The Survey Says!

Like their counterparts in other professions, today’s physicians are realizing that customer satisfaction is a key factor in both the delivery of quality service and the ultimate success of their businesses.

“To stay competitive in a lot of marketplaces, physicians are becoming - like most businesses today - increasingly consumer-driven,” says Edward McEachern, MD, chief operating officer of Quality Data Management in Cleveland. “Those that delight their customers the best, are in front of the pack.”

The very words “delight” and “customer” may raise the hackles of many physicians, who often see the diagnosis and treatment of disease as their primary task. But, says Donald Logan, MD, chief medical officer at Dean Health Systems in Madison, Wis., this is the direction that medicine is going.

“You may be a good person, but the patient may not be getting the message that you’re an OK guy, you like them, and want them to like you back,” he says. “We think this is important to the business but is also good for the patient.”

One of the best ways to find out how patients feel about the care they receive is to ask them. A growing number of practices are conducting patient satisfaction surveys to assure that the physicians are meeting their patients’ expectations and emotional needs. Following are some success stories.

Getting started

Physicians interested in conducting surveys have two basic options: they can hire a professional service to handle the work, or they can create and conduct their own. David Kirk, executive director of Intermountain Orthopaedics in Boise, Idaho, took the latter approach. Working with the practice’s management team, Kirk used a conglomeration of templates from professional journals to design an appropriate survey.

But creating the survey was only half the battle. At first, the Intermountain front desk staff asked patients to complete the surveys at home and mail them in. As a result, the response rate was low. So Kirk asked the practice’s 12 physicians to hand the forms directly to their patients. The response rate improved; however, Kirk discovered that, if a doctor thought a particular encounter was not going well, he or she would not hand out a survey.

Kirk has continued to refine the process, and now office staff randomly chooses five patients per doctor each day to receive surveys. Patients are encouraged to complete surveys after they have gone through the billing and collection process. The group’s medical information manager enters the data into a tabulating computer program.

Despite such efforts, however, a group’s results are meaningless without a basis for comparison, says David Bryant, chief operating officer of the Myers Group, an Atlanta-based firm specializing in healthcare surveys and data analysis.

“The key and real power in the results is being able to benchmark them to a standardized survey being conducted across a larger pool so you can see what you’re doing across your specialty and your office,” Bryant says.

With that in mind Intermountain submits its data for comparison to Medical Management, a Boise-based national practice management company.

“Each physician gets a report with all the names and data on it. It generates good discussions,” Kirk says. “Then we provide [the physicians] with articles on how they can make patients feel like they are getting their questions answered, such as using models to explain diagnoses, sitting down with the patients, making eye contact and listening.”

Hire a professional

Physician practices that don’t have the time or energy to create their own surveys can utilize the services of a professional organization, such as the Alexandria, Va.-based American Medical Group Association (AMGA). Under its “Patient Satisfaction Program,” AMGA works with individual practices to administer surveys over a three-week period to a random selection of each provider’s patients. Patients are handed the survey after the office visit and asked to complete the survey onsite and return it to a confidential drop box before leaving the office. Survey data is then forwarded to AMGA to be included in the organization’s benchmark database. One month later, AMGA sends a comprehensive report with overall clinic, specialty, site, and individual provider-level analyses.

Currently about 100 medical groups - some as small as 10 physicians, but on average consisting of 200 or more physicians - are participating. The survey can be personalized with the individual practice’s logo, and AMGA provides training and data collection protocol to office personnel. The entire process typically takes three months from start to finish: one month for set-up, one month to survey, and one month for AMGA to prepare the report.

The association runs the raw data for each physician through statistical application software and calculates the percent of responses received for each question. Results are compared to average scores and “best practice” benchmarks for 45 specialties, compiled using data from nearly one million surveys.

“When physicians are confronted with less-than-acceptable results, first they’re surprised, then angry, then they may be resentful and unaccepting,” says Julie Sanderson-Austin, vice president of quality management and research at AMGA. “Then they say, ‘OK, what makes me different from the others who scored more ‘excellents’ and what can I do to change?’”

Dean Health Systems, a multi-specialty group of more than 400 physicians, began using AMGA surveys five years ago. The survey costs Dean roughly $6 per physician. To be included, physicians must have 30 or more patient visits during the survey period. In 2000, Dean used handheld computers, each the size of a tissue box, to collect the data onsite. These “Point of View” boxes cost around $1,000 each. Dean owns several and rotates them among its 45 offices.

“It’s important to know what patients think about us,” says Greg Motl, MD, chairman of the department of internal medicine at Dean. “In our organization, if patients are loyal, that’s the bottom line.”

A marketing tool?

AMGA surveys are meant for internal use by physician practices. However, Sanderson-Austin says once groups begin doing systematic assessments of how well they are meeting customer needs, some use the results for external reporting.

“For example, they compare them to our benchmarks, then go to a large employer group that they contract with and say, ‘Here’s what we’re doing, how we compare to the region or nation,’” Sanderson-Austin says. “They’re using them to market themselves.”

But does patient satisfaction data really have an impact on physicians? The National Research Corporation (NRC) is banking on it. The Lincoln, Neb.-based company, which gathers patient satisfaction statistics for health plans, physician groups, and hospitals, is currently developing DoctorGuide, a project designed to measure patient satisfaction for all primary-care physicians in the nation, rate them, and develop scores that will eventually become available free to the public.

In its first phase, NCR requested and received lists of members and the names of more than 500 primary-care physicians from health plans in Portland, Ore. NCR then sent surveys to the patients of these physicians. The results are available on the Internet, and the company is gathering similar data for the Cincinnati area.

“We’ve done a lot to be sure the questions are measuring what they are intended to measure, and to be sure the sample is representative of the individual physician’s practice,” says Joe Carmichael, vice president of research and technology at NRC. “The response in Portland from health plans, physicians, and consumers has been very positive.”

At Dean Health Systems, patient satisfaction data may soon affect physicians’ contracts.

“It makes doctors uncomfortable to have patients affect their pay, but it makes me happy because it makes physicians cognizant of what brings patients in to see us again,” says Logan.

Janice Rosenberg can be reached at editor@physicianspractice.com.

This article originally appeared in the March/April 2001 issue of Physicians Practice.