Recently I was asked, “How can I improve my Press Ganey scores?” Presently this question applies mostly to hospitals as CMS is requiring hospitals to use the HCAHPS as a part of their quality reporting. Press Ganey can manage the HCAHPS for hospitals. Few physicians or physician groups presently survey patients for satisfaction; they should begin thinking about doing so in the near future as it seems likely that CMS will require them to use a clinician and group survey, CG-CAHPS in 2013 or 2014 as part of the Physician Compare program.
No matter what the setting, how would I respond to the question “How do I improve my Press Ganey scores?” First I would assess the client’s attitude towards the survey. Does he resent the survey or see it as an opportunity for better patient outcomes? If the client feels pushed into doing the survey without any rewards for doing so, then I would first counsel him to see the advantages of focusing on patient satisfaction and the rewards for doing so. For instance, satisfied patients are generally more loyal and are better in following a doctor’s care directions. Patients who are satisfied generally recommend their physician to their friends and acquaintances which may in turn lead to new business. I would also rely on the fact that the Medical Group Management Association recently stated that better performing medical practices focused on patient satisfaction, among other processes. Hopefully this would improve the client’s attitude towards the survey.
If the client has a positive attitude I would next review any survey information that he may have on recent scores, looking for areas of low satisfaction. Perhaps patients are negative about timeliness of service. Do they have trouble getting an appointment? Do they have to wait long periods for admission to a hospital or at check-in to see a doctor? Do they feel rushed when they do see the doctor, feeling as if they are not receiving adequate care?
Once we have identified some areas to focus upon, I would then share a story about what not to do to improve scores, such as this. An ED doctor had a patient encounter in which the patient described that he was in terrible pain, that he ached all over. After a thorough examination he could find no reason for the pain and suspected that the patient was not telling the truth. The patient asked for a prescription for some drugs that would relieve his pain. Although the doctor was suspicious he went ahead and wrote a prescription for a strong pain relief medication as the administrators at the hospital had repeatedly told the staff to “do whatever you can to make the patient happy” in order to improve their patient satisfaction scores. To me this is the wrong approach to improving scores.
Rather than focusing on the scores and losing site of the health of the patient I believe that physicians should provide care that will enable the patient to resume a healthy lifestyle as much as possible. For those with acute conditions this is usually fairly straightforward. For patients with chronic conditions it means working with the patient to find ways to best manage her disease. This may involve other members of the staff such as a nurse counselor or care coordinator. If such care is successfully provided then the satisfaction scores will improve. Of course there may be a few disgruntled patients who will give low scores but these will be overridden by the positive scores of satisfied patients. Providers should not generally worry about a few outliers (disgruntled patients) as they rarely significantly skew scores of physician groups or hospitals that provide excellent care.
Direct physician care is not the only place to look at when trying to improve patient satisfaction scores. Patient encounters with other staff also affect the scores. Patients may have an excellent encounter with a physician but have very poor check-in or admission process. How do you think this will affect their scoring on a satisfaction survey? They will probably have a generally negative report as individuals tend to remember more vividly negative events than positive ones in my experience.
If a satisfaction survey indicates problems with encounters with staff other than physicians then the staff should be involved in creating solutions. For instance, if patients complain of difficulties at patient check-in at an ambulatory site, then a team of front staff representatives and physicians should look at the check-in process. This would include creating a timeline that would detail all of the activities a patient is asked to do at check-in. If the staff finds that some of the activities are redundant or unnecessary, they should be eliminated or shortened. At one group of sites, patients were asked to fill out forms that they had already completed at another site in the same medical group; patients complained. The staff found a way to communicate between the sites using a common off site computer server that had secure transmission of data and eliminated the source of complaints.
In summation, how can you improve you patient satisfaction scores? First, focus on the patients and not the scores. Then, identify processes or services that have low scores. Work as a team, staff and physicians, to design solutions to the problems. Finally, work together to implement and maintain the designed solutions. New surveys should reflect improvements in scores. If they do, find new areas to improve.
Donald Tex Bryant is a consultant who helps healthcare providers meet their challenges. He can be reached at Bryant’s Healthcare Solutions.
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