Patient satisfaction surveys are an important part of maintaining compliance and ensuring adequate clinical and business practices. However, many clinicians are not properly using the information that is afforded by these surveys.
A typical patient satisfaction survey will address the operations of the clinic, services provided and the actual product received. This could include the greeting at the front desk, the patient’s experience scheduling an appointment, interaction with the clinician, the type and quality of education received about a device and questions about the actual device itself. Although surveys do not have to be standardized, it is important to ask questions that correlate with durable medical equipment, prosthetics, orthotics, and supplies quality standards created by the Centers for Medicare and Medicaid (CMS), as well as the standards set by any accrediting body, such as the Board of Certification/Accreditation (BOC) and American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC).
Once the surveys are administered and returned, clinicians often struggle with collecting the data and turning it into useful information that could improve business practices.
“We did our own surveys in the office basically to be in compliance with anybody that might want to see that we have patient service evaluation forms,” Glenn Crumpton, LPO, CPed, owner of Alabama Artificial Limb & Orthopedic Service, told O&P Business News. “We would get them back, and if we saw a negative mark, we would address it, but otherwise we were doing nothing with them other than to have them in the files and establish compliance.”
This is the case with many practitioners, who often do not have the time or resources to properly review and document all of the surveys that they receive.
“We were getting information, but it was information without real data flow,” John Held, CO, co-owner and president of Great Steps Orthotic & Prosthetic Solutions, said. “We weren’t able to compile the data and use it appropriately.”
One way to amend this issue is to hire a consulting firm to handle the distribution and reception of patient satisfaction surveys. Quality Outcomes is one such consulting firm that specializes in the O&P industry.
“Entering patient satisfaction surveys into an Excel spreadsheet to evaluate them is low on the priority list, but it’s one of those things that has to get done,” Scott Williamson, MBA, CAE, the president of Quality Outcomes, said. “We make it easy for you by essentially bringing in an unbiased outsider giving you manpower that you can’t really spare from your daily operations.”
This is especially important when patients respond with negative comments that should be addressed immediately.
“If the patient responds and indicates that he or she wants to be followed up with or there is a problem, we will send you an email immediately so you can look at that survey,” Williamson said. “So you can respond immediately, and your patients won’t fall through the cracks.”
Hiring a third-party consultant is also advantageous because it can provide an outside and unbiased perspective about how the clinic is being operated.
“When you are deep in the weeds day to day looking at everything, you don’t necessarily get the chance to look at things from an objective perspective,” Williamson said. “So I can bring that viewpoint into your operation.”
Elizabeth Carlstrom, the owner of O&P Business Solutions, expressed similar ideas about the benefits of hiring a third-party consultant to conduct surveys.
“I am an outsider looking in, and I have an unbiased opinion,” Carlstrom said. “Patient satisfaction surveys give a fresh view, and when you have someone doing your surveys who can actually coach you and provide tips and perspective on the overall results, I think there’s the value right there.”
“We need to be able to communicate our results back to our referral sources, and they are going to want to see objective data on why you are making claims,” Williamson said. “If you can point to a third party who says that you are doing well, then you have more credibility.”
Patients are typically more honest on surveys when they understand that a third party will be receiving the results.
“I have found that patients are more likely to be honest when you have an outsider who is reviewing those reports,” Carlstrom said. “They are more honest about the way they were treated.”
Crumpton agreed, saying that “patients are more willing to share how they truly feel if it is an outside source.”
Working with a consultant can also help practitioners maintain compliance with Medicare and other accrediting bodies because their surveys are directly generated out of the standards created by these organizations.
“This is one of those areas where I would rather focus our time on what we do best, and let the professionals handle what they do best when it comes to satisfaction surveys,” Held said. “I have better things for my staff to be doing.”
Surveys can be administered to patients in a number of ways. Traditionally, they are mailed to a patient’s house or given to the patient during a visit with an explanatory letter and stamped and addressed return envelope, but more recently, technology has enabled surveys to be delivered through email.
“We have email delivery, paper delivery or you can do it on an iPad or any kind of web enabled device,” Williamson said. “And we are totally integrated with Futura and OPIE, so it’s an automated process if you are a user.”
Although email simplifies the process, clinicians must be careful about how they approach this method.
“You are dealing with a variety of different folks, and clients have told me that their patients are older and don’t use email,” Carlstrom said. “So they prefer the manual process versus email.”
“In Alabama, there are very rural areas that we serve, and in those rural areas, some of those people don’t have Internet access,” Crumpton added. “They are not going to answer an Internet survey, so we give them a paper copy and let them mail it
in and then input the numbers.”
When using Internet-based services, it is also important to follow all HIPAA and other privacy guidelines to ensure that the patient information remains protected.
“We encrypt our information, and everything is held as if it is protected health information,” Williamson said. “The other thing that is important is that we will never initiate contact with a patient that is not authorized by the company first. We maintain strict confidence of those patient email addresses.”
This is crucial to communicate to patients when asking for personal email accounts, because many patients might be wary of sharing them.
