Mastering patient satisfaction measures and using them to guide operations decisions is a powerful practice management tool.
Ms Protomastro is Chief Operating Officer, Maternal-Fetal Medicine Associates, Carnegie Imaging for Women, New York, New York.
Mastering patient satisfaction measures and using them to guide operations decisions is a powerful practice management tool. This low-cost methodology can yield large returns in retaining current patients, attracting new ones, and streamlining practice workflows.
• Improved outcomes and healthier patients. Satisfied patients are less anxious and doctors are more successful in eliciting information needed for decision-making about their health. Higher satisfaction rates have even been associated with reduced readmission rates.1
• Patient retention, loyalty, and growth, because happy patients spread the word.1
• Improved standing with managed care payers, because patient satisfaction ratings are a significant component of regular Healthcare Effectiveness Data and Information Set (HEDIS) audits. Practices with high ratings are generally better regarded and often are promoted by insurers to their customers.1
• A direct effect on Medicare reimbursement, because hospitals forfeit 1% of their Medicare revenue if they don’t score well, and that penalty rises to 2% in 2017.2
• Lower cost of business and improved risk-management profile. Patients are less likely to sue and staff turnover is lower in practices with high patient satisfaction ratings.1
As you begin to work toward improving ratings in your practice, it’s really patient loyalty you’re seeking. While they may seem alike, satisfaction and loyalty are distinctly different concepts. A satisfied patient simply means one who is not dissatisfied. She’d gladly go to another doctor if she thought she’d have a better experience. On the other hand, a loyal patient is one who has had a meaningful experience, is enthusiastic, and likely to share her experience with others.
But how do you gauge loyalty and know whether you’ve achieved it? It’s actually quite simple: ask, “How likely are you to recommend this practice to a friend or colleague?” Leading researchers point to this question as the primary indicator of loyalty and an integral component of any satisfaction assessment or survey. A patient who responds with a 4 (out of 5) in response to a loyalty question is 6 times more likely to defect than one who responds with a 5, and a satisfied patient is 6 times more likely to defect than a loyal one.3
• A doctor with a patient dissatisfaction rate as low as 5% may experience a reduction of revenue in excess of $100,000.3
• Practices that have loyal patients reduce physician turnover, with average estimated replacement costs per physician of more than $300,000.3
• 77% of medical malpractice claims result from a breakdown in doctor-patient communication. For every patient who expresses dissatisfaction or voices concerns, there are 9 or 10 more who keep quiet.3
• 68% of patients who leave a medical practice do so because of indifference shown to them.3
• Dissatisfied patients are vocal-they are likely to tell at least 20 people of their experience (or go to an online review site).3
Press Ganey, a company that surveys patients on their satisfaction with doctors and hospitals, cites customer loyalty as the single-most-important driver of long-term financial performance, and has defined 5 key elements that improve “likelihood to recommend.”3
1. The staff works together to provide care.
• Patients expect a seamless process from appointment scheduling all the way through their final bill payment.
2. The practice demonstrates concern about keeping patients informed.
• Expectations for appointments and processes are outlined clearly at intake.
• Procedures are explained in advance.
• Patients are told when they can expect lab results.
• Staff is friendly on the phone and in the reception area.
• All team members are properly introduced to patients.
• Patients are thanked for choosing the practice at the end of their visits.
4. Responsiveness to patients’ concerns
• Staff is trained to list to patients’ problems, apologize for them, and resolve them locally.
5. Sensitivity to patient needs
• Patients are listened to without interruption.
• The team appears to be empathetic and staff members make eye contact with patients.
Building on Press Ganey’s principles, author Fred Lee explores ways to build patient loyalty in his book If Disney Ran Your Hospital: 9 ½ Things You Would Do Differently.4 Applying methodologies borrowed from Disney to build patient loyalty, Lee advocates a strong culture dedicated to patient satisfaction as an essential first step. Demonstrating that commitment begins with practice leaders and trickles down through all staff levels. In hiring decisions, candidates’ friendliness and courtesy should be as important as their technical skillset. Lee advocates that medical practices focus on prompt problem resolution, empowering staff to solve problems locally and avoid the escalation that occurs when patients are passed from staff, to supervisor, to manager, in their search for resolution.
Creating a practice culture that builds loyalty starts with a mission statement-one that won’t be relegated to an obscure binder on the practice’s bookshelf. It needs to be a constant topic of conversation, among all levels of staff, in both formal and informal practice dialog. Practice leadership should set the example by modeling the mission at all times.
Practices should develop service standards in support of their mission to generate loyalty. Service standards are the methods by which practice leaders communicate service expectations and teach staff to “live the mission.”
• Define how patients should be welcomed and develop scripts for staff to use with patients.
• Be respectful of patients’ time by reducing waiting time.
• Decrease patient anxiety by communicating results and returning phone calls promptly.
• Say goodbye and thank-you when patients leave your offices.
• Use brief staff huddles to outline daily expectations and manage challenges-waiting for the weekly meeting to get a message out is far too long.
• Allow staff to solve problems when they arise-educate and train them to deal with problems.
• Develop a tracking system to find trends in service failures.
• Employ casual rounding with both patients and staff to open lines of communication-it’s amazing what can be learned by simply talking to people in hallways and waiting areas.
• Reward and recognize-make sure you publicly celebrate staff members who exemplify your patient loyalty mission.
