Sponsored material Special supplement to HealthLeaders PATIENT SATISFACTION AND PUBLIC ACCOUNTABILITY

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1 PATIENT SATISFACTION AND PUBLIC ACCOUNTABILITY

2 North Mississippi Medical Center in Tupelo reinvents its cafeteria menu at least monthly. Its breast care center, located in a separate building so that patients don t have to go into the main hospital for their mammograms, has the calming atmosphere of a Zen garden. Candidates for new hips and knees attend Joint Camp they are admitted to the hospital in groups of ten to twenty and receive presurgery education and sometimes even post-op physical therapy together. As a result, they have support not only from clinicians and their families, but from peers who know exactly what they are going through. All these things and much more are a direct result of regular patient satisfaction surveys, says John Heer, president and CEO of North Mississippi Health Services (NMHS). Heer came to the five-hospital system three years ago with a mandate from the board to improve patient satisfaction. We make hundreds of small changes each week based on patient feedback, Heer says. Measuring Patient Satisfaction: The Standard Of Performance Most hospitals survey their patients regularly and take varying degrees of action on the results. A recent poll of more than 300 hospital executives, conducted by HealthLeaders Media, showed that 99% have a system in place to do regular patient surveys, and 91% use an outside vendor to handle those surveys (see Chart A). The HealthLeaders Media poll included senior hospital executives, patient representatives, and directors and managers of quality assurance. Measuring patient satisfaction and acting on the information acquired can benefit hospitals in a multitude of ways, including improved quality of care, better financial health, a stronger competitive position, and more loyal employees. Because patients assume that their hospital will provide high-quality care, their perceptions of their experience are often shaped much more by how they are treated as people whether nurses are polite, whether their families get the information they need, or how long they have to wait to leave on discharge day. Sacred Heart Hospital in Eau Claire, WI, makes follow-up phone calls to all discharged patients to check on their condition and make sure they understand their medication list and discharge instructions. The 206-bed hospital also has a nurse specializing in pain management assigned to each department. And each patient room has a whiteboard where patients can write what is most important to them that day, whether it is being wakened for visitors or having tests done punctually. All of these policies stem from survey feedback. Everyone wants to put things in a box quality care in one, patient satisfaction in another, says administrator Steve Ronstrom. But patient satisfaction is related to good communication, which prevents errors and improves patient outcomes. Measuring patient satisfaction and acting on the information acquired can benefit hospitals in a multitude of ways, including improved quality of care, better financial health, a stronger competitive position, and more loyal employees. Satisfied patients are also less likely to sue their hospital. Thibodaux (LA) Medical Center uses an outside vendor to administer and analyze its patient satisfaction surveys, and ranks in the top one percent among that vendor s client hospitals for its high patient satisfaction levels. Not coincidentally, it is growing its market share and has doubledigit operating margins and no debt, says chief executive Greg Stock. Measuring patient satisfaction leads to tangible action at Thibodaux. We are always looking to wow our patients, Stock says. Years ago, we had lots of little kingdoms within our hospital, and issues were put off and not resolved. Now people are empowered, and expected, to fix things on the spot. About seventy miles west of New Orleans, 140-bed Thibodaux recently lured one of the area s premier heart surgeons from a competitor and is attracting newly minted surgeons in other specialties who have heard of its reputation as a great place to practice, Stock says. Thibodaux also draws patients from as far away as New Orleans. The Government Steps In Until recently, the decision to measure patient satisfaction was the provider s choice. But now, the 1

