QP in Healthcare Chp 7: Measuring Customer Satisfaction
Commonly, tangible products include such things as
facilities, equipment, and appearance of personnel. However, a more intangible product would be information that is collected in a database. It is used by many customers, but only rarely would that database be printed out on paper in its tangible form.
It is easier to aggregate data from
A survey than information from an interview because surveys usually are composed of structured responses. The responses to interview questions, on the other hand, must be analyzed to identify common themes and perceptions.
Currently, pain management is an important function, as noted by various public and private entities. Pain management is:
A continuous process; patients' pain must be monitored, and their medication dosages must be adjusted, when necessary, to keep pain within their individual tolerance levels.
Direct observation
A data collection method in which the researchers conduct the observation themselves, spending time in the environment they are observing and recording these observations
Often, the only time a department representative hears about the expectations of internal customers is when
A process has been mismanaged or has resulted in a negative outcome. Giving internal customers the opportunity to vocalize their expectations increases their overall satisfaction.
The construction of an effective survey tool, a research instrument used to gather data and information from respondents in a uniform matter, requires
A significant investment of time. (See the discussion of survey tools later in this chapter.)
Perceived quailty
Also an important aspect of healthcare service. This consists of the organization's reputation for the quality of its services and consumer reaction to these services and products based on their experiences with the organization.
As discussed in chapter 2, researching and defining performance expectations includes:
An investigation of what the customers of an organizational process expect from that process.
Customers receive a product or service as a result of:
An organizational process.
Reliability
Another aspect of quality that customers may emphasize in their evaluations of healthcare performance. Reliability is the level at which an organization can provide an offered product or service when requested and as advertised.
Step 1: Identify Internal and External Customers
Assessing whether a process meets the expectations of its customers is difficult when some customers have not yet been identified. To identify customers, the performance improvement (PI) team should list everyone who comes in contact with the process and takes away a product or a service. (See figure 7.4.)
Empathy
Can be defined here as the staff's willingness to relate to customers during the provider-customer relationship as fellow human beings who have feelings and emotions. This can be a particularly important aspect in healthcare settings because when people are ill, they frequently have emotional reactions to the illness.
Emergency care physicians are the customers of
Central supply services when they request sterile suturing trays to close a patient's laceration.
Because there are many types of organizational processes, there are also many types of customers. Their expectations:
Characteristics that customers want to be evident in a healthcare product, service, or outcome, must be identified and incorporated into the design or redesign of an effective process.
Identifying the patient, client, or long-term care resident as a customer should seem fairly straightforward. But,
Customers can be identified for all kinds of healthcare processes. The families and friends of patients are the customers of volunteer services when they ask for a patient's room number.
Although HCAHPS is a core set of questions, hospitals may also add:
Customized questions to reflect their organization and services lines. These additional questions would not be publicly reported, but hospitals can use this additional data to support improvements in internal customer services and quality-related activities.
Once the process or service is identified for improvement, the PI team must:
Determine which aspects are relevant to the process or service under examination and then complete the cycle of measurement and improvement, as necessary, regarding each aspect.
Features are the aspects of healthcare services that:
Distinguish one organization from another or that add particular value in the customer's evaluation of an organization. For example, an organization may be renowned in its community for providing exceptionally successful heart disease treatment with few negative outcomes, while employing the latest in diagnostic imaging and therapeutic modalities; or an organization may have upgraded its service by adding a number of new birthing centers at its facility.
Step 3: Identify Quality Measures and Satisfaction Scales for Each Product and Service
For each quality aspect of a product or service, performance measures must be identified. For example, if a PI team was assessing a patient's experience at a physician's office for a medical appointment, waiting time would be a relevant performance measure. After the team identified waiting time as a performance measure, the team would need to develop a satisfaction scale. The PI team would need to decide whether to measure waiting time in seconds, minutes, or hours.