Patient satisfaction surveys provide data to drive efforts to build loyalty in medical practices. The survey form used can vary based on practice size and type. In hospital settings, most doctors use the regulatory Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHP) surveys often conducted by Press Ganey. Smaller practices can either create their own surveys or work with a third party that provides these services such as SullivanLuallin, MGMA, Survey Vitals, and Press Ganey.
When designing a survey, keep it brief (no more than 15 to 20 questions). Approximately 75% of the questions should be ratings questions with scaled numeric answers, and about 25% of the questions should be open-ended for patients to add comments.5 A 10%–20% response rate is generally indicative of a reliable, well-performing survey tool.5 All surveys should include the following questions:
1. Would you recommend our practice to a family member or friend?
2. What could we have done better?
3. What else would you like to tell us?
And never ask about something that you’re unwilling or unable to change!
It is important to have a sound methodology for collecting, organizing, and sharing data. A significant benefit of working with professional survey providers is that their surveys are generally conducted electronically with data flowing into sophisticated online dashboards. From there, data can be sorted by variables such as dates of service, doctor, and practice location. Most commercial vendors will also have developed nationwide means by which practices can measure their standings against other similar populations.
Survey results should be reviewed openly. Reports should be generated at least monthly to all levels of staff and discussed at all practice meetings. Communicating survey data broadly and frequently is the cornerstone of any satisfaction-oriented culture, and is the method by which the practice’s mission is continually conveyed. By emphasizing, discussing, and even celebrating survey results, practice leaders energize and mobilize their staff so everyone understands that efforts to build patient loyalty are key performance objectives. Finally, survey data analysis can be a key driver of improvement initiatives by shedding light on system weaknesses that might otherwise have been overlooked.
Patient satisfaction surveys are only one feedback channel. Increasingly, more emphasis is being placed on online physician review portals. Most patients are searching for doctors online and looking at physician reviews before scheduling appointments. In most cases, their searches land on online review portals long before linking to a specific practice’s website. Online reviews are powerful-88% of consumers trust anonymous online reviews as much as personal recommendations.6 Hence, managing your online reputation is an integral component of building loyalty, protecting your base, and attracting new patients.
• 62% of patients who read online reviews go to physician ratings sites as a first step when seeking new doctors.6
• The number of patients who used online review sites increased from 25% in 2013 to 42% in 2014.6
• 44% of patients were willing to go out-of-network based on more favorable online reviews in 2014, compared with 26% in 2013.6
Online reviews and surveys are the new “word of mouth.” A study published in the Harvard Business Review in 2011 demonstrated that a half-star rating increase could increase practice revenue by as much as 5%-9%.6
Managing your online reputation is essential to maintain and grow a healthy practice. When practices have been able to elevate the percentage of positive online reviews to 90% or more, there was an associated 18% increase in patient growth.6 And while it is difficult to control anonymous information that lands on the Internet, several important measures can help practices gain mastery over this frontier.
Claim your profile: Regardless of how your practice landed on a review portal, it is possible in most cases to register as the owner of record for the listing. As registered owner, you have the ability to correct demographic information that may be inaccurate, and ensure that reviews belong to your practice.
Monitor online activity: Consider posting your internal satisfaction rating on your own website as a proactive counter-measure. Most importantly, resist the urge to fire back at a negative review. Rather, consider negative reviews an opportunity to calmly address concerns. Negative reviews can be an effective improvement tool.
Manage your reputation: Negative reviews cannot be erased, so the best defense is to work toward surrounding them with positive reviews. When satisfied patients ask how to show their appreciation, encourage them to write online reviews in place of giving gifts to you or your staff. Do not provide incentives in return for reviews or ask staff members to “plant” positive reviews. First, it is unethical to do so. Secondly, those efforts tend to backfire. Most review sites track IP addresses of reviewers so they’re able to pick up on counterfeit postings.
All businesses, including medical practices, are increasingly consumer-driven. Gaining mastery over satisfaction measurements and learning to build a loyal patient base have become key determinants in the long-term viability and fiscal health of medical practices. And above all else, “Whatever you do, do it well. Do it so well that when people see you do it they will want to come back and see you do it again, and they will want to bring others to show them how well you do what you do.”-Walt Disney
1. Language of caring. The benefits of a quality patient experience and exceptional patient satisfaction for medical practices and ambulatory care. http://languageofcaring.com/resource/the-benefits-of-a-quality-patient-experience-and-exceptional-patient-satisfaction-for-medical/. Accessed September 15, 2015.
2. Hablutzel J. Quality improvement, reimbursement drive quest for patient satisfaction data. http://www.mgma.com/practice-resources/mgma-connection-plus/mgma-connection/2014/january-2014/quality-improvement-reimbursement-drive. Accessed September 15, 2015.
3. Jones T. Shifting focus: turning patient satisfaction into patient loyalty. http://www.mgma.com/practice-resources/articles/fellow-papers/2010/shifting-focus-turning-patient-satisfaction-into-patient-loyalty-acmpe-fellow-paper-2010. Accessed September 15, 2015.
4. Lee F. (2004). If Disney ran your hospital: 9 1/2 things you would do differently. Bozeman, MT: Second River Healthcare Press.
5. Gain an edge with patient satisfaction. (2013, February 1). MGMA Connection, 41.
6. Rydberg J. Turning loyal patients into practice advocates. http://www.mgma.com/practice-resources/mgma-connection-plus/mgma-connection/2015/july-2015-(1)/turning-loyal-patients-into-practice-advocates. Accessed September 15, 2015.