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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The statewide external environment provided the context for the hospitals' involvement in the public reporting process, and respondents generally viewed the external environment as a facilitator for the adoption of a standardized approach to quality measurement. As this was the first time hospitals in RI adopted a uniform survey instrument and report, a complex statewide coordination effort was required. Respondents indicated support for the goals of measuring and publicly reporting patient satisfaction by the hospitals.

   First of all, philosophically, we were all on the same
   wavelength ... that we should bring the information forward.

   I think that it went very well for something of this scale that
   really hadn't been done before.... There were very definite
   concerted efforts to involve all the hospitals ... to make this
   scientifically sound ... and to try to keep personal opinion and
   politics out of it. It was very well done.

   It has been an excellent process. It has taken a lot of people a lot
   of time, with healthy discussions and compromises, and a lot of
   improvements have come from it.

Respondents also pointed to the leadership roles of the state health department and the hospital association in coordinating and facilitating an open and collaborative process, "with about as much buy-in as you can possibly get." While federal government requirements were an impetus to QI, a few mentioned competing state and federal regulations as potential challenges to QI.

DISCUSSION

Hospital executives in RI described their QI programs and various ways hospitals were using the public report data on patient satisfaction for QI. Their comments indicate that data from the standardized statewide patient satisfaction survey and the public reporting process have been used to identify and target new QI initiatives; evaluate performance over time and in comparison to other hospitals; and monitor QI progress. QI initiatives encompassed all survey domains in the public report, as well as related efforts (e.g., improve customer service). These more general efforts were prompted by but not directly measured in the patient survey, and they were relevant to several survey domains (e.g., staff courtesy, patient loyalty). The increase in QI initiatives, vendor data collection, and use of data over the period that began before the statewide pilot survey and continued through the release of the first hospital patient satisfaction public report in late 2001, suggests that hospitals have strengthened their QI activities consistent with the results on both the pilot and public report surveys.

While all of the hospitals participated in the public reporting process, they varied in the stage of development of QI activities at the beginning of this process and in their adoption of the statewide approach for their own QI programs. Some hospitals were early adopters in using comparative patient survey data to support QI efforts. Before the statewide survey, these hospitals used a vendor-designed instrument to survey their patients, enabling them to track performance and compare their progress to a national database. After the first public report, three additional hospitals adopted a vendor survey to generate the data for interim monitoring. Thus, many hospitals recognized the importance of standardized data with benchmarking capabilities and the value of using a standardized survey to monitor performance. The remaining hospitals were "late" adopters, participating in the statewide survey process and making QI changes but maintaining a homegrown approach to ongoing monitoring of patient satisfaction. Moreover, while most hospitals used the pilot survey data to refine and drive their QI efforts, others described the release of the public report data as the catalyst for QI.