Where: Denver Health Medical Center, a 525-bed teaching hospital in Colorado.
The issue: Using patient satisfaction data to improve care.
At Denver Health, scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey were lower than desired, according to Kim Indovina, MD, ACP Member, an academic hospitalist at Denver Health and an assistant professor of medicine at the University of Colorado. These scores affected patient satisfaction-related incentives and penalties but, more importantly, reflected the patients' perspective of their hospital stays, she said.
In 2013, hospitalist program leaders began to look at how to improve patient satisfaction. When they surveyed hospitalists, they found that the clinicians were unaware of their patient experience scores but were interested in receiving ongoing feedback, Dr. Indovina said. “At the time, we didn't have a mechanism to provide our group with this type of feedback in real-time,” she said. “We had our HCAHPS scores, but these came from surveys that were typically done as long as 6 weeks after a patient's hospital stay.”
To address this, she and her colleagues developed a new method for tracking patient satisfaction and presented the results at Hospital Medicine 2015 in National Harbor, Md., last spring.
How it works
Patients on hospitalist services assessed how their clinicians were doing at listening to them, explaining what they wanted to know, and being friendly and helpful. Patients were surveyed once daily for up to 4 consecutive days until they were discharged, met exclusion criteria, or were fully satisfied, giving the highest possible (or “top-box”) scores for all 3 questions.
A total of 455 patients were randomized to either a control group (n=227) or an intervention group (n=228). Feedback from the latter was sent to the hospitalist caring for each patient on the same day of the survey. Hospitalists in the intervention arm were coached on the importance of patient satisfaction and on etiquette-based communication and were asked to revisit patients to address any concerns, whereas those in the control group received no feedback or coaching.
The patients' satisfaction scores didn't always correlate with what the hospitalists expected they would report, Dr. Indovina said. “One of the things that was striking to me was that, when we gave this real-time survey feedback to the hospitalists, a lot of times people were surprised at which of their patients were satisfied, and which were not,” she said. “We may not be as good at subjectively gauging who's happy and who's not with their experience in our hospital, without actually asking the questions.”
The research found that patient satisfaction generally improved from the first day of hospitalization to the last, but there was little difference between intervention and control groups. The physicians' effort did show more effect in the 65 patients from the study (30 intervention, 35 control) who ended up taking the HCAHPS surveys. A higher proportion of intervention patients reported top-box scores for doctors' listening, communication, and respect: 90%, 80%, and 93% of intervention patients versus 83%, 77%, and 86% of controls, respectively.
Using HCAHPS percentile rankings from 2013, the researchers found that responses from patients in the control group would have put the hospital in the 10th percentile of patient satisfaction, whereas those in the intervention group would have ranked it in the 75th percentile, Dr. Indovina said. “While we didn't see a significant improvement in the daily scores, the percentile differences in the HCAHPS scores were substantial,” she said
How patients benefit
The research team asked patients for open-ended responses, and many commented about how their physicians were improving, according to Dr. Indovina. “Patients were pretty on board with this and seemed to think that it was a good way to have their voices heard and comment about [their care] in real time,” she said.
Some physicians were more leery of the system, Dr. Indovina said. “There was a little bit of resistance, of course, to getting ‘scored’ in real-time, but I think most people really liked having that immediate feedback and the opportunity to do service recovery during the hospital stay, rather than hear about issues days to months later,” she noted.
Dr. Indovina and her team plan to launch a similar, ongoing survey tool on a medical/surgical unit at Denver Health and ultimately implement the system throughout the hospital, using tablet and email systems.
Words of wisdom
“Of course, the priority is to improve patient experience for the patient, but if we can in the process improve our scores, then that certainly benefits our hospital, as well,” said Dr. Indovina.