Quality, Efficiency and Satisfaction

Rob Bessler writes…

Most hospitalists focus on three main areas when they describe the value they bring. Quality, efficiency and satisfaction. In a consumer driven healthcare environment we all focus on measuring and improving the satisfaction of those we serve. At the center of course is the patient. The HCAHPS survey is a standardized set of questions used across the country that allows hospitals to compare themselves against a similar benchmark.  The most recent bulletin is troubling to say the least.

The bulletin  describes some rules around what I described to my team as rules of engagement. What we can and can’t do to help drive the satisfaction or perceived satisfaction of our patients higher. If you have had your oil changed lately or had your car fixed at a dealer lately the attached bulletin will ring true. CMS is trying to level the playing field to make all hospitals “play fair”. They want to regulate how one goes about driving up the satisfaction by not unduly influencing the patient prior to them filling out the survey.  While I applaud their efforts to make the results of the survey more meaningful, I am concerned that those organizations that take this bulletin seriously and  are serious about improving satisfaction will be scared as to where they draw the line and those that continue business as usual will continue to achieve abnormally high scores because they will ignore the bulletin.

We built a call center to ask the patients, were their meds filled (at some sites up to 40% were confused about their medication regimen post discharge), did they make their follow up appointment (address access and readmit rates i.e. 60% of readmits nationally within 30 days haven’t seen their pcp) and then we talk with the provider post discharge. In addition we talk to the  the patient about their experience. This information is extraordinarily valuable to apply training and don’t forget the high yield and value pertaining to risk management.  We do this because we all know the challenges that every survey company faces. Did they identify the provider for the patient correctly in today’s challenging environment of hospitalist medicine? The ward clerk enters the admitting doc or does he or she enter the “attending” or the primary? What if the patient was discharged by a doc at 10am but the doc that saw the patient all week was a different doctor due to a scheduling issue. All of these issues have been identified previously including white papers by the Phoenix Group.

If the goal is high perceived satisfaction, there are many ways to improve the satisfaction. Telling people you care about their satisfaction. I am concerned that more regulation only further complicates our ability to innovate new ways of improving the experience of our patients.

1 Comment

  1. Nagaraj on July 18, 2009 at 9:20 pm

    These patient satisfaction surveys are limited in identifying real patient outcomes. Even if patients are happy with the care provided by you, a few points off here or there can push you to the the top or bottom of your group. Just because you are on the bottom, does not mean you are a bad Doc. I have been told that you have to tell the patient that they will be receiving a survey and ask them to make sure they fill it out. Most patients at the time of Hospital discharge are very pleased with your care. I think soliciting patients is unprofessional. We don’t work in a Car Dealership. Any comments

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