ASA October 2003 Newsletter

I was amazed recently to look at a report from a consultant hired by a hospital authority to measure patient satisfaction. The parameters had moved from 80 percent to 0 percent and vice versa in two consecutive quarters, which was really absurd. Even stranger was the fact that the administration believed these numbers to be credible as they were given by a “consultant”!

Patient satisfaction surveys are becoming increasingly important to medical practices in today’s health care industry. Even insurance companies and health care maintenance organizations have started to depend on them. Often consultants are hired by administrations, and doctors and nurses are advised to modify their practices on the basis of the consultants’ recommendations. To save ourselves from such situations, it is wise to maintain our own client-satisfaction profile.

There are several programs on the Internet that may help us be our own consultants and conduct our own patient satisfaction surveys. Two very simple templates were developed for that purpose that may either be used unchanged by some facilities or may be modified easily to fit individual local needs and for different services [Tables 1 and 2]. Twenty questions were used, adding up to a total score of 100 points for easy calculation and analysis. The questions are arranged more or less according to the sequence of events encountered by the patient. They may be rearranged according to different components of service, e.g., facility, nursing, surgeon, etc.

The results of the survey may be analyzed in various ways. Individual scores may be assigned for every patient, and overall trends may be noted. Also a single question or a subset of questions relating to the individual component of service may be followed through several patients to identify specific problem areas. For example if question number 16 in Table 2 is followed, and a low trend is detected, more time should probably be spent with patients focusing on explanation of risk and the benefits of anesthesia.

Usually surveys are anonymous, but provision may be given to name the pain physician, anesthesiologist or surgeon in the survey so that any individual practitioner may be followed and compared to peers. Individual trends may be followed over time in a more objective fashion from the patient satisfaction perspective.

In a small facility, data may be saved and analyzed manually. There are agencies that will maintain a remote database for a facility and may be surprisingly inexpensive. Health Insurance Portability and Accountability Act regulations have to be checked before outsourcing any patient data. Local information technology/data entry experts in any facility may develop a program for the facility, scan all the survey response forms, perform analyses on them and report the results.

These surveys may go a long way to boost the morale of a health care team through positive inputs from patients and may work as a powerful tool to answer what is frequently felt to be an onslaught from hired consultants. Above all client satisfaction surveys help us to continually monitor and improve our services, make us understand our weaknesses and strengths and provide us with the perspective of the most important person of our service, the patient. Addresses of some Web sites are given below for review.

<www.autodata.com>; <www.sur-sys.com/products.html>; <usfweb.usf.edu/ugrads/eandt/bubble.htm>; <www.surveyproducts.com>; <www.scantron.com>.

Anesthesia Practice Administrators’ Views on Patient Satisfaction Surveys

A number of anesthesia practice administrators shared their experiences with patient satisfaction surveys with Karin Bierstein, J.D., Assistant Director of Governmental Affairs (Regulatory). A sampling of their comments follows:

“The issue of patient surveys, in my opinion, will become more important as the onset of consumer-directed health grows in momentum. That is, as employers push more expenses to employees and attempt to educate enrollees about how to comparison shop for medical care, patient satisfaction measurement will grow in importance. Pain, as a destination service, will show up sooner, and operative anesthesia will follow.

“Moreover as managed care plans are beginning to target pain costs, they may need to rely on patient satisfaction data as a component or even as proxy for pain control outcome data. (Costs to the plan mean revenue to the providers, and pain is an area of expansion for even primary care doctors now. Without data, it’s tough to frame the debate.)

“So even if people aren’t doing them (and we are remiss here, although I have started the drum-beat), and even if people aren’t interested in learning the art, the increasing cost pressures on employers and their cost shifting to enrollees will result in more questions by consumers. This will happen quicker than most of us think. And patient satisfaction, for this reason, is an emerging issue worthy of attention.”

“[Through patient satisfaction survey data, we] are able to identify potential problem areas, i.e., scheduling, staff behavior, physician ‘bedside manner’ problems. Mostly we have gotten very positive feedback, and we have shown this data to insurance plans when negotiating.”

“We have used our own in-house patient satisfaction survey for the pain clinic portion of the practice. It has been a great source of information as well as a marketing tool. When involved in hospital negotiations, we usually reference the fact that the pain clinic has consistently high patient satisfaction scores. We have long pondered the idea of using one for the anesthesia portion of the practice, but the concerns have always been related to how negative data would be interpreted and applied to the anesthesia providers."

“We don’t use a patient satisfaction survey. I’d rather see an article talk about correct patient encounters that set realistic expectations on outcomes and show progress toward those mutual goals, then the rest falls into place. People get irritated when the physician encounter doesn’t go well, and they need a whipping post (e.g., receptionist, nurse, etc). I’m curious, for every item on the survey, what do they have in place to ensure high marks? If they don’t [have anything], it’s putting the cart before the horse in many respects.”

“We do patient satisfaction surveys here on a regular basis. We have actually picked up some things needing follow-up, both on the clinical side and on the physicians’ behavior side. One of our most challenging problems is how to identify a patient who has died before we send the survey… we pull our target audience from our billing data, but that database will not always know if a patient has expired since the original hospitalization.”

Ashok K. Saha, M.D., is Chair, Department of Anesthesiology and Medical Director, Pain Management Center, Bay Regional Medical Center, Bay City, Michigan.

return to top