3 John Heer President and CEO North Mississippi Health Services Annette Odland Clinical Services Leader Wright Medical Center Steve Ronstrom Administrator Sacred Heart Hospital Greg Stock Chief Executive Thibodaux Medical Center Chart A Does your hospital use an outside vendor to measure patient perceptions of care? 0.6% 91.1% 8.3% No, we don t survey No, we survey using our own internal resources Yes SOURCE: Service Quality Improvement Practices survey, fielded by HealthLeaders Media. May/June federal government is involved as well. Beginning with July 2007 discharges, the Centers for Medicare and Medicaid Services (CMS) began requiring hospitals to submit patient-satisfaction data for inclusion in a national database that consumers can use, in conjunction with clinical quality data, to choose a healthcare provider. The program, called the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, has been in a test phase since 2005, and submitting data has been voluntary. Although technically it will continue to be voluntary, hospitals that do not submit their HCAHPS data will not receive their full federal reimbursement updates for The HCAHPS survey has 27 questions about the frequency of several standard patient-satisfaction measures, including how often staff members were courteous and respectful, how often treatments and medications were adequately explained, how often help was available when requested, how often things were quiet at night, and how often pain was well controlled. More than 250 hospitals participated in the test phase for HCAHPS in 2005, and a total of 2,800 hospitals submitted HCAHPS information in 2006, the first year that the survey instrument was generally available. Hospitals will be required to submit data from 300 complete HCAHPS questionnaires per year. The resulting database will be the first publicly available apples-to-apples comparison of patient satisfaction data among all hospitals. It is too early to say exactly how HCAHPS will affect hospitals. An analysis commissioned by CMS and performed by consulting firm Abt Associates, Cambridge, MA, showed that data collection will result in an additional cost to hospitals per year, but the cost will depend on the method used and whether the hospital combines it with other patient satisfaction measurement efforts. Hospitals that conduct patient satisfaction surveys by phone, either internally or through an outside vendor, will likely find their costs rising substantially more than those that use a mail survey, because each phone conversation will take extra time to complete. Hospitals currently using a mail survey to gather data may incur only a minimal cost increase since the HCAHPS questions can be incorporated into existing surveys. As for the impact of the data itself, respondents to the HealthLeaders Media survey say the most likely benefit will be to increase hospitals motivation to improve their quality of care (see Chart B). But HCAHPS on its own will not give hospitals all the information and direction needed to improve patient satisfaction. For that, most will continue to turn to more comprehensive surveys and advice from outside patient-satisfaction survey vendors. 2

4 Chart B Thoughts about the impact of HCAHPS vary Three-quarters of respondents agree HCAHPS will motivate hospitals to improve the quality of care; however, fewer agreed the data would be the most important benchmark for evaluating service performance. HCAHPS will... MOTIVATE IMPROVEMENT AFFECT HOSPITAL IMAGE IMPROVE SERVICE HELP INFORM CONSUMERS 47% 59% 58% 72% HELP PAYERS COMPARE HOSPITALS MAKE HEALTHCARE BETTER GIVE CMS A GOOD BENCHMARK BE THE MOST IMPORTANT BENCHMARK FOR SERVICE LEAD TO CLOSURES 14% 26% 39% 42% 39% 0% 20% 40% 60% 80% (Percent of respondents who agreed or strongly agreed with each statement) SOURCE: Service Quality Improvement Practices survey, fielded by HealthLeaders Media. May/June North Mississippi Health Services (NMHS) participated in the HCAHPS pilot test period to see how HCAHPS varies from the organization s current patient satisfaction surveys, which are administered and analyzed by Press Ganey Associates, Inc. The firm also administered the HCAHPS questionnaires for NMHS. CEO John Heer believes that although HCAHPS has potential value in spotlighting patient satisfaction issues and making hospital information more transparent to the public, it will not replace his current patient satisfaction surveys. It s not as thorough as the Press Ganey survey, Heer says. Wright Medical Center, Clarion, IA, a 25-bed critical access hospital, has been surveying its patients regularly for the past six years. Annette Odland, clinical services leader, sees HCAHPS as a different way to ask the same questions. Wright has acted boldly on the information yielded by its patient satisfaction surveys: rebuilding its emergency and outpatient departments to put walls rather than curtains between patient bays for better privacy and releasing completed surveys internally so that employees can see who is praised or condemned by name. Wright has also tried to boutique itself, with massages and facials for inpatients to the point where it attracted a busy orthopedic surgeon to move his practice. The tiny hospital now performs ten major joint operations a week and has doubled its gross revenue in each of the last two years. HCAHPS on its own won t give hospitals all the information and direction needed to improve patient satisfaction. For that, most will continue to turn to more comprehensive surveys and advice from outside patient-satisfaction survey vendors. I do believe in data transparency, whether it is patient satisfaction or quality of care, Odland says. Patients looking at coming to us for orthopedic procedures are shopping around, checking how many we have done, asking about infection rates. With the Internet, it is the future. Greg Stock, at Thibodaux Medical Center, admits to a little heartburn when the hospital first tried out the HCAHPS survey last summer during the pilot test period. The questions are different and not as broad as the survey Press Ganey does 3