“Some people don’t like to give them out, but I will preface it by saying, ‘by Medicare requirements, we are required to survey people. If you give me your email address, we will email you this and not use your email for any solicitation and that this is only going to be used for your treatment,’” Held said. “And at that point, I would say nine out of 10 people realize that it’s fine.”
But no matter how the surveys are delivered, it is important to at least give patients a few options for completion.
“Generally, we found that we get more responses if we give them more than one option for how they would go about doing it,” Crumpton said.
It is also important to involve the clinicians in the survey process. Patients are usually more willing to answer surveys when asked directly by their clinician, rather than by a member of the front desk staff.
“I have found that it is more successful when I give my clients the tools,” Carlstrom said. “They just give the patient the letter and survey and envelope, and I have found the returns to be much more successful.”
Williamson agreed, saying, “We are seeing that when the practitioners get involved in this process, we are getting a 50% to 60% response rate. But if it comes as a surprise or somebody else tells them, they tend to be less likely to fill out the surveys.”
Involving practitioners in the survey process can also improve relationships with patients.
“It’s a way to communicate, and it’s allowing us to discuss with the patients a little more significantly about their overall health versus just getting a product,” Held said.
Using the survey results
Depending on the consultant a practitioner chooses, the results of patient satisfaction surveys can be delivered in a number of ways. Williamson conveys results on the Quality Outcomes website, where practitioners are given a username to view information in real time.
“It’s displayed graphically, so it’s very easy to look at your company’s scores and reports and see what trends might be developing,” Williamson said.
“You can look at the results in graph or pie form or any number of ways that make it easier to tell at a glance if anything deserves more attention. Then we can drill down, and after we see certain trends within the company, break it down into exactly who is doing what,” Crumpton added.
If practitioners don’t wish to review their survey results online, other consultants, such as Carlstrom, deliver results via spreadsheets and power point presentations.
“I receive the surveys directly from the patients and report on a quarterly basis to my clients,” Carlstrom said. “And then I will give them an end of year overall report.”
The results are broken down by individual practitioner and clinic location, if there is more than one, which allows practitioners to watch for trends and identify specific areas that may need improvement.
“This allows you to find where there is a coachable moment in your staff, and you can make them better,” Williamson said. “We want to use this not for discipline, but for coaching and improvement. It’s a motivational tool and a human resources tool.”
Objective data is also helpful when approaching staff about potential concerns, because staff members might be more receptive to listening to suggestions.
“Being able to actually put your hands on an outside survey gives the employee an extra sense of nonpartisan results,” Crumpton said. “We are not steering the results — this is what the patients are saying.”
Williamson also aggregates the data to allow comparisons to national results, so a practice can identify how it is performing in comparison with others around the country.
“We score all of the surveys the same way every time, and we can tell you how you do compared with your peers,” Williamson said.
“You have to compare apples to apples,” Held said. “I don’t just want to see how my guys are doing against each other. I want to see how we are doing against everyone else. You want to be able to benchmark yourself against the best practices.”
In addition to addressing the standard aspects addressed in a patient satisfaction survey, Carlstrom suggests following up with patients several weeks after they have received their devices to obtain a more accurate idea of patient satisfaction.
“When patients respond if they were happy with the workmanship on the device they received, I’ve seen a pattern of patients saying, ‘it’s too soon to tell,’” Carlstrom said. “They are usually happy with the device when it is delivered, but that may not be the case 2 weeks from then.”
A second survey could be administered when the patient comes in for the first follow-up appointment to address this.
“You have to look beyond the immediate delivery survey and go into post-delivery to manage results,” Carlstrom said. “That way you can actually see the progress, or lack of progress, from a device and monitor the quality of your products.”
Images: Scott Williamson
This can help practitioners identify trends among actual products and any issues that may be present.
“If you are fabricating a device in-house and your patient’s straps have to be replaced all the time, then we need to figure out why,” Carlstrom said. “If you have multiple patients you are following with the same device type, you can actually watch for trends and patterns by device type and material and things like that.”
Even if a clinic chooses not to hire a third-party consultant, it is important that they are monitoring their survey results and looking for potential trends that may need attention.
“With CMS, there is an entire section of performance management that is also required by both ABC and BOC,” Williamson said. “And one of the big things they want you to do as accrediting organizations is to look at your data and identify and spot trends and tell them what you are doing about it.”
The survey results could also reveal positive trends within a clinic that reinforce the value of certain business practices. For example, Crumpton said that before he started analyzing his practice trends, he was unaware of how beneficial the post-mastectomy care division was.
“We wondered if it was even a valuable service to have, because it’s not a profit center,” Crumpton said. “But we found that it creates such good will for the patient that we were going to keep the service.”
“Recognize the good that you are bringing to patients’ lives and use it to your advantage,” Williamson said. “We are trying to make you aware of that through the surveys and help you promote it.” — by Megan Gilbride
Disclosure: Williamson is the president of Quality Outcomes. Carlstrom is the owner of O&P Business Solutions. Held and Crumpton have no relevant disclosures.