Using Patient Satisfaction Surveys for Practice Improvement

For Sutter Independent Physicians (SIP), patient satisfaction surveying was a fragmented process. According to the independent physician association (IPA), giving practices actionable insights about the patient experience that could yield effective practice improvement efforts had long been a challenge.

That is, until the organization tapped point-of-care patient satisfaction surveying.

“Our aim really is to work on improving the clinical quality of care and then the service quality of care,” Jose Arevalo, MD, the chief medical officer for SIP, told PatientEngagementHIT. “And this effort is related to the service quality of care, identifying the voice of the patient, and using that information to identify opportunities for improvement in providing service to the patients we serve.”

Most experts agree that having detailed insights into the patient experience, usually collected via patient experience surveying, is the best bet for getting to that practice improvement. That survey data can help an organization pinpoint key patient pain points and understand which stakeholders will be important in implementing practice improvement.

But at SIP, which serves almost 600 independent docs in the Sacramento metropolitan area, that process was fragmented, leaving the IPA without the tools it needed to guide its participants in practice improvement.

That’s in large part because not every practice within the IPA is using the same type of technology, according to Debbie Young, the Service Excellence manager for SIP. The IPA is part of Sutter Health, a large and notable health system in the US. And even though SIP used the same patient satisfaction survey vendor as the larger Sutter system, only about a third of SIP’s independent docs were using the same EHR.

And that seriously hampered their ability to get those surveys out to patients.

“So, it really wasn't telling the story of the patient experience that we knew existed within our community,” Young said in the same phone interview.

That limited survey dissemination, which Arevalo added was further impeded by patient privacy efforts and the mail-out survey process, created some response bias. In the past, SIP considered a good response rate somewhere around 20 percent, and Arevalo noted a lot of times those responses came from folks who felt passionately about a good—or bad—clinic experience.

“If you delay surveying over a period of time, then you'll get a select or so-called biased population that either has a lot of great things to say, or unfortunately people don’t remember it,” Arevalo explained. “Or you select out people that may have not had the best experience. So that overall, when you look at the results, it may look biased one way or the other.”

But using point-of-care patient satisfaction surveying from CipherHealth, SIP was able to obtain more granular, and ultimately more accurate and actionable, information. The surveys are hosted via tablets within the actual clinic, which lets independent practices collect patient information right when the patient receives care.

According to Arevalo, it also lets practices circumvent some of the bureaucratic barriers to disseminating patient satisfaction surveying.

“Moving to a point of service survey, it was right then and there we would get the information,” he explained. “We said, we want to know what the experience of all the patients are, because it's critically important that we identify the whole voice of the patient. It's critically important that we understand what the experience is.”

It was that promise of more actionable insights that led SIP to get buy-in from its independent practice participants, Young explained.

“We've now gotten a lot more buy-in from our physicians, because we really wanted to be able to provide the IPA with a survey and a reporting solution that really enhanced our quality initiative, and that really differentiated us from the medical group,” she explained.

“A lot of our physicians are data-driven, and utilization of our survey with the improvement initiatives, really provides that quantitative data that the physicians are looking for to really see that the changes that they're making are making a difference,” Young continued.

To that end, the IPA needed to be judicious about how it built out the patient satisfaction survey questions, both Young and Arevalo pointed out. It was important that SIP ask patients questions that would yield data about factors that the organization truly cared about, while also letting SIP compare how the IPA is performing against the medical group.

Young said SIP selected a key set of questions from the CAHPS survey, a national industry standard. Young and her team carefully pulled out only the most relevant questions out of the more than 28 questions on the CAHPS surveys, homing in on the criteria and feedback SIP needed to shape practice improvement programming.

The organization also peppered in some questions from its annual patient assessment survey.

“Being an IPA, one of the things that was important to us as an organization is we also wanted to align with better health,” Young stated. “Because we wanted to be able to share that comparison of how the IPA is performing against the medical group.”

Arevalo added that this mixture of questions allowed SIP to assess both internal and external patient experience metrics. The patient assessment survey is unique to SIP and Sutter, while CAHPS survey results are publicly reported on an annual basis. Including both in the point-of-care survey means SIP can see a reflection of what the external world sees, as well.

Ultimately, this information drives practice improvement efforts guided by the IPA. After all, patient satisfaction insights are only as effective as they are applied to change management.

With Young at the helm, SIP has developed a number of strategies for guiding individual practices through clinical improvement projects. The Service Excellence team is able to build educational programming using the data gleaned through the point-of-care patient satisfaction surveys, and then incentivize practices for attending those forums. According to Arevalo, those forums are very well-attended.

“We have several of the practices who really want their patients to have an optimal experience,” Young added. “In addition to those programs that we're doing for our entire population, we also have created coaching compacts where I have coaches who are at the elbow support with the practice, focusing on a process improvement initiative, based on the feedback of their patients.”

And in a third program, the Patient Experience Champions program, Young and her team empower individual practice staffers in leading clinical quality improvement.

“We have found in our interactions with our independent practices that we have some staff who really embrace patient experience, but maybe they don't have as many opportunities to really develop that skillset,” Young explained.

“Because a lot of our practice managers and practice administrators are just so busy that this allows us an opportunity to extend our reach and to really develop those practices, to have what they need to be able to be successful on their own.”

At the end of the day, this kind of data collection and then practice improvement is essential to remaining competitive in an increasingly competitive market defined by healthcare consumerism.

“When we developed this excellence program, idea was the competition is doing this, the competition is measuring the voice of the patient in a variety of ways,” Arevalo concluded.

“If we, as an independent practice association, don't create a high-level tool that can really help us understand the voice of the patient, but more importantly is use the results of the tool to find ways to improve care. If we don't do a high-level program like this and don't really work to improve the patient experience, then it's going to be a disadvantage to these practices.”