5 for us, and we were not sure how the comparisons and benchmarks would go. We felt confident in our ability to do this, but we did not want to be embarrassed by getting a different result, he says. As it turned out, the heartburn was for naught: Thibodaux is scoring well on the HCAHPS survey. Stock says HCAHPS could have an impact on patient perceptions in the marketplace, especially if the media embrace the information when covering healthcare issues. He is concerned that hospitals may selectively advertise their HCAHPS results but ultimately believes that a hospital s reputation rests on more than a billboard. If you exceed their expectations, patients will tell their friends, he says. They have a clear sense who is doing it right. Word of mouth is still very powerful, and people are not fooled by billboards. Unfavorable HCAHPS numbers may inspire action. Some hospitals will be influenced by the public accountability especially public hospitals that have board members in the limelight, Stock says. If people know you have not been doing a good job, that creates an urgent platform for change. 70% 60% 50% 40% 30% 20% 10% Chart C A growing number of hospitals are now using patient satisfaction in their incentive programs. A large percentage of senior executives are being rewarded and incentivized for improving satisfaction, with incentive for all other employees not far behind. (Percent of respondents with incentives) 0% 61% Incentives Senior Executives 43% Incentives Other Employees SOURCE: Service Quality Improvement Practices survey, fielded by HealthLeaders Media. May/June In some hospitals, that really needs to happen. I think HCAHPS is a great move, says Steve Ronstrom of Sacred Heart Hospital. Just having the information in a standardized format will separate the wheat from the chaff and show which hospitals are truly concerned and which are not. That is going to drive accountability in a way that has not been measured before. Market Strengthens For Outside Vendors Fewer hospitals are trying to manage their patient satisfaction surveying process by relying exclusively on internal resources. Hospitals are using outside vendors for a myriad of reasons. For some, the logistics involved in gathering and analyzing data is too complex. And for many others, there is a desire to benchmark themselves against other hospitals, which can only be accomplished when multiple providers use the same survey and share their data with a central repository, such as those managed by outside vendors. Hospitals are also looking to outside vendors due to the growing use of patient satisfaction data used in staff incentive programs. More than 60% of respondents to the HealthLeaders Media survey said their hospitals use patient satisfaction data in setting incentive payments to senior executives, and more than 40% use the data to set incentive payments for all other employees (see Chart C). HCAHPS is likely to increase the outsourcing of patient surveys even more, as vendors incorporate HCAHPS compliance into their offerings and seek guidance for their service performance and improve improvement efforts. Respondents to the HealthLeaders Media survey were asked to evaluate the performance of some of the most widely used patient satisfaction measurement vendors (see Chart D). Wright Medical Center used to handle its patient satisfaction surveys internally, but switched to Press Ganey six years ago. We were only measuring against ourselves, says Annette Odland. When you start measuring nationally, you can see what you really need to do to improve. And the employees are proud of our great scores and take ownership of them. Their likelihood of recommending our hospital to patients and potential employees has risen dramatically, and they re our best marketers. 4

6 Vendor Evaluations Chart D Vendor offerings are becoming increasingly important as hospitals seek guidance for their service performance and improvement efforts. To help readers sift through vendors, HealthLeaders Media asked hospitals to evaluate the performance of some of the most widely recognized patient satisfaction measurement and improvement vendors. Below are the results. THE JACKSON PRESS GANEY GALLUP NRC/PICKER ORGANIZATION OTHER* A division of HealthStream, Inc. Competent customer support staff Powerful online reporting tools Relevant survey questions Support in customizing survey questions Quality of benchmark database(s) available Easily understood reports Useful data for quality improvement Scientific rigor Accuracy of data and analysis Research expertise Knowledge of healthcare industry Delivers results in a timely manner Guidance in prioritizing areas of improvement Assistance in preparing for HCAHPS Support in improving service quality Reliability of vendor Reputation of vendor Survey mailing or distribution service Integration of satisfaction, clinical, and financial data Value Overall rating *OTHER: Vendors with fewer than a statistically appropriate number of responses have been combined in aggregate. SCALE: Based on a five-point scale: 1=one of the worst, 2=below average, 3=average, 4=above average, 5=one of the best. SOURCE: Service Quality Improvement Practices survey, fielded by HealthLeaders Media. May/June