Abstract
A question has been brewing in my mind about the use of standardized patient satisfaction surveys. Something that has been gnawing at me for the last year or so. And here it is: Why are we still using them? At least in the mandated way HCAHPS surveys are used. I understand, and believe, that surveys of the patient experience are critically important. We absolutely should be held accountable and care about the patient’s experience of care.
Yet the current surveys are inadequate for a variety of reasons. First and foremost, its incredibly difficult to do service recovery in a meaningful way 6 weeks after the fact. This delay amplifies the dissatisfaction…a patient might appreciate the call on one level, but they are definitely wondering why it took so long on the other. Whether quality or experience issues, hospital systems need to know about the concerns much earlier to rectify them. In addition, as highlighted in pieces in this quarter’s journal, the surveys are subject to bias and impacted by a variety of factors beyond the single question. This can include actual functional outcomes, as well as presence of comorbidities like depression, severity of illness, and medical or surgical practices, and the number of beds influences ratings. Bias includes the type of person who actually takes the time to complete the surveys. In addition, the surveys are tied to an individual physician on the hospital side when a given patient can be touched by over 30 caregivers a day, any one of which has the opportunity to make or break the experience of care. Lastly, new models of care, like the shared medical appointments discussed herein, and virtual visits also need to be assessed. Our internal experience suggests that patients are significantly more satisfied with these interactions than in a person visit—likely because we are actually meeting them where they are.
Not all clinicians believe they have responsibility in building better experiences, and efforts to drive individual accountability can never end. That being said, I’m also seeing incredible frustration within teams who are working hard to move scores, but don’t see real change in their HCAHPS numbers (or percentile rank). Yet, they are launching projects that will enhance the experience of care. Making patients safer, delivering higher quality, and doing it in a way that embraces patients as partners. I worry we will continue to disengage our colleagues and caregivers if we don’t advocate for more meaningful, actionable, timely feedback.
Despite all these valid arguments about the patient satisfaction surveys, they still offer real power. That power comes from the narrative—the comments and stories captured by the surveys. So, we can do better. As a field, we should lead the charge to create a better delivery of the survey content, a better capture of it (especially seeking populations that don’t typically respond), and make real adjustments for the factors we already know impact the results. The solution likely sits with technology that enables a mobile survey that uses branching logic, artificial intelligence, customization, and voice recognition. And most importantly, we have a significant responsibility to not contribute to the survey and metric overload that drives burnout. Especially when it comes to something as precious as the experiences patients have under our watch…our patients and caregivers deserve to be heard.
By Regina Holliday
This jacket was painted for Megan Sargent Grocki and focuses on her interest in healthy food. One of Megan’s children has food allergies and Megan is very aware of the importance of healthy homegrown food in their family diet.
Regina Holliday is a Maryland-based patient advocate, artist, speaker, and author known for painting a series of murals depicting the need for clarity and transparency in medical records. This advocacy mission was inspired by her late husband Frederick Allen Holliday II and his struggle to get appropriate care. Her artwork became part of the national health-care debate. Regina regularly paints and speaks at medical conferences throughout the world.
She also started the “Walking Gallery” movement, where more than 350 volunteer members wear patient story paintings on the backs of their business suits when they attend health-care conferences. The jackets, which were painted by Holliday or one of 42 artists, depict the story of a patient or an element of medical advocacy. These jacket paintings combined with the tools of social media have spread the word about the importance of the patient’s voice in health-care discussions. She recently wrote a book “The Walking Wall: 73 Cents to the Walking Gallery.” For more info about the Walking Gallery or Regina’s work, please visit http://reginaholliday.blogspot.com/