Many patients – well, some of us, anyway – appreciate being asked for feedback about their experiences with the health care system.
After all, it wasn’t long ago that patients’ opinions were rarely sought. Now they’re being queried about everything from whether their hospital room was clean to how quickly the nursing staff responded to their pain.
When analyzed in ways that are accurate and meaningful, patient surveys can provide health care organizations with a reality check on what their patients really think about the care they’re receiving. Is there consistently negative feedback about inattentive staff or awful parking? Maybe it’s a sign that these need to be addressed. Consistently good feedback, on the other hand, is a strong indication of an organization that gets a lot of things right about the patient experience.
It may be time to ask, however, whether patient surveys have crossed the line into overkill.
The American Hospital Association recently said “enough already” to a plan by the Centers for Medicare and Medicaid Services to add two new types of patient surveys, one for hospital outpatient surgery departments and the other for ambulatory surgery centers.
In a four-page letter, the hospital association asked CMS to reconsider, saying the Consumer Assessment of Healthcare Providers and Systems program already includes multiple and overlapping surveys. Adding even more will likely lead to confusion among patients, the AHA contended. It’s possible, for example, that ambulatory surgical patients could receive as many as three similar surveys for the same episode of care, the AHA said.
There’s also the administrative burden of administering all these surveys and compiling and analyzing the results, the hospital association pointed out.
The AHA’s suggestion: Instead of developing separate new surveys for outpatient and ambulatory surgery patients, why not just add some supplemental questions to existing survey tools and be done with it?
If you listen closely to health care providers, you can sense the creeping onset of survey fatigue.
“Hospitals and doctors, unaccustomed to being rated and ranked like resort hotels and American Idol contestants, are suffering from performance anxiety and feeling an intense desire to be left alone,” observes Dr. Robert Wachter in a recent blog post that asks an important question: Do surveys and rankings really help improve care?
The answer seems to be both yes and no.
Poor survey results can penalize providers for factors that may be outside their control – for instance, hospitals that have large numbers of patients living in poverty, Dr. Wachter writes. Moreover, surveys sometimes apply inaccurate yardsticks or measure the wrong thing altogether, hence severely limiting their usefulness.
On the other hand, a disappointing ranking might be the motivation a health care organization needs to get serious about improving its performance. And consistently good ratings don’t tend to happen by accident; usually they signal organizations that are higher-performing.
How to reconcile these two opposites? Dr. Wachter writes:
Public reporting of quality measures not only improves the work of the measured, it improves the work of the measurer. Ultimately, a healthcare ecosystem in which reasonable measures help guide patient and purchaser choices will lead to improvements in both the quality of care and of the measures themselves. I believe we can look forward to an era of more accurate measures, measures that capture the right things (not just clinical quality but teamwork and communication skills, for example), and measures that are less burdensome to collect and analyze.
By all indications, we aren’t there yet.
Surveys that ask patients for feedback are just one piece in a larger picture that also tracks how providers are doing on key measures such as recommended immunizations and screenings, hospital-acquired infection rates and use of best practices in managing diabetes, congestive heart failure and more. Even patient surveys, however, don’t necessarily produce reliable information.
The American Hospital Association’s letter to CMS points to new research suggesting that how patients fill out surveys may be more related to patient characteristics than previously thought. The AHA cites an analysis by the Cleveland Clinic that found that when patients were sicker, patient satisfaction scores tended to decline. The researchers found the same thing among patients who were depressed.
Other studies have discovered that when patients feel strongly about the care they receive, they’re more likely to fill out and return a survey. Research also has found that even seemingly minor factors such as geographic region and time of the year can have an influence on the answers patients are likely to give on a patient satisfaction survey; Midwesterners seem more willing to give higher marks to hospitals than patients on the East Coast, and scores overall tend to decline slightly during the winter months.
It’s not clear what to make of all this information, nor how to use it effectively. Throw clinical measures into the picture and it becomes even more complex. Do we really need more patient surveys? Maybe what’s needed are better, more reliable measures and better ways of interpreting and understanding the data already being collected.