HCAHPS provides an approved vendor list for
Healthcare organizations to complete their patient satisfaction surveys. (See table 7.1.) Most of these surveys also provide healthcare organizations with important benchmarking feedback, which measures their customers' satisfaction against that of other, similar
Just as we can identify the customers of a clothing store or an auto dealership, we can also:
Identify the customers of a healthcare process. For example, when a nurse inserts a catheter into an artery to administer medication, the patient is receiving a service from the nurse. Or when a pharmacist dispenses a medication to a patient, the patient is receiving a product from the pharmacist.
The HCAHPS survey can be used by organizations to:
Identify their performance on quality measures and their level of patient satisfaction. The HCAHPS questionnaire is mailed to a sample of discharged hospital patients who, after completing it, return it to a vendor for aggregation and analysis of results.
Customers can be placed in one of two categories:
Internal customers or external customers.
It may or may not be important to look at the quality of a healthcare product or service from all of these aspects. In the process of planning the PI activities for a period of time:
Leadership must be willing to prioritize the impact of the possible projects on the organization's performance, the number, and scope of projects that realistically can be undertaken given available resources, and the criticality of making the improvement at this particular time.
With external customers, particularly patients, identifying expectations about service quality is
More complicated. Patients' expectations are multifaceted and often based on the condition for which the patient is being treated. Assessments of patient expectations must be undertaken judiciously.
It is important to recognize that internal and external customers:
Must be identified in relation to the organizational process under consideration. Each process has a unique set of customers whose needs and expectations must be recognized.
Step 4: Collect and Aggregate Data on Each Performance Measure
Next, the PI team should determine the best methods for collecting data on each performance measure being assessed. In assessments of customer satisfaction, the principal methods of data collection are survey tools, interviews, and direct observation.
The opinions of internal and external customers regarding the effectiveness of a healthcare process should be:
Of primary importance to healthcare organizations. No one is a better judge of products and services than the customer. In addition, a dissatisfied customer is said to tell 10 times as many people about a negative experience than the satisfied customer is to relate a positive experience.
Reliability example:
One hospital in the western United States advertises that patients visiting its emergency department will receive care within 15 minutes. To be judged reliable by customers, that 15-minute goal must be met when they show up for emergency services.
External customers are individuals from:
Outside the organization who receive products or services from within the organization. In the preceding examples, patients, family members of patients, and friends of patients are external customers.
Administrative subjects, such as
Parking, hours of operation, room decor, and so forth, can be assessed using an anonymous patient satisfaction survey.
A statement such as "Your completion and return of this survey implies your consent to use your feedback for quality improvement purposes" should be
Prominent in the survey introduction so that respondents are aware that their responses will be used individually and collectively. If patient or client responses will be identified as specifically belonging to them by name or associated to information gathered from their health records, organizations may want to include approvals from privacy officers or privacy boards to ensure compliance with current privacy laws and regulations.
Responsiveness
Refers to how an organizational staff responds to unanticipated service needs. This includes staff willingness to continuously monitor both the customer's condition and his or her satisfaction with services.
In determining the customers of a process, however, the organizational frame of reference also must be taken into consideration:
Sometimes the frame of reference modifies the customer type, as is graphically displayed in figure 7.1. Figure 7.2 graphically displays an overhead view of figure 7.1. The large oval is Western States University Hospital as a whole organization.
When major illness strikes, or when fragile individuals such as children or the elderly are involved, the emotional response can be intense. Healthcare customers expect that:
Staff and providers will understand these kinds of feelings and help them cope with these trying situations.
Healthcare organizations have been collecting data on patient satisfaction for many years, but there has been a lack of:
Standardization of this process.
Step 2: Identify Products and Services Important to Customers
The PI team should develop a list of the products and services used by internal and external customers. However, not every product is tangible—it is not always seen and evaluated as an object in the environment.
Customers judge responsiveness to pain management on
The basis of the staff's willingness to go the extra distance to attend to this often continually changing need.
The healthcare PI term assurance describes
The knowledge and courtesy of the staff that provide the goods and services. This aspect of care quality generates customer trust and confidence in both the individuals providing the products and services and the products and services themselves.
