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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In describing their QI efforts, respondents talked about several facets of hospital decision making for QI that could either facilitate or hinder QI efforts. Hospital executives described existing structures and processes to accomplish QI including those that evolved over time in response to the public reporting program, as well as those already in place at the onset.

Hospital QI Approach. Most hospitals had taken a decentralized approach to QI, in which each department or unit was responsible for identifying opportunities for improvement and implementing QI projects to effect change. Yet, the reporting of QI activities and results was centralized. While hospitals may have separate departments for QI and quality assurance, at most hospitals there was a hospital-wide QI committee that met regularly to monitor and report QI up from the department level to the board. At all the hospitals, results from the public report were usually brought for consideration to senior leadership and management, as well as to other staff at the department level. This structure is illustrated in these quotes.

   We have a department ... which is ... a central repository for all
   quality [data], though it acts as the facilitator, because each of
   the areas is responsible for their own quality and improving, making
   plans and reporting.

   Individual supervisors are responsible at a department level for
   making sure that their department has a performance and outcome
   project that they're working on and to report the results
   periodically and also at year-end.

   An individual coordinates and integrates the organization, and it's
   really a decentralized culture here where everybody's responsible
   for it in their own area.

   I presented it to the Board; first I do a quarterly report to them
   on quality issues, and I presented it to the Senior Management and
   to the medical staff; and then I gave everyone copies so that they
   could then take [it] to their respective staff.

   Well, I know the Board of Trustees, the leadership of the medical
   staff, it was fully shared and discussed. We use joint
   conferences ... [and] I think it was taken all through the
   operational directors.

   [It was] presented to the Board, to the Medical Executive Committee,
   every meeting that we could go to.

Many respondents described the need to prioritize their QI efforts based on the results from the pilot and public report surveys. They described processes for decision making about where to focus their QI activities and reported examining the survey data in order to select the areas on which to concentrate, usually those areas with the greatest need for improvement, based on their satisfaction scores and ratings. Their comments suggest that the hospitals used the survey results and decided whether or not to pursue QI activities related to specific domains.

   Well, we looked at those top ten areas for improvement and looked
   for the similarities and grouped them together and took the larger
   picture. So it's education and admissions wait time. And we had a
   team on each of those issues ... it was prioritized in the executive
   management meetings.

   We looked at the results, again high level and even some of the
   subset results, and department heads were asked to look at areas
   where we were not at average or above average, and others that
   wanted to even further strengthen areas that were above average.
   So we let the departments select quality improvement initiatives in
   their own areas, and those were signed off on by the customer
   service  committee. I think we looked at where our scores were the
   lowest, and at the same time, the correlation with patient
   satisfaction so that, you know, if we had to pick one over the
   other, we were going to pick the one that had the most impact on
   moving the score, and the best correlation coefficient.

   We put the teams together to do a root cause analysis.... Really
   spent time looking at the whole process [and] included the medical
   staff, the house staff, the ER staff, the nursing staff, the floor
   staff to come up with a different way.

   We picked things we thought were actionable based on the questions
   that we had [survey] data on. So we certainly had data on discharge
   planning and education ... talking to our patients and preparing
   them for what to expect in managing at home.