Other patient feedback methods….
The following are additional patient feedback methods culled from the CAHPS Improvement Guide and the California Healthcare Foundation (see webpage resources below) that practices might consider as tools to enhance the patient experience. A description is provided for each strategy.
- Focus groups: Staff and/or patients are brought together in a moderator-led discussion group to collect information about a specific problem and ideas for improvement strategies. When possible, videotaping focus groups and showing the footage to staff can have an even greater impact in changing staff attitudes because hearing and seeing patients tell their stories brings to life the emotional impact of service successes and failures.
- Walk-through: Staff members play the role of patients and family members. They go through the clinic procedure exactly as a patient and family member would in order to identify system, flow and attitude problems. A walk-through is not only an effective way of re-creating for staff the emotional and physical experience of being a patient or family member, but it may uncover rules or procedures that have outlived their usefulness.
- Shadowing: With the patient’s permission, a staff member accompanies him or her through a visit and takes notes on the experience.
- Complaint/compliment letters: By reviewing these letters, a clinic can get a picture of what is working well and what issues need to be addressed.
- Comment cards: The purpose of the comment cards is to give a patient the option to provide feedback after their visit. The cards can be structured to ask patients to rate service quality and to give feedback about their overall experience, or they can be completely open ended and provide a vehicle for comments that patients would like to make.
Assessing Other Needed Changes to Increase Satisfaction. In addition to obtaining feedback from patients/clients, an organization can engage in other activities that will yield clues on how to improve patient satisfaction. Conducting audits on the staff’s customer services skills, or on a facility’s cleanliness and atmosphere, can help focus an organization’s attention on areas of improvement. Understanding how a patient/client experiences the workflow as he or she moves through a visit can also help inform areas of improvement. In addition, measuring staff satisfaction can identify areas in which employees may be dissatisfied, and where their feelings might affect their ability to provide good customer service. Patients are more likely to be satisfied when employees with whom they interact are happy with their work.
Patient satisfaction/experience tools
- CAHPS survey (.pdf) — Use the Clinician and Group Surveys to ask patients to report on and rate their experiences with a specific primary or specialty care provider and his or her practice. The CAHPS PCMH item set has additional patient experience questions. Additional surveys are available on the AHRQ website.
- IBHP Integrated Behavioral Health Patient Satisfaction Survey (.pdf) — Use this tool to review how patients are experiencing care in an integrated behavioral health setting.
- Patient Satisfaction Survey (.doc) — Customize and use this tool to review how your organization is doing. The tool includes guidelines for administering the survey; a formula to estimate the cost of administering it; a description of how to calculate the sample size; and recommendations for data collection, analysis, and reporting (Source: SAMHSA-HRSA Center for Integrated Solutions).
- Primary Care Clinic Satisfaction Survey(.doc) — Customize and use this tool from Coastal Behavioral Primary Care Clinic to review how your organization is doing (Source: SAMHSA-HRSA Center for Integrated Solutions).
- Sample Patient Experience Survey (Spanish version also available) — adopt this tool to measure patient experience in a medical setting (Source: The Midwest Clinician’s Network).
- Sample Behavioral Health Patient Experience Survey — adopt this tool to measure patient experience in a behavioral health setting (Source: The Midwest Clinician’s Network).
- Sample Questions For A Client Experience Focus Group(.doc) — Customize and use this tool to review how your organization is doing.
Other supportive tools
- Staff Customer Service Audit Tool (.doc) — Customize and use this tool to audit/observe staff customer service. (Note: I suggest changing title of the Word document to “Staff Customer Service Audit tool”)
- Facility Audit (.doc) — Customize and use this tool to review how your facility stacks up.
- Patient privacy checklist (.doc) — Customize and use this tool to review how staff are doing.
- Sample Employee Satisfaction Survey (.pdf) — use this tool offered by the Midwest Clinician’s Network to measure employee satisfaction and identify areas of improvement.
- Questions to Consider in Redesigning Workflow (.doc) use this tool to answer questions that help organizations understand how workflow affects the client’s experience (courtesy of Anthony Salerno, PhD for the National Council for Behavioral Health, SAMHSA and HRSA).
- The CAHPS Ambulatory Care Improvement Guide: Practical Strategies for Improving the Patient Experience webpage is a comprehensive resource for health centers, medical groups, health plans, and other providers who are seeking to improve their patients’ experience.
- California HealthCare Foundation’s Patient Experience webpage offers numerous articles on enhancing the patient experience, with several articles focused on health centers.
- Patient Satisfaction/Experience Surveys and other resources are available from the Community Health Association of Mountain/Plains States.
- Triple Aim Measurement Toolkit for Health Centers from American Institutes for Research provides detailed information on how to achieve the triple aim of improving patient experience, improving the health of populations, and reducing costs of care.
- Association for Patient Experience is a nonprofit organization sponsored by the Cleveland Clinic that has numerous resources for patients, families and providers.