Most of us use CMS’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) to gauge how inpatients perceive their hospital stay as our basis for understanding patient satisfaction. While HCAHPS does provide valuable insight into the patient experience, it has its limitations, including low response rates and lag time between hospitalization and availability of results.
About two years ago, CEP America’s EDs at Banner Del E. Webb Medical Center and Banner Boswell Medical Center began using care cards to facilitate communication between providers and patients. The card lists provider names, tests ordered, results, and expected wait times. It also includes a section for patients to write down their questions.
After introducing the care cards, we noted some real improvements in our satisfaction scores. Unfortunately, we had a lot of difficulty getting traction with the program. The cards didn't fit into our existing workflows, and they weren't used consistently. So eventually we put the program on hiatus in order to rethink our approach.
Collecting Feedback at the Bedside
A few months ago, we launched a new patient satisfaction initiative. In addition to reintroducing the care cards, we wanted to find a way to gather real-time patient feedback to identify service issues quickly. We hoped that addressing problems while the patient was still in the hospital would help boost patient satisfaction scores on the mail-in survey.
After researching options for a real-time patient feedback system, our team decided to partner with Qualitick. The vendor’s tool enables us to gather critical performance data at the patient’s bedside via tablet computers. The system allows us to customize questions specific to our health system and provides reports to help us identify trends in safety, service, and quality.
The tool is incredibly easy to use. But it does require training and a dedicated group of people to gather feedback from patients. We also needed to determine the best time during an ED encounter to invite this feedback.
At Boswell and Del Webb, we use scribes to administer the survey. They gather feedback in the patient’s room at the end of each encounter, just prior to the nurse returning with discharge instructions. Patients are asked 10 questions about their encounter, including:
- How would you rate your experience today?
- Is there anyone in particular you’d like to acknowledge?
- Is there anything we could have done better?
Spotting Problems in Real Time
Prior to implementing this program, we had to wait six to eight weeks to get results from a paper survey or follow-up phone call. The great benefit of collecting patient satisfaction in real-time is that the scribe can immediately alert the provider to a service issue so that we can begin service recovery to fix the problem.
The feedback tool also features an administrator dashboard that shows us real-time data. We can break it down by question or by provider. We’re able to gather immediate feedback and quickly hone in on a problem. If it’s a one-off complaint, we work with the patient to resolve it. And if we see a pattern emerging with a particular provider or department, we can step in and address it.
While our ED team members have great clinical skills, issues sometimes arise related to their interactions with patients. For example, if someone doesn’t take the time to explain discharge instructions or the patient receives the wrong prescription, we can alert the provider so that he or she can immediately correct the problem.
Now, when the patient receives the survey in the mail, their answer to the question is, “Yes, I did understand my discharge instructions,” or “Yes, I got the right prescription.”
Considerations for Implementing Real-Time Patient Satisfaction
While the tool is relatively simple to use, there are some issues to consider before jumping into the world of real-time patient satisfaction surveying.
Who will administer the survey? We use scribes because they’re working in a similar capacity with patients already. You could also utilize another hospital-based employee or even a volunteer.
What is the cost? With the vendor we chose, we paid a one-time fee for each of the iPads and also pay a monthly fee for the service. Right now, CEP America is covering the cost of the survey tool under an innovation grant. CEP’s innovation grants support new ideas that can be replicated across CEP America sites. You’ll need to include the cost for an electronic real-time patient feedback system in your budget.
We implemented our program about two months ago at Boswell and more recently at Del Webb, and we’ve already seen positive results.
At Del Webb, where satisfaction scores had been trending downward for several months, we’ve seen a recent uptick. That may be partially attributable to the reintroduction of the care cards. I believe it’s also because we’re doing some real-time service recovery in the ED as a result of the immediate patient feedback we’re gathering.
We’ll continue to monitor the results of our real-time patient satisfaction program. This feedback is valuable not only in helping us identify and correct issues, but also in recognizing physicians, nurses, and other staff who receive positive feedback. There’s so much we can do with this immediate and personalized data; we look forward to further developing our program in the coming months.