Surgeons are the customers of
The pathology laboratory when they request frozen-section examination of tissue in the operating room during resection of a breast lesion.
In the preceding examples, surgeons are the internal customers of:
The pathology laboratory, and emergency care physicians are the internal customers of central supply services.
Similarly, the health information professional is a customer of:
The patient registrar or admitting clerk, because the health information professional relies on the patient registrar to collect accurate demographic information to properly identify the patient in the electronic health record and assign the correct health record number.
Patient expectations about subjective topics, such as pain management, are completely different from one patient to the next. Another highly subjective area that influences a patient's satisfaction is:
The patient's return to an acceptable quality of life after treatment. One of the most important factors that influence patients' assessments of their care is how they are treated by caregivers.
Outcomes of care are not necessarily tangible, either. To report outcomes of care:
The recipient of the care service needs some established means of describing the outcome, or clinical staff may have to use healthcare monitoring instruments to determine improvements in the patient's condition. For example, heart monitoring equipment might need to be used to determine whether a drug has had the appropriate effect on a patient's arrhythmia.
If the frame of reference is at the departmental level, as depicted in figure 7.3:
The surgeons would be identified as the external customers of pathology lab processes and the pathologists would be identified as the internal customers of the laboratory technicians who process the specimens.
The healthcare organization's institutional review board (IRB) should preapprove
The use of any data-gathering tool. IRB approval is mandated by federal regulations on the use of human subjects in biomedical and health services research.
Patients are external customers because
Their frame of reference comes totally from outside the organization.
Although policies and procedures vary across organizations, PI teams using such data-gathering methodologies should recognize
Their responsibility to obtain IRB approval to maintain the highest research standards respecting their human subjects. If the organization has no IRB, then either the quality council or the committee involved in the approval of PI projects should review the use of all tools.
Interviews are often easier to use than survey tools because
They consist of a series of open-ended questions, which are posed to individuals either in person or by telephone to collect information about their experiences with the organization or unit.
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey
Was initiated to provide a consistent format and process for gathering patient satisfaction and perspectives on hospital care
Assurance example
When a patient selects a physician, assurance is a key consideration. If the new patient does not trust the physician's judgment, he or she will probably question the outcome of all visits or find another provider.
There are several ways for an organization to obtain information about its customers' perceptions of its products and services.
With internal customers, the organization can simply ask them. Many internal customers never get the opportunity to express their expectations in a positive context.
Within the healthcare organization setting, internal customers are:
individuals within the organization who receive products or services from an organizational unit or department.
When we think of the organization as a whole, surgeons, on the other hand, are identified as
internal customers because they are members of an organizational unit—the medical staff.
Clinical subject matter pertaining to the patient's condition and medical and nursing treatment, however:
may need to be assessed from the viewpoint of the clinicians involved in the patient's care and the outcomes achieved through that care.
Since 2008, HCAHPS has allowed valid comparisons to be made across hospitals locally, regionally, and nationally. The HCAHPS survey includes three broad goals:
• Collect consistent data on patients' perspectives of their care that allow for comparison between hospitals • Publicly report survey data in order to incentivize hospitals to improve their quality of care • Enhanced accountability for care provided (HCAHPS 2015a).
To monitor and improve customer satisfaction, an organization must know
• Exactly who its customers are • What its customers want and value • What improvements could be made to better meet its customers' needs
The vendor then reports the results of the HCAHPS to CMS. The areas of focus on the survey include:
• Quality of interactions with nurses in terms of courtesy and respect • Quality of nurses' ability to listen to the patient • Ability of nurses to explain relevant aspects of care to the patient • Call button response times and attitudes • Quality of interactions with physicians in terms of courtesy and respect • Quality of physicians' ability to listen to the patient • Ability of physicians to explain relevant aspects of care to the patient • Cleanliness and quietness of the care environment • Quality of assistance with ambulation and elimination activities • Sufficiency and attentiveness of staff to pain medication • Education of patient about medications administered in hospital • Planning for post-discharge assistance and continuing care • Overall rating of the hospital