Using public reports of patient satisfaction for hospital quality improvement

Health Services Research,  June, 2006  by Judith K. Barr,  Tierney E. Giannotti,  Shoshanna Sofaer,  Cathy E. Duquette,  William J. Waters,  Marcia K. Petrillo

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RESULTS

Hospital QI Activities

The interview responses describe QI initiatives implemented by the hospital, as well as their collection and use of patient satisfaction data to identify and monitor these efforts.

QI Initiatives. Respondents reported on a wide range of QI initiatives addressing the nine survey domains in the public report. Every hospital reported at least two of the survey domains in describing their QI activities, and half mentioned six or seven domains. As shown in Table 1, three-fourths or more of the hospitals mentioned at least five domains. The most frequently mentioned areas for improvement were: admitting timeliness and flow (n = 9); patient education in preparation for discharge (n = 9); nursing care (n = 8); treatment results (e.g., pain control, outcome of care) (n = 8); and food service (n = 8). Examples of QI activities are illustrated in the following quotes from respondents.

   One of the things that the ... team tried to do [was] to manage the
   experience of waiting. [Admitting domain]

   We added a staff person who was in a supportive function on that
   unit to make rounds on patients more frequently [to] help with
   little things, like where their water was, to help with things
   nurses weren't able to get to on time. [Nursing domain]

   We've worked with the dietary department ... so that if the patient
   isn't happy with their meal ... they can call, so somebody from
   dietary can come up and address that concern right away. [Food
   Service domain]

   We have a call back program to be sure that the patient went home
   with services that they expected, when they expected them; and the
   patients who went home with no services were accurately determined
   not to need services. [Patient Education domain]

Fewer hospitals reported QI activities in the other survey domains: other staff courtesy (n = 6); physician care (n = 5); and comfort/cleanliness (n = 4). Only one hospital reported QI activities directed to patient loyalty, the final domain, a more general category that is likely to be affected by QI efforts in other domains.

Most hospitals were also involved in QI initiatives in areas that were not specifically addressed in the public report, although the report may have stimulated activities in these areas. For example, many hospitals (n = 9) had worked on one or more initiatives with a customer service focus, such as staff training, improving accommodations for visitors and family, and improving signage throughout the hospital. This broader approach could affect several of the survey domains, including physician and nursing care, staff courtesy, and comfort/cleanliness.

   One of the things ... coming out of the ... report is a more
   broad-based customer service program ... addressing broadly what
   the expectations of customers are.

   Our service standards are multi-faceted around communications,
   attitude, appearance, waiting time. It is a customer standards
   program and customer service training.